HomeMy Public PortalAbout9651 BROADWAY_Building__ APPLICATION FOR BUILDING PERMIT
�FOK7"PPLICANTTOFILLIN (Print or type only)
COUNTY OF LOS ANGELES
Bi,ILDING
ADDRESS . �j �a DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION•
NO.OF SLUGS. BUILDING �—
SIZE OF LOT Z p. NOW ON LOT ADDRESS
TRACT � �� BLOCK LO LL��pp � LOC4LITV
OWNER Q 1V
TEAS-7
OI-D NEAREST /
I
p� ��I CROSS ST. t
ADDRESS �rp5� ��-�E•+-• a(A:A MAP BOOK r PAGE PARCEL
5�•r' rr��
DISTRICT GROUP TYPE FIRE CESSED BY
-CITY &ARZ C� ZIP I CONST. ZONE
ARCHITECT OR TEL , t L G
ENGINEER ( NO. �"�Z� STATISTICAL CLASSIFICATION SEWER MA
ADDRESS - CLASS NO. 7J DWELL.UNITS BK PG '
CONTRACTOR `' LQ s7 NO. "O"!I SE NE NO. p<.
ADDRESS Ps:CWim we NO. - 2 SPECIAL
LIC. - CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED - YES ❑ NO ❑
CONSTRUCTION LENDER.
NAME AND BRANCH ri Wkpcep BLDG.SETBACK FROM -
FRONTPROP.LINEOF - - —(STREET)
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD -
SO.FT.. NO.OF NO.Of (( CHECK - FRONT PROP.LINE HIGHWAY WIDTH
SIZE Q r STORIES FAMILIES 1 ONE _ y
DESCRIPTION OF WORK NEW ❑ + O
p BLDG.SETBACK FROM m
ADD �f SIDE PROP.LINE OF - tSTREETI O
FPS 1G,I` - ALTER ❑ w
HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING
USE OF REPAIR. ❑ SI DE PROP.LINE HIGHWAY WIDTH Z
EXISTINGBLDG. DEMOL ❑ +
APPRINTNT ` NO ,611!!5 CORNER CUTOFF YES ❑ NO ❑
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE( - -
- IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$
y-17-78 064-7
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ��L/�G_ A�CW
AND LAWS REGULATING BUILDING CONSTRUCTION. CERTIFY THAT DOING THE ,i
WORK AUTHORIZED HEREBY 1 WILL EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIAIF IN RELATING i0 WORKMEN'S COM
PENSA -
SIGNATUTU E OF
RE OF -
PERMITTEE
ADDRES AbQA0_9 - J'
II ((����..,, FT NAL
CITY AYLA��" NO. 'Q DATE
MAKE CHECKS PAYABLE TO: - FEE $ / FET $
HARVEY T.BRANDT.COUNTY ENGINEER j /:/ • .Z z .7 7
PLAN CHECK VALIDATION CK. M.O. CASH (✓ PERMIT VALIDA 1 ON cK. m.0. CASH
0 4 0 cz,s1w; '1 i P 3 0. 1 (i7 r �!L fl, c z
i
7 2 1 nrEE 17 1 0 . e, •s
®3 76A63BACEN8033-75'
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t,
,.A..„SEs....... APPLICATION FOR BUILDING PERMIT �.
COUNTY OF LOS ANGELES BUILD]
N j—
DEPARTMENT OF COUNTY ENGINEER ADDRESS a3
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A.LAMBIE.COUNTY ENGINEER NEAREST
CASSATT O.GRIFFIN,SUPT OF BUILDING CROSS ST.
,DISTRICT N GR OyE TypE ESS D
FOR APPLICANT TO FILL IN CONST Q
BUILDING SEWER MAP
ADDRESS STATISTICAL CLASSIFICATION B p
LU I a, � -0 CLASS NO LTDW ELL. UNITS I `C
LOT NO. - FVgMAP STATE YES
/,��I 7 l' _Pn� /I NUMBER Q HWY.
TRACT lq _5 4o /� Lt/i /`{c�/P�C USEZONE SPECIAL
t NO.OF BLDGS. _ CONDITIONS
SIZE OF LOT7,624? C y� NOW ON
USE OF. =� Z (�
EXIST TING BLDG. BUILDING ]ST.
/h- SETBACK YARD
HWY STREET NAME IDTH
OWNMAIL Q / / FRONT
ADDRESS Ok,
SIDE
CITY NO -Qa P.L.
