HomeMy WebLinkAbout1006 CARLSBAD VILLAGE DR; ; 81-518; PermitDECLARATIONS
LENDER
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- WORKER'S COMPENSATION • . ' OWNER/BUILDER ' CONTRACTOR*'V-D I 'Inereby affirm thai there is a constructionlending agency 'or Ihe performance ol Ine work lorwtocfr Wus perrnii is issuer) jSec 3097 Civil Code.1 *Y^Copy is filed *itn Ifie city ,D Certilied copy IS hereby furnished -CERTIFICATE: OF EXEMPTION FROMWORKERS COMPENSATION INSURANCE(This section need not be compleled if the permit '( is 'or one hundred dollars IJiOC) or less)n 1 certify that in Ifie performance ot tne work (ori which Ihts permit is issued 1 shall not employ anyperson in any manner so as to Become subiec! lo*" the Workers Compensation Laws ol CaliforniaNOTICE TO APPLICANT II after making Ihis Cam,dcate of Eiemplion you should become subject lothe Workers Compensation provisions ol the LaborCode you musi forthwith comply with suchprovisions or this permit shall be deemed revoked!EXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAtO CiTYGRANTING OF THiS PERMITz
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^^SIRUCMOI^WHhTHbHbfbCIHfcU HhHtlN UH NUT i ALSO AGHfeb 1U bAVt INUtMNIH ANU .ppycAM'r S SIGNATURE * nwNFRD CONTRAPTOP B-KEEP HARMLESS THE CITY- Of CARLSBAO AGAINST ALL LjASiLWES JUDGMENTS COSTS AMD A^£>*7r S SVSM*™*E „,? OWNER CONTRACTOR fc**APPROVED BV st? a DATE Ic^- J ... |w o o ±;ECAREFUCLY EXAMINED THECQMPLETED APPLICATION AND PERMIT' AND DOFY Ur40lR PENALTY OF PERJURY THAT ALL INFORMATION HEREON (NCLUCARATf&WS ARE TRUE AND CORRECT AND i FURTHER CERTfFY AND AGREE IF A fD fO COMPLY WITH ALL CITY, COUNTY, AND STATE LAWS GOVERNING SU!LD\
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expire by limitation and become rtull aiby such permit is not commenced wftrjirif the building or work authorized byit any time after the work is commenceid votd If tne180 days frorfsuch permitd for a oenodIding or worke date of suchsuspended or188 davsn
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V , 1* AN QSHA PERMIT IS REQUIRED FOB EXCAVATIONS OVER 15 0 DEEP AND DEMOLITION OR CONSTRUCTION OFSTRUCTURES OVER 3 STORIES IN HEK3HT— (o
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j n I hereby affirm mat 1 have a certificate of consent 1to sell insure or a certificale of WorkersCompensation Insurance or a certified copy thereof }•(Sec 3800 LapA Code) - '/ . ( 1POLICY NfX ]O
ELECTRICAL PERMIT ISSUE•^^PPH
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rtSflsS1 iiilHIiluj [iiflflilliii!¥ '"Q 1 hereby affirm that 1 am licensed underr provJalona of CHaptar 9 (comrnenclng w(tfi, .Section 7000) of Division 3 of the Business,»nd Professions Code, and my license is Infull force and effect i1 ir Nn Class' i ,EACHINSTAl, ALTER REPAIR WATER PIPEVENT FAN SINGLE DUCT ^ *" "MECHANICALEACH GAS SYSTEM 5 OR MORE-METAL FIREPLACE ' ' ^^o
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• 'EACH GAS SYSTEM 1 TO 4 OUTLETSBOILER/COMPRESSOR 3 15 HP ^N
TOTAL PLUMBEACHWATER HEATER AND/OR VENTBOILER/COMPRESSOR UP TO 3 HPN
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INSTALL FURN DUCTS UP TO 100 000 BTUs
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DATE OF APPLICATION///2S/Wac
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n CARLSBAP6UILDING DEPARTMENT A^ICATION & PEF- - 1200 Efm, Carlsbad, California 92008 (714)438-5525H
i USE 8ALL POINT PEN ONLY & PRESS HARD ^ > ' APPLICANT T&'ILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONSWhite — Inspector Green,^ (1) Finance (2) Data Process, Yellow — Assessor Pink —'Applicant Gold — Temporary File
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