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HomeMy Public PortalAbout9537 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(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,L.ab. C.)` Policy No. Company FOR APPLICANT TO FILL IN BUILDING a.^ ADDRESS ❑'Certified copy is hereby furnished. ,. BUILDING' / �f T" LOCALITY ADDRESS. �7 E. 1"i) `"A 13 Certified copy is filed with the county building inspection p I NEAREST department. LocaLlTr TIP 'G,� CROSS ST: AREST - - DISTRIC NO. UP TYPE •.IP,lOC SED By Date Applicant '=CROSS ST. rALfAl R014C— . CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT' NO. BLOCK } COMPENSATION INSURANCE N — (CIRCLE)AY NO.'• -- (CIRCLE) STATE.M AJOR.SECOND LOCAL (Thisection ."need not be corn leted if the work involved NO. OF BLDGs. 0- s P TRACT. NOW ON LOT USE.ZONE SP CIALCONDITIONS o by the permit is for one hundred dollars ($100) or less.). E U USE: OF _' - - SIZE OF LOT � EXISTING BLDG. I certify that in'the performance of the work.for which this permit is issued, I shall not employ any person in any mannerOWNER e�yf_KDAnM(L Y14 o so as to become.subject to the Workers' Compensation Laws. AIL ®!�-) A / - -OCCUPANCY GROUP U LU ADDRESS /r 3 7 Ems. ' (M"T� T" DAA a. Date Applicant to TEL: (� T OCCUPANT LOAD Z NOTICE TO APPLICANT: If, after making this Certificate of clTv Gry No.. 6d1 1-77 Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or"this permit shall be TRAILER USE E] GEOLOGY INSPECTION ❑ N0 Spec. Know deemed revoked. h ❑ LICENSED CONTRACTORS DECLARATION occuPArvcY INSPECTION Panic Devices .I hereby affirm that I am licensed under provisions.of Chapter" SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of.Division 3 of the Busk-. n, s and Professions Code, and my license is kn full force and PARKING. fect. SPACES ' REQ'D O PROVIDED O cense Number Lic.Class LIMITED TIME USE Contractor Date DATE DAT E • . - FROM: TO: _ OI am exempt from the licensing requirements as I am a, licensed.architect or a-registered professional engineer SIZE OF NO. OF INSPECTOR'S acting-in' my professional capacity (Section 7054 .BU$- EXISTING BLDG. STORIES SIGNATURE . iness and Professions Code). 11 ,� _ L S0 FINAL APPROVAL I RESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER.DECLARATION ON LO O EXISTING BUILDINGS ._ OT AND USE I hereby affirm.that° I am exempt from the Contractor's f # I�e,��'L License 'Law for the-follbwing reason (Section 7031.5, Busi- ;0:040;-0:0 ness and Professions Code): No. PARKING 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).. ROPOSED;USE OF BUILDING fr%0�:ff& 514012. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this:peimit is issued-(Sec. 3097,Civ.C.). Lender's Name aRoaosen rrwx. occ. Lender's.Address PERMIT FEE .' I certify that I have read this application and state that thea above information is correct. I agree to comply with all County. Issuwrvce FEE ordinances-'and .State laws relating to.building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned property for insp ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . � nature of Per tee D WORKERS'CO?vIPENSATI ON DECLARATION :E 875 (11$4) MISCELLANEOUS APPLICATION �:E 87 1 hereby affirm that 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 FI LL IN ADDRESS L! 0 Certified copy is hereby furnished. 1BUILDING I� 7(- �// �ADDRESS X53 /T�,V/ LO CA LI?Y z ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department. Temple City CROSS S Date -Applicant NEAREST DIST' N GR P TYPE P CESSED BY ICR OSS ST. CONST CERTIFICATE OF EXEMPTION FROM WORKERS' L LEGAL i �� COMPENSATION INSURANCE f' DESCRIPTION (LOT NO. (BLOCK jMAP HIGHWAY { No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. __ (This section need not be completed if the work involved F'TRACT IWON LOT RUSE ZONE'SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) j USE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of tile, work for which this permit is issued. I shall net emplo}' any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. �O MAIL OCCUPANCYD I ,SZ�/1•S pp GROUP _ AD DR ESS _ Date Applicant NOTICE TO APPLICANT: If. after making tlli-- Certificate of $i=I-Y 1�il/G!