ARCHITECT OR TEL. INSPECTION RECORD
ENGINEER NO.
rESS `
ACTOR
.F. TEL
\ J C
S
DESCRIPTION OF WORK A
.
NIF. ADD ALTER REPAIR ' DEMOLISH
SQ.FT. NO..OF NO.OF .A ih L
SIZE STORIES FAMILIES / P
USE OF STRUCTURE ...1-' A,J t7-.L__
SIGNATURE OF 'pY 1 4,
I`KVa ROVALS
APPLICANT
DATE INSEECT4R S SIGNATURE
ADDRESS FOUNDATION:
OION
i FORMS, RALSy�---
$ OT.3 P.C. $ FRAME: FIRE STOPS, a
FEE BRACING, BOLTS _
VALUATIOI4� $ / 0 FURNACE: LOCATION.
FEE GAS VENT,DUCTS /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT.
PLICATION.AND STATE THATTHE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT.
STATE LAWS REG N UI CONSTRUCTION.
SIGNATURE O HOUSE NUMBER COR- �-
PERMItt RECT AND POSTED
ADDRESS / , �� FINAL
CLYDE N. DIRLAM. PRINCIPAL ST URAb.ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
lrfoE 7 31 ro (dOV 17- 1 A 21-00 N,
COUNVt OF Lor, ANGELES - TEMPLE CITY #•0508 BUILDING.PERMIL
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS- ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT 'TEMPLE CITY CA BL 0508.9711130010
PHONE: (818) 285-0488 EXT: DUPLICATE
LEG ID: - NO. OF. CONST__ BUILDING ADDRESS:
ON FILE - SQ. FT _ STORIES TYPE 9647 BROADWAY
STRUCTURE: 2600 VN TEMP CA 917803211
ASSESSOR INFORMATION NUMBER: - .. NEAREST CROSS STREET: TEMPLE CITY BLVD.
8588-009-031 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: R SID USE ZONE: R-I ISSUED,ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 11/13/97 VG 11/13/98
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL UATE FINAL BY: CODE:
LYNN, JOANN (626) 287-8214- 5,000 �y���....,,//�,J
9647 BROADWAYtILF/ 'OT� "I II—lC7
TEMP 917803211 EE PAID DESCRIPTION OF WO K
T/0 EXIST ROOF, RESHEAT AND INSTALL COMPOSITION SHINGLES
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
JOHNSON (714) 761-1550- AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 5000-00 VAL 0-50 SPECIAL CONDITIONS:
D2 PERMIT W/O EN-HC —5000.00 VAL 133.05
P�G,ELET L`;O� 161.30
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SPINNAKER BUILDERS (818) 355-0075-
P.O. BOX 624 LIC. NO LOCATION AND S TBAC S
SIERRA MADRE, CA 91025-0624 720155 * �jJ�
SOILS.ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. N0: vDATION7TRENCH70RMS
LIC. NO: SLAB/UNDER FLOOR
• 1111 , AIAISED FLOOR FRAMING
I _
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMF': y^_ `!'p`I �{ UN'D ERFL�R INSULATION
147-269 3 Oi PUBLIC IF 170B1 \S 7L� SHEA HI NSG
NO. OF' FAMILIES: DWELLING UNITS: APT/ OND: STAT CLASS:
NO 21Sl
/� SHRO F SHEA;HE N /
SCHOOL WITHIN HAZARDO S - ® OO_ OQ `eco tk PAN L
AIR QUALITY: 1000 FEET MATERIALS 0
NO NO NO �aC a A`O` FR MF. INSPECTION
REQUIRED TOTAL SETBACK FROM EXISTFIRE SPRINKLERHANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH: V• �1
FRONT PL- INSULATION/WEATHER` INSULATION/WEATH R STRIP
SIDE PL- &ervice , ` IN ERI OR-LATH/OTYPAL L
ll��
EXTERIOR LATH
RATED FLOUR/CEIL FLOUR/ ASSE .
