HomeMy WebLinkAbout13371 (57) CITY OF DIAMOND BAR �
�-��� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
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N I HEREBV AFFIRM UNUER PENALTV Of VERIURV ONE OF THE FOLLOWING DECLARATIONS:
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Z 1 CERTIFV THA7 IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
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p DATE: APPLICANT: SMIP �/y n
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� SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
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a CONSTRUCTIONLENDINGAGENCY Pq��4�FEE: �
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ZABOVE-MENTIONEO PROPERTY FOR INSPECTION PURPOSES. COMMENTS �
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