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Home My Public Portal About9502 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 75(11-84) CE 875 MISCELLANEOUS APPLICATION CE 8 I hereby.affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'fl insure,ier a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). .42 PolicyNo.—Company BUILDING P Y FOR APPLICANT TO FILL IN ADDRESS �(iz Certified copy is hereby furnished. uILDING �_? V LOCALITY ADDRESS Certified copy is filed-with the county building inspection cALITY C NEAREST department. G rr1..g/1_ 4 ZASTa,lu CROSS ST. Date Applicant NEAREST DISTRICT NO. GRTYPE CESSED BY CROSS ST. �{ �J ,QOUP _ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �V 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 SIZE OF LOT 2 0O� EXISTING BLDG. G(� I certify that in the performance of the work for which this �! V C:) permit is issued, I shall not employ any person in any manner OWNER V'fl n p ri n y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP —� o ADDRESS 8 Date Applicant L TEL. / OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CIT NO. 1 � `i-6� _ N Exemption, you should become subject to the Workers' r APPLICATION FOR EXIT HARDWARE: z Compensation provisions of the Labor Code, you must forth G° with comply with such provisions Or this permit shall be TRAILER USEGI GEOLOGY INSPECTION Eldeemed revoked. ❑ ❑ 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 o effect. Oi- 1 p PARKING REQ D PROVIDED SPACES License Number Lie. Class UaLIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF1� NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 3QV� STORIES ` SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING �-��` 0`\.� �f Lic.or Reg.No. Date i 21 FEE HOME OWNER-BUILDER DECLARATION NO. OF EXISTING B LDI Gs �+ -� 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- a 'v` S aE—'s,?; ;_y ;';_:``;s ness and Professions Code): NO. PARKING ❑ 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 i ix Sale P q for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. C L c) Q� U . t cp_ 7} 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 r ting to building construction, GU and hereb authorize repre nt atives of this County to enter TOTAL FEELg up nth bove-mentioneroperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICA 9 I®N 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. UILDING 9502 LOCALITY !ADDRESS 1%8GXLasTunas Dr All- �i- ❑ Certified copy is filed with the county building inspection NEAREST LoTemple Clty department. CROSS ST. Date Applicant EAREST Claverly DISTRICT NO. GRO TYPE RO CESSED BY CROSS ST. �> >' CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL b COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP rvo. (CIRCLE) STATE MAJOR SECOND LOCAL d NO. OF BLDG$. (This section need not be completed if the work involvedTRACT NOW ON LOT USE ZONE S ECTAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) U 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 vNArt MC CO V OCCUPANCY GROUP so as to become subject to-the Workers' Compensation Laws. IL ADDRESS 5229 Arde'nek Temple City. -•-� a Date Applicant to Temple City TEL. NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. 286-16 OCCUPANT LOAD Exemption, you should' become subject to the Workers' 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 C ❑ ❑ No spec. Knowl. ❑ deemed revoked. Panic DOVIC@S ❑ ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT i (LIST ITEMS BELOW) NO. OF EXITS ❑ 9'(W`mmencing with Section 7000) of Division 3 of the Busi- nen 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 SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, 'BUS= EXISTING BLDG. STORIES 'SIGNATURE IneSS and PlOfeSStOnS COde). ESENT USE OF BUILDING . FINAL APPROVAL �'►.•'r.�. =a•�,f`°- = - Lic.or Reg.No. Date ^ ^ g � — HOME OWNER-BUILDER DECLARATION No. of EXISTING BUILDINGS # 0 O D o ON LOT AND USE 0;0 O O O O O G I hereby affirm that, I am exempt from the Contractor's , i , - License Law for the following reason (Section 7031.5, Busi- 0 2 7—8 4 ness and Professions Code): NO. PARKING SPACES PROVIDED - ❑ I, as owner of the property, will do' the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). Auto Parts a I s • OPOSED USE OF BUILDING , 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 correct.I agree to comply with all County IssugNce Fee ordinances and State laws relating to building construction, TOTAL FEE ®V �' and hereby authorize representatives J ,dof this C unty to enter V /upn the above-mentio d property for insp tion purposes. SEE REVERSE FOR EXPLANATOR ANGUAC$P n Signature of Permittee at S'COMPENSATION DECLARATION 4 CE 875(11-84) MISCELLANEOUS APPLICATION CE 87 I hereby affix.;.-4hat I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING r _ ADDRESS E Certified copy is hereby furnished. BUILDING ADDRESS 0 Certified copy is filed with the county building inspection LOCALITY INAResr department. ' p C' L6 C( sr. Date Applicant NEAREST I _ �` ISTRICT NO. GROUP CONS O ES5EOBY CROSS ST. �/!v CERTIFICATE OF EXEMPTION FROM WORKERS' LEGALCOMPENSATION INSURANCE DESCRIPTION LOTND. BLOCK PSTATE MAJOR SECOND LOCAL NO. OF BLDGS.