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d101'==ns <br />STATE OF CALIFORNIA <br />LICENSE/REGISTRATION NUMBER: GA-LR-1000701441 <br />Disclaimer _ <br />Legal Disclaimer & Consent <br />Legal Disclaimer & Consent <br />Notice and Consent to Use Personal Information (Civil Code Section 1798 et seq.) <br />U <br />By submitting personal information about yourself and your company In order to obtain a License or Registration, you consent to <br />DLSE's use of that personal information for purposes authorized by Department Of Industrial Relations, which provides for the issuance <br />of such licenses and registration Note that DL5E's use of such personal information Includes the disclosure of informat-on about you <br />and your company to third parties who want to verify your Registration Application. This Notice is effective lanuary 2012, and subje,t <br />to revision. <br />SOCIAL SECUR TY NUMBER COLLECTION <br />The social security number will be cg:Ietted pursuant to California Family Code section 175201d), It Is used in the administration of <br />registering employers in the Garment Manufacturing & Contractor industry, and to aid in the collection of monies owed pursuant to a <br />judgment or order for child or family support in a case being enforced under Title IV-D of the Social Security Act Collection of the social <br />security number is mandatory. Failure to furnish the social security number may result in DENIAL of an application for issuance or <br />renewal of a registration to engage in the business of Garment Manufacturing & Contractar. <br />INFORMATION PRACTICES ACT NOTICE (California Civil Code Section 1798.17) <br />1. The information an this application is being requested by the Department of Industrial Relations, Division of Labor Standards <br />Enforcement. <br />2. The state official responsible for maintaining this application, and who shall, upon written request, Inform you of the location of <br />where this application is maintained and the categories of any persons who use the information contained herein is: <br />Division of Labor Standards Enforcement <br />Manager, Licensing and Registration Unit <br />1515 Clay Street, Ste. 1902 <br />Oakland, CA 94612 <br />Telephone. (510)-285.3398 <br />3.The information an this application is collected and maintained pursuant to California Labor Code section 2675. <br />4. With respect to the information requested on this application, all of it is either mandated by Cal fornia tabor Code section 2675 or <br />must be ascertained by the Labor Commissioner in order to issue a license, except for the following information, which is provided <br />voluntarily: A) Title of corporate officers/ LLC members <br />5. if you fall to provide all or any part of the information requested In this application. the Labor Comm:ss€oner may deny issuance J <br />renewal of a registration to engage in the business of Garment Manufacturing & Contractor. <br />6. The principal purposes within the Division of Labor Standards Enforcement for which the information on this application will be used <br />are: (1) administration of the registration program for the Garment Manufacturing & Contracto- industry, and (2) enforcement of <br />California labor laws. <br />7. The following are known or foreseeable disclosures of the information contained herein which may be made pursuant to subdivision <br />(e) or (f) of Section 1798.24 of the California Civil Code by the Division of Labor Standards Enforcement Response to a request under <br />Me Cdilrornld PUL)OL RCLurd] Art. <br />8. You have the right to access records containing your personal information that are maintained by the Division of Labor Standards <br />Enforcement. To make an appointment to access such records, please contact the Manager, Licensing and Registration Unit at the <br />address shown in item 2 above. <br />Legal Disclaimer & Consent <br />Notice and Consent to Use Personal Information (Civil Code Section 1799 et seq.) <br />Reglstration Services Page 1 of 7 12/16/2= 10:01:56 AM <br />