HomeMy Public PortalAbout5930 AVON AVE_Building_6/26/1984_extend kitchen WORKERS'COMPENSATION DECLARATIONI hereby
insure, oraa.certificaffirm te ofaWorke s' Compensation eInsuran
c j } t f)
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESScJ ADDRESS ® AVOW A Vfzr- D .0 1.20- 84
Professions Code): PRESENT
IBUILDING.
, as owner of.the property, or my employees with ADDRESS
wages as their sole compensation,will do the work'and
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL'
I, as owner of the property,am exclusively,contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS' .
tion 7044, Business and Professions Code).
REQUIRED' TOTAL SETBACK FROM EXIST.'
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
hereby affirm that there is a,construction lending agency for FRONT
the performance of the work. or which this permit is issued P.L: �v v' a ® D
(Sec. 3097; Civ: C.). SIDE
m "P.L
Lender's Name
P.C. Fee$ Permit Fee
Lender's Address
I certify that I have read this application and state thcit"the Issuance Fee
above information is correct. I agree to comply with.all County Investigation Fee
ordinances and State laws relating to building onstruction, Total Fee JOU'
v and hereby authorize rep fives this my to enter
upon the above-menti ed pr erty or inspe ion.purpos
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature-6f App is or Agent D .,®s