RATED WALL ASSEM LIES
RA ID SNA S/OPE INGS
T-81,R CEILINGS
* ADDITIONAL DATA ON FILE
LOT�DRAINAGE
REPORT ID: DPR261 ROUTE TO: OS0508
COUNTY OF LOS ANGELES TEMPLE CITY # .4i08 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS - ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9803060002
PHONE: (818) 285-0488 EXT: -
LEGAL ID: NO. OF CONST UI LDING.-ADDRESS:+
ON FILE SQ. FT STORIES TYPE 9651 BROADWAY
STRUCTURE: 0 VN TEMP•CA{917803211 1-
ASSESSOR INFORMATION UMB R: NEAREST\CROSS STREET: \•
8588-009-032 THOMAS PAGE: 597 GRID: A3 LOCAL'I TY TEMPLE CITY
T EN A N7 EXIST BLDG USE: RESID USE ZONE: R- ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 03/06/98 UT 03/06/99
_
OWNER: TEL. NO: BLDGS. NOW ON LOT: , t� VALUATION: FINAL DATE FINAL BY: COpE-
9651SILVERTHORNBROADWAY
CAROLYN R;ROGERS JAMES (626) 292-1715- 1 1 �^c •, .` -. �. ,4,500 l/1?� tat/J W/ 1M� chq n� q
9651 BROADWAY \ r/�',�/ 1Ul�J ,` l�``"'VV
TEMP 917803211 FEES PAID- DESCRIPTION OF WORK T
REMODEL EXISTING LAUNDRY/STORAGE TO LAUNDRY/BATH, INSTALL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SHOWER, TOILET 8 SINK AND WINDOW-NO NEW SQ. FT.
APPLICANT: TEL. NO:
WESTEC CONSTRUCTION (818) 760-8530- AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESIDE X4500.00 VAL 0.50 SPECIAL CONDITIONS:
AX BUILDING REVIEW-FEE—- 54.70
D2 PERMIT W/O7EN_HC_ ELF q 450000 NAL- 133.05
TOTAL.FE' 216.00
CONTRACTOR: TEL. NO: - '/^ -y = � �i.-.`_ �/�.� *•a - APPROVALS DATE INSPECTOR SIGNATURE
WESTEC CONSTRUCTION (818) 760-8530- �+
6207 BABCOCK LIC. NO ` LOCATION AND SETBACK
NORTH HOLLYWOOD, CA 6682608 -
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: 111111 SLAB/UNDER FLOOR
RAISED FLOOR—
' 1I4AP NO:7H269 SEWER MAP BOOK: PAGE: FIRE ZONE: CMOP' U�� C T9 O �IJ� UNDERFLOOR INSULATION
F02 K - + FLOOR SHEATHING
NO. FAMILIES: DWELLING UNITS: AP COND: STAT CLASS: , - —_ - —'
NO 21 e 6i ROOF SHEATHING
r
o lam
AIR QUALITY: 5000 FEET CHOOL WITHIN HAZARMATER IDALS \ Q OUS �] .L$}I }tSHEAR PANELS
NO NO NO �l �t•�_jX FRAME INSPECTION I _
REQUIRED TOTAL SETBACK FROM IS �V� N C)t� FIRE SPRINKLER ANGERS 4
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- \ S -—gp�gj INSULATION/WEATHER STRIP
erVIC6� _ O
SIDE PL-
TERI LATH/DRYWALL Z�
.. EXTERIOR LATH 7
RATED FLOOR/C .
RATED WALL ASSEMBLIES
RATED SHAFTS/0 EN S
T-BAR CEILINGS
LOT DRAINAGE
REPORT 10: DPR261 ROUTE TO:,BS0508
° WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self O �(/�l �Ipp�(I� FOR
II �rry�p��`/��s I��y�r��[j�/��pN//A��
insure, or a certificate of Workers' Compensation In rance - APPLIC��°- MON L1 _OR 13MOI G PLSO�lUVl1� r
or a certifi11d co y th ref (Sec. 3800, Lab. C.) COUNTYOFLOS ANGELES - BUILDING AND SAFETY
Policy No/ Compan -
❑ Certified co is hereby f rmshed. FOR APPLICANT TO 1N BUILDING /S/
copy, Y / ADDRESS
Certified copy is filed with the county building inspec- - BUILDING. -
tion department. ADDRESS
Dotq Applicant'" 144
- CITY 'ZIP LOCALITY -
CERTIFICATE OF EXEMPTION FROM WORKERS'--- - O. OF BLDG5. I NEAREST- -
SIZEOF LOT NOW ON LOT - CROSS ST.
COMPENSATION INSURANCE I v ASSESSOR
hundred
o l need not be completed ed if the permit is for one - - TRACT °Y BLOCK ^- '- -"LOT'NO. S ' MAP BOOK - - PAGE PARCEL
hundred dollars ($100)or less.) - - - TEL y USE ZONE MAP
' ..- OWNER - NO. S / NO.
