HomeMy WebLinkAbout17979 �� CITY OF DIAMOND BAR I
� DEPARTMENT OF COMIvIIJNITY&DEVELOPIvfENT SERVICES ':��'
21825 E.Copley Drive
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I (909)860-3195 Fax(909)861-3117
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� I HEREBY AFFIRM UNDER PENALTV OF PERJl1RV THAT I AM IICENSED UNDER PROVISIONS OF CHAPTER � l
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
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w I AGFEE TO COMPI.V WITH ALl CITV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 1/ 1 i A /
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