HomeMy WebLinkAbout1794 BASSWOOD AVE; ; 83-133; PermitDECLARATIONS LENDER WORKER'S COMPENSATION OWNER/WICDER CONTRACTOR -1 I1 in - n m z w C -I D > n 4 + 3 31 D - L! ... , Dl V V - m
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White - Inspector Green - (1) Finance (2) Data Process, Yellow - Assessor Pin$z&pplicant Gold - Temporary File ???
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A!pE"IQN PROPERTY OlW:
An "owl~sr-huilder" building permit has been applied for in your name and bearing your
signature.
Please camplete and return this information in the envelope provided at your earliest
opportunity to avoid unnecessary delay in processing and issuing your building permit.
No building permit will be issued until this verification is received.
1.
2.
3.
4.
5.
I personally plan to provide the major labor and materials for construction of
the proposed property improvement (yes or no) r&
I (havelhave not) signed the applicatiocfor a building permit.
I have contracted with the following person (firm) to provide the proposed construction.
NXIE Phone
Address Contractors License No.
City
I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major wrk.
Phone Name
Address Contractors License No.
City
I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated:
Name Ad&ess . Phone Type of Work
Signed: Property Owner
.- Social Security Number
Date: 3/~9/~ 3 / /
EACH SUBCONTRACTOR YltL BE INSTRUCTEO TO OBTAIN A CITY OF CARLSBAD
BUSINESS LICENSE AND FURNISH A CERTIFICATE OF WORKWAN'S COMPENSATION TO THE CITY OF CARLSBAD. In9tlals