HomeMy WebLinkAbout12-1975 CITY OF DIAMOND BAR `���e�'��
�--"-�`-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'"�"` BUILDING PERMIT APPLICATION FIIRMLY
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w TURE.PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STA7EMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRAC70R5 LI- �
� CENSE UW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7NE BUSINESS AND PRO- POOVSpe
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� I HEREBY AFFIRM UNDER PENALTY OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � . . '
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a
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Q � THE WOPK FOR WHICH THIS PERMIT IS ISSUED. �
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Z I CERTIFV THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(� SHAIL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
�/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE I
= SU&1EC7707HEWORKERS'CAMPENSA710NPROVISIONSOFSECTION37o00FTHELABOR
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� SU&IECTANEMPIOYERTOCiiIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000).IN ADDITION TO THE COST OF cAMPENSATION,OAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
OCONSTAUCTION LENDING AGENCV PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CANSTRUCTION IENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,qV.C.).
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� I CERTIFY TFIAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE WFORMATION IS CARRECT.
w I AGREE TO COMPLV WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING
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~ WHITE—DepaAment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOIDENROD—File Copy,GREEN—Applicant's Copy
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TEMP POWER FIREPLACE BOND BEAM
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ROOF COVER PRE-GRADING
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SHOWER/TUB TEST POOL ELECTRIC
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