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' ` CITY OF DIAMOND BAR �
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(,i} SHALL N01 EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE INSPECTION FEE -
� WORKERS'COMPENSATION LAWS OF CALIFORN10.AND AOFEE THAT IF I SHOULD BECOME .
SU&IECTTOTHEN�ORKERS'COMPENSATIONPROVIS�ONSOFSECTION97000F7HEUBOR ,a ��
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DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOR IN ..�
� SECTION 3T080F 1T1E If.BOR COOE.INTEREST,AND ATTORNEY'S FEES. AETENTION FEE: �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
CC I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CANSTRUCTION LENOINO AGENCV
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� LENDER'S NAME
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� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT hIE ABOVE INFORMATION IS CORHECT. TOTAL F E ES '\�� 1 / ,
� I AOREE i0 COMPLV N7TH ALL CRY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING � �
� CONSTRUCTION,M1D HEREBY AUTTIORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPERT'FOR INSPECTION PURVOSES.
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