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m CERTIFICATE OF EXEMPTION FROMWORKERS COMPENSATION INSURANCE(This section need not be completed if the permtt is for one hundred dollars ($100) or less)) certlty thai in the performance oi the work torwhich this permit Is issued, I shall not employ anyp*^son in any manner so as to become subject tothe Workers Compensation Laws of CaliforniaNOTICc TO APPLICANT If, after making this Certificale of Exemption, you should become subjectto the Workers Compensation provisions of theLabof Cads, you must forthwith comply with suchprovision* or this permit shall be deemed revokedI HAVE CAREFULLY EXA MINED THE COMPLETHEREBY CERTIFY THAT ALL INFORMATION HEFURTHER CERTIFY AND AGREE IF A PERMIT ISCOUNTY AND STATE LAWS GOVERNING BUILDSPECIFIED HEREIN OR NOT I ALSO AGREE TOLESS THE CITY OF CARLSBAD AGAINST ALL Lf > z s£°
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PRIME CONTRACTORSTATE LICENSE1LICENSED CONTRACTOR S DECLARATION1 hereby affirm that i am licensed under provisions ot Chapter 9 (commencing with Section7000) of Division 3 ol the Business and Profes -sions Code and my license Is m full force and effeetSN
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