% Go/q %0- OCCUPANT LOAD Exemption, you should become subject to the Workers' - Compensation provisions of the Labo- Code, you must, forth- APPLiC.4T10 1 FOR ! E XT HARDLNARE: with comply with such provisions or this permit shall be iTRAILER USE ', GEOLOGY INSPECTION � r deemed revoked. - u ) No Spec. Know!. i LICENSED CONTRACTORS DECLARATION IOCCUPANCY INSPEC-IONgg PBnIC D2V':ceS I _— 1 hereb- affir,l th,,- I an: licensed under provision sc Chante: 1 (LIS- – I I mlr 9 (con7enclwith Secn-m 7'`100) of Div;slor : t`` ti:e Bus $, =_A=ET ERM:T - .- E BELOW. t NO. OF EMTs nes; and Professions Cod., and r _ license is in tiL_`orcc.and f p p--- --J efleCt, f" '–•�I`�� V Pc.RKINC —�— �. : / I SPAC__ REO'D ' i YR 01'ID ED License iN'ui:.ter Lic. Class LIMITED TIME USE C.O nlraCivI— _ _ Da,c �1 •Y— IFaoM: Tc: I i 31',1 exenlpt IrOF1 -lie i1C::;1i27i= rdC:'L 'P.ii.;li< l license, ^..;v'.lii.e:;t OT_ a ..1 eC -.C.f$s L1 a _ _ NC. C� ({ INSPE OR's .i:1111_- toill'. Jr Ol eSSl Jl1a1 '":N�. 6�7G. cr O P.IE. i SIG UR mess and pIo;f.ssions Code',. USE OF BU11_DING FINAL .-PROVA:_ I �/ I or Ree. Nc'-- --- •gate--------- - ---- I 'L ��0i AW - - HOME- Di.Cl_-,P,A lICI NC, OF EXISTING BUILDINGS —� ON _OT AN- USE ^_ _— he7eb_\ atlt7iP. illat License Lal;' 1 07 ti,e fol1,,..inc , a5e .. ;Sv.._.v iC....:. Busi- 11eSS 3Ild ;`IOteSSiG 175 O:/c-!: i NO. PARKING ^� (SPACES PROVIDED E 1. ;ts owne of ale rro^ o, a i; ani' Il7.e ---- `J stj"1._rule ', ;7i)`. Il ltelij-'ii C%r it i'f ICd lily San`: ,S..:a16;7 .7C,1 Btl Sine Ss aIlii Prb;eSsiollS C,nd"I, I i, i-i.li µ1 'Lu',_ �� i� "'ROPOSCC' USE 76(OF BUILDING Yy CONSTRUCTION LL?:DINC; AGENCI L---- i hereby affirm that Cher: is :I consiractic•n, iei.din_ a_cnc,. I for the performance of the v:ork fr>_ which this penmi! issued (Sec. 3097.Cil. C.). E Lender's Name-- --- - -F OF MAX. OCC, Lender's.Address- ----___- PERMIT FEE 25.00 I certify that I have read this application and state that the above information is correct i.gree io coniniv with all County I ISGUA.NC.E FEE. ordinances and State laws gelatin- to buildinE: construction. - - and hereby authorize representatives of this Count' to enter TGTAL FEE: 25.0 upon the ab tee-mentioned prop Ifor inspection parpo�es. v 'E RE Et 5E FOR EXPL. N.-, TORY LANCi:AGf. ��'� Cio -rI1,P of PFrmittee' Date 1': WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insuie, 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 j I"7 ADDRESS �J I ❑ Certified copy is hereby furnished. BUILDING ADDRESS 5 C LOCALITY J ❑ Certified copy is filed with the county building inspection NEAREST -.q�,tn department. LOCALITY �_ CROSS ST. /2�%�lzv � Date Applicant AREST r� DISTRICT NO. G OUP TYPE IPRWSr=D BY It CROSS ST. m Q� ,�O� CON,S T." CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL t DESCRIPTION LOT NO. BLOCK } COMPENSATION INSURANCE ""P HIGHWAY - NO. � (CIRCLE) STATE MAJOR SECON OCAL � NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE tPECIAL CONDITIONS O by the permit is for one hundred .dollars ($100) or less.) USE A /� 0 /Y�'/ 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 4to<NER14 It-i Q so as to become subject-to the Workers' Compensation Laws. IL OCCUPANCY GROUP _ DLU DRESS W �l/ 0- Date ApplicantC/I .TEL. NOTICE TO APPLICANT: If, after making this Certificate of TY NO. OCCUPANT LOAD Exemption', you should become subject to the Workers' EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- APPLICATION FOR with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION NO Spec. Ktlowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I-hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) No. F Exlrs ❑ 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 PROVIDED License Number Lic.Class LIMITEDTIMEUSE 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 IGNATU E lness and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date AF-S S u r HOME OWNER-BUILDER DECLARATION NO. OF EX STING BUILDINGS 1 ON LOT AND USE 1 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 SPACES PROVIDED, ❑ I, as owner of the property, will do the work and the z 1 2 1,5 A structure is not intended or offered for sale (Section 7.044,Business and Professions Code). # o 0.0 © 8 8 to ROPOSED USE OF BUILDING O O O O O O O a CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 12 1 2`. 