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SENT BY: SPECTRUM EXPLORATION; 5-99 16:03; 2094658773 => ; if3/3 <br /> JAMM120- <br /> J08 <br /> ADDRESS PERMiT#: OP Q9 ,'�J - <br /> r <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that 1 am licensed under the Provisions of Chapter 9(commencing with Section 7000 of Diviswll <br /> 3 of the Business and Professions Cafe,and my kense is in full force and effect. <br /> License O S Expiration Date_ �' —ZOO l <br /> Dais ntractor t((,cnti•. Inc <br /> Signature <br /> KERS'COMPENSATION DECLARATION <br /> I hereby affirm under penaitJ of Perjury One Of the following decalarations. <br /> O t have and will rnainlein a certificate of consent to self-insure for workers,compensation, as provided for b; <br /> Sectfon 3700 of the Labor Code,for the Perfomlance of the work for whkh this perrrmt Is issued. }1 <br /> O t have and will maintain workers'compensation insurance,as required by Section 3700 of the La xx Code. <br /> for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier <br /> and policy number aro: <br /> Carrier_ J.TT t� FO ktQ PvNcy Number <br /> 0 1 certify that in the Wormance of to:work lvr which tfus Penn%Is blued,I shah not OmPloy any Person in any mariner <br /> 90 as to become subject to IN workers':S&ekc <br /> 1perlsa of C&Womin and eye(fist i<I should bsCotrre subject 10 <br /> the workers'compensation provislonis offon 3 oI tabor Code.I OWN �PtY with those proftlans. <br /> Date 16--1 licant -1107 <br /> WARNING*FAILURE TO 3ECURE WFORKERa'CONDENSATION CO 18 UNLAWFUL,AND SHALL SUBJECT <br /> AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINE$VP TO ONE HUNDRED THOUSAND DOLLARS <br /> (100,000),IN ADDITION TO THE COST OF COMPENZIATiON,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF <br /> THE LABOR CODE.INTEREST,ANO ATTORNEY'S FEES. <br /> �as�sas•.''a �aa�.-- <br /> t.wn Eaawara. dna <br /> O.nc <br /> AS ' aurw Ica+.CA <br /> 105 <br /> 209.44S.a712 r C <br /> X4)4 4r,-,A773 fax <br /> .. .. <br /> ,1 <br /> 1.t rl, 1' 14.1:I 11 i °l <br />