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LENDER WORKERS COMPENSATION OWNER/BUILDER CONTRACTORr
Lender s Address1 — 1 1 hereby afffrm that there is a construction lendingagency for the performance of the work for which th s permil is issued (Sec 3097 C i Code)r
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KEEP HARMLESS THE CITY OF CARLSBAD AGAINST ALL LEXPENSES WHICH MAY IN ANY WAY ACCRUE AGAINST SGftANTWa OF THIS PERMfTE
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S"I HAVE CAREFULLY EXAMINED THE COiVIPLEreO APPLICATION A£40 PERMIT A&O DOCERTfFY UNDER PENALTY OF PEFUtW THAT ALL INFORMATION HERfON JNCtUDDECLARATIONS ARE TRU£ AND CORR£CT AND t FURTHER CERTIFY AMD AGREE |F A PISSUED TO COMPLY WITH ALL CITY COUNTY AMD STATE LAWS GOVERNING SUfLD- z m ~» *£
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