HomeMy WebLinkAbout11054 (5) -1�— CITY OF DIAMOND BAR
� COMMUNITY DEVELOPMENT D�PARTMENT
21660 E.Copley Drive Suite 190 PRES•S•
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o� JOBSITE � � APPLICATION ������� PERMIT P/C
ADDRESS DATE NUMBER #
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z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
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� CENSELAW(CHAPTER9(CAMMENGINGWITHSECTION70W)OF�NISION30FTHe0USINE55ANDPRO � PooVSpa
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� NE55 AND PftOFES510N5 CODE:THE CONTRACTOflS LICENSE LAW�OES NOT APPLY TO AN OWNER OF � �
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� THROUGHHISORHEflOWNEMPIOYEES,PROVIDEDTHATSUCHIMPROVEMENTS�RENOTINTENDEDOR m
0 OFFEREDFOFiSALE.IF,HOWEVER,THEBUILDINGOftIMPflOVEMEMISSOLDWITHiNONEYEAflOFCAMPIE
� TION,THE OWNEF-BUILOER WILL HAVE THE BUROEN Of PROVING THAT HE.OP SHE DID NOT 6UIlD OR
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W ❑I,ASOWNEROFTHEPROPERTY,AMEXCI.USIYELVCONTRAGTWGWITMLICENSE�CONTRACTORS
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFF�RM UNDER PENALTY OF PERJURY THAT I AM LICENSE�UNDER PROVISIONS OF CHAPTER �,
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X MY UGENSE IS W FULL FORCE AND EFFECT.
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� �'""7�OfiKEftS'COMPENSATION DECLARATIO Q
� IHEREBYAFFIflMUNDEHPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLAHAfIONS: � � �
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W I NAVEAN�WILL MAINTAIN WORKEFS'COMPENSATION INSURANCE,AS flE�UIRED BY SECTION '
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. Z I CER7IFV THAi 1N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,l MEGH
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(/) WORKERS'COMPENSATIONLAWSOFCALIFOFINIA,ANOAGREETMATIFISHOULDBEGOME NSPECTIONFE `
� SUBJECT TO THE WORKFRS'COMPENSATION PPOVISIONS OF SECT 3700 0F THE LABOfl
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J WARNING:FAILURE TO SECURE WOPKERS'COMP NSATION COVERAGE IS UNL4WFUL,ANO SHALL BE ENERGY P/C
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� SECTION 3�ae OF THE LABOR CO�E,INTEREST,AND ATTORNEV'S FEES. - RETENTION FEE:
d CONSTRUCTION LENDWG AGENCY PRE-ALT FEE: -
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� 1 HERE9YAFFIRM UNDER PENAITY OF PERJURV THAT THERE IS A CONSTPUCTION LENDING AGENCY �
FOFI THE PERFORMANCE OF THE WORK WR WHICH THIS PERMIT IS ISSUED(SEC.3oH],CN.C.J.
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� LENDER'SNAME... .__ . .
H LEN�ER'SAODRE55 �
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� I CER7IFY THAT I HAVE REA�THIS APPUCATION AN�STATE THAT THEABOVE WFORMATION IS CORRECT. -
W I AGREE TO COMPLY WITN ALICITY AND COUNTY ORDINANCESAND STATE LAWS RELATING TO BUILDING �
� CONSTRUCTION,AND HEPEBV AUTHORIZE REPRESENTATlVES OF THIS COUNTY T TE PO�I THE - -
� ABOVE�MEN D PfiOPERTY FOR INSPEC710N PUFPOSES.
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