HomeMy WebLinkAbout16331 � ,. _ _�� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117 PRE$$
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� NESS AND VROFESSION6 CODE:THE CONTRACrORS LICENSE L�W OOES NOT APPLV TO AN OWNER OF � � I
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V'� SMALL NOT EMPLOV ANV PEf150N IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
(n WORKEHS'COMPENSATION LAWS OF CALIFORNI�AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE '- �" ' ��
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
CAOE,I SH�LL FOR iTH COMPLYwIhI7HO3E PROVISION l ISSUANCE
p DATE: ���4� APPLICANT.1'�L'Li�U I � ��L�ST Jr�� �SMIP� � �
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� WARNINO:FARURE TO SECURE N9HKER5'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
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J SECTqN 370!OF THE LABOR CODE,INTEREST,AND ATTORNEI^S FEE9.
� - RETENTION FEE:
oCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFIRM UNDER PEN/�LTY OF PERIURV THAT TMERE IS A CqNSTRUCTION LENDWO AOENCY
f-0R THE PERFORMANCE OF TNE WORK FOR WHIC}1 THIS PERMI715 ISSUED(SEC.70D7,qV.C.�.
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� LENDERS NAME
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� I CERTIFV THAT I MAVE REPD THIS APPLICATION AND STATE TNAT THE ABOVE INFOfUlAT10N IS CORAECT. TOTAL FE ES
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� CONSTRUCTION,AND HEREBV AUTFiORRE REPRESENTATIVES OF 7HIS COUNTV TO ENTER UVON THE .
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