HomeMy WebLinkAbout15573 (23) CITY OF DIAMOND BAB EXP�(��D
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�Z NRE,PRIOR TO ITS ISSUANCE,ALSO REW IRES THE AP7LICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMENT THAT HE OR SHE IS LICENSED WiiSUANT TO THE PROVISIONS OF THE CONTMCTORS LI�
� CENSE LAW(CHAPTEH Y(COAIMENCINO WITN SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpO
FESSpNS OODE)OR THAT HE OR SHE IS EJ(EMPT THEREFROM AND THE BASIS FOR hIE ALLEGED EXEMP�
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� ACML PENALiV OF NOT MORE TNAN FfVE MUNORED DOLLARS(i500).):
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WILL 00 THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a4,BUSI• J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPIY TO AN OWNER OF
� PROPERTYN?iOBURD50RIMPROVESTHEREON,ANDWHODOESSUCHWORNHIMSELFORHERSELFOR m
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Z 'TqN,THE OWNEREUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
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Q TO CONSTRUCT THE PR0.IECT(SEC.70M,BUSINESS AND PROFESSIONS CODE:THE CANTMCTORS LI- V81U8f1Of1 GU ADJ.AREA ' -
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F LICENSE�CONTRACTORS DECLARATION �j LL7�4� R a�c-,�-. I
� I HEREBY AFFIRM UNDER PENALTY Of PEiiIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Ur yy'���
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COMPENSA710N,AS PROVIDED BV SECTION�700 OF THE UiBOR CODE,FOR 7HE PERFORMANCE U
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_I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSUMNCE,AS REOUIRED BV SECTION �
Q 770o OF THE LABOR CODE,FOR hIE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMI715
ISSUED.MY WtORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� POLICV NUMBER �J 2 eOd��-�� ELECTRIC
� (fFO6SECIlONNE�NOT8E00A4LEfH10FhEPERMTEF7�RONEMJIi%imDOLLARS(5100)ORLESS} PLUMBING
Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,7 SHALL HOT EMPLOY ANY PERSON IN M!V MANNER SOAS TO BECAME SU&IECT TO THE
y WORKERS'COMPENSATION LAWS OF CALIFOHNIh AND AGREE THAT IF I SHOULD BECOME ECTIO E
S SU&IECT TO THE NlORI(ERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR . / _ �
CODE,1 SHALL FORTHWI7M COMPLY WI7H THOSE PROVISIONS. � �SSUANC �
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p DATE: APPLICANP. � . .
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J WARNIN�:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
� SU&IECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE MUNDRED THOUSAND EN IT
DOLLARS(5100.000),IN ADDITION TO THE COST OF CAM�ENSATION,DAMAGES AS PHOVIDED FOR IN
� SECTION370lOFTHEUBORCODE,MTEREST,ANDATTORNEV'SFEES. � � pNTIONFFF� �'��
a CONSTRUCTION LENDING AGENCY .
� I HEREBV AFFIRM UNDER PENALTV OF PE0.IURY THAT TMERE IS ACONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF iHE WORK FOR WHICH 7HI5 VERMIT IS ISSUED(SEC.3007,CIV.C.). � � � . � �
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� LENDER'S NAME � '
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� ICERTIFVTHA7IHAVEREADTHISAPPLICATIONANDSTATETNA77HEABOVEINFORMA710NISCORREC7. TOTAL FEES f' • � � ,
w I AGREE TO CAMPLY M7TH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS REUTING 70 BUILDING 1•�...,�.,,� -
� CONSTRUCTION.AND HEREBY AUh10RIZE REPRESENTATIVES OF THIS COUN7V TO EMER UPON 7HE � � ' � �
� ED PROPERTV FOR INSPECTION PURPOSES. COMMENTS � �
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SIGNA F PERMfTTEE DATE � '
RECPT.NO. PAID BY VALIDATION
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TEMP POWER � FIREPLACE BOND BEAM �
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EXT. LATH/SIDING POOL FENCING
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CEILING INSULATION OFF SITE IN1PS. �
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SEEP PI7/L.L. -. ' ON SITE IMPS.
GAS AIR TEST F1NAL Z�f�ING
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