HomeMy WebLinkAbout1097 CHESTNUT AVE; ; 86-1212; PermitDECLARATIONS
LENDER WORKER'S COMPENSATION OWNER/BUILDER CONTRACTOR
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^ <F ~ c o Hi 3 ™ s 3f! IIII ill =D 1 hereby affirm that 1 have a certificate of consent tosell-insure, or a certificate of Workers' Compensation In-surance, or a certified copy thereof (Sec. 3800. Labor Code)POLICY NO-COMPANYfor this reasonD go ||||f|n |||a||g||sz |a||p|||ff|
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iilf! S|!f|jII||8isM o2fots fl!iH2-Sh tfflil:!2i5air!i §~~ Q 1 hereby affirm that 1 am licensed underprovisions of Chapter 9 (commencing withSection 7000) of Division 3 of the Businessand Professions Code, and my license is in_ full force and effect.(EXPENSES WHICHGRANTING OF THSPERM*. L/<£fg&dlCAH-''//<JL&e BY PHONED) ^ | l/lfllfclIS mUOI ION, WHblHtH WkClHtU HtKtIN OH HOI. 1 ALSO fcWHtt IO b(W b (NUtMNiH «*U Appi irAWT'i QI^MATI IDC M. *r n S APPROVED BY nirc i / 1KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LIABILITIES. JUDGMENTS, COSTS AND APPLICANT^ SIGNATURE * ^ ^ OWNEfiJ^ CONTRACTOR D | APPROVED BV ^ ./, /. |fn m m T
r- O 33 >E CAREFULLY EXAMINED THE COMPLETED "APPLICAiFY UNDER PENALTY OF PERJURY THAT ALL INFOARATIONS ARE TRUE AND CORRECT AND 1 FURTHERED: TO COMPLY WITH ALL CITY. COUNTY AND STATETION AND PERMIT1RMATION HEREONCERTIFY AND AGRLAWS GOVERNINC TtO §
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1DESIGNERDESIGNER'S ADDRESSDESIGNER'S PHONESTATE LICENSE NO.v PV- /rfX .-,,.^^ •. *'•'*:**• v.,/ ' '•• ' 'v, ' " '*• • ' '"3 ' '.».IjOiT o,ui ii/i9/e6rr<QT .30 =<.' ' * - T_ " •' - , • " . "j ^ -, J .•"-•"''Not Vitfid Unffi Machine CertifiedO
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zm•£»•!DATE OF APPLICATION///W?6BUSINESS LICENSE ttVALUATIONJPERMIT NUMBER'¥)V^CARLSBAD BUILDING DEPARTM2075 Las Palmas Dr., Carlsbad, CA 92009-4859 (6192
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:ILL IN INFORMATION WITHIN SHADED AREA AND DECLARATIONS.White — Inspector Green — (1) Finance Yellow — Assessor Pink-;—'Applicant GolcT— Temporary File