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HomeMy Public PortalAbout5519 HALLOWELL AVE_Building__ 76A636A CE#803 9-68 � • APPLICATION FOR BUILDING RMIT COUNTY OF LOS ANGELES BUILDING ADDRESS �� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUP T OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE PROCESSED B (Print or type only) 1:5-1 CONST i [EXISTING ILDING STATISTICAL C SSIFICATION SEWER MAP - DRESS s CLASS NO. OWELL,UNITS BK PG 3 T NO. BLOCK USE ZgNE MAP ' /� NO. C ACT - F r �{ CONDSPECIAL TIONS NO.OF SLOGS. ZE OF LOT �B - (D Q NOW ON'LOT E OF BLDG, BLDG.SETBACK FROM (STREET) L. FRONT PROP.LINE OF OWNER ® ETYPE OF 1EXISTING1 SETBACK I HIGHWAY + YARD = TOTAL ADDRESS Saa HIGHWAY WIDTH FROM C.L. ' vL CITY be) I s-0 ,-:? o + BLDG.SETBACKFROM ARCHITECT OR _ TEL. SIDE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK" 'HIGHWAY + YARD = TOTAL ADDRESS � HIGHWAY WIDTH FROM C.L. TEL. + _ d CONTRACTOR NO. C LIC. c ADDRESS NO. _ CORNER CUTOFF YES ❑ NO � C CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS, LL CONSTRUCTION LENDER a NAME AND BRANCH Z ADDRESS - - SQ..FT, �7 NO. OF NO. OF NEW ❑ SIZE �/ STORIES FAMILIES USE OF ADD STRUCTURE ALTER ❑ REPAIR❑ - SIGNATURE OF APPLICANT DEMOL ❑ VALUATION $ , OD APPROVALS DA INS CTOR'S G TUR. P.C. PMT, C'�� FOUNDATION: LOCATION C FEE $ FEE$ r J FORMS, MATERIALS J FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT.. LABOR CODECO THE STATE OF -CALIFORNIA IN RELATING TO WORKMEN'S ATION INSURANCE//] LATH, EXT. 3V C SIGNATURE OF ll//////%%��// HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL PLAN.,CHECK VALIDATION CK. M O. CASH JOHN F. LEWIS. PRINCIPAL STRUCTURAL EN R PERMIT VALIDATION CK. M O. CASH ,;� a 1-6,3 5"` AUO 10 2 2.5 0;- q 76A638A CE #803 3-69 r, AP-PLICATION FOR. BUILDING- PERMIT-7 COUNTY OF LOS ANGELES BUILDING DEPARTMENT-OF COUNTY ENGINEER ADDRESS.. BUILDING AND SAFETY DIVISION '' - JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY. COLEMAN W. JENKINS, SUP•'T.OF BUILDING NEAREST... - CROSS ST. FOR APPLICANT TO FILL IN DISTfjLT N0:' GRQJP -- TYPE; • (PRINT C)R •TYPE'ONLY.) �/ ) BUILDING STATIST ICAL'CLAS IFICATION• ,� �-,Aa.^•.ajSEWER•MAP ,r ;, .� ADDRESS CLASS NO.' DWELL ~UNITS �� BK PG_ _ f LOT N0. BLOCK USE`ZONE MAP -•'° `"" "` - ) oq N0. TRACT SPECIAL �•, +. - - _ , /C OF BLDGS.- I CONDITIONS_ SIZE OF LOT NOW ON COT' USE OF EXISTING BLD - BLDG."SETBACK FROM "^'•' ` - + 'FRONT-PROP.'LINE OF -_ ^- '-•`--� �'- - I.L OWNER ya ! "'(STREET•)- Q / 'TYPE OF EXISTING SETBACK HIGH WA'Y•' `+'• YARD = TOTAL ° 'HIGHWAY WIDTH FROM C.L. ADDRESS - - + CITY - __ BLDG.SE �FRONI .{ ARCHITECT OR, TEL. SIDE PROP. LI (STREET), ENGINEER N0. _ EHIGI COF EXISTING SETBACK w AY -+' YARD TOTAC ADDRESS WAY WIDTH FROM C.L: TEL. •, - - _ -CONTRACTOR ,NO, _ - _ ••I _ _ _ -- '•'.+ -- -- _ '} ADDRESS NO.` _ CORNER CUTOFF:_ :!