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� �.,,� CITY OF DIAMOND BAR i"�
. -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��y
: � . 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
�'A�' BUQ,DING PERMIT APPLICATION FIRMLY
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ADDRESS � � DATE � �G' NUMBER.,;���Y�%'�" #
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� NE55 AND PqOFES510N5 CODE:7HE CONTMCTORS LICENSE LAW�OES NOTAPPLV TO AN OWNER OF �
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COMPENSATION.AS PflOVIDED BY 3ECTIIXJ 37000F THE LABOR CODE,FOR TME PEflFORMAhCE �U
Q OF 1HE WONK fOR WHICN THIS PERMIT IS ISSUED. �
W _I HIIVEMID WILL MAINTAIN WORKERS'COMPENSA7;DN INSURANCE,AS RE�UIqEO BY SECTION
Q 37000FTHELABORCODE,FOR7HE?ERFORMANCEOFTHEWORKf-0RWHICHTHISPEflMITIS �
�' � ISSUED.MY WORKERS'COMPENSRTION INSUflPNCE CANRIER AND POLICY NUMBER AflE: CONSTRUCTION _���_�
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#� J WARNINGFAIWRETOSECUREWORKEFS'COMPENSATIONCAYERAOEISUNUWFUL,ANOSHALLBE ENERGYP/C � .f ^�' C.I�O� __ __,_
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