HomeMy WebLinkAbout17357 (10)� - -
----_�� — CITY OF DIAMOND BAR y �
DEPARTIv�NT OF COMMUNTI'Y&DEVELOPI�NT SERVICES �
21825 E.Copley Drive .
(909)860-3195 Fax(909)861-3117 PRESS
�»M� BUILDING PERMiT APPLICATION . FIRMLY
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� OI,ASONTJEROFTHEPROPERTV,ORMVEMGLOVEESWIiNWAGESASTHEIRSOLECOMPENSATqN, � COmfflBfClel
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� NESS AND PROFESSIONS CODE:THE CONTPACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
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w THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPqOVEMEMS ARE NOT INTENDED OR m
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I HEREBV AFFIRM UNOER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
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� I HEREBV AFFIPM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECIAAAT10N5: V
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COMPENSATqN,AS PROVI�ED BV SECTION 37oa OF THE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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W _I HAVE M1D WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN
Q 37000F THE LABOR COOE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS pERM1T IS
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WOR)(FOR WHICH TH PERMIT ISSUED,I MECHANICAL
C.�} SHALL NOT EMPLOV ANY PERSON IN ANY MANNEF 50 AS TO BECOM SU&IECT THE
(/� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHAT SHOUL ECOME INSPECTIONFEE
= SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SE 3 ME UBOR C�
DE.I SHAI�OR TH COMPLV WITH Tl-IOSE PROVISION ISSUANCE 7 O�y
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� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CML FINES UP T 1 WSAND ENERGY PERMIT � �
DOLURS(5700,OOo),IN ADDITION TO THE COST OF COMPENSATION,DAMAOES A PROVI D FOR IN
J SECTION 37oB OF THE LABOR COOE,MTEREST,AND ATTORNEV'S FEES. �
OC RETENTION FE�:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:.��.`x
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THEFE IS A CONSTRUCTION LENDINO AGENCV ��'_--...
FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.CJ.
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� LENDER'S NAME
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w I CEFTIFY THAT I HAVE READ THIS APPIICATKKJ AND STATE hUT THE ABOVE INFORMATION IS CqRRECT. TOTAL F E ES V •
� I AGREE TO CAMPLV WfTH ALL CITV AND COUNTY ORDINANCES AND STATE UWS RELATINO TO BUILDINC
Z CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS CWNTY TO ENTER UPON THE � ^�^ I _ �� ���� �}��'_�
ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. S / 7F 1 7
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ROOF SHEATHiNG • ' ' 8 F7. B�ND BEAM � •
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ROO{=COVER PRE-GRADING
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