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NG PERMITPLUMBIh-a INSTALL FURN. DUCTS UP TO 100,000 BTUEACH FIXTURE TRAPOVER 100.000 BTU*EACH BUILDING SEWERBOILER/COMPRESSOR UP TO 3 HP£EACH WATER HEATER AND/OR VENTi—B01LER/COMPRESSOR3-15HPEACH GAS SYSTEM 1 TO 4 OUTLETS\BOILER/COMPRESSOR 16-30 HPEACH GAS SYSTEM 5 OR MORE\VENT FAN SINGLE DUCTEACH INSTAL., ALTER. REPAIR WATER PIPE^AUST- HOOD/DUCTSX.
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REMODEL/ALTER PER CIRCUITv WORKERS' COMPENSATION DECLARATION1 nereby affirm that 1 have a certificate of con-sent to self-Insure, or a certificate of Workers'Compensation Insurance, or a certified copy(hereof (Sec. 380Q, Labor Code).POLICY NO. ;- lr ' ^' ~? ~^_
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APPLICANT'S SIGNATURE- , OWNERQ CONTRACTOR^,'f~'' i'f~^-(.- L.~f~ r '/f/'l'-l- <• — -*> <-~^- AGENT D BY PHONEQuJ»u33uflr
1 HAVE CAREFULLY EXAMINED THE COMPLETED "jPf^PUCATION ANO PHEREBY CEHTIPY THAT ALL INFORMATION HERTON IS TRUE AND COPFURTHER CERTIFY AND AGREE IF A PERMIT IK^ISSUtD; TO COMPLY WCOUNTY AND STATE LAWS GOVERNING BUX^OING CONSTRUCTION, WHSPECIFIED HEREIN OR NOT. I.ALSO AGFje€ TOSAVE INDEMNIFY ANDLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES, JUDGMENTSEXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SAID CITY IN COOF THE GRANTING OF THIS PERMIT."CERTIFICATE OF EXEMPTION FROMWORKERS1 COMPENSATION INSURANCE(Tfils section need not bo comoletecJ if the per-mit la for ons hundred dollars IS100) of less).1 certify that In the performance of Iha wo'k lotwhich this permit la Issued, 1 shall nol employ anyperson In any manner so as to tocome sublet tothe Workers' Compensation Laws of California.NOTICE TO APPLICANT: II, after maKIng this Cer-llficalo of Exompllon, you should become sublectto the Workers' Componsation provisions ol IheLabor Code, you must forthwith comply wilti suchprovisions or this permit shall be deemed revoked._jjt\\CONSTRUCTION LENDING AGENCY1 tie to by affirm that there is a construction len-ding agency for Ihe performance ol the work forwhich this permit Is Issued (Sec. 3097, Civil Code).