HomeMy WebLinkAbout17798 CITY OF DIAMOND BAR
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�'%»r� BUILDING PERMIT APPLICATION FIRMLY ��
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I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMP7 FROM 7HE CONTMCTORS LI- G8�0(J2/C8fj10R
W CENSE LAW FORTHE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CITV OR (�
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w TURE.PRIOH TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 70 7HE PROVISIONS OF THE CONTRACTORS ll-
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 9 OF 7HE BUSINESS AND PRO� V' POOVSPB
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V 710N.ANYVIOUTIONOFSECTION7o91.5BYANYAPPLICANTFORAPEFiMI75UBJEC75THEAPPLICANTTO Z RB-R001
A CIVIL PENALT/OF NOT MORE THAN FIVE HUNDRED DOLLARS(S500J.):
❑I,ASONRJEROFTHEPROPERTV,ORMVEMPLOVEESWI7HWAGESASTHEIqSOLECOMPENSATION, �
Z WILL DO THE WORK,AND THE STRUCTURE IS NO7 INTENDED OR OFfERED FOR SALE(SEC.7a��,BU51� J COrt1rtIBfC181 - ,
N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE lAW OOES NOT APPLV TO AN OWNER OF = , I
PROPERTV NMO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THA7 SUCH IMPROVEMEN75 ARE NOT INTENDED OR m
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Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
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w ❑I,AS OWNER OF THE PROPERTV,AM EXCLUSIVELY CONTRACTING WITH LICENSED CON7RAC70RS
[[ TO CANSTRUCT THE PR0.1EC7(SEC.704�,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS ll� V81UflflOfl ADJ.AREA
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� I HEREBV AFFIqM UNDER PENALTV OF PERJURV 7HAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTEH � i h T '_
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X MY LICENSE IS IN FULL FORCE AND EFFECT. {
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� WORKERS'COMPENSATION DECLARATION Q
� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF 7HE FOLLOWING DECLARA710N5: Z
� IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
Z CAMPENSA710N,AS PROVIDED BV SEC710N 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE `U
¢ OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED.
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w ✓I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
' O 37000FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
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Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL I��'�- '
(.7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO 7HE -
N WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE � V �y
� SU&IECTTOTHEWORKERS'COMPENSATIONPROVIS OFS 37ooOF7HELABOR i IYIHI\ /• � � (
� CADE1.l SH���F,O,�R HW�ITHCOMPLVWITHTHOSEP NS. � ISSUANCE � .�11�7
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WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE �
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT - � �
DOLLARS(f10D.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ---
J SECTION370BOFTHELABORCODE,INTEREST,ANDATfORNEV'SFEES. RETENTIONFEE:
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� I HEREBV AFFIRM UNDER PENAL7V OF PERJURV THA7 THERE IS A CONS7RUC710N LENDING AGENCY
� FOR THE PERFOFMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. �
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2 LENDER'S NAME
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� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THA77HE ABOVE INFORMATION IS CARRECT. 1`
w I AGREE 70 CqMPLV WITH ALL CITY AND CAUN7V ORDINANCES AND STATE LAWS REUTING TO BUILDING V � ,
� CONSTRUCTION,AND HEREBV AUTHORIZE fiEPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PROPERTV FOR INSPEC710N PURPOSES.
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