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Home My Public Portal About6031 KAUFFMAN AVE_Building__ ` ORKERS'COMPENSATION DECLARATION ffirm that I have a certificate of consent to self - APPLICATION FOR BUILDING PERMIT ns�we, ora cbrt icate of Workers' Compensation Insurance, or a celilfiecl-copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ADDRESS 1J ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Q'? Date Applicant CITY ZIP 1 �/ LOCALITY .I C - CERTIFICATE OF EXEMPTION FROM WORKERS' NEAREST 512E OF LOT NOW ON,LOT ` ST. �1JQQ COMPENSATION INSURANCE (This section need not be completed if the permit is for one / &t• ASSESSOR hundred dollars($100)or less.) TRACT S6 BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL393. USE Z NE MAP I certify that in the performance of the work for which this OWNER // NO. �7 NO. permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL so as to become subject to the Workers' mp nsotion Law . CONDITIONS 0 Date Applica t CITY / ZIP >D U NOTICE TO APPLICANT: If, after mak g this Certificate of ARCHITECT OR TEL. DISTRICT GROUP. TYPE FIRE PROCES D BY 0 Exemption, you should become subject to the Workers' ENGINEER NO. �� CONST ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS / LtJ with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C DO. t� deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. _DWELL. UNITS I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK dC PG 13u VALIDATION SQ. FT. NO.OF NO. OF CHECK 1J License Number Lic.Class SIZE X STORIES FAMILIES ONE EW VALUATION U Contractor Date DESCRIPTION OF WORK ADD ® $ ❑ I am exempt under Sec. ALTER ❑ ® # ° O B.&P.C. for this reason REPAIR $ �l❑ o USE OF I'a �33U Date: DEMOL ❑ EXISTING BLDG. Signature APPLICANT (, / TEL. p FINAL o 7A 7 a 8 7 OWNER-BUILDER DECLARATION PRINT M ,/1� (/D l NO. a 9 DATE z�� 1 hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS F A Professions Code): ❑ BUILDING I, 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. YYI with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETQBACIREK YARD HWY TOTAL SETBACK pL NE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name � LDMA Ref. # P.C. Fee$ Permit Fee < Lender's Address —�{ I certify that I have read this application and state that the Issuance Fee ! L/ J Cf It.MA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter m upon thea ove-mentioned property or inspection purposes. a, / /7/� SEE REVERSE FOR EXPLANATORY LANGUAGE Si tura of Applicant or Agent Date '2, 7� i ORKERS'COMPENSATION DECLARATION affirm ,hat I havecertificate of consent to self ° APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, ` or a ce tamed copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING / 2 � ADDRESS ❑ 'Certified copy is filed with the county building inspec- BUILDINGa tion department. ADDRESS Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one Ki-6 �- dl ASSESSOR hundred dollars ($100)or less.) TRACT Ki BLOCK LOT. 1/ MAP BOOK PAGE PARCEL TEL. ^� USE ZONE NO. ` 2-6 I certify that in the performance of the work for which this OWNER l/ NOa2�/�. 73� J " permit is issued, I shall not employ any person in any manner ' /2, SPECIAL so as to become subject to the Woge�� ADDRESS ./ CONDITIONS O CITY i ZIP /Date Applicant ARCHITECT OR TEI.NOTICE TO APPLICANT: If, after DISICT� GR UP TYPE FIRE PROC SSE BY O ENGINEER NO. Exemption, you should become subject to the Workers' !I CONST. E U Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be CLI TEL. STATISTICAE CLASSIFI TION APT. I CO N deemed revoked. CONTRACTOR A I NO. LICENSED CONTRACTORS DECLARATION LIC. 2 CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP ' Professions Code, and my license is in full force and effect. CITY CLASS BK PG3� VALIDATION SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES IFAMILIES ONE VALUATION DESCRIP ON OF WORK NEW ❑ Contractor Date ADD ❑ $ ❑ 1 am exempt under Sec. [:]ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ;p 7 4 9.6 A Signature APPLICANT TEL d 7�q FINAL 7 # 0 0 0 0 0:1 g PRINT i Lt N NO. OWNER-BUILDER DECLARATION DAT I hereby affirm that I am exempt from the Contractor's License ADDRESS - /• C• Li1 0 0 6 Q 5 0 Law for the following reason (Section 7031.5, Business and Professions Code): / O %y 0,0 06 Q 5 0,5 ❑ BUILDING ,U I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ® Q 7. 