HomeMy WebLinkAbout17619 (42) _��_ CTI'Y OF DIAMOND BAR �
DEPARTIv�NT OF CONIIvIUNI'TY&.DEVELOPMENT SERVICES
21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
"%���� BUILDING PERMIT APPLICATION FIRMLY
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w TURE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIONED W Petio/Deck
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Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701a,BU51� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NM110 BU0.D5 OR IM VROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q 7HROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
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�XI MY LICENSE IS W FULL FORCE AND EFFECT. � � �1 m
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w HAVE M1D WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS RC-0UIRED BV SECTKKJ
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Z I CERTIFY iNAT IN THE PERFORMANCE OF T WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
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(n ,^�WORKERS'COMPENSA710N IAWS OF CALI IA,AND AOREE THA71F I SHOULD BECOME INSPECTION FEE
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� WARNING: AILURE TO SECURE WO FS'CA NSATION CqVERAGE IS UNUWFUL,AND L BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMI ALPENALTI DCfVILFINESUPTOONEHUNDREDTH U D ENERGYFERMIT
DOILARS(5100,000),IN ADDITION 7HE COST O PENSATION,DAMAGES AS PHOVIDE F IN
� SECTION 3708 OF THE LPBOR COD INTEREST,AN �rroaNers FEEs. RETENTION FEE: ' _�
OCONSTR LENDING AGENCY PRE-ALT FEE: '
� I HEREBV AFFI{iM UNOEF7 PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDINa AOENCY
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.308],CIV.C.).
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� LENDER'S NAME j .
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wI CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TMAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES 1 n� l \�/
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� CONSTRUCTION,AfJ�HEREBV AUTHORRE REPRESENTATNES OF THIS CWNTV TO EMER UPON THE �
Z ABOVE-M ED PROPER7V FOR INSPECTION PURPOSES. COMMENTS
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