-YES Q,;,,,_ _•..NO ,,,�„. ,` LIC. p� CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS C CONSTRUCTION LENDER tF, NAME AND BRANCH �y r ADDRESS z SQ. FT. NO.,OF N0. OF I SIZE STORIES FAMILIES NEW - - USE OF ADD STRUCTURE ❑ '"•s`' C.. _ E ALTER REPAIR SIGNATURE OF DEMOL APPLICANT - ' ' VALUATION,$ me, Lf✓ APPROVAL _ - DATE.-'b IN5PECTO R'S 51GNAT.URE P.C. . PMT. FOUNDATION: LOCATION, - - �:• `FEE $ . FEE $ ♦ , FORMS '•MATERIALS FRAME:,FIRE,STOPS*, C HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS, APPLICATION- BRACING BOLTS' - - •'�` ' AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS.r�-.. TION. I CERT Y THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT E OY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH,-•INT. ' OF THE STATE. FORNIA IN REL�G TO WORKMEN'S COM- - ' PENSATION INSURANC l LATH, EXT.-`,". SIGNATURE OF ti PERMITTEE - HOUSE'NUMBER CORRECT _ - - AND POSTED ADDRESS FINAL' _ JOHN F: LEWIS, PRINCIPAL STRUCTURAL EN PLAN- CHECK VALIDATION CK. 'M.O. CASH PERMIT VALIDATION CK. m.q. CASH a 1JLr1'!iL'L 1�1L,1V 1' V_r aV1LLLlVV lii`I J.J ►7lir i+i i �,�' -�- --�-----�:' - --' ------' ! ° � •-, COUNTY OF' LOS ANGELES ' - - -WM. J. FOX, CHIEF ENGINEER _- _ �.0 ®• "G . -. FOR APPLICANT TO FILL' IN `'.:FOR OFFICE.USE ONLY DISTRICT •NO:.. PLAN CK.',NO. PERMIT,"NO. BUILDING -ADDRESS )Q(_/7 .fiJ,r.�IY�� ' ' �• LOCALITY C//y,�, j� }G! rre RECEIVED BY DATEOF APPL. /y'DATEJIB9/L7�ED/, NEAREST ��{I •� �/'...// CROSS HT. ��Y/.lean�, j _ - t, L V 'e BUILDING* ••� /,�, _ OWNER. /'/r "/-A.��✓�.n..!"J ADDRESS .MAIL ADDRESS 'LOCAL-ITY, on. NEAREST— CITY TEL. CITY - 'TE CROSS HT. :O'�✓�✓ii�/.,'' .-,�: `. ,. �, ,,,, FIRE - NO.•OF •.TYPE . .+GROUP ARCHITECT OR, TEL.` ZONE I' PLANS' l- "ENOINEER -NO. - ' _ ADDRESS, - SETBACK;?LINE •� _ i - '•APPROVED 1 I;-• ` ,:..: .: TEL. BY 1 - .^DATE' CONTRACTOR - .,• - - - USE. , _ APPROVED ADDRESS ZONE,LEdAL .BY • >: ,DATE I r. DESCRIPTION I' LOT NO. _.•� •I' BLOCK.' CORRECTIONS `• ��'•'V 'TRACT sC .� �_�� r ... s - ..�' '// /.a l•��r/-n �`� .., NO. OF BLDOH. J .HIZE OF LOT NOW, ON-LOT• k'USE OF ',NO.OF NO. EXISTING 'BLD G. .y t,f, FI.MILI[6 RODMH /,` •;��, - - DESCRIPTIONCOF WORK NEW ALTERATION ADDITION' REPAIR MOVING DEMOLISH NO OF. . Y SIZE. ' v ROOMS-, '�'• STORIES- '" - - ' ,•F WALL _ ,COVERING•�/ r0/,d COVERI NGL _,�-�/ _ - _ r•' 1 _ .USE OF NEW ,I/') 'rq 'y�O.• / �' a C �•.� {-,t BUILDING .'/7.iY:. AA/AfYIYJ•lf�.G�Sp� f1.� /. �' - ',• •• J ',, .I ,, _ `HEREBY ACKNOWLEDGE 'THAT_ 1'HAVE READ•THIS '} APPROVALS �,,_''•� •APPLICATIDN"AND,'BTATE THAT THE ABOVE IS•CORRECT• FOUNDATION:-.LOCATION, .� •INSPECTOR _ DATE,' FORMS, MATERIALS AND AGREE TO COMPLY,.WITH_ALL COUNTY ORDINANCES AND STATE LAWN REGULATING BUILDING C0NSTRUCTION. 