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KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS. COSTS AND APpL'eANT'S SIGNATURE * OWNER$1 CONTRACTOR D 1_ *>, , v i x i>TD
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'E CAREFULLY EXAMINED THE COMPLETED "IFY UNDER PENALTY OF PERJURY THAT A.ARATIONS ARE TRUE AND CORRECT AND 1 FED: TO COMPLY WITH ALL CITY COUNTY AN°5F?in H _ Tl-II ZC> m -n o=J3Q>TION AND PERMIT"RMAT1ON HEREONCERTIFY AND AGRI LAWS GOVERNIN)»S2S
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O 3*g^33r cr m -<Expiration Every permit issued by the ButlcCode shall expire by limitation and becomeauthorized by such permit is not commence!permit, or if the buitdma or work author)abandoned at any time after the work is coning Orficiat under thenull and void M thei withm 1 80 days fromled by such permitimenced for"KP/r*odprovisions ofthissuddtng ot wortfthe date of suchs suspended orof 180 davs.* AN OSHA PERMiT I-S 0 DEEP AND DESTRUCTURES OVEfREQUIREDMOLITION Of1 3 STORIESFOR EXCAVATIONS OVE» CONSTRUCTION OFN HEIGHTa
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L_J^^P^-frtereby affirm that 1 have a certificate of consent to^^gJfc-Wisure, or a certiticale ot Workers' Compensation In-surance, or a certified copy thereof (Sec. 3800. Labor Code)POLICY NO.•^COMPANY £2l~3&TTfrT~st s ~ **.. Slor this reason' S*lCa ^D P1!1PI!|E IIil|illl|!!-_ I|SIO\
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