1 7"8 7 the structure is not intended or offered for sale(Section LOCALITY " 7044, Business and Professions Code), MOVING TEL. hLL 1, 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). CK FROP7— CONSTRUCTION LENDING AGENCY SETT REQUIRED ACK YARD HWY TOTAPROP .SETBALINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name /} LDMA Ref. # P.C. Fee$ Permit Fee (J(/r' Lender's Addressll I certify that I have read this application and state that the Issuance Fee V v V LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee Ocs LDMA Perm. # and hereby authorize representatives of this County to enter upon thea e-me tioned properI r for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of Applicant or Agent Date " L WORKER°J COMPENSATION DECLARATION z r.. • affiom� iat I 'have a certificate of consent to self -• insure or 41 Late of'Workers' Compensation Insurance, r APPLICATION. FOR BUILDING PERMIT . or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN'. ADDRESS �Q ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date Applicant CITY ZIP /, ci LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ,ST. (This section need not,be completed if the permit is for one / ASSESSOR hundred dollars ($100)or less.) TRACT �c0 BLOCK LOT NO. �7�x MAP BOOK AGE PARCEL TEL.��/-J p/ USE ON�E MAP ,2 I certify that in the performance of the work for which this OWNER NO. J t0 NO. permit is issued, I shall not employ any person in any manner � — SPECIAL so as to become subject to the Workers'Comp nsation Laws. ADDRESS S O Q CONDITIONS CITY ! ��' ZIP Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after maki g this Certificate of ENGINEER r� DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ^�� nCONST. ZQNE U Compensation provisions of the Labor Code, you must forth- ADDRESS a✓✓� /�(1 W CL with comply with such provisions or this permit shall be TEL. STATISTICAL CLASS)ICrTION APT. J\riQND0. Cn deemed revoked. CONTRACTOR A NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section-7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASSBK VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE ❑ V ATION O O DESCRIPTION OF WORK NEW Contractor Date ADDC3s ' , I am exempt under Sec. r ALTER B.BP.C. for this reason rte— REPAIR $ n USE OF 4 ❑ # 0 a 0 0'a ,n Date: EXISTING BLDG. ( DEMOL ❑ I c - 8 7'3.I8 Signature APPLICANT TEL. p FINAL OWNER-BUILDER DECLARATION PRINT) NO. —�! DATE ' F 1 hereby affirm that I am exempt from the Contractor's License ° ° ° 8 7,3 8.c� Law for the following reason..(Section 7031.5, Business and ADDRESS I L Professions Code): PRESENT �I"C �� 0 �'� 1 7 ❑ BUILDING I, 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 Profession's Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. v----with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQEDCONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAPROP.AIINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name - LDMA Ref. # m P.C. Fee$ Permit Fee ' Lender's Address I certify that I have read this application and state that the Issuance Fee (/ L LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee t� LDMA Perm. # 0 and hereby authorize representatives of this County to enter m upon the oboe mention�roperty for inspection purposes. n SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Applicant or Agent Date t WORKERS'COMPENSATION DECLARATION insure, d afcAertif cane of Workers'lComtpensation eInsuran of APP_ LIC ' TION FOR BUILDING PERMIT or a certified'copy thereof (Sec. 3800 4ab. .) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company �"w \ BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 0 Certified copy pis filed with'the coun wilding irispec- BUILDING ' I tio ndepartment: ADDRESS YwG Date Applicant CITY ZIP LOCALITY CE IFICATE OF EXEMPTION F OM WORKERS'• NO.