(This section need not be completed if the work involved TRACT NOW ON LOT d E ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF EXISTING BLDG.�(� I certify that in the performance of the work for which this SIZE OF LOT 11vo o permit is issued, I shall not employ any person in any manner OWNER o as to become subject to the Workers' Compensation Laws. QCCU ,--.ROUP. ` MAIL � P. NCY,G .ti Date Applicant AD RES. �l A/, v L(U `�ti;�,\�. '.'*` � a y.- TEL. W NOTICE TO APPLICANT: If, after making this Certificate of CITY (, � NO. �j--7/ � OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be deemed revoked. TRAILER USE ❑ GEOLOGY INSPECTION No Spec. Know]. 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 REO'D D PROVIDED 1� License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE F1I am exempt from the licensing requirements as I am a FROM: To: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 3 �,�.. STORIES SIG ATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING � 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 r- c-- License Law for the following reason (Section 7031.5, Busi- ness. usi- - `r_i -I s ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED t' structure is not intended or offered for sale (Section •` i L- .8.3 50 7044,Business and Professions Code). 1; 50` CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING (-_HAINS_E a F hE I hereby affirm that there is a construction lending agency I for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name 4 9 PROPOSED MAX, OCC. L� ( 3 .�* �a'i� Lender's Address - s Y:i `•'a.J-S I certify that I have read this application and state that the PERMIT FEE 70 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-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WOR M6ERTCOMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION 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. 06U ILD ING 2 Q� LOCALITY J A DRESS (�( FCertified copy is filed with the county building inspectionLo uTY 1 NEAREST department. l�'�?' 1 (/_ �/p CROSS ST. Date Applicant N6EAREST /i a �,�� !� DISTRICT NQQ. G O TYPE CESSED B CROSS ST. C.- J O (� 7 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL U (— COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAOR SECOND LOC 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 ($100) or less.) usE S of E OF LOT EXISTING BLDG. I certify that in the performance of the work for which this 1 C::)permit is issued, I shall not employ any person in any manner 1IW OWNER so as to become subject to the Workers' Compensation Laws. //`i— '�/I A/ /jJ OCCUPANCY GROUP ADR ESS 365 1/V ` 5, q�/` XUl. ( O Date Applicant L` NOTICE TO APPLICANT: If, after making this Certificate of CITY CGtdrN.�. i OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with Such provisions or this permit shall be TRAILER USE 0 GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter S FETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS El ness and Professions Code, and my license is in full force and effect. OU PARKING REO'D E� PROVIDED License Number SPACES Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). FINAL APPROVAL Ilk INO PRESENT USE OF BUILDING Lic.or or Reg.No. Date a F"EE HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's �� !` � O�'�9/°$ License Law for the following reason (Section 7031.5, Busi- v ness and Professions Code): NO. PARKING ❑ 1, as owner of the property, will do the work and the SPACES PROVIDED ai,jca AM 8104 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY % PROPOSED USE OF BUILDING C� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is n yrs issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address D /u 3o U ZEE I I certify that I have read this application and state that the PERMIT FEE U above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, D anA hereby a horize e atives of this County to enter TOTAL, FEE d on the ab en ' d per or insp ti pur ses. \ 2 9 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o e ittee Date tVORI:I':Rs'ConlPl•:NSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION CE 875 (1 1-84) 19ure. o a cert that 1 have a certificate of consent nc self COUNTY OF LOS ANGELES - PUILD-iNG AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No._ pany FOR APPLICANT TO FILL IN BUILDING ADDRESS _CgmC. Certified copy is hereby furnished. /_GJ BUILDING a Zu D LOCALITY XX ADDRESS ,�OZ. L Certified copy is filed with the county building inspection LOCALITY - NEAREST department. XX �em le CIT f17910 CRO SS sr. Date_— __Applicant NEARESTVF DISTRICT NO. GROUP TYP E P O ESSED BY .. /./ � �1 CI{R"I 11 1('A'Tf:OE EXEMPTION FROM WORKERS' LEGAL CROSS ST. CLO a J� CONST. COMPENSATION INSURANCE DESCRIPT to,, LOT NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL . (!Ills 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 ($►00) or less.) usI' OF SIZE OF LOT EXISTING BLDG, p I certify that in the performance of the work for which this ::�:l�� 1 D_ permit is issued, I shall not employ any person in any manneRX OWNER of buildingCt)an r IVue I uI as to become subject to the !Yorkers' Compensation Laws. MAIL �/n OCCUPANCY