HomeMy WebLinkAbout16506 (57) _!�� CITY OF DIAMOND BAB •
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 ,_. PRESS
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;STATEAIENT THAT ME OR SHE IS LACENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U� � �
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TION.ANY VIOlAT10N OF 5ECT10N 7031.6 8V ANV APPUCANT FOR A PERMIT SU&IECTS THE MPLICANT T0 Z Re-Roof.. .
� ACML PENALTY OF NOT MORE 7HAN FIVE HUNDRED DOLL�RS(f5oo).):
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WILL DO THE WORI�AND THE STRUCTURE IS NOT IHTENDED OR OFFERED FOR SALE(SEC.70u,BU51- J
� '!{ESS ANO PiqFESS10NS CODE THE COHTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWHER OF
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Z �'TION,THE OWNER-BUILDER WILL MAVE THE BUR�EN OF PROVPI(i THAT FIE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF 9ALE} �
❑I,AS OWNER OF THE PROPEHTV,AM EXCLUSIVELV CONTMCTINO NTM LICENSED CONTRACTOR$
� TO CONSTRUCT T1TE PROJECT(SEC.70l1,BUSINE53 AND PROFESSIONS CODE:THE CONTMCTORS U� V81U8IIIX7 A0.1.AREA
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� I HEREBV AFFIRM UNDER PENALTY OF PERIUFY THAT I AM LICENSED UNDER PROVISIONS OF CFIAPTER � ��7�� �G
d Y(COMMEHCMO WRH SECTION 7000)OF DIVISION 3 OF h1E BUSINESS AND PROFESSIONS COOE,AND Z V yY�. �jK�
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COMPENSATION,AS PROVIDED BY SEC710N 3�0o OF THE LABOR CODE,FOR THE PERFORMANCE W
Q OF THE WORK FOR MA/ICH THIS PERMIT IS ISSUED. � �/ �
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- 1 HAVE MlD VALL AWNTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION 1�
Q3700 OF iHE LABOR COOE,F-0R THE PERFORMAMCE OF hiE WORN FOR N711CH THIS PERMIT IS I
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Z I CERTIFY THAT W THE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �
� SHALL NOT EMPIOY ANY PERSON IN ANV A/ANNER 50 AS TO BECOME SU&IECT TO THE /�
(p WORKEHS'COMPENSATION UWS OF CALIf-0RNIA,ANO AOREE THAT IF I SHOULD BECAME INSPECTION FEE ���
SUBJECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTKKJ�700 OF THE LABOR `'�
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� WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNUWFUL,AND SH/�LL BE ENERGY P/C
LL SU6IECTAN EMPLOVER TO CPIMfNAI PENALTIES AND CML FINES UP TO ONE HUNDRED TMOUSANO ENERGY PERMIT
DOLLARS(f100.000).IN ADDfT10N TO THE CQST OF COMPENSATION.DMIAOES AS PROVIDED FOR IN
¢ SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTOFNEY'S FEES. RETENTION FEE:
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV 7}/AT THERE IS A CONSTPUCTION LENDWO AOENCV
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� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOFUTATION IS CORRECT. TOTAL FE ES
w I AOHEE 70 COMPLV V.7TH ALL ClTY M1D WUNTY ORDINANCES M1D S7ATE UWS RELATINO 70&11LDIN0 � , � `
� CONSTRUCTION.AN�HEREBV AUTFIORIZE REPRESENTATIVES OF THIS COUNTV TO INTEfl UPON THE �
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