Laserfiche WebLink
05/21/2001 07:23 2094671118 AGE STOCKTON PAGE 03 <br /> 05/18/2001 13:05 7073745S.,, WOODWARD DRILLING PAGE 02 <br /> 12'18 530676G@9a STRATus NO CALIF PAGE 02 <br /> "s3�8 08:21 2894583433 t`ITIH F1_OOR <br /> PAQE 03 <br /> . remrrt>rNtal lflAiilt ; �`Y1';aF ,i:tlhft 11h <br /> • � ' - !7',, `'. .-.•�:KirMr-!"r• - .,`-W�rrnw 1-V. _— _� . 4'-i9na:�vi �ii117. <br /> UCEMBED CONTRACTbRS DECLARAMON CD i <br /> i <br /> Hereby.et+trm that I am 6pertsed wndar the pravlsiana of ChWer 17(cammUnranp iNFN1>3emn 7�of Divtsto <br /> . 3 ciG RusInsw and Pnofimsions Cade and my!icons#is in full fioroe and elf edL <br /> -71 ,.. Dftstian dam: -7 1 <br /> date, __ r r+trt�ntor:, 1_. 7D6V t ,� ,i4,Q/GL/ _ <br /> 5pnaeie+�s Tide �Ff��T�ON 5�7�1n�Ar� <br /> prlrrivd Ritit�• ��./e� �dlt��'�L'? <br /> i <br /> i <br /> WORKERS' OOMP€NSATION DMwARAYION <br /> i ;haMby aflfrm under pmnW of perjury ono afthe tnllowirtg declarations: (ONgr-K ALL THAT APPLY) <br /> • I <br /> I have mid will rpaintaln a certifiaste at mnaent to saNneure for Worllors'eompenestion,as prvMed fie by ! <br /> $tion 3700 nt titer Us or Cade, for the peftm&nee of the work for WHO#rets pW1II is r5sued, <br /> I <br /> I I have and will rwiti%in Wo>X*M'compensation Insurence,as required by 8sman 3700 of the!.Moor CO*, <br /> for the perfoumneee of the wont for which this permit is issued. My vd66mrs'compalsati0rl Ineuranae I <br /> Dialer and p+alioy numbers are* <br /> I c rtliy thed in%e perWrnance of t to work fcr which this permit is Isaa d,I shrill not employ any Pam In <br /> any manner as to heoorne sul�eot to ttte workers'oompems6on sews of Calrfami% and agree that if t <br /> shoWd ttGootre subjant to the workem'cQM.Po safiO!prlsvlsi0n6 of Sdctbn$700 of the Labor Cade, I ai914 <br /> fonthvvb aorMiy wet the piovtslons. <br /> Printed Name: <br /> WA[Wli�tG:I;AILURQ,T'ta$�C13R1=V�l�fZit�sit�''CC>ridl'�'MBV11"bN OpY�I§ !R UNLAWF�Jk,ANb Sfihi.l.�UBJ�C`C <br /> J►4l FJAPl.O1fMl�j O Cti1NIlbfAL PEHAI.�IES 4rtb CiVtL FtMRS UP 7�6NR H<�NI�RRD 1 itOLI�pMD C301J.AFiB <br /> l PRpS1i0 p���aalsTrq���SY��Ir`aE3llffi,KiC'l$�, �•iN1�REt37,ATTORNEti"S�6i.AMtf bAflAf�t�t�5 AS <br /> I <br /> l r Fox z n P#I __ IC BT licenv*4 Aulbnrlxr d repr a enftfive),I' raw <br /> I7-T4 .. <br /> to sign thio fie+ !esquire Gaurrly tNfrtJl parMIt Applicaou"eA my behalf, i underotar'+d this atdtwrinuori is valid for <br /> ane M) esr and li the vworic An 48Wd an ff M front of Wo *OIL <br />