HomeMy WebLinkAbout2649 OCEAN ST; ; 84-676; PermitDECLARATIONS
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ISTRUOTION WHETHEKFiEP HARMLESS THECITY OF CARLSBAD AGAINST ALL LIABILITIES JUDGMENTS CCH T
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CD the WorXeVy Compensation Laws of California .NOTICE TO APPLICANT If after making this Ceni |dcate of Exemption you should become suhieci IMthe Workers Compensation provisions o» the Laboi 1Code vou must forthwith comply with such ^provisions or this permit shai1 be deemed 'evoked11_ 1n ! ne'eby aH'im mat mere .s a (.onsiiuri-n^ |lending agency 'or :ne rjerturma^ce of Ihe *orv 'orwhich this permit is issued (Set 309/ Civil Coaei 11V 00 ~?ss>F CAREFULLY EXAMINED THE COMPLETED APPLICAIFY UNDER PENALTY OF PERJURY THAT ALL INFOARATIONS ARE TRUE AND CORRFCT AND 1 FURTHERED TO COMPLY WITH ALL CITY COUNT Y AND STATE['ION AND PERMIT AND DORMAI'ION HEREON INCLULCERTIFY AND AGREE IF A FLAWS GOVERNING BUILDz 3 Z I
ilss^ cr m -<Expiration Every permit issued byCode shall expire by limitation andauthorized by such permit is not conpermit or if the building or workabandoned at any time after the wohe Building Official under (hebecome null and void If theimenced withtn 180 days fromauthorized by such permitk is commenced for a periodprovisionsof thisiLfildmg or workIhe date of suchs suspended orof T80 days'f* AN OSHA PERMIT IS REQUIRED FOR EXCAVATIONS OVER5 0 DEEP AND DEMOLITION OR CONSTRUCTION OfSTRUCTURES OVER 3 STORIES IN HEIGHT\ r*"1
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_-— -LICENSE TAX 01 00 00 8162CERTIFICATEWORKERS CO(This section needis 'or fme hun(Q l certitJthit m Jrwhich thisipe/mit/scAEXtMPTlON FROM .PE*4SAT"lON INSURANCFran dpujrs !$100! <.T 'eSSip performance of the *on> tor jissued i shall not employ an>T1
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CD COMPANY1Q Copy is filed witn the cityQ Certified copy is hereby furnished 1"D
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— H i ,~~ 1n l hereby affirm that 1 have a certificate o' consent 1to self insure or a certificate of Workers ,Compensation insurance or a certified copy thereof(Sec 3800 Labor Codei IPOLICY NO 1D [ELECTRICAL PERM)crn
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c_n ui Asa homeowner 1 ammg conditions exist1 The work is 1)2 I have livedpnoi to compl3 1 have not clast three yeaT3
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-t.improving my home and the tollow 'sing performed prior to safem my home for twelve months Istton of this workaimed this exemption curing the 'EACH GAS SYSTEM b OR MORE:o
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^<!EACH WATER HEATER AND/OR VENT !BOILER/COMPRESSOR UP TO 3 HPIE
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COoen Ll 1 as owner ot the property am exclusively contractingwith licensed contractors to construct the project (Sec 7044 tBusiness and Professions Code The Contractor s LicenseLaw does not apply to an owner of property who builds or improves thereon and who contracts 'or each projects with a |contracior(s) license pursuant to the Contractor s LicenseLaw) 1tACH BUILDING SEWER 1OVER 100 000 BTUen
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I am exempt from Ihe Contracie following reason (Sec 7031 5 1Code Any ciiy or county whicri re 1ruct alter improve demolish orto its issuance also 'equres 'he ap |file a sianed statement that he isT-
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1CONTRACTORS PHONE «•/j£?-1v.:T$-i fj 1 Hereby atflrm that 1 am licensed under_ provisions of Chapter 9 (commencing withSection 7000) of Division 3 of the Businessand Professions Code and my license is infull force and effectlir Nn Claw-OB AODRE.SS AV ST RD NEAREST CROSS ST$.C-?4-9 O'.>*i/^-^ ST — 1*>KMVc_.MDATE OF APPLICATIONi-- 19 -to.r
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I CARLSBAD BUILDING DEPARTMENT APPLICATION & PEF1200 Elm Carlsbad California 92008 1989 (619)4385525H
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