The URL can be used to link to this page

Home My Public Portal About9249 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS A P P L.I C A T I O N CE 875 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 ADDRESS ❑ Certified copy is hereby furnished. 'BUILDING y .. r LOCALITY ❑ ADDRESS ` �'( 1�,rj -, A 15 i 7.ti'+. Certified copy is filed with the county building inspection �, NEAREST de artment. LOCALITY ! ;, CROSS ST. Date A licant NEAREST i DISTRICT NO. GROUP TYPE JPROCKSSED BY pp CROSS ST. "� e'`i CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK NOP (CIRCLE) STATE MAJOR SECOND LOCAL U - 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.) LU USE OF � SIZE OF LOT EXISTING BLDG. LL I.certify that in the performance of the work for which this , permit is issued, I shall not employ any person in any manner :a•OWNER 1 ; y;i•J ' e 1,f�� } so as to become subject to the Workers' Compensation Laws. »} OCCUPANCY GROUP 0: G MAIL cc ADDRESS ( 1'+.I '#- Q Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY "' fir; ca I I rvo. OCCUPANT LOAD d Exemption, you should become subject to- the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- F -with comply with such provisions or this permit shall be TRAILER USE[J GEOLOGY INSPECTION No Spec. Knowl. El revoked. Panic Devices ElLICENSED CONTRACTORS DECLARATION occuawrvcv INSPECTION Q I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) No. of Exlrs a 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 REO'D PROVIDED 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 slzE of NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). 1• 1 FINAL APPROVAL y, P7#ESE NT USE OF BUILDING ,: � ,: �,. .�,�� , Lic.or Reg.No. Date t HOME OWNER-BUILDER DECLARATION ON NO.LOT EXISTING BUILDINGS OT AND USE I hereby affirm that- I am exempt from the Contractor's ;E, I t•A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, 9 Fa 9 a'�SSz SPACES PROVIDED t ❑ 1, as owner of the property, will do the work and the -a- I structure is not intended or offered for sale (Section : +Io-a • u F 7044, Business and Professions Code). r' { $ to OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY l S itt I hereby affirm that there is a construction lending agency 3 ? s.i 4- f;i 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 , r I certify that I have read this application and state that the 'above information is correct'. I'gree to comply with all County ISSUANCE FEE ordinances and State lawg relating to building'construction, TOTAL FEE and herebV,authorize replesentatives of this County to enter upon the,above me4o erd property pectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ` 9liAnature of Permittee / Daae WORK_F,RS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION {� CE 875 U I here't�; 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 BUILDINGADDRESS ❑ Certified copy is hereby furnished. UILDINGADDRESS �2 LAS �� LOCALITY Certified copy is filed with the county building inspection NEAREST 74 department. LOCALITY v;H.OLtr CROSS T. �, �q/ S Date Applicant AREST f / �y DISTRICT N OUP TY E PROLE SED BY CROSS ST. �s sA J4,C>, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECO LOCAL Q. NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. cc 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 WNER LCL �+4N/N I' 444 V so as to become subject to the Workers' Compensation Laws. p'�`'( D OCCUPANCY GROUP111 ADDRESS / Q • _ 0- Date- Date Applicant z �D li �1 TEL. NOTICE TO APPLICANT: If, after making this Certificate of Irr Al �/ 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 PERMIT I--i (LIST ITEMS BELOW). 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 REO'D O PROVIDED 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 SI NATURE iness and Professions Code). P Nr USE OF BUILDINGFINAL APPROVAL / Lic.or Reg.No. Date L b �✓1 O L� G NO. OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's ;23437A- License 23437ALicense Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # • • • • 8 8 SPACES PROVIDED N ❑ I, as owner of the property, will do the work and the � �,.1 1 -$5 z structure is not intended or offered for sale (Section 7044, Business and Professions Code). POSED USE OF BUILDING j1'l0 V .� 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.). 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 rrect. I agree to comply with all County ISSUANCE FEE ordina an S to a 'ng to building construction, TOTAL FEE an ereby a ri epresent• ives of this County to enter u o 'fie a v -1 ioned op.rty for inspectio purposes. _,,SEE REVERSE FOR EXPLANATORY LANGUAGE S' ature of Per ittee Date ECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 L, ) I here at L... a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 111 ill insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). F 0 1 _ Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING G1 L, ADDRESS f Certified copy is hereby furnished. ApoRess LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. V I CROSS ST. Date Applicant NEAREST DISTRICT �/GR �{ / P CONSTTYPE PROCE CROSS ST. L �V .j CERTIFICATE OF EXEMPTION FROM