-OF BLDGS. NEAREST / - COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST... - r+a (This section need not be.completed if the permit is for•one - ASSESSOR , hundred dollars ($100)or.less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER tri NO. USE ZONE MAP /SG I certify that�in the performance of the woik for which this SPOECIAL 0. permit is issued,'I shall not employ any person in any,manner A ( O. CONDITIONS "so as to become subject to the Workers'Compensation Laws. DDRESS 0 Date Applicant CITY 7-• - ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT - .GROUP TYPE FIRE- P O SSED BY g ENGINEER NO. CONST.. ZONE V Exemption, you should become subject to•the Workers' �j 'Compensation provisions of the Labor Code;you must forth- ADDRESS V I\�/ 9L with comply with such provisions or-this permit shall be - deemed revoked. i^ TEL. .- STATISTICAL CLASSIFICATION APT. J.JDNDO. CONTRACTOR NO. ?'' LICENSED CONTRACTORS DECLARATION7 LIC. u 7 „� CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS//.3 (e NO. Fi ] ea 01 (commencing with Section 7000)of Division 3 of the Business and --+_ - LIC. r SEWER MAP Professions Code, and my license is in full force and effect. CITY oft -C CLASS /d BK.9PG. 3Y VALIDATION SQ. FT. .OFNO. OF CHECKLicense Num r9- E Lic.ClassJ� SIZE STORIES FAMILIES ONE ❑ VALUATION DESC TION OF WORK -� NEW Contract rDate ADD ❑ $ V ❑ 1 am exempt under Sec. �'4"' , ALTER B.&P.C. for this reason REPAIR $USE J Date: EXISTING BLDG. r DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. DATE -1 r ° I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINA 2'5 0 2 0 A Professions Code): PRESENT Bygg s BUILDING _ . . _ # 0 0 0 0 0 1 ❑ I, as owner of The property, or my employees with ADDRESS wages as their sole compensation,will do the work and I -J 24,88, the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). - MOVING TEL. ' El 1, NO. . ° 1 2�I 8 8 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- .0 7. 1 4'"8 6 ADDRESS «-\� •��,'S tion 7044, Business and Professions Code). \Z \ �•\ v REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY' PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT i. the performance of the work for which this permit-is issued P.L. (Sec. 3097, Civ. C.). SIDE n _ P.L Lender's Name -- LDMA Refs#, m Lender's Address P.C. Fee$ Permit'Fee ZV ; > /� !1 I certify that I have read.this application and state that the Issuance Fee - d. C/ LDMA P/C a above information is correct. I agree to comply with all County Investigation Fee - ordinances and State laws relating to building construction, Total Fee J O �' LDMA Perm. # d and hereby orize representatives of this County toe ter upon-the mentioned property for inspection urp ses. a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o^Applicant or Agent to PRS°e011�; ."?' .•. v ECLARATION rMn,that I have r certificate of consent to Self APPLICATION FORBUILDING PERMIT Plis., a ceriificate o;'Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES . BUILDING AND SAFETY Policy No. 'Company H; ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN •o ADDRESS 03 otanJ 'Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ® 7 i Date Applicant CITY ZIP �/ �� LOCALITY ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. Q (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL � �� TEL. I certify that in the performance of the work for which this OWNER �/c-C�G1` TEL. rX�9�t'o USEJZNE permit is issued, I shall not employ any person in any manner ADDRESS - �[!SPE61ALCONN i so as to become subject to the Workers'C pensation Laws. CONDITIONS C) Date Applicant CITY ZIP / NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O UExemption, you should become subject to the Workers' ENGINEER CONST. ZONE- Compensation provisions of the Labor Code, you must forth- ADDRESS tJ� _5 W. with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. 60NDC. