HomeMy WebLinkAbout12-492 �� CITY OF DIAMOND BAR II
DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES
' 21810 Copley Drive,Diamond Bar,CA 91765 '
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
, '9^'� BUILDING PERMIT APPLICATION FIRMLY
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PROPEHTY NM1IO BUILDS OR IMPROVES THEREON,AND NMO DOES SUqi WpRN HIAISELF OR NEHSELF OR �
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� WORKERS'COMPENSATION DECLARATION � � �
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� _IHAVEAND�WILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWOPo(ERS �
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�i HAVE AND WILL AUINTAIN WOR)(EAS'COMPENSA710N INSUfLWCE,AS REWIRED BV SECTION
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(q WORKERS'CAMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOVI.D BECOME INSPECTION FEE
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� SUBJECTANEMPIOYERTOCRIMWALPEN�LTIESANOpVILFWE5U7TOONEHUNDREDTHOUSAHD ENEROYPERMIT
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J SECTIDN 370!OF THE LABOR CODE.IMERE3T,AND ATTORNEV'S FEES. � - - � �
�C - RETENTION FEE:
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�, LENDER'S NAME _ � � - '
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� 1 AfiREE TO COMPIV N77H ALL CRV AND COUNT'/ORDttJANCES AND STATE UWS HELATWO TO BUILAINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESEN7ATNE5 OF TTnS COUMV TO ENTER UPON iHE "
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ROOF COVER PRE-GRADtNG
ROUGN HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISN GRADING
SHOWEWTUB TEST POOL ELECTRIC
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