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CITY OF DIAMOND BAx �
-- DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES i
w 21660 E.Copley Drive Suite 190
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TURE,PRIOR TO ITS ISSUANCE,�LSO REWIAES h1E MPLICANT FOR SUp1 PERMIT TO FllE A SIONED w
� STATEMENT THAT ME OP SHE IS LICENSED WRSUANT TO THE PROVISIONS OF TNE CONTAACTORS LI- �
! CENSE UW(CHAPiER Y(COMMENCIN(i W17H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PFO- POOVSp9
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WILL DO THE WORK.AND THE STRUCiURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oN,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS UCEH9E LAW DOES NOT MPLV TO AN OWNER OF � �
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� I HEREBYAFFIRM UNDEF PENALiY OF PER1UpY T1UT I AM LICENSED UNDER PROVISIONS OF CliAPTER �
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QW _I HAVE M1D WILL MMNTAPI WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SEC7KKJ
370o OF TiE LABOR CODE,FOF THE PERFORMMICE OF THE WORK FOR NM111CH THIS PERMIT IS
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SU&IECT TO THE WORKERS'COMPENSA7KKJ PROVISIONS OF SEC7KKJ 3700 OF THE LABOR r[�
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� SU&IECTMI EMPLOVER TO CRIMRI/�L PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT C/�y}�D>'�
DOLURS(f100.DD0),IN ADO1710N TO 7HE COST OF COMPENSATION,DAMA�ES A$PROVIDED FOR IN
J SECTION 370E OF THE UBOR COOE,INTEREST,AND ATTORNEY'S FEES.
� RETENTION FEE: �U
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTY Of PE0.IURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV
FOR THE PEHFORMMICE Of 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30P7,CIV.C.�.
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¢ I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE 7HAT THE ABOVE WFORMATION IS CORRECT. � �
w I AOREE TO COMPLV N7TH ALL CIT'M1D COUNTY ORDINANCES AND STATE UWS RELATINO TO BUpDING
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� CONSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE �
Z ABOVE�MENTqNED PROPERTV FOR INSPECTION WRP0.SE5. COMMENTS -
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