HomeMy WebLinkAbout18386 CTTY OF DIAMOND BAR . � P���'
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21525 E.Copley Drive .
(909)860-3195 Fax(909)861-3117 RESS
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w TURE.PRqR TO ITS ISSUANCE,AL50 REDUIRES THE AP7LICANT FOR S�1CH PERMIT TO FILE A SIGNED w
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� CENSE LAW(C}1APTER 8(COMMENCINO Wlhl SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPO
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� NE55 M1D PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNEP OF �
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� I HERFBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOW WQ DECLARATIONS: Z ,
� _1 HAVE AND WILL MAINTPJN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOR)(ERS' _
� COAIPENSATqN,AS PROVIDED BV SECTION 37000FTHE LABOR CADE.FOR THE PERFORMANCE U
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Qw I HAVEAND WIL�MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
37o00F THE LABOR CADE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS f ��. �
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C'3 SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO7HE
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECTTOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION37o00FTHELABOR
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p DATE� •O APPLIC� SMIP ��T�
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� SU6IECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDT}KKISAND ENERGYPERMIT
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� SECTqN3708OFTHEUBORCODE,INTEREST,MlOATTORNEI"5FEE5. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDEF PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENOINO AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,CIV.CJ.
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� LENDER'S NAME
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w I CEFTIFV THAT I HAVE READ THIS APPLICATqN pND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES , J�
� I AGREE TO COMPLY WITM ALL CITY AND COUNTV ORDINA7JCE5 AND STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF HIS WUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PROVEflTV FOR INSPECTbN PURPOSES. COMMENTS
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'ROOF SHEATHING � I 8 FT. BOND BEAM ' ` `
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