HomeMy WebLinkAbout17884 (1993) � `---_��-- C1TY OF DIAMOND BAR
• DEPARTIvIENT OF COMMUNTTY 8c DEVELOPMENT SERVICES
21825 E.Copley Drive +'
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
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Z TURE.PRIOR TO ITS ISSUANCE,/�LSO FEOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SI(iNED
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� CENSE IAW(CHAPTER o(CAMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� POOVSPB
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Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.70a�,BUSI- J
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oC 1 HEREBV AFFIRM UNDER PENAL7Y OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � / � _ / �
d D(COMMENCINO WITH SECTION 7000)OF OIVISION J OF THE BUSINESS AND PROFESSKKJS CODE.AND Z �L�
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NI HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z .
� �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR NbRKERS' a '
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COMPENSATION,AS PROVIDED BV SECTION 3�OOOF THE LABOR COOE,f-0R THE PERFORMANCE U
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Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATKKJ INSURANCE,AS REWIRED BV SECTION
370o OF 7HE UBOR CODE,FOR THE PERFORMANCE OF THE WORK F-0R WHICH THIS PERMIT IS
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Z I CER7IFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL .
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N WORNERS'COMPENSATION LAWS OF CALIFO �MB �D BECOME INSPECTION FEE
S SUBJECTTO THE WORKERS'COMF PROVISIONS OF SECTION 3700 THE LABOR
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DOLURS(1100.000�,IN ADDI710N TO THE COST OF COMPENSATqN,DAA/AGES AS PROVIDED FOR IN
J SECTION 3�OB OF THE LABOH CODE.INTEREST,AND ATTOHNEV'S FEES.
�C RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALN OF PERJURY THATTHERE IS A CONSTRUCTION LENDING AGENCV
FORTHE PERFORMANCE OFhIE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3ae7,CIV.C.�.
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w I CERTIFY THAT I HAVE flEPD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES
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� CONSTRUCTION,AND HEREBV AUTI-N)RIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON 7NE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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— RECPT.NO. PAID BY VALIDATION
WHITE—DepaAment Copy,YEILOW—Finence Copy,PINK—Assessor Copy,GOLDENROQ--�File Copy,GREEN—Applicant's Copy
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ROOF SHEATHffVG 8 FT. BOIVD BEAM
FRAMINGNENTIUATION FINAL BOND BEAM
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