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12 1-1999 10:09AM FROM TO 15592587126 P.e3 <br /> 3422 W. Hammer Lane, Suite x PERMIT#: l <br /> I` JOB ADDRESS' I <br /> I <br /> l <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby affirm that 1 am 11censed under the provisions of C'zaptor 9 (commenc:ng with Section 7000 of Division <br /> 3 of the Business and Professions Code. and my license is in full force and effect. <br /> License Expiration Date <br /> Cate 4/12/00 Contractor The Twining Laboratories Itic. <br /> WORKERS' COMPENSATION DECLARATION <br /> I hereby affirm that i have a certificate of consent to sell-insure, or a certificate of Workers' CornpenSZ60n <br /> insurance, or a certified copy thereof(Sec. 3800, Lab.C). <br /> Exp. Date 10-8-00 Company United Pacific Insurance <br /> tD Certified copy is hereby fumiShed <br /> :9 Certified copy is filed with the County Building Inspection Division <br /> CERTIFICATE OF EXEMPTION FROM WORKERS' COIVIPENSA T10N INSURANCE <br /> (Phis section need not be completed,if the permit is for one hundred dollars($100) Of less) <br /> 1 certify that in the performance of the work for which thts permit is issued, 1 shall not employ any person in any manner Sa <br /> as to become subject to the Worker= Compensation Laws of Caiifomia. <br /> Date Applicant <br /> NOTICE TO APPLICANT: If. after making this Certificate of Exemption,you should become subject to the Workers' <br /> Compensation provisions of the Labor Code, you must forthwith comply witrm suctm Provis'ons or this permit shall <br /> be deemed revoxe<L <br />