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Home My Public Portal About9162 LA ROSA DR_Miscellaneous__ I \iORf:LRS'CO\IPENS\TION DCCL\ft.\TION CE 3751(1.1 aa) MISCELLANEOUS APPLICATION cs ass 'I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Insure, or-a certificate of Workers'Compensation Insurance,or 2 �. a certified c6py thereof(Sec. 3800, Lab.C.). P,licy No. Company FOR APPLICANT TO FILL IN BuO 1Ln�Nc G// a ADR SS Certified :opy is hereby furnished. pp BUILDING 9162 E. LA ROSA DR. TEMPLE CITY, LOCALITY A ADDRESS (] I F] Certified copy is tiled With the county building Inspection X LOCALITY CA 91780 NEAREST department. CROSS ST Date .-\p Phcant NEAREST DISTRICT NO GRO P TYPE ESSED BY cRoss sT.ENC INITA STREET �— CONST. I CERTiFIC aTE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSUR.\N(.E DESCRIPTION LOT NO BLOCK AAP wIGwW�v NO. ICIR CLE) STATE NAJOR SECOND LOCAL ' NO. OF SLOGS. _ (Tills section need not Ile completed if the ,vork involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ISM)) or less.) USE OF - I .ertifv that to the-❑er'urmancc vi 'he •lQrk .'o: '%bleb 'his SIZE OF LOT EXISTING BLDG. permit is issued. f shall not emplo} any per-,on :n my manner % OWNER OTTING ENTERPRISES, INC. so as to become sublet: o the Workers' Comcensanon Lasts. p p(p _ OCCUP4NCY GROUP A AD OR ESS P.O. BOX 722 ' Date a onccant- X TEL. NOTiCL• TO aPPLIC 0,T If, atter makire :his : euu , a .i[e of clr� GLENDORA NO. (818)338-2116 OCCUPANT LOAD • Eeerription, you ;iiould become sub)ecr :o the Workers' APPLICATION FOR E;UT HARCWARE Compensation ormisions of the Labor Coue. '"ou must torth «[tli comply ' till -u,:t p-mis;ons :'r .ris -ermit ,hall be — f • -RAILER JSE _ GEOLOGY INSPECT'Ory \10 Spec K:nowl El. ' deemed re,oked. LICENSEDC O\,TR.aCPORS DECL.\R k'10', occJPAs+c" IN's PEcziory B Panic Dunces Q I IICCeb}' at`trm that f am licensed under piovisiens of Chaorer SAFETY PERMIT 7 (LIST ITEMS BELOW) 9 (commencing '•tnh Section 7000) of Ditision 3 of the Busi- ness and Professions Code. and mt license :s in -till :orce and PARKING effect. SPACES REO'D E PROVIDED �I License \umber Le Clas, LIMITED TIME USE Contractor Date o,r� DATE 1 un e erupt rot: -he licensing :eauue:nenis a ; cin 1 - E licensed .ircaitec: or n -ecistered -irntession.il enL•tnee- 31ZE OF NO OF INSPE -OR S z acting m 'nx, orute,sional aoaL:t Sec::en 'I_I Bkls- -XIS-'74G SLOG, 1 STORIES SIGMA URE iness,tid P-ofessions( ode 1. FiNAL APPROVAL ESE`+T 'JSE OF 3UILDING 5 `r,�iVVXX LIc.or Rei., V,, - — D,II,: - I • HOME 0\k\FR-RLILDER DELL 0 \f10.\, NO OF ExtsTING BUILDINGS ON LOT AND USE l/ I hereby atf iron :hat L .un e%empt :nm aie Contractor s License Last for [lie tollo,,in^_ reason Se,:ion "031 : B«,l- �D ness and Protessions Code) NO. PARKING SPAC<S -40VID ED 1, as ostner of :lie on,o:•riy. '•till do-die sort. Ind'-he structure is nor untended or oite-cd 'or .aie •Sec:ion -044 Busuiess and Protessions Code) C:ONSTRLCTIO\ I_LNDING \GENC 1 PROPOSED 'JSE OF BUILDING l hereby affum that :liere Is a construction lending a--encv t for the performance of the Work for Mitch this permit Is issued tSec. 30Q7,CLv C ) Lender's N.une — — --- PROPOSED MAX OCC , Lender s \ddress 25.00 I certify that 1 (lace read this application and state that the PERMIT FES above information is correct I agree to comply 1t ith all County ISSUANCE FEE ' ordinances and State lasts relating to building construction. and herehv authorize representatives of this County to enter TOTAL FEE 25.00 upon �ttth-e a,,,bove- n io d property for inspectton'purposei, R tom" Y % ?J��3 qg SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION I hereby caffirm.that I have a certificate of consent to self F LOS ANGELES BUILDING AND SAFETY'DIVISION insure, or a certificate of Workers'Compensation