HomeMy WebLinkAbout1685 CHESTNUT AVE; ; 81-5; PermitCONSTRUCTION LENDING AGENCY1 hereby affirm that there is a construction len-ding agency for the performance of the work forwhich this permit is Issued (Sec. 3097, Civil Code).v
\CERTIFICATE 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 forwhich this permit is issued, I shall not employ any __person 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 suchprovisions or this permit shall be deemed revoked.SPECIFIED HEREIN OR NOT. I.ALSO AGREE TO SAVELESS THE CITY OF CARLSBAD AGAINST ALL LIABILEXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINSOF THE GRANTING OF THIS PERMIT.INDEMNIFY AND KEEP HARM-TIES, JUDGMENTS. COSTS ANDT SAID CITY IN CONSEQUENCE frA*«rfcANT'S SIGNATURE' OWNERf] CONTR ACTOF?(DAGENT D BY PHONE DTJT)
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w 1 HAVE CAREFULLY EXAMINED THE COMPLETHEREBY CERTIFY THAT ALL INFORMATION HFURTHER CERTIFY AND AGREE IF A PERMITED "APPLICATION AND PERMIT, AND DOEREON IS TRUE AND CORRECT AND 1s ISSUED; TO COMPLY WITH ALL CITY,•AN OSHA PER_MI-T~rs~REqi5'-0" DEEB-A'ND DEMOMTISTRUCTURES OVEB<3sTOIRED FOR EXCAVATIONS OVDN OR CONSTRUCTION OFRIES IN HplGHTfm
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^WORKERS' COMPENSATION D&3L&RATION1 hereby affirm that 1 have a ce«Slficata»f con-sent to self-insure, OF a certificate ipjrvVorkers'Compensation Insurance, or a nejmied coafthereof (Sec. 3800, Labor Corf&)J" V 1 JV[POI ir.Y un IV"* \ W ™REMODEL/ALTER PER CIRCUIT-nm
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^SIGN PERMIT•WATER SOFTNERRELOCATION OF EA FURNACE/HEATERBUILDING PERMIT-
INSPECTION EACH LAWN SPRINKLER SYSTEMMECH EXHAUST - HOOO/DUCTSEACH INSTAL. ALTER, REPAIR WATER PIPEVENT FAN SINGLE DUCTEACH GAS SYSTEM 5 OR MORE>BOILER/COMPRESSOR 16-30 HP—EACH GAS SYSTEM 1 TO 4 OUTLETSJ
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STATE LICENSEWW31iLICENSED CONTRACTOR'S DECLARATIONI hereby affirm that I am licensed under provi-sions of Chapter 9 (commencing with Section7000) of Division 3 of the Business and Profes-sions Code, and my license is in full force and ef-fect.Go
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