1• r •FRAME:. FIRE STOPS,— SIONAT,URE-DF. 13RACINGr--BOLTS*;,'. Vt •�Y W ' I - e•� wJ� - ' OWNER ' LATH,-INT.: AUTHORIZED AG AG _ iVSO LAT H, EXT. - P.,C.SI PLASTER. INT. ,�f/-L/�/ FEE !'A' PLASTER,'•EXT. . VALUATION' // FEE! QOP FINAL •• �',�� •l� ,ems `L BUILD NG 1 EI ADDSS V `� //' / ! X//4GU+�d�•'Cf/ APPLICATION ' LOCALITY NEAREST �• DIVISION OF BUILDING AND SAFETY CROBB BT. Department of county Engineer DISTRICT NO. RECEIPT NO. PERMIT NO. County_ost• Los Angeles (� 3 3. -"3 WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED CASBATT D. GRIFFIN, SUPT OF-BUILDING ^j'� �,r���•v� FOR APPLICANT TO FILL IN• T?r NBT. RECEIVED BY lea OWNU MAP MAIL ER ' NUMBER l / STATE YES NO ADDRESS y ���% j 'TEL. 1 �j UBE20NE SPECIAL CITY / %IV9/IAA.rLCo 'i7itoJ NO. f) CONDITIONS 1 ARCHITE6T OR f TEL. D ENGINEER' / NO. BUILDING YARD HvwY STREET NAME EXIST. ADD EBB SETBACK WIDTH ��Iii�/1 0%f... O. P.L. CONTRACTORNFRONT - SIDE ADDRESS BUILDING• /-'�' /y} t/�J D '/ - DATE CORRECTIONS,' - :INSPECTOR. •ADDRESS LOT NO. y BLOCK TRACT — o NO.OFBLDGB. •SIZE OF LOT I NOW ON LOT BE OF IEXISTINQ ULD0. lQ t DESCRIPTION OF WORK a NEW ADD ALTER REPAIR DEMOLISH Z SM FTNO. OF NO.OF D SIZE STORIES FAMILIES r UBE BT CTU/RE-f NO.OF - JA - - - EMPLOYEES 1 HEREBY ACKNOWLEDGE THAT 1 HAVE REAP- PLICATION AND STATE THAT THE INFORMATIAPPROVALS INBPECTOR'®SIGNATURE DATE CORRECT. I AGREE TO COMPLY'WITH'ALL COUNTY FOUNDATION:'LOCATION AND•»TATE W9 REGULATING BUILDING CONFORMS,MATERIALS % /J ,�// / FRAME: FIRE STOPS. I / �j,.• /",r SIGN IRE OF /C///�� l/v L/IBRACING,BOLTS 1�� ✓�/ ��lr�J�+ PERMITTE FURNACE:.LOCATION, GAS VENT,- 'DUCTS ADDRESS , LATH, INT. AUTHORIZED AGT. _ xLATH, EXT. $ v P. C. HOUSE NUMBER COR- + FEE RECT AND POBTED VALUATION (/(/(/ FEE 0-0 _ FINAL 7SA636A D99 3 4-84 U.� ®.�• A APPLICATION LOCALITY ...r,� 10. (01�'. NEARESDIVISION OF BUILDING AND SAFETY- CCT. —t Department of County Engineer DISTRICT NO. RECEIPT NO. PERMIIT NO. County of•Los Angeles S.- (Q. �4 G7 5-s— WM. J. FOX, COUNTY EN©1HEER GROUP' DATE RECEIVED DATE ISSUED CASSATT D. GRIFFIN, SUPT or,BUILDING, - _ •�r / L�� FOOjR� APPPLICtA'JNT TO FILL' IN. . ' TYPE CONST. RECEIVED BYPISSUED BY OWNER �. _ j 7�f/I � V� MAP' d STATE YEB STATE R,FJ�f�61.6'�C . HUMBE ADDRESS �J' - ,�y USEZONE, SPECIAL ' :f Aw • -" / i CONDITIONS CITY ,..��n.e� A_.J• v NO. '/� /� .• - . ARCHITECT OR }�/ �' l TEL.'/,`. P � - IcI5V- (°) ENGINEER NO. �„ r BUILDING- YARD HM1Y STREET NAME EXIST. i SETBACK WIDTH ADDRESS (^ *-�'✓ ' �� /� P L. FRONT CONTRACTOR ( ' CSC .Fe K� P e+^ NO. ' r SIDE P. L. ; ADDREE38 DATE CORRECTIONS INSPECTOR BUILDING y-- -1 9 - ADDRESS 7 LOT NO. ., BLOCK ` TRACT �.dlll• ���. •+ D IU r o //ll y NO. OL'OOF BLDGB. SIZE OF LOT O �Y�1 ,} lO LJ N T SIZE OF LOT /0 USE OFEXIB ' TI •4� -DESCRIPTION_ OF WORK ' o NEW - ADD •ALTER REPAIR DEMOLISH Y SO. FT. 