HomeMy WebLinkAbout1114 BUENA VISTA WAY; ; 84-370; Permit1 DECLARATIONS OWNERIBUILDER WORKER'S COMPENSATION It LE~DER I1 c VI rn W c 0 r W z 4 W rn z 0 z 7 < Po W W rn v) VI I * W 0
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Pink - Applicant Gold - Temporary File White - Inspector Green - (1) Finance (2) Data Process, Yellow - Assessor
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u $370-
ATTENTION PROPERTY
An "owner-bui 1 der" si mature.
NO
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OWNER:
building permit has been applied for in your name and bearing your
Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. building permit will be issued until this verification is received.
I personally plan to provide the major labor and materials for construction of
1 (-- L signed the application for a building permit.
I have cont acted with the following person (firm) to provide the proposed construction.
Name
*'
the proposed property improvement (w
\ \ Phone
Y.,
\ Address \, Contractors Lf cense No.
City ,, \, k '\
I plan to provi coordinate, sup and provide the major work.
Name Phone
Add res s Contractors License No.
io s of the work, but I have hlred the following person to
city
I will provide some of the wor x but I have contracted (hired) the following persons to provide the work indicated:
Name Address Phone Type of Work - &hAA&L&
Signed: Property Owner LJ4 V Social Security Number
Date: 7 - u- fy-
EACH SUBCONTRACTOR WILL BE INSTRUCTED TO OBTAIN A CITY OF CARLSRAD BUSINESS LICENSE AND FURNISH A CERTIFICATE OF WORKMAN'S COMPENSATION TO THE CITY OF CARLSBAD.