HomeMy WebLinkAbout16990 (225) CTI'Y OF DIAMOND BAR
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p I HEREBY AFFIRM UNDER PENALTV OF PE0.IUHY THA7 I AM EXEMP7 FROM THE CONTRAC70RS Lb Gef89B/CBfpOR
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w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
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Z WILL DO THE WORK,AND THE STNUCTURE IS NOT INTENDED OR OFFERED FOP SALE(SEC.70a4,BU51- J
� NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS ANO PROFESSIONS CODE,AND Z
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� WORKERS'COMPENSATION DECLARATION Q ,� ` �
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� I HEREBY AFFIRM UNDER PENALN OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z /�/�--
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� IHAVEANDWILLMAINTAINACERTIFICA7EOFCONSENTTOSELF�INSUREFORWORKERS' 2 �� � , • r1_ O
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Q OFTHE WORK FOR WHICH THIS PERMI7IS ISSUED. � I OoF � CV'\S/V
� �I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REOUIRED BY SEC7ION L � A � £x� S �` OU
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �, 1 � � C�.
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �� �
(J SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME UBJECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAG ETHTI ISHOULDBECOME INSPECTIONFEE
= SU&IECTTOTHEWORKERS'COMPENSATIONP OVISIO OF C I 37000 � OR � �1
CADE,ISHALLFORTHWITHCOMPLVWITHTH sioNs. ISSUANCE i
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� SUBJECTANEMPLOVEFiTOCRIMINALPENALTIESANDCIVILFINESUP OONEHUNDREDTHOUSAND ENERGYPERMIT
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�J SECTION37080FTHELABORCODE,MTEREST,ANDATTOHNEV'SFEES. RETENTIONFEE: �II1� , ' 1' ' ,
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pw_, CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THEHE IS A CONSTRUCTION LENDING AGENCY _
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). I�,..{�_�,c,--:_..- .
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� LENDER'S NAME
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w I AGREE TO COMPLV WITH ALL GTV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPflESENTATNES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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SLAB GRADE FIRERLACE FOUP�DATIC}N __
TEMP POWER I ' FiREPLACE BOND BEAM � _____ ___
WATER SERVICE j i I �r11� � HT. BQND BEAM __ ____ ___
ROOF SHEATHIIVG i 8 FT'. BOND BEAM �
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ROOF COVER � PRE-GRAaING � _ � _ �_ _
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