'NO. OF NO.OF r SIZE -STORIES .FAMILIES _ - USE OF,STRUCTURE NO.OF / tY MP OY 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ. THIS AP- PLICATION AND STATE THAT THE INFORMATION 131VEN 119 APPROVALS INSPECTOR'S SIGNATURE DATE CORRECT. I AGREE TO COMPLY WITH.ALL COUNTY ORDINANCES FOUNDATION: LOCATION AND STATE-LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALS (/tel'/, FRAME: FIRE'STOPS, SIGNATURE OF � `' i�d IFD �J BRACING,BOLTS. PERMITTEE FURNACE: LOCATION, GAB VENT,DUCTS - ADDREB= LATH, •INT. AUTHORIZED AMT.---- LATH, OT:- LATH, EXT. Iirsc► � ��'"� $ P.C.III HOUSE NUMBER COR- FEE RECT AND POSTED VALUATION !/ F E FINAL 76AS38A DBS 3 4-54 /1� COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9708110004 PHONE: (818) 285-0488 EXT: LEGA ID: NO. OF CONST BUILD NG ADD ESS: TR: 30308 LT: 4 SQ. FT STORIES TYPE 5519 HALLOWELL AV STRUCTURE: 0 VN ARCD CA 910078418 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8586-015-027 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: PESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXP RES ON: EXIST OCC GRP: 08/11/97 RF 0 /11/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE JINAL BY: CODE: BRUNO JACK A;NORMA V (818) 444-9967- 11 9,160 ` 5519 HALLOWELL AV 1 ARCD 910078418 FEES PAID DESCRIPTION OF WORK REMODEL EXISTING KITCHEN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: MC CORMAC CONSTRUCTION (626) 447-6193- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 9160.00 VAL 0.92 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC- -9.160.00 VAL 217.80 TOTAL FEES 246.47 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE MC CORMAC CONSTRUCTION (818) 447-6193- 370 W. CAMINO REAL LIC. NO LOCATION AND SETBACKS ARCADIA, CA. 91006 482010 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I UNDERFLOOR INSULATION 147H273 3 " 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION p REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED S AFTS OP N[ T-BAR CEILINGS OT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 APPLICATION FOR BUILDING PERMIT au COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILD;. DDRESS or a certificate of Workers' Compensation Insurance,or a certified ill, HAI_L®w�ZL copy thereof(Se .3800,Lab..C.) r _ �j �/� CITE _ ZIPG� Policy No.�l z 'Company (��ri / "V �J � l e G•7 7 L LOCALITY SIZE OF LCT NO.OF BLDGS.NOW ON LOT 7 ❑(Certified copy is hereby furnished. ��/ 7 NEAREST CROSS ST. LJ Certified copy is filed.with th�Cc�� building spection TRACT BLOCK LOT NO. dep' tmen. USE ZONE MAP NO. Date t2 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 1 TES NO. y COMPENSATION INSURANCE _ �`~�� Lf -1 / WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed-if the permit is for one hundred ADDRESS dollars($_100)or less.) h"� 'v . 4LL i✓t L� DISTRICT GROUP TYP ONST FIRE ZONE PROCESSED BY CITY _ ZIP 1/ 7 7 I certify that in the performance'of the work for which this permit n `� [ is issued, I hall not employ an wL L'per` !