HomeMy WebLinkAbout10-1041 CITY OF DIAMOND BAR �
-��� DEPARTMENT OF COMMUNITY&DEVEL��P�$E�L��3�,
t� 21825 Copley Drive,Diamond Bar,CA 91765 '� LSL�J
(909)839-7020 Fax(909)861-3ll7 Building lnspection Hotline(909)839-7027' � PRESS
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w NRE,PRIOR TO RS ISSUANCE,ALSO REQUIRES THE APPIICANT f-0R SUqi PERMIT TO FILE A SIONED W Petlo/Deck
STATEMENT 7HAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF hIE CONTMCTORS lJ-
� CENSE LAW(pUPTEF o(COMMENCINO WITN SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPB
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� I HEREBY AFFIRAI UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
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OF 7NE WORN FOR WHICH THIS PERMIT IS ISSUED. W
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3�00 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
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C� SHALL NOT EMPLOV ANV PERSON IN ANV MANNEq 50 AS TO BECOME SUBJECT TO THE
(/J WORI(ERS'COMPENSATION I.AWS OF CAIIFORNIA�ND AGREE THAT IF I 5F10ULD BECOME INSPECTION FEE
SUBJECTTOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION�7o0OFTHELABOR �� y
O CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ANCE (J
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� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
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w SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. N ION F F
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� I HE{iEBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS ACANSTRUCTION LENDIN�AOENCV
FOR THE PEFFOFAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.�.
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� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATpNISCARRECT. TOTAL F ES �aa..�✓
� 1 AGREE TO COMPLV WITH ALL CfTY AND COUNTY ORDINANCES AND STATE UWS REUTINQ TO WILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPER7V FOR INSP rwN auaaoses. COMMENTS
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