Insurance,or COUNT�,'`J a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL I N BUILDING ADDRESS (O FlCertified copy is hereby furnished. BUILDING O LOCALITY ADDRESS 11A Ph9- 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. - Date Applicant NEAREST DISTRICT NO. GR UP TYPE PRO SSED BY CROSS ST. A16 ♦ i7 CONST - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /L- COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY • NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this slzE of LOT EXISTING,BLD 6. �/ O permit is issued, I shall not employ any person in any manner OWNER so as to'become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP aADDRESS EZil Date Applicant ♦ ♦ `� TEL. r LV NOTICE TO APPLICANT: If, after making this Certificate of clTr N D NO. l Of -,2, OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. OF EXITS ness and Professions Code,and my license is in fullforce and effect. SPA CESG REQ'D PROVIDED License Number Lic. Class • LIMITED TIME USE Contractor Date DATE DATE FROM: TO: El I am exempt from the licensing requirements as I am a ' licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIESPiG7A7URE iness and Professions Code). 0A UFINAL APPROVAL /0 q Z_ PRESENT USE OF BUILDING �' j V '7 • Lic.or Reg.No. � Date AM E HOME OWNER-BUILDER DECLARATION rJo. OF EXISTING B UILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following.reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ✓f� 5�y i i Ail .c- ❑ I, as owner of the property, will do the work and the SPACES PROVIDED .IIJ�1 1 °:I= structure is not intended or offered for sale (Section. 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY /\ PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency (,�� for the performance of the work for which this permit is & Nib NOMA) ovkmw issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address I - I I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and ereby authorize representatives of this County to enter TOTAL FEE n he gok-m ntioned property for ins pecti n purpose . �Y SEE REVERSE FOR EXPLANATORY LANGUAGE Signat of ermit a Date WC?;�KERS;,COMPENSATION DECLARATION 76M444 M"I SC E L LA N E O U S APPLICATION CE 875 (11-84) I Wreby affirm that I have a certificate of consent to self COUNTY OF LOS,ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy_thereof(Sec. 3800,Lab.C.). ^ DING ADDRESS Policy No. Company FOR APPLICANT TO FILL IN BUIL Ess ❑ Certified copy is hereby furnished. BUILDING �' —'ll �//�� p LOCALITY (/� y /� 7 ADDRESS J A-Us (��-l• �- C, ! l.. /#0 Certified copy is filed with the county building inspection LOCALITY NEAREST /I ' department. Qj% CROSS ST. H Date Applicant NEAREST '/ DISTRICT N GROUP TYPE P CESSED BY CROSS ST. ,�j /✓ (/ ^ CONS CERTIFICATE OF EXEMPTION FROM'WORKERS' LEGAL D d COMPENSATION-INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. - (CIRCLE) STATE MAJOR SECOND LOCAL _ NO. OF BLDGS. • (This SBCtIOn need not be completed if•the work involved TRACT - NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT EXISTING BLDG. - I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER ��' � =' so as to become subject to the Workers' Compensation Laws. MAIL J OCCUPANCY GROUP o ADDRESS Date Applicant LU.J NOTICE-TOAPPLICANT: If, after making this Certificate of clrYpt (2��(/� To� OCCUPANT LOAD Exemption, you' should become subject--to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with Such provisions or this permit shall be TRAILER USE ❑ - GEOLOGY INSPECTION ❑ No Spec. Know). deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION F] I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT [� (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the BusV NO. OF EXITS ness and Professions Code, and my license is in full force