HomeMy WebLinkAbout13099 � CITY OF DIAMOND BAx
DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRE�$
_ �'� BUII.DING PERMIT APPLICATION FIRMLY
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CEN9E lAW(CHAPTER G(COMMENCWO WITH SEC710N 7000)OF DM$ION 9 OF THE BUSINE55 AND PRO- POOUSP9
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LICENSED CONTRACTORS DECLARATION �
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I HEREBY AFFIAAI UNOER PENAL7V OF PER1UiiV 7YUT I AM LICENSED UNDER VROVISIONS OF CHAPTER �
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NI HEREBV AFFIRM UI�ER PENALTV OF PERIURV ONE OF THE FOLLONrtNG DECLARATIONS: Z
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Z I CERTIFV hUT IN THE PERFORMANCE OF hIE WORK FOR WFiICH THIS PERMIT IS ISSUED,I MECHANICAL
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y WOR!(ER5 COMPENSATION LAWS OF CALIFORNI^AND A6REE THAT IF 1 SHOVLD BECOME INSPECTION FEE
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� ENERGY P/C
WARNINO:F/ULURE TO SECURE WORKERS COMPENSATKKi COVEMGE IS UNLAWFUL,AND SHALL BE
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� LENDERS NMIE
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� I CERTIFV TMAT I HAVE REM THIS MPLICATqN M1D STATE hIAT T1E ABOVE INFORMATION IS CORRECT. �
� I AOREE TO CAMPLV WITH ALL CfTY AND COUNTV ORDINANCES AND STATE UWS RELATWO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUT}K7RIZE REPRESENTATIVES OF THIS COUN7V 70 EMER UPON THE
ABOVE�/EN710NED PROVERTY FOR INSPECTION PURPOSES.
COMMENTS '
� PERMITTEE NAME(PRl/fn '
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� SqNANREOFVERM1TfEE DATE RECPT.NO. PAID BY VALIDATION
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