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Home My Public Portal About9529 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(11-84) M 8 SC fE L LA N E O U S 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 'fl a certified copy thereof(Sec. 3800,Lab.C.). BUILDING Policy No: Company FOR APPLICANT TO FILL IN ADDRESS ��/ ((( Certified copy is hereby furnished. Bu'L°'NG 2 T LOCALITY ADDRESS ® Certified copy is filed with the cou ty building inspection LOCALITY NEAREST deyartment h�1Yj. LQ (�, CROSS ST. jyJ - QSrQ Date — 9�Applicant r NEARESTI DISTRICT NO ff_ROUP TYPE SSED BY CROSS ST. . D CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCKMAP 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 EXISTING BLDG. d 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 ` s' so as to become subject to the Workers' Compensation Laws. MAIL O OCCUPANCY GROUP CD /J ADDRESS U Date Applicant w TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY � R No. �� S —e�SL 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 ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION ❑ Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PX IT ❑ (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 REq'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 Professions Code). f� PRESENT USE OF BUILDINGO I FINAL APPROVAL Lic.or Reg.No. Date Lp HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's i #ii E}!—I {tj=1 161" �; License Law for the following reason (Section 7031.5, Busi- '_' ness and Professions Code): NO. PARKING 5_ .. 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 A 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 aut} rite representatives of this County to enter TOTAL FEE upon thea , en ' ned erty spection purposes. _ _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee /ate �/ .,WORKERS'COMPENSATION DECLARATION CE 875 (11-84) pI SC E L LA N EO US APPLICATION I hereby affirm that I have a certificate of consent 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.). 1-2 Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. BUDRILDESINGS �/��Z Gi i�� & Su� ��' LOCALITY AD ElCertified copy is filed with the county building inspection 6, LOCALITY NEAREST department. 1„E CROSS ST. Date Applicant EAREST //r� (/� / Az DISTRICT NO. G��QQQ UP PE RO SSED BY CROSS ST. "1�,O(/(,/� /c,.� '`� 5�, / O Q �p� ONST. I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL vJ 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' BLDG.OF I certify that in the performance of the work for which this SIZE OF LOT permit is issued,I shall not employ any person in any manner D E E � so as to become subject to the Workers' Compensation Laws. AIL �OCCUPANCY•GR,OUPI o ADDRESS �rE '"i' - '• \ I.— Date Applicant TELLo NOTICE TO APPLICANT: If, after making this Certificate of ITY NO. _ `•.--OCCUPANT LOAD � 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 ❑ (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 D PROVIDED D SPACES 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 IN SPECTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). NT FINAL APPROVAL Q -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 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 0 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). 9 5 9 0.:0 A CONSTRUCTION LENDING AGENCY OPOSED USE OF BUILDING L nn # D D D o 8 8 1 hereby affirm that there is a construction lending agency D o D o D o o for the performance of the work for which this permit isI 110-86.( 0 i$6 issued(Sec. 3097,Civ.C.). ; 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 �upon he ove-mentioned property/for mspectio rposes. i�GY.� Ciru.2�. r (j fn SEE REVERSE FOR EXPLANATORY LANGUAGE , Signature of Permittee Date WOR:CERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION {� CE 875 LI I hereby affirm CE 875 (11 -84)that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,+ur a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FI LL IN BUILDING a `ate ADDRESS Certified copy is hereby furnished. AUILDING ��/f/2 LOCALITY FADDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST CCCiii department. CROSS ST. Date Applicant NEAREST DISTRICT NO. YOU TYPE CESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. ,D111.1 CONST LEGAL 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 EXISTING BLDG. > cz I certify that in the performance of the work for which this C3 permit is issued,I shall not employ any person in any manner OWNER C' so as to become subject to the Workers' Compensation Laws. MAIL /�/l — r r (� OCCUPANCY GROUP ® C:) ADDRES v `1 J ~ Date Applicant LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY S 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ 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 Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'D E� PROVIDED SPACES License Number Lia 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 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 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS N>ID FEE 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 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). j) CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING 2// r�' P&RC. 1 ' I hereby affirm that there is a construction lending agency e G.r 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 a d State laws relating to building construction, � and hereby a thorize representatives of this County to enter TOTAL FEED, upon t e abov -mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of lirmittee Date ` WORKERS'COMPENSATION DECLARATION 'E 8754(11 84) M ISCELLANEOUS APPLICATION 1,hereby affirm that 1 have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AtN1 D SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN ADDRESS �Sa��Z �v�c-�� Certified copy is hereby furnished. XX. ADDRESS 9529-, LAS TUNAS DR LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. 3tx TEMPLE CITY CA 91780 CROSS $T. Date Applicant NEARESTr - DCOT NO. UP CONST.r7/ PROCESSED BY CROSS $T. PRIMROSE VX/� IT PH CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY N _ (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 EXISTING BLDG. I certify that in the performance of the work for which this permit is issued, I sliall not employ any person in any mannXx OWNER o of building so as to become subject to the Workers' Compensation Laws. MAIL V OCCUPANCY GROUP ® C3 Date Applicant ADDRESS P.O.BOIL 267 U TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY SANTA ANA CA9270 NO- 7 14 973-13 16 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 E] 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 full force arix effect. Name of business , N/A ARKING PACES LL REQ'D PROVIDED I - I License Number Lie. Class __ J LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF FRDM. TO: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGN URE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date ll HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �e ON LOT AND USE 0�, 1 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 r••-n , -r:-; c; „ ❑ SPACES PROVIDED ULI`ly^I 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section I�Gy(1 _ AM 0=55 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING 1 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 FIRST AMERICAN TRUST COMPAN A MARY L. DISCHE CO—TRUSTEED OF DISTHE FA41LY TRUST PROPOSED MAX. OCC. Lender's Address T1 — L 1� PERMIT FEE I certify that I have read this application and state that the 25. 00 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-mentioned property for inspection purposes. - I SEE REVERSE FOR EXPLANATORY LANGUAGE XX xx �--,,r- 1 r NEWPORT BEACH, CA 92660 Signature of Permitte11 e Date i WORKERS' COMPENSATION DECLARATION 76M444 CE 875 (11-84) M ISCELLANEOUS APPLICATION i hereby affirm that l have a certificate of consent tself COUNTY ('F LOQ ANGELES BUILDING AND SAFETY DIVISION insure,-vr a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec. 3800.Lab.C.). _ Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ALIDRE55 Certified copy is hereby furnished. BUILDING ''��[(]] 1 c, t� (�[, T19 - ADDRESS ��/'t /2 1 � l ��'� JI - \�` ��l LOCALITY I Certified copy is filed with the county building inspection LOCALITY "�,�A.^ �� ] NEAREST department. K/VVV ('� ( p ceoss sr. Date Applicant NEAREST D I S TRICCC..��T NO. GROUP TYPE PR CESSED BY CROSS GA D� CONST.j/ I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION TLOT NO. BLOCK MwP HIGHWAY NO. OF BLOGS. (CIRCLE) STATE MAJOR SECOND LOCAL NO. (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 (SI00) 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 U so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ' AD ESS Date .applicant NOTICE TO APPLICANT: If, after making this Certificate ofrTRAILER NOL C - 777 OCCUPANT LOAD — Exemption, you should become subject to the WorkersAPPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth I with comply with such pf0�"IS10R$ Or Ch1S permit shall beE IJ GEOLOGY INSPECTION No Spec. Knowl. deemed revoked. - LICENSED CONTRACTORS DECLARATION UPANCY INSPECTIONPanic Devices I hereby affirm that I am licensed under provisions of ChapterSAFETY PERMIT (LIST ITEMS BELOW) ' 9 (commencine 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 REO'D PROVIDED SPACES License Number Lie. Class e_1 e—, LIMITED TIME USE SJ 9� z) Contractor Date DATE DATE L ❑ FROM: TO: ! I am exempt from -,he licensing requirements as I am a licensed architect or a registered professional engineer I SIZE OF NO. OF INSPECTOR'S