HomeMy WebLinkAbout18141 CITY OF DIAMOND BAR ��— '^/�' �
� - --��` --- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES _
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- (909)860-3195 Fax(909)861-3117 PRESS
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w TURE,PRIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
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� NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLY TO AN OWNEP OF ?
PROPER'TV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOFK HIMSELF OR HERSELF OR
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w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGOHIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
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� I HEREBY AFFIRM UNDER PENALTY OF PE0.IURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � w�� H�9� �
� 4(COMMENCING WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS CAOE,AND Z O
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECURATIONS: Z
� IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENT705ELF-INSUREFORWORKERS' ¢
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Z I CERTIFV THAT IN THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
(7 SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTTO7HE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR
� CODE.ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. • ISSUANCE � '
p DATE: � T �2 APPLICANT: V�T� '� t�:T-rA N SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSA710N COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION 70 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION37080FTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE:
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� I HEREBV AFFIpM UNDER PENALTV OF PERJURY THATTHERE IS ACONSTRUCTION LENDINCa AGENCV
FOR THE PERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ.
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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 CORRECT. (n�� / )
� I A�REE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE L4WS RELATING TO BUILDING Y V
� CONSTRUCTION,AND HEFiEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONEDPROPERTVFORINSPECTION PURPOSES.
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FRAMINGNENTILIATION I I FINAL BOfVD BEAM __ � ___
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ROUGH ELECTRIC , ROUGN GRADING ___ ______
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FINAL ELECTRIC � __ ' � DEV. �EES PAID _ .
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