HomeMy WebLinkAbout18122 (3) _ . �
1F� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ��
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
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� NRE,PRIOH TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
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WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOF SALE(SEC.7041,BUSI- J
NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF
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� I HEPEBY AFFIRM UNDER 7ENALTV OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: U
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' � COMPENSATION,AS PROVIDED BV SEC710N 370o OF THE LABOH CODE,FOR THE PEHFORMANCE �U
OF THE WOPN FOR WHICH THIS PERMIT IS ISSUED. �
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w �t HAVE AND WILL MAINTAIN WOHKERS'COMPENSA710N INSUMNCE,AS REQUIRED BV SECTION
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
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N WURKERS'COMPENSATION UWS OF CALIFORNIq AND AGREE THAT IF I SHOU�D BECAME INSPECTION FEE
S SUBJECT 70 THE MfORKENS'COMPENSA710N PFOVISIONS OF SECTION 3700 OF THE IABOR /r.�.�
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DOLLARS(S10o.oao).IN ADOITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oe OF hiE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. � RETENTION FEE:
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d CONSTfiUCTION LENDING AGENCY PRE-ALT FEE:
' � I HEREBYAFFIRM UNDER PENALTV OF PERIURY 7HAT THERE IS ACONSTRUCTION LENDING AGENCY
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w I CER7IFY THAT I HAVE READ THIS APPLICA710N AND SUTE THA77HE ABOVE INFORMATION IS CORRECL TOTAL FE ES �6�-� y/V
. � I AGREE TO COMPLY WITH ALL CITY AND CAUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
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