HomeMy WebLinkAbout2327 CARINGA WAY; 3; 81-29; PermitCONSTRUCTION LENDING AG1 hereby affirm that there is a consding agency for the performance of-|Ii'!§"tS' 5 ?' >v ^.CERTIFICATE OF EXEMPTIONWORKERS' COMPENSATION INS1(This section need not be completemit is for one hundred dollars ($100) >I certify that in the performance ofwhich this permit is issued, I shall notperson in any manner so as to becorrthe Workers' Compensation Laws ofNOTICE TO APPLICANT: If, after maktificate of Exemption, you should beeto the Workers' Compensation proviLabor Code, you must forthwith compprovisions or this permit shall be deenDCopy is filed with the city.DCertlfied copy is hereby furnished.» •< 2. 9 a OSo.3ios.c-na. s o 3 <£ * w g sT - ~ £ £-. * ? ffl -» ^ = -n^CI)~*'J"Oiiuptti^r3T C — "S" O 0> — IB ^ T) 'SSiTE? o5° ?b•Dz Sf ^WORKERsCtOMPENSATION DECL1 1 hereby affirm that 1 have a certifisent to self-insure, or a certificateCompensation Insurance, or a ceithereof (Sec. 3800, Labor Code).POLICY NO. t-f-fl (el I/5. o n S,S 5s >° 2.3o ;• IT o aUDgCDo ro o Z3 » °^t5§|"is«-Si» ^9-.Iii.£ls »l i« 3» i^stlnll ifi sfp 1 =•ilHiiPti ilHlHISJfii ~P>Il!l!!!iilc!ijfitlUff !i|f]fif|f!ti |!iil!l?iHii!il%s P ii!!!!!i!»!!iIsi^ii ?|alll&lc|gio ffi??8||i:|;|;|gI?°*i:I fl|H|i*liil3 f|gitasr!:;so*!t;l ' LICENSED CONTRACTOR'S DECL1 hereby affirm that 1 am licensedsions of Chapter 9 (commencing v7000) of Division 3 of the Businesssions Code, and my license is in full 1feet.i SifSlll iliili'illlif Pffitl-fffsfff2 fljfflIP rf9?-?SS? S.S.I'S2.£3.5i!!?°o8 Si-SxxoJ?. SJ| = = i3 * ? i ¥•1 HAVE CAREFULLY EXAMINED THE COMPLETED "AFHEREBY CERTIFY THAT ALL INFORMATION HEREONFURTHER CERTIFY AND AGREE IF A PERMIT IS ISSUfCOUNTY AND STATE LAWS GOVERNING BUILDING CCSPECIFIED HEREIN OR NOT. 1. A LSO AGREE TO SAVELESS THE CITY OF CA.RLSBA.Q A.GMNST ALL, LIA.B1LEXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINSOF THE GRANTING OF THIS PERMIT.yj j- Z Z ^D (f) j_5 "•- 2 J? ° c 55°5g|>i
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DATE OF APPLICATION1-14-8109
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