and h5 effect. i PARKING REQ'D O PROVIDED D ' SPACES License Number Lia Class �dx o LIMITED TIME USE Contractor - Date - DATE DATE FROM: TO: F] I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF y� NO. OF INSPECTOR'S EXISTING BLDG. -O STORIES SIGNATURE acting in my professional capacity (Section 7051, Bus- 0 - inessand Professions Code). �V p p�116� FINAL APPROVAL E PRESENT USOF BUILDING V /` Jp Lic.or Reg.No. Date (C (( HOME OWNER-BUILDER DECLARATION NO. OF EXISTING-BUILDINGS ^ P W ON LOT AND USE D I hereby affirm that I am exempt from the Contractor's License Law for'the following reason (Section 7031.5, Busi— ness and Professions Code): NO. PARKING 1 I'I'I D 1 I, as owner of the property, will do the work and the SPACES PROVIDED 11L'i structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING •-'/F/��/¢� �8 , I hereby affirm that there is a construction lending agency for 'the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name • PROPOSED MAX. OCC. Lender's Address e. (PERMIT FEE- ' a I certify that I have read this application and state that the - , above information is correct. I agree to comply with all County ISSUANCE'FEE ordinances and State laws relating to building construction, and hereby authorize repres ntatives of this County to enter TOTAL FEE 2„J upon the above-men ' ned o ty f inspection purposes. 2i zSEE REVERSE-'FOR EXPLANATORY LANGUAGE Signature of Permittee D WORKERS'„COMPENSATION DECLARATION 76M444` �p CE 875 (280), .MISCELLANEOUS' APPLIC.AT,ION I-hereby affirm' that I'have,a certificate of-consent-to-,self ' COUNTY OFLOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compehsation Insurance;or a certified copy thereof(Sec. 3800,Lab.C:) BUILDING - r , Policy No. _ Company- FOR APPLIC=ANT TO FILL IN ❑ -, ` • ... .- - Certified copy is,hereby furnished`. Bu,ILDING 9162 - LOCALITY / •' ” - ADDRESS Certified copy is filed with-the county building inspection' NEAREST r de'partment.• LOCALITY. I CROSS+ST. Date Applicant ' EAREST T' DISTRICT-NO.v GR UP TYPE PROCESSED BY CROSS ST. DmCinitaS •. - - - CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL" COMPENSATION'INSURANCE DESCRIPTION Lor NO. • BLOCK MAv HIGHWAY.. 1.10. - (C—CIE) - STATE••M AJOR SECOND LOCAL ' }i NO.'OF BLDGS. - Q.. (This section need not',be7 completed if the work involved TRACT NOW ON LOT US Ef ZONE .SP-ECIAL CONDITIONS- ry ,'.by' the permit is for one hu red dollazs ($100) or less.) _ VV - -,USE SIZE'OF, LOT- -��'` ' EXISTING BLDG. I certify-that in the performs tt is,'`. �: _��y� permit is issued-, I shall not,em oer, OWNER. p p Cotnmuni':ty D f§ 'o s a17-Co -_<�;T so,as to become su6'ect'to ihe- ns .4. s.' OCCUP.ANC'Y GROUP.. P LDate Applicant' REss'9167' La-Rosa' D ii "''• X_r_� a 4—�� +EL' ,OCCUPANT LOAD '• Z_ NOTICE TO APPLICANT::If, after making this Certificate of clTv No. '28 fi_33'L}2 ' Exemption; 'you •should become subject 'to the.1 Workers'-' APPLICATION FOR EXIT HARDWARE:• Copipen'sation provisions of the-Labor Code, you•must'.forth- < With comply',with Such provisions or ,this'permit shall be TRAILER USEG EOLOGY INSPECTION - ❑. ❑ No Spec. Knowl. deemed revoked. z OCCUPANCY INSPECTION �' - - Pan' ic,Devlce$ ❑ ' - LICENSED CONTRACTORS*DECLARATION ' I= ereby affirm that I am,licensed under provisions•of Chapter, S'A.FETY.PERMIi ❑, (LisT ITEMS BELow ' ` " 1 - NO: OF'EXITS� •-�'(commencing with Section 7000)\of Division 3 of the Busi- '. n�ss 'and Professions Code, and•my license is-in full force and PARKINGr effect. REO' SPACES D PROVIDED D •- LLJJ License Number LIc:Class `LIMITED' TIME' USE Contractor " Date DATE .' DATE .