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION ULIC. CLASS NO. 414? DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP / Professions Code, and my license is in full force and effect. CITY CLASS BK. CPG 3 X VALIDATION SQ. FT. NO.OF NO. OF CHECKUUU License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION \ Contractor Date DESCRIPTION OF WORK -NEW Ws U ADD ❑ pill. I am exempt under Sec. ❑ ALTER B.BP.C. for this reason I REPAIR ❑ f � USE OF 7495A Date' EXISTING BLDG. DE ❑ Signature APPLICANT TEL. FINAJ� ✓ # 0-0.0 ® °.1 OWNER-BUILDER DECLARATION PRINT �L� NO. 3 DATE LZ C/ I hereby affirm that I am exempt from the Contractor's License ADDRESS .° - 9675 Law for the following reason (Section 7031.5, Business and IF Professions Code): PR ENT B = ❑ BUILDING ° ° ° 9 6.7 5 6 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY ' 0 7. 1 7 8 7 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. ly I I, as owner of the property, am exclusively contracting CONTRACTOR NO. LAI\ with licensed contractors to construct the project (Sec- ADDRESS +. tion 7044, Business and Professions Code). ROM EXIST. CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY. TOTAPROP.SETBLIINECK F WIDTH I hereby affirm that there is a construction lending'agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee ' I certify that I have read this application and state that the Issuance.Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # R and hereby authorize representatives of this County to enter M upon the above-mentioned property for inspection purposes. a Lid% i6t— � SEE REVERSE FOR EXPLANATORY LANGUAGE Signafure of Applicant or Agent Date ORKERS'COMPENSATION'DECLARATION AVinsure, araafcertif cai2 of Workers' Compensation eInsuranc that I have a certificate ofto slf e,, APPLICATION FOR BUILDING PERMIT lora certifie2i copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Pol Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING l ADDRESS / Certified copy is filed with the county building inspec- BUILDING 0 tion department. ADDRESS Date Applicant CITY ZIP dJ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' // y NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT SCP / NOW ON LOT CROSS ST. 20 (This section need not be completed,if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK I PAGE PARCEL TEL. d USE ZONE MAP I certify that in the performance of the work for which this OWNER I` NO. J/ SPE permit is issued, I shall not employ any person in any manner �Z SPECIALt so as to become subject to the Workers'Co ensation Laws. ADDRESS CONDITIONS 0 p A 6 CITY r ZIP V Date Applican NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT G UP TYPE / FIRE P CESSED BY O ENGINEER O. � �/� CONST.J ZONE U Exemption, you should become subject to the Workers' ��/ �rJ1 Compensation provisions of the Labor Code, you must forth- W ADDRESS with comply with such provisions' or this permit shall bePT. 0. deemed revoked. TEL CONTRACTOR NO. STATISTICAL CLASrS/IFI/C TION ACONDO. N LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. t/ DWELL. UNITS - I I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS A NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP/ C� Professions Code, and my license is in full force and effect. CITY CLASS BK (/PG 3 h VALIDATION SQ" F // / NO. OF NO. OF CHECK UUU License Number Lic.Class SIZE (� J STORIES FAMILIES ONE ❑ - VAL TION DESCRIPTION OF WORK NEW Contractor Date $ U(J ADD 1:31I am exempt under Sec. , N n ALTER ❑ B.&P.C. for this reason `� REPAIR ❑ $ Date: USE OF DEMOL EXISTING LDG. ❑ Signature APPLICANT ° TEL" �`�� /b FINAL _ OWNER-BUILDER DECLARATION PRINT �- NO. S/ DATE I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS �p �� pl ;P 81 k 4 A Professions Code): PR - BUILDING Y 018 I, as owner of the property, or my employees with ADDRESS #I®0*®®4 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. 001049,885 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. :A 0.0 6''8 7 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issuedP.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # Lender's AddressP.C. Fee$ Permit Fee r ' 0 1 certify that I have read this application and state that the Issuance Fee V LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee (� LDMA Perm. # R and hereby authorize representatives of this County to enter m upon the above-mentionedproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Applicant or Agent Date