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ATC PLEASANTON PAGE 07 <br /> 06/19/2000 03:30 925-463- P5 <br /> Jun 18 01 04: 15P ' 06 <br /> 06/18/2600 03:23 925-463-2559 ATC PLEASAWON <br /> stn Jotquln Ccwtty�TM <br /> ts(Flsaur SielY{Cts�ilrllt fY WNI Permit ApPlleau°n+lupplemN+t <br /> PERMIT SR1k <br /> J4B AvDRJF-.' <br /> 3�33�r/, f/ll�illl!'�' • <br /> LICENSED CONTRACTORS DECLARATION ( ) <br /> d Chapter(9(=MfMel+k9(with 59CW 7000)of Division <br /> 1 hereby affirm$& i am a�rtssd t W raid m�yMstiDerWA tc in full fbat and effect <br /> 3 Of(tae 8uainesg ProfoesioM IL j- <br /> /- <br /> tlo <br /> dO Lyiran Dare laq <br /> LlCensY P y ~ ✓ �� <br /> tits: <br /> 3"ture. <br /> printed patlt+e: <br /> WORKM.GOMPEp& ATIQN DECLAPAMN <br /> I hereDy affirm under P"lry 0 Perry one of Vas faa w a Aed"+atlorw (C"FCK AU-THAT APPLY) <br /> I have and wit!ltaalnlain a castsic"of 00n%wt to sW40fu m far worriers' ��provided faX by <br /> of the work for Whirl+this permit is Issued. <br /> Section 3700 of the Labor Code.ftx the psr<om►snes b ��3700 0[the tBbot(:'.Dale, <br /> _✓I have and wru mok Wn work&W w++P�n 1 ss raciuimd Y <br /> artsurtnCp <br /> for the perfttanance of rA wo*for wffiClt this DetriUl's isWed. My workers tom sem^ <br /> Carrion and pa ao <br /> potty Number <br /> fraRtfr <br /> ( OW h the performanes&the worts tot which this Permit if 4VAW,1 shay rat��2 [n <br /> to the Writers'COMW S10on W"of Ca"I Mia. <br /> any mermen:o as to became suerpmv% of Sectlan 9700 of WA Labor Code.t shall <br /> should become suoJed to trw wrorkam OOm <br /> Whwith Comply with MU ProvislorM <br /> signature. <br /> Printed Nana: ` <br /> WApm": FAILURE TO SECURIVj0M t'F0 fISATIOM W u AND SK"L SUM= <br /> sal EIr�OY>St� tai trIWM V IruMt>�a <br /> (S10Q,dQaJ. AS <br /> INADDIT MTOTM�(FCO11fPiN�►'fi011 QiTIitEST.AYfORNIeY"3f s <br /> MOy1OED FOR W SKI"V06 OF THE LAWR CODE. <br /> 2wreoSrv4.rtwcrtwdautlaoRzed fepres"tivOL <br /> 4 <br /> haety a4VWor(=e(Print name) <br /> to et9ntwo San JaagWn Coun>Y�Ferrera%APP�O" <br /> en my k»h.K. 1 undo�tand this aunwrfza114n is valid lot <br /> or►w(f)YW and is ttmitad <br /> to the,wrark Plan daW4 On the trMt ro0 or that awioption- <br /> 3.17-z000 r Mt <br />