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Home My Public Portal About9048 LAS TUNAS DR_Miscellaneous__ tvnnl:3LRS'COMPCNSt1TION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 675 1 hereby affirm cert that 1 have a certificate of consent nc self COUNTY OF.LOS ANGELES BUILDING AND SAFETY DIVISION U utsure, or a certificate of Workers'Compensation Insurance,or _ ,", ,I certified copy thereof(Sec. 3800,Lab C.) Policy No (ompanY FOR APPLICANT TO FILL IN BUILDING ADDRESS FlCertified copy IS hereby furnishedBUILDING LOCALITY XX ADDRESS daN �0�1� ElCertified copy is filed with the county building inspection LOCALITYNfiAREST department Xx B�' /uE .Roes sr A6 9 Date _Applicant NEAREST DISTRICT NO I GROUP TYPE 9CESSED BY .Ross sr ru.—T ? corvsr CLR]IFICATE OP EXEMPTION FROM WORKERS' LEGALC OMPFNSA PION )NSURANCI. DESCRIPTION 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 SPfi CIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF 1 certify that in the performance of the work for which this slzE of Lor EXISTING BLDG o n permit Is Issued, 1 shall not employ any person in any manneRX OWNER of building �o as to become subject to the Workers' Compensation Laws MAIL (y L/ OCCUPANCY GROUP -� o ADDR E35"1/0 N1 V Date—_---- Applicant —_ w NOFICE TO APPLIC'AN] If, after making this Certificate of CITY /�. Ch_ Nfi. r8 7vt- OCCUPANT LOAD �"J L-'emption, }ou should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth ❑ with C0111p1} With StILII provisions lir this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec Knowl. deemed rooked 1.ICFNSLD C0N'I RACIORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices I hereb} affirm that I ani licensed under provisions of Chapter SAFETY PERMIT ❑ )LIST ITEMS BELOW) 9 (coniniencang with Section 7000) of Division 3 of the Bust- NO OF EXITS nets and Professions('ode,and my licence is In full force anix effect Name of business PARKING AREO'O PROVIDED I License Number Ltc Class 6 SPCES LIMITED TIME USE Contractor-_—_ — Date DATE DATE FROM TO El I am e\enipt front the licensing requirements as I am a licensed arclittect or a registered professional engineer SIZE of NO. OF INSPECTOR'S acting in Illy pIofesslonal capacity (Section 7051, Bus- EXISTING BLDG. STORIES S GNATURE mess and Professions Code). " PRESENT USE OF BUILDING FINAL APPROVAL Lic or Reg No _ Date IIOt`II-OWNER-BUILDER DECLARATION No of EXISTING BUILDINGS O n �� ON LOT AND USE 1 hereby affirm that l ani exempt from the Contractor's License Law for the follo%%ing reason )Section 7031.5, Busi- /�'t� ness and Professions Code) NO. PARKING El1, 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) =1c•; Nfl , ^y,: CONS]RUC f10N LENDING AGENCY PROPOSED USE OF BUILDING 1 herebt affirm that there is a construction lending agency for the performance of the work for 1khich this permit Is issued (Sec 3097,Civ C.) I Lender's Name PROPOSED MAX.*OCC. ender's Address_ 25 - 00 I certify that I have read this application and state that the PERMIT FEE above mforlmation is correct I agree to comply 1%ith all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby aut r s of this County to a ter TOTAL FEE 25 .00 1 t do I pro or inspection pu os t — — — SEE REVERSE FOR EXPLANATORY LANGUAGE XX Lf G" uIc Int I'rinullrr -- I Ile WORKERS'COMPENSATION DECLARATION CE 875 (11-64) MISCELLANEOUS APPLICATION CE 875 I hereby affirm-that I have a certificate of consent to self COUNTY OF LOS ANGLE BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). BUILDNG Policy No. Company FOR APPLICANT TO FILL IN ADDRESS `r,aa ADDRESS C /l�� Certified copy is hereby furnished. ADDRESS GIT LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NQ. I GROUP TYPE PROCESSED BY CROSS ST 0 f/ CONST C;J CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD GS. (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 SIZE OF LOT EXISTING BLDG.OF ` d I certify that in the performance of the work for which this iN��S C:)permit is issued,I shall not employ any