WORKERS' EGAL // V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. � (CIRCLE) STATE MAJOR SECOND CAL 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.) E E of I certify that in the performance of.the work for which this SIZE OF Lor EXISTING BLDG. �/ a 0 permit is issued, I shall not employ any person in any manner V OWNER �Zq / '' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP E�� o ADDRES ~ Date Applicant re uJ NOTICE TO APPLICANT: If, after making this Certificate of cir N _ LZ OCZ CUPANT LOAD Exemption, you should become subject to the Workers' APPLIC TION R 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], El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO Panic Devices El 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 REQ'D O PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: ❑ 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING / Lic.or Reg.No. Date c 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- ;26624A ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 0 0.00-88 structure is not intended or offered for sale (Section 7044,Business and Professions Code). 010d—$8 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.Q. Lender's Name PROPOSED MAX. OCC. - Lender's Address (11 V 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, t6� and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. � ��. to � SEE REVERSE FOR EXPLANATORY LANGUAGE Signatuurd of Permittee Date WORKERS'COMPENSATION DECLARATION 7E 875(11-84) CE 875 MISCELLANEOUS APPLICATION /--I 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 ADDRESS / Certified copy is hereby furnished. BUILDIN ,/�j LocwLlr ADDRESSG 1,45 El Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DIS RICT NO.1 G OUPTYPE PROCESS D BY CROSS ST. -, y• I/ �. CONST• CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP /� 16HWAY NO. 3 (CIRCLE) ATE MAJOR SECOND LOCAL NO. OF BLDGS.' (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITI S by the permit is for one hundred dollars $100) or less.) USE OF SIZE OF LOT EXISTING BLDG. C, d I certify that in the performance of the ork for which this permit is issued, I shall not employ any erson in any manner OWNER i, ik7 ,A,4% y so as to become subject to the Worke ' Compensation Laws. OCCUPANCY GRO P z MAIL O ADDRESS � Date , Applicant TEL. L" NOTICE TO APPLICANT: If, aft r making this Certificate of CITY Gi p�'L' ej) No, ��i3�-72 j`7S ' OCCUPANT LOA N Exemption, you should beco e subject to the Workers' z Compensation provisions of th Labor Code, you must forth- A PLICATION FOR EXIT HARDWARE: with comply with such pro v sions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know . deemed revoked. LICENSED CONTR CTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am censed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Secti n 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code and my license is in full force and ldS� SSS PARKING effect. SPACES REQ'D PROVIDED License NumberLic. Class IMITED TIME USE Contractor Date ATE OA TE FROM: TO: I am exempt from th licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No. of d<t� NSPECTOR S acting in my profess' nal capacity (Section 7051, Bus- EXISTING BLDG.® �� STORIES SI NATO E iness and Professions.) rofessions ode). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING VA 6641 T pp H/af -BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE - I hereby t I am exempt from the Contractor's License Lfollowing reason (Section 7031.5, Busi C. ness and Code): NO. PARKING SPACES PROVIDED I, asthe property, will do the work and thestruct intended or offered for sale (Section 7044nd Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING J� I hereby affirm that there is a construction lending agency `j t;Y ey A for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name /Jl Lender's Address PROPOSED MAX. OCC. �sI 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 upon the above-n ritioned property for inspection purposes. ,! SEE REVERSE FOR EXPLANATORY LANGUAGE y GJ o Signature of Permittee Date . , 1VOKKLRS'COMPENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS APPLICATION I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or s certified copy thereof(Sec. 3800,Lab.C.). Policy No.. Company FOR APPLICANT TO FILL IN BUILDING �d! •'� /) )e ADDRESS �7J /uNHS 2w,(/,E, F1. Certified copy is hereby furnished. BUILDING Z� l /�s ��IV14S., D��11� LOCALITY �jy �� :��' f7�� ' X}i ADDRESS .0 0 Certified copy is filed with the county building inspection LOCALITYr 9p pp NEAREST department. XY /�� `l' �� lir/) 17& cwoss sr: Date_ _ApphCant NEAREST DI RIOT nNO GROUP TYPESSED BY CROSS ST. O ,y 2— CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL U v CONI PENS ATI ON 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.) I USE OF SIZE OF LOT >_ EXISTING BLDG. O_ certify that in the performance of the work for which this C-) permit is issued, I shall not employ any person in any mannekX OWNER of building % so as to become subject to the Workers' Compensation Caws. OCCUPANCY GROUP �'O2 ac MAIL ADDRESS C_; Date_____— Applicant L, NOTICE -1-0 APPLICANT: If, after