HomeMy WebLinkAbout12-1114 _�„�_ CITY OF DIAMOND BAR � '
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
_,,,W . 21810 Copley Dnve,D►amond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 RESS
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUEO,1 MECHANICAL
U' SHALL NOT EMPLOY ANY 7ERSON IN ANY MANNER 50 AS TO BECAMESU&IECT TO THE
� WORKEHS'COMPENSATION IAWS OF CALIFORN11 NQ AGREE 7HAT IF I SHOUID BECAME INSPECTION FEE
= SUBJECT TO 7HE WORKERS'COMPENSATION PROV SIONS OF�SECTION 7700 0F THE LABOR � - � �
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p� RETENTION FEE:
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� 1 HEREBYAFFlPM UNDER PENAL7V OF PEf�URY THAT THERE IS ACONSTRUCTION LENDINO AGENCY '
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w 1 CERTIFV THAT I HAVE READ 7HI5 MPLICATION AND STATE THAT THEABOVE INFORMATION IS CORRECT. TOTAL FEES� � j����_Cl/
d 1 AGREE TO COMPLY N7TH ALL CfTY AND CAUNTV ORDINANCES AND STATE UWS FEUTWG TO BUILDIN6 � /
� CONSTRUCTION.ANO HEREBY AUTHOPIZE REPRESENTATNES OF 7HI5 COUNTY TO EMER UPON iHE � . �
Z ABOVE-MEM ED PROVERTY FOR INSPECTION PURPOSES. COMMENTS �
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