HomeMy WebLinkAbout17730 ��_ CTTY OF DIAMOND BAR � �
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive /
'� (909)860-3195 Fa�c(909)861-3117 � PRESS
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o� JOBSITE � �` APPLICATION PERMIT P/C
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w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCFI PERMIT TO FILE A SIONED w Patio/Deck
� STATEMENT iHAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
CENSE lAW(CHAPTER�(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OG THE BUSINESS AND PRO- � POOVSPB
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CC t MEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
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�Z _I HAVE AND WILL MAWTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢
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w _I HAVE M1D WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION
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J ISSUED.MV RKE`R_S'COnMPENSATION IN�S,U"FA,NC,E CARRIER AND POLICV �MeEanae: CONSTRUCTION
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
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� SU&IECTTOTHEWOFKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR � � `�
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� I HEREBV AFFlRM UNDER PENALTV OF PERIURV TMAT THERE IS A CONSTRUCTION LENDING AGENCV
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� LENDER'S NAME
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w I CERTIFY THAT 1 MAVE READ THI$APPLICATION AND STATE iHAT THE ABOVE INFORIAATION IS COqRECT. TOTA L FE ES � '� S�
� 1 AGREE TO COMPIV N7TH ALL CITV AND COUNTV ORDINANCES ANO STATE UWS REUTING TO BUILDINO
CONSTRUCTION,AND HEREBV AUhHJRRE REPRESENTATIVES OF hli5 CWNTY TO ENTER UPON THE
ZABOVE�MENTIONED PROPERTV FOR INSPECTION PUFPOSES. COMMENTS
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� RECPT.NO. � PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GAEEN—Applicant's Copy
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EX7. LATH/SIDWG POOL FENCING ` '
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SEWER FINAL ENG.
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