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1 HAVE CAREFULLY EXAMINED THE COMPLETED APPLICATION AND PERMIT AND OO HEREBYCERTIFY UNDER PENALTY OF PERJURY THAT ALL INFORMATION HEREON INCLUDING THEDECLARATIONS ARE TRUE AND CORRECT AND t FURTHER CERTIFY AND AGREE (F A PERMIT ISISSUED TO COMPLY WITH ALL CITY COUNTY AND STATE LAWS GOVERNING BUILDING CONSTHUCTSOH WETHER SPECIFIED HBREtN OR 1*01 "i ALSO AGREE TO SAVE WDEMWFV ANDKEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LtABILITtES JUDGMENTS COSTS ANDEXPENSES WHICH MAY J»4 ANY WAY ACCRUE AQAJNST SA» CITY IN CONSEQUENCE OF THEGRANTING OF THIS PERMIT8^xS§
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DESIGNER S ADDRESSI 3NOHd S U3NOIS3Q (7/M/B3766* 30o0(Not Valid Unless Machine Certified1 LOT BLOCK SUBDIVISION " ASSESSOR PARCEL NO"DESIGNER"LICENSE #STANDARD PLAN #BUILDING SQ FOOTAGEOWNER S MAfLfNG ADDRESS^n^ VTA RTVFRA. PAI CK VF»HP. CAI TPHRNTA 0097^CONTnACTOS S ADDRESS1R7R Mflaym TA a\/P.JLICENSE NO9fiQ7£ifi•or
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