HomeMy WebLinkAbout16669 (32) ` � CITY OF DIAMOND BAR
J� DEPARTMENT OF COULtifUN1TY&DEVELOPMENT SERVICES �
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21825 E.Copley Drive
(909)860.3195 Fa�c(909)861-31 l7 PRESS
BUILDINC PERMIT APPLICATION FIR Y
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� ACMLPENALTYOFNOTMOFET/I/JIFIVEHUNDREDDOLLARS(fSOC�):
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� LICENSED CONTRACTORS DECLARATION W
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� WORKERS'COMPENSATION DECLARATION Q
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Z I CERTIFYiMAT W TME VERFORMANCE OF 7HE WORK FOR WHICH MIS PERMIT IS ISSUED.1 MECHANICAL
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� SVOJECTANEMPLOYERTOCRIM'NAl7ENALTIESAtiDCMLFINE5UPi00NEHUNDACDT�qU4AYD ENERGYPERMI '
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J SECTIDN770lOF7MELAL70�iCODE,NTEREST,ANDATTORNEY5FEE5. �
Q RETENTION FE ry'
oCONSTRUCTION LENDING AGENCV PRE-ALT FEE: �� ---_ • �
� INERCBVI1iFIRMUNOCRFCNALTVOfP[fiJURYTIU7THCfiE15ACOK5TRUCTIONLE�D�NOAGENCY
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� I CERTIFYTHAT I HAVE REID TMIS APVLICATION AND STATE THAT TNE ADOVE NFORMATION IS CORRECi.
W IAGREETOLOMPLYMATNALLCfT`IANDCOUNTYORDINANLESANDSTATEUwSREUTIhGTOBUILDING �� �
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