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CITY OF DIAMOND BAR
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21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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w • 1 HAVE AND WILL MACJTAIN WORKFAS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
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ISSUED.UY WO WN7ENS 1TKNJ MSUHANCE CARRIER A!&J POLICY NUTABER ME CONSTRUCTION
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� 70LICYNUMBER .� 2 \ ELECTFlIC .
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� WORKERS COMPENSATION UWS OF GLIFORMtiAHO Al3REE THAT IF I SHIXAD BECA4E INSPECTION FEE
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� 1 AGREE 70 COMPLY WfTH ALL UTV ANO COUNiY ORDINAIJCES ANO STATE UwS REUTWG TO BU0.D4Xi
� CONSTRUCTION.M!D HEREBY AUTTIORIZE REPRESENTATNES OF THIS COUIfTY 70 EMER UPON THE .
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