HomeMy WebLinkAbout12-706 �� CITY OF DIAMOND BAR � /
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �/
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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CAMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR CODE.FOR THE PERFORMANGE �U�
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� w �1 HAVE AND WILL MAIMAIN WORKERS'�COM7ENSATION INSUHANCE,AS REIXJIRED BY SECTION � �
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� � WORKERS'COMPENSATION IAWS OP CALIFORN11 AND A REE iHAT IF H BECAME INSPECTION FEE
= SU&IECT TO THE WORKERS�COMVENSATIDN PF IS OF SE 770 F THE LABOR
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DOLLARS(5100,000),W ADDITION 70THE COST OF CAMPENSA710N,DAMAGES AS PROVIDED�FOH IN
� SECTION 3�oB OF TNE LABOR CODE,IN7ERE5T,ANDATTORNEYS FEES. - RETENTION FEE: �
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBY AFFIRM UNDERPENALN OF PERIURY 7HAT THERE IS ACANSTRUCTtON LENDING AGENCV ��.-� � �
FOR 7HE PERWRMANCE OF 7HE WOFiK FOR WHICYi THIS PERMIT IS ISSUED�SEC:3097,CN.C.).
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w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE 7HAT7HE�BOVE INfORlAATqN IS ODRRECL TOTAL FE ES �� i-�
� 1 AGHEE TO CAMPLV WI7H ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELA7ING 70 BUILDING ✓���
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