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SENT BY:9163622318-Sacra. , CA ; 4-17- 0 ; 1:36PM ;RADIAN INTERNATIONAL- 2094683433;# 8/P9 <br /> '�"«'�� �ul pH LARD CHRISTENSEN FOO. 5306622896 <br /> '"t AYr81P:962281$-Sacra., CA : 4.12- 0 : 2:11PM :RADIAN INTERNATIONAL, <br /> 8300622t19s:# 2i 2 <br /> LICEN8ED CONTMC;'F0M DECLARATU)N (� <br /> 3010Myhbhbaa and ProAaslons C4tle and r�W Scone isions or s in full%W*WLL w%Sldbn 7000)of <br /> DM61on <br /> LLawt 510011 _... Exgrafan Dale: MAY 31. lj} �_ <br /> Do APilIL 14 20 <br /> �4 �CeRMrebr.__ LAYNS CH�_ZZZSTF,NRN_COMpANY <br /> 6gnitw ` - tel' �_TYIe• nlsrxlcT MA <br /> Mew nueec F.R1C N V]NCE,1T._ <br /> WOPABR9'oOMPGNSATION DECLARATION <br /> heraby$Mrm bnderwafy of perIury cm of the kaNtakiny declaradona: (C71C(;K ALL THAT APPLY) <br /> 1 nave and"mahNain a ceglilca a of DOnaent io 110i lneure for workord compv4s tion,as prodded for by <br /> Section 1700 Of the Labor Cod N lot trim PericrmpoMA 0e of work for wi h thla Permit Is laded. <br /> R -1 havC and w10 meit"I&w0r)k"'o7MW lotion inaurance,as aped by Sec tm 9700 of tho Labor Code, <br /> wr a,o Pa(iumance ofthe wont for wNi*lhleyama le Issued. My workman' cOntW.&anon irxursnce <br /> Carrier and pokoy numbers are: <br /> Cantu! Ri$I,1ANCh' �A110 ipnu�^LSTpoUryNumber NWA 0,UBt1_ <br /> I ar*that in the porforma l:a of the work for wNch Ons Perrnik k lesued' I shell not _. <br /> sty anner so ae to become subN of to Ole wortcers' OmPloy any parson k) <br /> should I»Oorm subfaot to the worker'aoi aal{on bwi Of CaMiorn n.end sorsa <br /> AxWr ith comply with those ,vska,a "Por"ion Ptarielprs of 6sotlon 3760 of rtr Labor Code,I shaq <br /> Dale:_AI11TI. 14 Bronston: <br /> PHntsdNarea: Rk1C N• V1.NCEN'f �_ <br /> 11WAMNt NG:FAILLIRA TO 4ECURE WORHENe'COa1PFNa MN COV9FAtlG 18 UNLAWFUL,AND of AU SUOJECf <br /> ON""TO MINNAL 0a,00o.1,,IN ADGTION TO TIC�COSTEOF 4o11PCNBAnOND 91M FOW u1MTH",r,p To ONE rATTORk 8 FQ 0,AND DAMAOke AS <br /> 6 roN In setmvn eros oP TNe LABOR clove <br /> r*stwnamry,hsaby <br /> eutaafia_,kADTAN 7N1'h_- _ FNATy N LLC <br /> W elan sib Ban Joairulp coonry WNI PertnNA ppadaeon on my behalf,IMIf. I undo+sfand thisalnNonudm Is valid far <br /> Urtllrau.pnu Is Il mired io the wyrlr pier W red an the hent psp of thea ___flwi. <br /> t <br /> r <br />