HomeMy WebLinkAbout1003 DAISY AVE; ; 80-93; PermitCONSTRUCTION LENDING AGENCY1 hereby affirm that there is a construction lendina aaencv for the performance of the work forpersoft in any manner so as to become subject tothe Workers Compensation Laws of CaliforniaNOTICE TO APPLICANT If after making this Certificate of Exemption you should become subjectto the l$s>Tkefs Gompensatom pTo^s\ons o^ theLabor Code you must forthwith comply with suchprovisions or this permit shall be deemed revoked1 HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT AND DOHEREBY CERTIFY THAT ALL INFORMATION HEREON IS TRUE AND CORRECT AND 1FURTHER CERTIFY ftNO AGREE IF ft PERMIT IS ISSUED TO COMPLf WITH ALL CITVCOUNTY AND STATE LAWS GOVERNING BUILDING CONSTRUCTION WHETHERSPECIFIED HEREIN OR NOT 1 ALSO AGREE TO SAVE INDEMNIFY AND KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS COSTS ANDEXPENSES WHICH MA Y 1 N ANY WAY ACCRUE AGAINST SAID CITY IN CONSEQUENCEOF THE GRANTING OF THIS PERMIT(.\ m
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*~-5 JAN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OV5 0 DEEP AND DEMOLITION OR CONSTRUCTION OFSTRUCTURES OVER 3 STORIES IN HEIGHT77\ i\ *
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s CERTIFICATE OF EXEMPTION FROMWORKERS COMPENSATION INSURANCE(This section need not be completed if the permil is for one hundred dollars ($100) or less)I certify that m the performance of the work forwhich this permit is issued I shall not employ anyCONTRACTORTOTAL ELECTRICAL-\
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—TEMP OCCUPANCY30 DAYS)—"HCopy is ftled with the cityG Certified copy is hereby furnishedOVER 200 AMPSTEMP POLE 200 AMPSTOTAL MOBILE HOMES
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I WORKERS COMPENSATION DECLARATIONI hereby affirm that I have a certificate of consent to self insure or a certificate of WorkersCompensation Insurance or a certified copythereof (Sec 3800 Labor Code)POLICY NOREMODEL/ALTER PER CIRCUITFENCE OVER 6S\
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0c0-H EACH GAS SYSTEM 5 OR MOREBOILER/COMPRESSOR 16 30 HPEACH GAS SYSTEM 1 TO 4 OUTLETSBOILER/COMPRESSOR 3 15 HPEACH WATER HEATER AND/OR VENTBOILER/COMPRESSOR UP TO 3 HPEACH BUILDING SEWEROVER 100 OOOBTUEACH FIXTURE TRAPINSTALL FURN DUCTS UP TO 100 000 BTU3
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~OWNER. OWNER S PHONE'7%OM4S 3~ f/TZ&^ALfr 4-5$y>/7oPRIME CONTRACTOR0fc*/g< ^ „STATE LICENSE1LICENSED CONTRACTOR S DECLARATION1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section7000) of Division 3 of the Business and Profes <sions Code and my license is in full force and effeet\
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DATE OF APPLICATION9-50-2DBUS LICENSETJ^ -^ mN§) l
01m ^H CITY OF CARLSBAD-BUILDING DEPARTMENT ^H^^ APPLICATION & PERMIT ^^ APPLICANT TCUSE BALL POINT PEN ONLY 120Q ELM AVENUE (714) 438,5525 MATION WITHIif
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