GROUP ADDRESS L-. Vrn/l[I �pl U Date - --- - -. Applicant---- --- - LLI TfiL.1 p NO•IICI: TOAPPLICANT: If, after making this Certificate of clrY�J `- No.v�p 33�j-p Z OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth with comply with such provisions or tills permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. ❑ El OCCUPANCY INSPECTION ❑ Panic Devices 1.1('I::NSb:1('ON•IRACI OKS DECLARATION _ I hereby affirm that I ani licensed under provisions of Chapter SAFETY PERMIT ❑ ,LIST ITEMS BELOW' 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force anix Name of business PARKING effect. `- , SPACES REO•D D PROVIDED License Number"____- -"_- Lic. Class._ 05CAR W e r1$G C' LIMITED TIME USE Date_ __ DATE DATE El I ant exempt front the licensing requirements as I am a FROM: TO: d_4 _ ' licensed architect or a registered professional engineer srzE of NO. OF INSPE CTOR�S acting m Illy professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). _ FINAL APPROVAL II.._.....-..-.-. PRESENT USE OF BUILDING Lic.or Reg. N � ._. ..__._ Date ...///I• 1,i 50-54 HOME OWNER-IMILDER DECLARATION NO. OF EXISTING BUILDINGS n ON LOT AND USE I hereby affirm that 1 ani exempt from the Contractor's J�11 License Law for the following reason (Section 7031.5• Busi �ifl _n Hess and Professions(.'oole): NO. PARKING K1, as owner of the property, will do the work and the SPACES PROVIDED structure, is not intended or offered for sale (Section 7044,13usiness 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,('iv.C.). Lender's _-__- PROPOSED MAX-OCC. Lender's Address.-- ----------_--- -- — I certify that I have read this application : PERMIT FEE nxi state that the ' 00 above information is correct. I agrce 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 th above-mentioned 11 for inspection purposes. ` SEE REVERSE FOR EXPLANATORY LANGUAGE ' XX./ I XX } \PORKERS'CO LiPENSATI ON DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ( f insure, or a certificate ofWorkers'Compensation Insurance,or � a certified copy thereof(Sec. 3800,Lab. C.). U Policy No. Company FOR APPLICANT TO FILL IN ADDRESS � !//S �/✓ � Certified copy is hereby furnished. X BUILDING ADDRESS �'j .r�tJ - 7 u LOCALIT Certified copy is filed\vith the county building inspzction NEAREST LOCALITY department. Temple City CROSS ST. Date Applicant NEAREST DISTR NO GR P TYP OCESSED BY CROSS GA a C� CERTIFICATE OF EXEMPTION FROM PORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION 7L.T NO. IHLOCK 1..P HIGHWAY STATE MAJOR SECOND LOCAL rvo' (CIRCLE) NO. OF BLDGS. (This section need not be completed It the work involved TRACT NOW ON LOT USE ZONE!SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) usE of SIZE OF LOT EXISTING BLDG. �- I certify that in the performance of the work for-which this permit is issued, I shall not employ any person in any manner OWNER -� Jso as to become subject to the',Porkers' Compensation Laws. MAIL � ,.e OCCUPANCY GROUP = - ADDRESS Date .Applicant_ - - NOTICE TO APPLICANT: If, after making this Ce.;nificate of c!TY �� No. ca� OCCUPANT LOAD - Esemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be deemed revoked. TRAILER usE I j GEOLOGY INSPECTION i 1 No Spec. Knowl. L_J OCCUPANCY INSPECTION Panic Devices ❑ LICENSED CONTRACTORS DECLARATION — 1 herebv affirm that 1 am licensed under provisions of Chapter SAFETY PERMI' �� 1ST ITEM- 9 (commencinz \witit Section 1000) of Division 3 of the Busi- — 1` LO V.') NO. OF EXITS ness and Professions Code, and mt' license is it-, full force and L' - I- PA RKINC- rect. SPACES REO'D �� PROVIDED License Number Lis Class LIMITED TIME USE Contractor DateATE— pDATE To: 17lam esentnt from the licensing requ ernents a> 1 a1 a 'J licensed architect or ?. rcg -istere *;roiessiottal engineer S=_ of r j NO. OF INSPECTOR S 7- aCLll7�_ In nil' prOfe$$10 nal Cal);.::I i"�.�.,Se:C101t ,tl•-„'1. BL:�- I EY;ISTING BLDG. i STORIES SIGNATURE iness and Professions Code). FINAL �.??RJVAL _� �QO I PR_-ENT USE OF BUILDING l� Li-.or Res.No. _— Dale _ _ �� 1 &�r_ U a HOME OWNER-BUILDER DEC'l—AkATION NO. OF EXISTING BUILDINGS ON LOT AND USE ,•I IV �I/ 1 hereby affirm that 1 in7 ex-,mint iron, tn-2 con-actors n�jVY License !aw for the follow-ing reason (_Section 1031.5. Busi- nes$ and Professions Code). NO.CES PARKING PROVIDED �� \ [, as owner of the prone.?), will do tit: \coni; and the SPA structure is not intended or offered -,'Or sale (Section 7044.Business and Professions Code). A PROPOSED USE OF BUILDING re CONSTRUCTION LENDING AGENCY _ t:, 1 hereby affirm that there is : construction. lending_ agency \ '� !�•' u ' for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). :! Lender's Name_ PROPOSED MAX. OCC. i,••., �, � Lender's.address PERMIT FEE 25.00 �+F? I certify that 1 have read this application and state that the s 1 above information is correct. I agree to comnly with all County I ISSUANCE FEE Ty orainances and State laws relating to building construction. and hereby authorize representatives of this County to enter tTOTAL FEE 25.00 upon the above-mentioned property for inspection purposes. 'r!' SEE.REVERSE FOREXPLANATORY L^\GUAGE 1-2— v _ _ aao I s Signature of Permit-Lee Date