HomeMy WebLinkAbout17458 (25) CITY OF DIAMOND BAR EXPIRED
�-�-� �� --- DEPARTMENT OF COARvtUNITY&DEVELOPIvIENT SERVICES
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(909)860-3195 Fax(909)861-3117 PRESS
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¢ A�oa�Ess_23650 Monument Canyon APPLICATION PERMIT � � P/C
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w TUHE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCM PERMIT TO FILE A SIGNED w
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� ��_I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
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= SUBJECTTO THE WORKERS'COM7ENSATION PROVISIONS OF SECTION]7000F THE LABOR �ar� lI'� � -�
CO�E.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE 1 V� .�/�� YT� T i^"�\ l.f
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� SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN�RED THOUSAND ENERGY PERMIT I
r DOLLARS(f 100.000),IN AOOITION TO THE COST OF COMPENSATION,DAMAGES AS GROVI�E�FOR IN � ^,
, J SECTION 77ae OF THE LABOR CODE,IN7EREST,ANDATTORNEV'S FEES.
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENOING AGENCV
FOR THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.]097,CIV.CJ.
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¢ I CERTIFY THAT I HAVE READ THIS APP�ICATION AND STATE THAT THE ABOVE INFORMATION IS COHPECT.
w I AC,FEE TO COMPLV WITH ALL pTY AN�COUNTY OFOINANCES AND STATE LAWS RELATINC TO BUILDING
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