HomeMy WebLinkAbout12-1135 �� CITY OF DIAMOND BAR
nEPAItTMENT OF COMMUNITY&DEVELOPMENT SERVICES -
z1810 Copley Drive,Diamond Bar,CA 91765
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� 1 HEREBYAFFI{iM UNDER PENALTY OF VERJURV ONE OF THE FOILOW W0 DECIARATIONS: V � '
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� _1 HAVE AND WILL MFJNT/UN A CERiIFICATE OF CONSEN770 SELF-INSURE FOR NOR1(ERS• � � ,
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_I HAVE AND WILL AWMAW WORICEA3'COMPENSA710N W SUqANCE;AS qEOUIRED BY SECTION
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(/� NbRNERS COMPENSATIDN UWS OF CAIIFORNI/� D AGREE THAT IF I S/iOVLD ME INSPECTION FEE '
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