• - - FROM:': _ TO: I ani exempt from'the licensing requirements as I am a - - - INSP.ECTOR'S licensed .architect ,or a registered professional engineer- SIZE OF : No:OF acting In my professional capacity (Section_7051, Bus- EXISTING BLDG. - STORIES SIGNATURE IneSS and PIOfeSS10RS Code). RESENT USE OF BUILDING '• FINAL APPROVAL _ O �0 Lic,or Reg.No. Date CSC./ ET.FrTRONTr COMPONENT DISTR.. NO. OF EXISTING`BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND usE I hereby- affirm'.that, I am exempt from` the Contractor's License Law for•tKe following reason (Section 7031.5,'Busi- D b'9 8 A ness and Professions Code): NO. PARK'ING' z SP,ACES'P-ROVID ED �. O I,''as,owner of.the;property, will do_the work and the •g'g structure is not'.intended or`offered• for• sale (Section _ " 7044, Business and Professions Code). PROPOSED USE OF BUILD ING .�O'O.O O(O�YIz 11 '� CONSTRUCTION LENDING AGENCY Q 1 `8—8 2.. I hereby, affirm that there is' a construction lending agency' ' for -the performance of the work for.which this p'errr%if•is , issued(Sec. 3097,Civ.C:). Lender's Name - - ,• • ' - , P,ROPOSED•MAX. OCC: Lender's Address PERMIT FEE - I certify,that'I have read this,application and state that,the above information is correci.•I agree to'complywith all County ISSUANCE FEE C_ ordinances,and State laws relating to building COnStrUCtlOn; TOTAL FEE $2J :00 (Pay t0'rC I ty of Tempi e 'C i ty-) and hereby'authori representatives of this County to enter u/po he ab ned perty for. inspection-purposes. SEE'REVERSE-FOR EXPLANATORY LANGUAGE 9/30/82 Signature of Perm-ttee' r Date ' ; -+WORKERS'COMPENSATION DECLARATION CE 8454(„ 84) MISCELLANEOUS APPLICATlON I hereby affirm that I have a certificate -of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ' insure, or a certificate of Workers'Compensation Insurance,or a certified-copy thereof(Sec. 3800,Lab.C.). Policy.No. Company FOR APPLICANT TO FI LL IN BUILDING /�� ADDRESS Certified copy is hereby furnished. BUILDING /2 - ocALITY ADDRESS O 0 Certified copy is filed with the county building inspection LOCALITY EAREST department. cRoss ST. Date Applicant NEAREST DISTRICT NO. I GR�QUP ITYPE CESSED BY CROSS ST. !('�D CONST. CERTIFICATE OF EXEMPTION FROM'WORKERS' LEGAL J o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY _ NO. F BLDG$. NO. (CIRCLE) STATE MAJOR SECOND LOCAL • - (This section'need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF . SIZE F LOT EXISTING BLDG. d I certify that in the performance of the work for which this — o permit is issued, I shall not employ any person in any manner NER �� f' y so as to become subject to the Workers'-Compensation Laws. MAIL OCCUPANCY GROUP -� o ADDRESS' O 72 7— Date Applicant L,., rEL: NOTICE'TO APPLICANT: If,'after making this Certificate of clry . '/ —� / OCCUPANT LOAD 0.- Exemption, you should become subject to, the Workers' Z Compensation provisions of the Labor Code;you must forth- APPLICATION FOR EXIT'HARDWARE with comply with such provisions.or this permit Shall be TRAILER USEGEOLOGY INSPECTION Eldeemed,revoked. E] ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION,❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter - SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3'of the Busi- No. of EXITS ness and Professions Code, and my license-is in full force and effect. PARKING SPACES REgD PROVIDED I-�J License Number Lie. Class LIMITED.TIME USE Contractor •Date - DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or-aregistered professional engineer SIZE OF NO. OF INSPE OR's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. -TORIES / SI URE iness and Professions Code). _ FINAL APPROVAL '. Lie.