HomeMy WebLinkAbout17203 (25) �� CITY OF DIAMOND BAR EX PI b�E[)
--- --��! — DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive JUN 19 20!�'
(909)860-3195 Fax(909)861-3117 PRESS
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Z 7URE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH 7ERMIT TO FIIE A SIGNED
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� CENSE UW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPB
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N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPERTV WHO BUILOS OR IMPROVES THEFEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� 7HROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m
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� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FUL�FORCE AND EFFECT.
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� WORKEFS'COMPENSATION DECLARATION � Q
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� 1 HEHEBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECUHATIONS: Z
� _I HAVE AND WILL MAIN7AIN A CERTIFICATE OF CONSEN7 70 SELF�INSURE FOR WORKERS' 2
Q COMPENSATION,ASPROVIDEDBYSECTION37000FTHELABORCODE.FORTHEPERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w I HAVE AND WILL MAIN7AIN WORKEFiS'COMPENSATION INSURANCE,AS REDUIRED BY SECTION ��/!1%A
Q 37000FTHE LABOR CODE,FOR THE PERFOR NCE O THE WORK FOR WHICH THIS PERMIT IS i u ey� .
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j CARRIER ��a` e �� PLAN REVIEW
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(iHIS5EC110NNEmNOTBE EfEDOFTHEPERAARISFORONEFNI�DREDDOlLA0.S(f100)ORLESS). PLUMBING ------
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHIC IS PERMIT IS ISSUED,I MECHANICAL +� � .��� �'� � � ��
�}' SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO B M UBJECT TO THE rI I � �' �
� WORKERS'COMPENSATIONLAWSOFCAUFORNIA,ANDAG TIF HOULDBECAME INSPECTIONFEE _
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DOLLARS(f100.000),INADDITIONTO TOFCOMPENSATION,DAMAGESA P OVIDEDFORIN
� SECTION370BOFTHEIABOPCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: �
� CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV,C.).
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� LENDER'S NAME
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� I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORHECT. TOTAL FE ES � 1 1 .��
w I AGF7EE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING �'
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
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ROOF SHEATHING (UZ- . ' 8 F-f. BOND B�AM � '
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SEEP PIT/�.L. ON SITE IMPS. �
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FINAL ELECTRIC DEV. FEES PAID
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