/Q S p y y person at any manner SO as t0 ARCHITECT OR ENGINEER TEL NO. become Subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO ' Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO.. SET BACK YARD HWY PROP LINE WIDTH (`-'h Compensation provisions of the Labor Code, you must forthwith /,JJ 3 $ T,5 FRONT comply with such provisions or this permit shall be deemed revoked. I_VADDRESS- d. A w LIC.No P L >_C .N. !t'�iLts.4 `t Ile _ 6Jr `J SIDE Ll. LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L 0 I hereby affirm that ]'am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO. F FAMILIES Professions Code,and my lic se is in full force and effect. g. t NEW SK PG O License Number 5LL in.��'.I�S�.� DE RIP7oj, N OF_WORK ADD ❑ VALUATION w 1Gi�✓/�� c�vb/� Contractor XLJt�� atep.2 =� Y ALTER ❑ $ �g ' �� CL 11 I am exempt under Sec. 0'. ©'v f lJqN g — REPAIR El $ Z B.BP.C. for this reason [!i o ye f , 6tfSR7714 DEMOL ❑ LDMA P/C# Date: U E OF EXI ING BLDG. URM ❑ i Signature APPAAANT(PRINT) TEL NO. LDMA Perm# 2 ❑ 1, as owner of the property, or,my employees with wages as 1�-r�C IZT �/ Z Ar ;(; o VIL their sole compensation, will do the work and the structure is _pDRESS ,w Q O not intended or offered for sale (Section 7044, Business and 6 fv,- *C � Aefl FINAL DATE C h}1 r t 6 # t°fo1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL f� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I J — S EI T:: ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECI,F�IE�D "'THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed'contractors to construct the project (Section 7044, YES❑ Noll J 1I AL :14 4 x >:..._� Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING f.HEC11; {44 o��I OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR !'• 4�lf GUIDELINESH . !� .00 I hereby affirm that there is a construction lending agency for_ YES❑ No the performance Of the work for Which this permit IS issued(.Sec. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 1I3I�3 —Ii }� fal�I'F_5 vt TITLE 2,CHAPTER 2.20 TIONS 20.700 THROUGH 2.20.140 CONCERNING HAZARDOUS f IS Lender's Name MATERIALg RE}yORTIN D R NTNG A PERMIT FROM THE SCAOMD. 3 Ail t YJ /11� 7-576 3 3 Ai F i t n I I iLender's Address OWN�ENT I certify that I have read this application and state under penalty a P.C.FEE PERMIT FEE p of perjury that the above information is correct.I agree to comply U) with all county ordinances and State laws relating to building m construction, and hereby uthorize representatives of this County ISSUANCE FEE toen upo a abov ention roperty for inspection purposes. c 11 76" o __�����P /fir� INVESTIGATION FEE TOTAL FEE /L/ .• / . ,rens«e of Mpmani«Agem oa�e iLf/ice �" (p � - SEE REVERSE FOR EXPLANATORY LANGUAGE