acting in my professional CapaCtil" iseltlOn 7051, Bll$- EXISTING BLDG. STORIES SIGN TURE iness and Professions Code). FINAL APPROVAL +PRESENT USE OF BUILDING Lie.or Res. No. Data E ! HOME OWNER-BUILDER DECLARATION i NO. OF EXISTING BUILDINGS � t 1 ON LOT AND USE l �� I herebv affirm that I am exempt from the Contractor's G�G�lI e _. ... ; I License Law for the following reason iSection 7031.:. Busi- ` /�V ness and Professions Code): J NO. PARKING 'll SPACES PROVIDED 1, as owner of the property. will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). -__ - CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby" affirm that there is a construction lending agency/ L� /VNC G�Mn�e I for the performance of the work for which this permit is issued)Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's:\ddres$ I certify that I have Iead this application and state that the PERMIT FEE CC above information is correct. I agree to comply with all County I ISSUANCE FEE ordinances and State laws relating to building-construction. and herebv authorize representatives of this Countv to enter I TOTAL FEE QtJ i upon t e above-mento edrol}erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature •i)Permittee �atz ( � WORKLRS* COMI'liNSAI ION DIJ I-ARAHON *,4�1 I i I MISCELLANEOUS APPLICATION COUN'FY 01- I.OS ANGHTS _TY DIVISION I hereby al'I'irin (flat I have it ceitil'icale of con, ot h, sell WILDING AND SAu-rII - I insure.or a certificate of Workers' Conipcii.,,alion hismance. of ;I certified 1201))' (hereof (Sec. 3800. I'ah. Policy No. Collipally ez( FUl i APPLICAN 1 10 FILL IN I BUILDING BIJILDAb ADDRESS ADDRESS El Certified copy is herchy 1*1111liShed. X 952-f; Las Tunas Dr. LOCALITY ❑ NEAREST Certified copy is I'iled with the COtInh hiFildilig 111"I)ck-lioll CITY ZIP department. Temple Cit 91780 .CROSS ST. DZtte. Applicant SIZE OF LOT OF BLDGS.NOW ON LOT PROCESSED BY -- CERTIFICAJE OF I'XLMI`II0N FROM WORKI.RS BLOCK LOT No. COMPLNSAIION INSURAN(I' TRACT I 1 1, ICIRCLE) STATE MAJOR SECOND LOCAL (This section need ml be completed it' file %%oih ifi%(11%ed 'ASSESSOR MAP BOOK PAGE PARCEL . I- by the permil is for one hundred dollars IsI10011 of less.) USE ZONE SPECIAL CONDITIONS I certil'y that in the performance if' ilic %k,iik hii \kIii,11 thisOWNER 6W Lin Qian 1 '289-0425 ------- t permit is issued. I shall not employiiny person ill mIII.Ijil ly � wl so as to become SLIbjCCI to the W,jkcis ( oinpcii:,zili-)I I I.Ziws. ADnRESS OCCUPANCY GROUP 805 S. Chaple Ave. #E Date.- Applicant CITY Alhambra 791801 NOTICE TO APPLICANT; If*. after making (his ( ertil'icate OCCUPANT LOAD of Exemption. %Otl Should become SUbjeci I,) the Woikcrs' Compensation p.provisions of the Labor('ode.you must Iort 11willi APPLICATION FOR EXIT HARDWARE: i t comply with such provisions or this permit ,hall be deerned TRAILER USE E GEOLOGY INSPECTION No Spec.Knowl. Q revoked. OCCUPANCY INSPECTION!� Panic Devices ❑ LICENSED CONTRACTORS f)l--( LARAIR)N I hereby af'I'irni that I aril licensed Undcr provisiolls Ill ( liziptcl SAFETY PERMITO ILIST ITEMS BELOWP NO..OF 9(commencing with Section 7000)of'[)I\ision 3 of the BLISineSS F and Professions('ode.and my license is in I'LI11 I'Orcc and eilect. PARKING: E= License Number Lic. Class SPACES REQ'D PROVIDED Cont(aclor Idle LIMITED TIME USE DATE DATE El I ant exempt 1'rom the licensing I-cquilellicills its I an) it FROM: TO: licensed architect or if registered professional criLimecr acting1, IftISFICSS SIZE OF INSPECTOR'S in my prolessional capacil) (Section 705 SIGNATURE and I'r01eSSi0IIS COLIC). EXIS FIN(,BLDG. PRESENT USE OF BUILDING LIC. or Reg. No. Date FINAL APPROVAL IcIt HONE E OWNFR-1111ILDI-K DI:( LARAlION NO.OF C Xlu r ING BUILDINGS ON LOT AND USE I hereby al'I'mu that I ;fill cwiupt frons the Coitliacioi'., I W11111' Law lar the 101i'millf; reason (Scclioll IfllillesN and Professions Code): NO.PARKING ❑ Las owner of [lie piopeil\. \Nill do the ,"Irk :Int! dw SPACES PROVIDED— ROVIDED S11110111C is 1101 intended or ollciYd 101 sale (Scclloll /fill. PROPOSED USE OF BUILDING Business and I'rOI'eSSi0IIS ('ode). MAW CONSTRUCTION LENDING ,\(if*N( I hereby affirm Thal llicie is it consimction lcildIIII! I.,I the performance of the \\oik for Mlicli (Iris permit is i>Nticd (Sec. 3097, Civ. (.). PROPOSED MAX.OCC. Lender's Naine APPLICANT,Plil!J1 1 TEL NO. Lender's Address ADDRESS I certify that I have read this application and state dial tile I I above information is correct. I agree to comply will Iall C(4111tv PERMIT FEE ordinances and State laws Mating 10 htlilding C01ISMIC11011,and — hereby authorize representames of this County to cruel, 1111oll ISSUANCE FEE the above-mentioned property for inspection,purposes. TOTAL FEE 7 X SLF RFVLRSE FOR EXPLANATORY LANGUAGE Z Signature of Permittee Dole