HomeMy WebLinkAbout17725 (42) CITY OF DIAMOND BAR �
��----��` -- DEPARTMENT OF COMMUNTI'1'&DEVELOPIvfENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fa�c(909)861-3117 PRESS
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ADDRESS O� 7��� �f�� /✓/C . DATE J �Z' NUMBER/77Z� #
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I HEREBV AFFItiM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTMCTORS LI- Gy�g9e/CefPOft
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w TUHE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED W
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� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- POOUSP2
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� NESS AND PROFESSIONS CODE:TNE CON7RAC70RS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF =
— PROPEHTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOFiK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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❑�,AS OWNER OF THE PROPERTV,AM E%CLUSIVELV CANTRAC7ING WITH LICENSED CONTRAC70R5
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� WORKERS'COMPENSATION DECLARATION a
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORNERS' _.
¢ CAMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR CODE.FOPTHE PERFORMANCE w
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKEi15'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FO(i WHICH THIS PERMIT IS /�� D
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Z I CERTIFV THAT IN THE PEFFORMANCE OF THE WORK FOfi WHICH THIS PERMIT IS ISSUE�,I MECHANICAL ��1 n -
C7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS 70 BECOME SUBJEC7 TO 7HE �� /'"�.� ^'
N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDACaREETHATIFISHOULDBECOME INSPECTIONFEE I - .
SU&IECT TO THE WOfiKERS'COMFENSATION PROVISIONS OF SECTION 3700 OF THE LABOR ��
� CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE I lIA�1 Il n �
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w I AGREE TO COMPLV WITH ALL CITY AND CAUNTY ORDINANCES ANO STATE lAWS REUTING TO BUILDING
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� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF 7HIS COUN7V 70 ENTER UPON THE
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TEMP POWER I � FIREPLACE BOND BEAM ___ � ___
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ROUGH HEATING � � � BENCHlNG _
ROUGH ELECTRIC , � ROUGF#GRADING
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CEILING IfV�ULATION �_ ; OFF SITE IMPS. _ _ �
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