HomeMy WebLinkAbout1050 GRAND AV (10) ^ _��_ CITY OF DIAMOND BAR .
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 1
21825 Copley Drive,Diamond Bar,CA 91765 I
(909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS
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� CENSE UW(pUPTER D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOI/SP8
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A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLAAS(f60o)J:
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Z WIIL DO THE WORK,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a1,BU51� J
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PROPERTV Nhq BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELFOR HERSELF OR
w THROUGH HIS OR HER OWN EMPLOVEES,GROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
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Z TION,THE OWNER�BUILDER WILL HAVE THE BUqDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
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¢ I HEREBY AFFIRM UNDER PEN�LTY OF VERJUFV THAT I AM IICENSE�UNDEF PROVISIONS OF CHAPTER �, � ��y�B
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� WORKERS'COMPENSATION DECLARATION �
� I HEREBYAFFIRM UNDER VENALTY OF PERJURY ONE OF THE FOLLOWING DECLAFATIONS; U
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Z� _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF•INSUqE FOR WORNERS' a
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Z I CERTIFV THAT IN THE PERFOqMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 ECHANICAL ^L• `
C� SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE
(n WORKERS'COMPENSATqN UWS OF CAIIFORNIA,AND AGREE THAT IF I SHOULO BECOME EE
SU&IECTTOTHEWORKERS'COMVENSATIONPROVISIONSOFSECTI 97a00FTHELABOR � O �
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� WARNING FMLUfiE TO SECURE WORKERS'COMPENSATION CAVEFUGE IS UNLAWFUL.AND SHNl BE ENERGY P/C
�y SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND EN IT
DOILARS(5100.000),IN�ODITION TO THE COST OF CAMPENSATION,DAMAOES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEI"5 FEES. RETEYJTI E: �� � l
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� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CANSTRUCTION LENDINO AGENCV
FOq THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7087,QV.C.).
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� I AOREE TO COMPLV WITH ALL CfTV AND CWNTV ORDINANCES AND STATE UWS REI.ATINO TO BUILOINO
� CONSTqUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CWNTY TO ENTER UPON THE
Z ABOVE�MENTIONED VR))OPE FOq INSPECTION PURPOSES. COMMENTS
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TEMP POWER FIREPLACE BOND BEAM
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ROOF SHEATHING 8 FT. BOND BEAM
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ROUGH ELECTRIC ROUGH GRADING
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SEEP PIT/L.L. ON SITE IMPS.
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FINALCONST. p • � �� FIRE DEPT. FINAL
FINAL HEATING `'��`� ' I r � HEALTH DEPT. FINAL
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