HomeMy WebLinkAbout165 CHESTNUT AVE; ; 80-59; PermitCONSTRUCTION LENDING AGENCY1 hereby affirm that there is a construction len-ding agency for the performance of the work forCERTIFICATE OF EXEMPTION FROMWORKERS' COMPENSATION INSURANCE(This section need not be completed if the per-mit is for one hundred dollars ($100) or less).I certify that In the performance of the work for._which this permit is issued, I shall not employ anyperson in any manner so as to become subject, tothe Workers' Compensation Laws of California.NOTICE TO APPLICANT: If, after making this Cer-tificate of Exemption, you should become subjectto the Workers' Compensation provisions of theLabor Code, you must forthwith comply with such' provisions or this permit shall be deemed revoked."l HAVE CAREFULLY EXAMINED THE COMPLETHEREBY CERTIFY THAT ALL INFORMATION HFURTHER CERTIFY AND AGREE IF A PERMIT 1COUNTY AND STATE LAWS GOVERNING BUILCSPECIFIED HEREIN OR NOT. 1. ALSO AGREE TCLESS THE CITY OF CARLSBAD AGAINST ALLEXPENSES WHICH MAY IN ANY WAY ACCRUE AOF THE GRANTING OF THIS PERMIT.:
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-WORKERS' COMPENSATION DEC1 hereby affirm that 1 have a certisent to self-insure, or. a certificateCompensation Insurance, or a cthereof (Sec. 3800, Labor Code), j^«~ 2.
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RELOCATION OF EA FURNACE/HEATERBUILDING PERMIT-EACH LAWN SPRINKLER SYSTEMMECH EXHAUST - HOOD/DUCTSEACH INSTAL, ALTER, REPAIR WATER PIPEVENT FAN SINGLE DUCTEACH GAS SYSTEM 5 OR MOREj
BOILER/COMPRESSOR 16-30 HP^EACH GAS SYSTEM 1 TO 4 OUTLETSV?BOILER/COMPRESSOR 3-15 HPEACH WATER HEATER AND/OR VENT1
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DESIGNER'S ADDRESSomU)GNEH'S PHONENot Valid Unless Machine Certified . .requires thesigned state-r~O-\BLOCKSUBDIVISIONASSESSOR'S PARCEL NO.Ill t 1 1 1 1 1 IIf . H3N91S30inH
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