I certify that in the performance;of the work,for which this - - - -
SPECIAL-
permit is issued, I.shall not employ any,person in any manner ADDRESS 7CONDITIONS Il
so as to become subject to the Workers' Compensation Laws. - O
.. CITY ZIP - I - V
Date Applicant ARCHITECTOR TEL. -
NOTICE TO APPLICANT: If, after making this Certificate of. ENGINEER NO. _ DISTRICT. GROUP TYPE FIRE «PROCESSED BY
Exemption, you should become subject to the Workers' „y P CONST �/) ZONE
Compensation provisions of the Labor Code, you must.forth- ADDRESS O . /" u d
with comply with such provisions or.this permit shall beZ
TEL STATISTICAL CLASSIFICATI GO APT. CONDO, N
deemed revoked: CONTRACTOR NO. -
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNrtS
I hereby affirm that I am licensed under provisions of Chapter 9 - ADDRESS NO.
LIC. SEWER MAP -
(commencing with Section 7000)of Division 3 of the Business CITY CLASS - -
and Professions Code and my license is in full fart not effect. BK.- PG 'VALIDATION
50. FT. q NO. F NO. OF CHECK s
License Number Li . Class SIZE ( STORIES FAMILIES ONE
yQ - VALUATION
Contractor ate �'- aO /1 DESCRIPTION OF WORK NEW ❑
• __ - . .ADD $ n a /� D
❑I am exempt under Sec.
ALTER
B.BP.C. for this reason -
- - - REPAIR ❑ S i'+ - J
Date: USE OF - - - - ' �.I I
• - EXISTING G. - DEMOL ❑
Signature APPLICANTW �oqs{- TEL
(PRINT) Q+_s-}— l.� NO. FINAL
OWNER-BUILDER DECLARATION DATE
I hereby affirm that I am exempt from the Contractor's License _ -
Law for the following reason (Section7031•.5, Business and ADDRESS FINAL:. �?;[17
Professions Code):• _ PRESENT.. _ .- _ - .--. By r
_ y
El1, BUILDING
I, as owner of the property, omy with ADDRESS _
wages as their sole compensation,will do the Work and - - - 'T',O 0 a5A )FI F NL 130 - 30
the structure is not intended or offered for sale(Section LOCALITY �J {
7044, Business and Professions Code.) - MOVING .TEL. - - �/� Q !`HE!_K 1_i�°Lfj
❑ I', as owner of the property,'am exclusively contracting CONTRACTOR - 3 Td.�(
With licensed contractors to construct the project (Sec- CHANGE CHANGE
tion 7044, Business and Professions Cade.) -
REQUIRCK
CONSTRUCTION LENDING AGENCY SET BAED YARD I HWY _TOTALPRSETBAOP. LICK FROM .EXIST. _
f Il�lil!-11111 ii, -
I hereby affirm that there is.a constructionNE WIDTH
on lending agency for FRONT � - r
the performance of the ork for which this ermit isissuedP.L. - - -- ' - - - c
(Sea 3097, Civ. C.). _ SIDE - - -- 1412 - �hlli
P
/ P.LL
Lender's Name � /p
a6X"¢/ �;. B-O. LDMA Ref. It ..
P.C.fee$ Permit Fee
Lender's Address -
o I certify that I have read this application and state that the - Issuance Fee «- I O C LDMA P/C# - D -
8 above information is correct. I agree to comply with all County Investigation Fee v -
2 ordi nano and State laws relating to building construction, Total Fee a �" LDMA Perm. If °
a and h eb authorize representatives of this County to enter
upon he ove-mentio a aperty for 'nspection purposes. -'- - - - -"- - • "- , --
n -
a _SEE REVERSE FOR EXPLANATORY LANGUAGE
- Signature of Applicant or a // Dote / • - -- - "
i
WORKERS'.COMPENSATION DECLARATION �//F��J 1p p I��'�y'�Iy��r��}r�p�.�L� _
hereby,affirm that have a cerhfimie of consent to self A PPUC./[1\'-T��`II�II 17� O IBll IRM 0 ISII�IOI/l T
insure or a certificate of-Workers Compenstion Insurance, or IN II (rYl 0 Cl Ill} hN
a certifiedcopy thereof (Sec. 3800, Lab, C.),
Policy c,80-45882 cdmponyEremont Indemnity 80-494 Lee`, - COUNTY OF LOS ANGELES BUILDING AND SAFETY
Py v FOR APPLICANT TO FILL IN BUILDING -
Certified m is hereby,
ADDRESS
�^ 'Certified copy is filed with the county building irispec- BUILDING '
tion department ADDRESS" rico - LOCALITY 6 '
' NEARE'T
Date 8/15/80- ,Applicant Rigid Mfg.' Co. CITY Temple Cit - zlP 1 80 CROSS T �
CERTIFICATE OF EXEMPTION FROM WORKERS' - NO. OF BLDGS. - ASSESSO
COMPENSATION INSURANCE • SIZE OF LO7 NOW ON LOT MAP ED,
K PAG ARCEL
.(This section need notbe completed if the permit is for one USE ZONE MAP
hundred dollars ($100)or less.) - TRACT BLOCK LOT NO. NO. }
_ TEL o '.1. R - SPECIAL - " 0.