person in any manner OWNER IA S v so as to become subject to the Workers' Compensation Laws. MAIL7 �r�yI/� tip/� OCCUPANCY GROUP D= ' JD Y vr� V Date ADDRESS Applicant TEOCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. � 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 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 E] (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 �[ _ bJ� 1 p fduK.W effect /1 PARKING REQ'D PROVIDED SPACES LL�� License Number Lic Class 0 1(Z QQ AJ LIMITED TIME USE Contractor Date 0 o X IU fil O DATE DATE 11 t PROM TO ❑ I am exempt from the licensing requirements as I am a Ra — -� licensed architect or 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) FINAL APPROVAL A PRESENT USE OF BUILDING Lic.or Reg.No. Date '\ i V ,l M GA HOME OWNER-BUILDER DECLARATION NO. F EXISTING BUILDINGS y y N1.4-3 PEE ON LOT AND USE �I/ � I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi I,fI^I_I_fEf(, -» ii(.: ness and Professions Code) No. PARKING 0 I, as owner of the property, will do the work and the SPACES PROVIDED _:_i7 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 5 nV for the performance of the work'for which this permit is issued(Sec 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address 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 hereby authorize representatives of this County to enter TOTAL FEE upo the above entioned property for inspection purposes. Q & q LSEE REVERSE FOR EXPLANATORY'LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION a CE 875 (11-84) MISCELLANEOUS APPLICATION CE 87 I hereby affirm that I have 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. BUILRDESS ING LOCALITY ADD Certified copy is filed with the county building inspection LOCALITYNEAREST department. CROSS ST Date Applicant NEAREST j DIST CT TYPE ��. P CES BY CROSS ST. CONST.'� / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` _ COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY rvo (CIRCLE) STATE MAJOR SECO 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 SIZE OP LOT EXISTING BLDG. permit is issued, I shall not employ any person man manner n o P P y OWNER � `� �®y� G!dr(®j/'e/Z =° so as to become subject to the Workers' Compensation Laws MAIL X' 8, OCCUPANCY GROUP o ' U Date ADDRESS 10 Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY �� No`' 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 PERMI ❑ (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. ocPARKING REQ'D PROVIDED I � sPwcEs .J License Number Lic. Class I SCP Cd LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM TO: licensed architect or a registered professional engineer SIZE OF NO. OF r SPECTOR•S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. �� IVdp sroRlEs ! SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING C.V�� FINAL APPROVAL Lic.or Reg.No. Date ,10 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 9 07 W 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- 0000-000I 5 ness and Professions Code) NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED If 9970 1 ANI structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING S" er S 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 , O 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 representatives of this County to enter TOTAL FEE 0 yp the abo mentioned roperty for inspection purposes. d SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of Perini a ate WORKERS'+COMPENSATION DECLARATION CE8754(2-80) , MISCELLANEOUS APPLICATION 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 FILL'IN BUILDING h` ADDRESS C/ Certified copy is hereby furnished BUILDING LOCALITY ADDRESS 9048 Las Tunas Dr.. - , J Certified copy is filed with the county building inspection LOCALITY department • City , CA 91780 CROSS ST Date Applicant NEAREST C DISTRICT NO. GROU TYPEIF?