making this Certificate of CITY No� �' �p OCCUPANT LOAD L' u Lxerilption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with co1np1V with such pTovisions Or this permit sllall be TRAILER USE � GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTIONE] Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby afttrrin that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (Conu»encinng with Section 7000) of Division 3 of the Busi- No. OF EXITS tress and Professions Code, and my license is in full force anjX (tet effect. Name of business PARKING REO'D 1 PROVIDED E::=SPACES _J License Number — Lie. Class_ 'J Gr d LIMITED TIME USE Contractor–_—_ Date DATE DATE El I am exempt from the licensing requirements as I am a FROM: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Brls- EXISTING BLDG. STORIES SIG AT URE f mess and Professions Code). y �/� PRESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg. No. — Date-- — 110NIF OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS '�-t- 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 1, 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 hereb} 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___—___. -- 25 . 00 I certify that 1 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 25. 00 upon the above-nnentioned property for inspection frp urposes. _ s i SEE REVERSE FOR EXPLANATORY LANGUAGE XXXX Cirn:Ilnrc IIf�P , filter Datc WORK ERs COntPENSAFION DEC L:vz:cllONI,,.I~.' MISCELLANEOUS AHeLIC:ATION I hereby al'firnl that I have it ceruficale of co-C111 1, ,elf COUN`fY OF LOS ANGELES BUILDING AND SAFETY DIVISION j I insure,or a certificate ol' Workers' Conlpcn,alion Insur;Uu:e%or it certified copy thereol (Sec. 3800. Lah. C.) j Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS _ ❑ Certil'ied copy is hereby furnished. S -ri((dh$ LOCALITY t ElCertil'ied copy is l'iled with the county building ill',pcction C TY ZIP C NEAREST ca � ) department. t; �, V CROSS ST. Date _ .Applicant SIZE OF L T NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPEPROCESSED BY CONST. 1 ERI 11 ICAhI: OIC t:XEMI'11ON FROM NORFI.R`' rancT BLOCK Lor No. -` (- C'OM11LNSAIION INSURANCE MAP HIGHWAY l; NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This seelimi need not be comple(ed tl (he \\'Uri. 111\ol\'ed ASSESSOR MAP BOOK PAGE PARCEL USE ZONE I SPECIAL CONDITIONS by the permit is For one hundred dollars (S 1001 or lv%s.) OWNER TEL NO. cerlily (hilt in the performance ol' the work III \which this — — L II permit is ISSUcd. I shall not enlploy any person UI an)' mallur I . ADDRESS I so as to become subject to the Worker' Compen,alion :.a\\-s. OCCUPANCY GROUP i Date--_-__ _ Applicant CITY ZIP NOTICE TO APPLICANT: II', after making this (eitificale OCCUPANT LOAD of Exemption, you should.become Subject to the Workers' APPLICATION FOR Compensation provisions of the Labor('ode.you must G)rthwith EXIT HARDWARE: comply with such provisions lir this permit shall bC dCeIlled TRAILER USE LJ GEOLOGY INSPECTION[j No Spec.Knowl. ❑ _ revoked. �j OCCUPANCY INSPECTIONK Panic Devices ❑ LICENSED CON TR,ACIORS DF('LAR.CIION 1 hereby' all Irlll Ibal I all( licensed Lmder prOVi Si011, 111 C b:l rater SAFETY PERMIT❑ ILIST ITEMS BELOW 1 9(commencing with Section 7000)of Division 3 111 the Builness NO.OF EXITS s and Professions Codc.and my license is in I'ull force and effect. r �nrnf c>r L.i\2.sni�SS PARKING. License NumbeiI.IC. Class SPACES REQ'D � PROVIDED X 'S- ` INC_ C'omractor Date LIMITED TIME USE D - - - DATE DATE ❑ I am exempt IrolTl the IICCIISIIIg fe ll lllrC nlCIIIS its I all( it FROM: TO: licensed architect or a registered professional clTuinecr aCting 111 Ill) Professional Capacity (SCCIIon 700 1. BL'SI10.1SS SIZE OF NO.OF INSPECTOR'S EXIS rING BLD( ____-__ SrORIES and PI'oIeSSlUlli (udC). ------ NATURE Lic. or Reg. No. Dale PRESENT USE OF BUILDING FINAL APPROVAL 16-5-01 IIOn91.: OWNER-Bull DI:R DI'.l'I.ARAfION NO. FXISIINGBUIL 11NG5 v � ON LOT AND USE Q 1 hereby affirm that I am cYcnlpt frons the Controclor's License --- Law for the following reason (Section 7031.5. Bu,ines and Professions Code): NO.PARKING SPACES PROVIDED ❑ I, its owocr of the popcity, \\Ill do the ,,,Irl, and Ibr — ----- - ---- --------- structure is not Illlelldcd lir ollered 101 Sall' (Secl ioll 7044. PROPOSED USE OF BUILDING Business and Professions Code). r. L1,41 S'j I/, CGi/L2; GM tiL CONSTRUCTION LENDING AGENCY r, -[ hereby al'l'irnl that there is a Construc(ion lending agenC) for k 7 ikl�1 C RAL- the performance of life work for \\hick this permit IS ISSUed (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. ` ) Lender's Name _-__ -___ .- -- - APPLICANT IPril."JTJ TEL NO. X 1�Ly1�l�c 6a6 —D 91 i Lender's Address 1 cerlily [hal I have read this application and suite than the above information is correct. I agree to comply With all Counly PERMIT FEE p ordinances and State laws relating to building construction,an ��' d C j9 "l I hereby authorize representatives of this County to enter Upon ISSUANCE FEE the above-mentioned property for inspection purposes, 1 / TOTAL FEE SLE REVERSE FOR LXPLANATORY LANGUAGE _ I Y Ignature of Permittee Date