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF-EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am 'exempt from the Contractor's - License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING i I as owner of the property, will do the work and the SPACES PROVIDED structure-is not intended or offered for sale (Section 7044,Business and Professions Code). , • CONSTRUCTION LENDING AGENCY PROPOSED-USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE - ordinances and State laws relating to building construction, and hereby authorize representat' es of this County to enter TOTAL FEE upon th a e mentioned pro ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee• Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I' hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETYY-DIVISIONI insure, or a certificate of-Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) BUILDING Policy No. Company -.FOR APPLICANT TO FILL IN ADDRESS .� Certified copy'is hereby"furnished. . BUILDING 9162 ,LA ROSA DR. LOCALITY - ' ADDRESS ❑ T Certified copy is filed-with the county building inspection q0 NEAREST department: LocwLlry TEMPLE• CITY, CROSS ST. Date Applicant - NEAREST �r�� DISTRICT NO. GROUP TV PE IPROC SSE D BY. CROSS'ST. •,ENCENITAS-_ � �/ /j� CONST./ C CERTIFICATE OF EXEMPTION FROM,WORKERS' LEGAL s I//1 V COMPENSATION INSURANCE DESCRIPTION., -LO.T.NO. BLOCK MAP /I MIGMWAV �1�,`7 ( ) STATE MAJOR SECOND LOCAL' } NO'.-OF BLDGS. ' NO. V7 CIRCLE a (This section need not be completed,if the work involved TRACT / , NOW,ON LOT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars'($100) or less.) { USE of momU ' SIZE OF LOT EXISTING BLDG.- I certify that in,the performance•of the'work-for which this lr permit is issued, I shall not employ any person in any manner OWNER O so as to become subject to,the Workers' Compensation Laws. AIL C MC OCCUPANCY GROUP - _ ,ADDRESS- 9162"-1A ROSA- DR: - - -- - w LU Date Applicant 0.N TEL NOTICE TO APPLICANT: If,;after making this Certificateof CITY TEMPLE CITY NO 285-3105 OCCUPANT LOAD 2 Exemption, you should become subject to the' Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the,Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ ❑ No Spec. Knowl. ❑ deemed revoked. _ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION occuPwrvcY INSPECTION® - I hereby-affirm that lam licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9'(commencing with Section 7000) of Division 3,of the Busi- ness and Professions Code, and•.riiy license is in full•force and PARKING• effect. SPACES REO'D O PROVIDED O License Number Lic.Class _ - LIMITED TIME USE Contractor Date DATE DATE • _ FROM. TO. I am exempt from'',the licensing requirements as I ani a, licensed architect br,a registered professional engineer SIZE OF NO. OF INSPECTOR S acting in my professional capacity•(Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). RAPPROVAL ESENT USE of BUILDIN FINAL APPROVA , � L0 /�' ,, Lic.or Reg.No. Date V'��° - PANEL OVARIAYS. HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND'USE:- - .•--. - I hereby affirm that• I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING $ A SPACES PROVIDED 2•7� S , Ell I, as owner-.of the property, will do the work and the ' structure is not intended or offered for sale (Section ,# o�e•lo 0 8 8 7044,•'Business and Professions Code). i - PROPOSED USE OF BUILDING SAPS- '• OOO'O 0110 0.2 - ' .. SAME- CONSTRUCTION LENDING AGENCY O}tax O G f 8 2 I hereby affirm that there is a construction lending agency for the performance of the work for which'this permit is, issued(Sec. 3097,Civ.C:). Lender's.Name PROPOSED MAX.OCC. ' Lender's Address PERMITTEE I certify that I have read this application and -state that the above information is correct. I agree to comply with all County ISSUANCE FEE .ordinances and State laws relating to building construction, 'an �jretiy autho 'ze representatives of this County to enter TOTAL FEE $25.00 (Pay 't0_,C i ty of Tempi e Ci ty) pone e) erty for inspecti n pu poses. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Perm ttee Date