�SSED BY CROSS ST Sultana _ CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK NO „CgRCLEY } (CIRCLE) STATE MAJOR SECOND LOCAL a /This section need not be completed if the work involved No. of BLDG3. USE ZONE SPECIAL CONDITIONS l P TRACT NOW ON LOT - 0 by the permit is for one hundred dollars ($100) or less.) U - USE OF SIZE OF LOT EXISTING BLDG. a, Ir- I certify.that in the performance of the work for which this 0 permit is'issued, I shall not employ any person in any manner OWNER John Conover so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP w Date Applicant ADDRESS9110Tunas Dr. N N NOTICE TO APPLICANT: If, after making this Certificate of CITY Temple- City NOL 285-9951., OCCUPANT LOAD ZZ 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 1:3GEOLOGY INSPECTION NO Spec. KfIOWI. ❑ deemed revoked Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) a NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect SPACES ' REQ'D E= PROVIDED D License Number Lic Class LIMITED TIME USE Contractor Date • DATE DATE FROM TO 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 STORIES y, SIGNATURE iness and Professions Code). Empty FINAL APPROVAL -7 ESENT USE OF BUILDING � UU Lic.or Reg.No Date HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that• I am exempt from the Contractor's ;9- 5022A ' License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO. PARKING SPACES PROVIDED # O'OIO O 4 0 I, as owner of the property, will do the work and the , structure is not intended or offered for sale (Section 0 0 0 0 0 0 7044, Business and Professions Code). 10. ' ' P POSED USE OF BUILDING Retail Sales, I _07,,19-82 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 1 alpipliances , for the performance of the work for which this permit is issued(Sec 3097,Civ.C.) igni office space for - store. 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, �l and hereby authorize representatives of this County to enter TOTAL FEE /r V upon t • ove-mentione ro t f inspects n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 21 SigrL&rreofPermittee Date \OIZI:LRS ( 0\IPLVS\TIONDE( L1R1110\ 87as t i aal CEMISCELLANEOUS APPLICATION c.. as fI herebv atfirm that I have a certificate of consent to sell . ,u tnsur:. ,2r a certnccate of \\orkers Conioensduon Insurance.or COUNTY OF LOS ANGELES BUILDING AND S.AFETY DIVISION a certified copy thereot .Sec. 3800.Lab C i - ••, IPohca No _l mmvart) — — FOR APPLICANT TO FILL IN ADDRESS d'T� Certified cop} is hereb\ lurnisheav BUILDING ` OCA LITY A ADDRESS L( f)jVk ElCertified copy iS tiled\kith the count% buiidmL inspection, LOCALITYNEAREST dep rtme t Temple City CROSS ST �/ Datt: ��\npll',drlt_- NEAREST '.DISTRICT NO GROUP TYPE P ESSED BY �1 CROSS ST �O CONS I CERrIr IC\TL OF E\E\IPTIO\ FROM ',t`Ri:E R� LEGAL I / l O\IPE\S ',TION l\SL R\\t l- OESCPIPT•ON LOT VO BLOCK I ++G Rw AY '+o ICIRCL�j STATE MAJOR SECOND LOCAL NO OF BLDGS (This section heels not he Lomoleted If the Illirk Involved I'RAC' ,O'.V ON LOT USE SONE SPECIAL CONDITIONS by the permit is for one hundred dollar, SI00) or less.) I usE OF 1 SIZE: OF LOT I EXISTING BLO I certify that in :Ice oeriortnance ,,f -he 'I,IrI. a ,bich -his 777 C permit is issued I sliall not -mplol im e-wn n n, mOWNER WNER ,u so as to become inert :o the 'corkers hlnaen�ane� r.aILG "AILe (�j OCCUPANC'; 3ROUP I� ADDRESS ((.. I I Date— \onlirant 7 - 1 FL d 3� ✓AL NOTICE TO \Pk LIL-\\T L, dt•e. -n..K:nL t:s' �- ntLtre ,r �(I cIT� � - ( �� 0 � ,� OCCUPAN- L E\emptio•i Iuu ,hontd becort: IL1PICCL -o •he 1,II*Ker, l.umpen,.Inon rrn•lslnm It rhe L1ho� .tae ,iii oust tush- a -L,CA71C-\1 '-?O =X'- -iJRCIIr-I=c 1 \1\Jill r0I11I111 N\1111 ,uLn •,roc i,.on, hl, emir ,hail lie - r� deemed .LI Ihz,i -R,1ILEq JOE �� EOLJ.Y N�PF,:'"CV — NO soec K"C-1 I LIC CNSFD 10\i R\CTORS DECL�R\Tlk)`I JcuPANc r NSPEC�ION gg �3n;C (�?b'C9S ❑ I liereb%ur.lilirm -hat I nn kLnsed undo-nrcli,ion,,,)r (I1.1wer SAFETY PERMIT (LIST ITEMS SELO'it 9 n , 1Lnelu k 1112 ith Seaton -00pt Jit Di%iwn ,Ii :he Susi- - NO OF EXITS nes, .Ind P otc,,tun, r odc aid :m hLrn,c I .n sail Ise Ind -- Ctll'L: PARKING REO' SPA^_ES D I I -R C'J ID EO f ' LiLense \umher_ Lc C:d„ LL LIMITED TIME USE y (ontrartor - -- I'.iie W H I am e\empr :coin .h-� iLensine reuuire:hent, Is I ani t i liLeme•i arLhirecr Or a reUbtered n-nie,stnnal zncineer =IZE OF No o- NSP TOR s ':I.3TI NG SLC.. -7P1�; SI AT RE z acus_ Ti nI prrt:'.Innal .In1-;I' ,..ulr -II:1 Ila. EX i FINIAL APPROVAL -- +nw I --- U •'RESENT USE OF BUILDING (� Li, or Rec \+, - ----- --- ---- D I --- - - - - IIU,IL O,\\1 R-I31 I L D L R 1)ECL>:t \Ilio\ NO OF EXISTING BUILDINGS / ► J� ON LOT AND USEV• /V/ I hereby di'irm that l ant exempt from the Contractor's i License Lair tur the follo,sms reason tSekrtun -031 : Busi- ness and P otessionsCudet PARKING SPACES SPACES PROVIDED I, as o%ner of the prupert} (sill do he Isork Ind the strucnire is not intended or offered tier Idle ISeLuon 7044 Itllr,nteNSand Prufessrons(-ode) (0NSI RL( 110\ LL\DI\G \GI N( PROPOSED USE OF BUILDING I Itereb} dtflrm that there s a consrnrcuon lending agencv Z I for the pertorm.mce of the ,cork for „such this perm[[ s issued t SeL 309'.Civ C I Lender s Name - -- -- --- -- - -- ---- PROPOSED MAX OCC i Lender's Address r-ti i•"'l,� I cernf) that I have read this application FEE 25.00 on and ,tate that the i'+t-F,T]I above Information is correLt h agree to comply utth all County ISSUANCE FEE Mi ordrnan"% and State la,cs relating to building construction, t't and hereby authorize representatiies of this County to enter TOTAL FEE 25.UU 1 upon the.[bo,e-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LA-NGU-\GE r a Q A Si Jia ire of Perinittee Date WORKERS' COMPENSATION DECLARATION I bM4,44 MISGtLLAIVtvu� Nt''f'rLIL.HI IVIY 20-006063DPW 12/90 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 a:rtified copy thereof (Sec. 3800, Lab C) � ` Policy No Company FOR APPLICANT TO FILL IN BUILDING G7D,L/O BUILDING ADDRESS ADDRESS � 7 O ® Certified copy is hereby furnished LOCALITY 1 Certified copy is filed with the county building Inspection TY ZIP NEAREST department / v CROSS ST Date Applicant SIZE OF i2bT NO OF BL GS.NOW ON LOT DISTRICT NO GR TYPE ESSED BY CONST CERTIFICATE OF EXEMPTION FROM WORKERS' Q COMPENSATION INSURANCE TRACT BLOCK Lor No SEGO MAP HIGHWAY NO ICIRGLEI STATE MAJOR SECOND LOCAL ('MIs section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this OWNER TEL NO eras t is issued,,l shall not employ an Property r� p p y person in any manner ADDRESS II/�Qr`"SII so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP ' /O Date Applicant CITY zIP 'NOTICE TO APPLICANT If, after making this Certificate C OCCUPANT LOAD ''of Exemption, you should become subject to the Workers' AF01 ICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ revoked ❑ OCCUPANCY INSPECTION❑ Panic Devices LICENSED CONTRACTORS DECLARATION 1 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 Business NO OF EXITS and Professions Code,and my license is in full force and effect. rGG,c/ PARKING License Number Llc Class f SPACES REO'D � PROVIDED Contractor Date LIMITED TIME USE I _ DATE DATE '�❑'•I •am�exempt from the licensing requirements as 1 am a - FROM' TO. licensed architect or a registered professional engineer SIZE INSPECTOR'S acting in my professional capacity (Section 7051,Business NO EXISTOING BLDG S OOFRIES SIGNATURE and Professions Code) Lic. or Reg No Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS // G ON LOT AND USE hereby affirm that I am exempt from the Contractor's License /II -Law for the following reason (Section 70315, Business and I rl to Frofessions Code)- NO.PARKING I ' SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044X PROPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY 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) PROPOSED MAX OCC Lender's Name APPLICANT(PAINT) TEL NO. Lender's Address ADDRESS I certify that I have read this application and state that the above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes TOTAL FEE X ld 1 B D SEE REVERSE FOR EXPLANATORY LANGUAGE rture of Permittee Da(e