HomeMy WebLinkAbout17566 CITY OF DIAMOND BAR ��,� .
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`"'����'��' BUILDING PERMIT APPLICATION FIRMLY
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� I HEREBY AFFIRM UNDER PENAITV OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAP7ER �
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OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(.'} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE
� WORNERS'COMPENSATIONlAW50FCALIFORNIA,ANDAGREETHATIF15HOULDBECOME INSPECT�ONFEE
� SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
� CO�E.I SHALL FORTHWITH COMPLV WITMjJ'�E PROVISIONS. ISSUANCE
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J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENEAGY P/C � O
LL SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(f 700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
� FOR THE PERf-0RMANCE OF THE WORN FOR WHICH THIS PERMI7 IS ISSUED(SEC.3097,pV.C.).
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� LENDER'S NAME
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� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COFRECT. �J.
w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBVAUTHORIZE REPRESENTATIVES OFTHIS COUNTV TO ENTER UPON THE
ZABOVE�MENTIONE�PROPERTY FOR INSPECTION PURPOSES. COMMENTS
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