I certiNTha(-in the performance of the woik for which this OWNER Lune fflnan N6.28 -1 44 - CONDITIONS - O
permit is issued, I shall not employ any'person in any manner - - DISTRICTGROUP TYPE FIRE P OC SED BY V
ADDRESS CONST! .
so bs'tobecome subject to the Workers'Compensation Laws. - i0 d N
g/15Yao Rig3a Mfg. Co.
Date Applicant CITY ZIP STATISTICAL CLASSIFICATION r APT. CONDO:
ARCHITECT OR TEL.
'NOTICE h, APPLICANT: If, after making this Certificate of - - - � / " W
ENGINEER � -t 'NO. CLASS NO DWELL-UNITS ' d
`Exemption, you should became subject .to the Workers' - y '
'Compensation provisions of the Labor Code, you must forth- - _ ADDRESS SEWER MAP - Z
;with comply-with-'such provisions-or.this permit shall be - -
deemed I.revoked - TEL' _ BK.2S—G, VALIDATION
CONTRACTOR - NO. r'
LICENSED CONTRACTORS DECLARATION - LIG _ .. .
I hereby affirm that I am licensed under provisions of{hapter,9 ADDRESS -NciI 59496 VALUATION
(commencing with Section 7000)of Division 3 o the Business and
Professions Code, and my license is in full force and effect: , CIT CLASS -RQ $ - -
SO. FT. NO.OF - NO.OF. CHECK -
License.Number 15,9496 1 class C-49 SIZE STORIES FAMILIES ( ONE
Contractor RTGTD MNG. CO. Date 8/1518o NEW O 8O - DESCRIPTION OF WORK _ -
ADD ❑
ham exempt from the licensing•requirements as I am a - ALTER FINAL
licensed architect or a registered professional engineer ..ryry-- Q'` �L —
acting in my professional capacity (Section 7051, CL(�$$ts`'n MATERIAL azs//P ' REPAIR DATE
.. Business and Professions Code). USE.OFFINAL
// ` - -
_ _ EXISTING BLDG. RESIDENCE // / IEEMOL L
By -
Lic.or Reg No. S. �• Date APPLICANT /, TEL. _
- OWNER-BU I LDER,DECLARATION- ' - (PRINT), - . NO. _ L
I hereby affirm that I am exempt from the Contractor's License _ ADDRESS 337 S. Woods AVe...L.A. CA. 90022 J • / '
"Law for the following,reason (Section 7031.5, Business_ and
Professions Lode).. '^ PRESENT - -
-.. _ _.. •. •. ,
I, as owner of�th'e property, or mBUILDING
y 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. _ .-
0 I, as owner of the.property, am exclusively contracting CONTRACTOR - - NO.
with licensed contractors to construct the project (Sec- t -
.-.. tion 7044;,Business and Professions Code).' - ADDRESS -
REQUIRED - TOTAL SETBACK FROM EXIST. 17 R 1 A
CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. UNE WIDTH
' I hereby affirm that there.is a construction lending agency for - FRONT t - -' #.s.o.a.e • �.,
the performance of the work for which this permit is issued
.(Sec. 3097,.Civ. C.). - ..SIDE _ - ✓ - 2•e e s3A00'
P1. ..i
Lender's Name - _ _ - " , 'o oe 3 [ Q Q
- - - P.C. Fee$ Permit Fee to V-- 0 p ,p _a O
ers 's
LendAddress _ - _ -7 �p V
w I certify that I-have read this application and state that the Issuance Fee 7 690 '
aabove information is correct. I agree to comply with all County Investigation.Fee - -
ordinoncesand State laws relating to building construction, ?//
m - and reby uthorize repres ntatives of this County to enter Total Fee VJT
v - . .
m on otic a ve-mentio pro erty far inspection pu`rp
SEE REVERSE FOR EXPLANATORY LANGUAGE'
na u.e 7 A i� can:or Agent Cfote h �s