84 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 tCounty 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-m tionedro ertfor inspectio purposes. SEE REVERSE FOR EXPLANATORYZANGUAGE Signa ure of Permittee Date WORKERS'COMPENSATION DECLARATION 76 44 (2-80) MISCELLANEOUS A eO L I CAT I O '� 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. 38002 Lab.C.) Policy No. 'Company FOR APPLICANT TO FILL IN BUILDING ADDRESS' ❑ Certified copy is hereby furnished. ILDING9537 Las Tunas Drs LOCALITY DRESS 3 ❑ Certified copy is filed with the county building inspection NEAREST ' department. LocwLlry CROSS ST. Date Applicant NEAREST DISTRICT NO.- G OUP TYPE PRO SSED BY pp Primrose Dr. • CROSS ST. � r 7 CONST.-I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRC1.RCLE) STATE MAJOR SECOND-LOCAL ) NO. OF BLDGS. Q, (This sectionneed'`not be completed if the work InVOIVed TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS �q by the peimit is for one hundred dollars ($100) or less.) ilsE of C� - S ZE OF LOT EXISTING BLDG. I certify that'in the pe'rformance of,the work for which.this permit is issued, I shall not employ any person in any manner WNER .D� bei itn —Richard Lee Hill I- I— so as to become•subject.to the Workers' Compensation'Laws. AIL OCCUPANCY GROUP l U 1 DRES53,r W, I—� I z/��/�f Date Applicant _ 'TEL. NOTICE TO APPLICANT: If, after making this Certificate of C,TY ?('AP 4. �_ TOO No. � � � Z 3 , OCCUPANT LOAD ' � Exemptionyou 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 - ❑ ❑ No Spec. Knowl. ❑ 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) ❑ 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. td'Ifect. SPACES REO`D E= PROVIDED O License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as Lain 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 SIGNATURE iness and Professions Code). , ESENT USE OF BUILDING., Resturant FINAL APPROVAL -�s 7-90 � Lic.or Reg.No. Date Coffee Shop 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 f`7 0 0 0 0 SPACES PROVIDED ❑ I, as owner of the property, will do the woek and the structure is not intended. or offered for sale (Section o o a o 050 0' 7044, $USinCSS and Professions Code). ROPOSED USE OF BUILDING Coffee Shop CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for-the performance of the work for wliich 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 IS FEE ordinance and State laws relating to building construction; TOTAL. FEE and a authorize represe�ntaflyes oft is County to enter u n t e bove-me Toned pfoi inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S• n e of Permittee Date . WZ AIKERS'COMPENSATION DECLARATION 758 - M I SC E L LA N_EOU S APPLICATION CE 87575 (11 84) 1 ;ureaffirm that I have certificate of consent to self COUNTY OF LOS ANGELES .f UILDING AND SAFETY DIVISION insure,, o or a certificate of Workers' rs'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 C L//rC _ XX ADDRESS "rTc% ��/' ✓ � ) LOCALITY FICertified copy is filed with the county building inspection LOCALITY NEAREST department. Xx CROSS ST. Date Applicant NEAREST DISTRICT NO. TYPE P CESSED BY CROSS ST. /�,//"!1S� /(,/ �GJD C/ CONST.j CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1,2pX COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS. 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 ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. � �(,� O I certify that in the performance of the work for which this g _ permit is issued, I shall not employ any person in any manneXX OWNER of building ='p- as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP` AD DR ESSG� �� � ., U Date Applicant ,7�.y 1-11NOTICE TO APPLICANT: If, after making this Certi TEL OV��$ OCCUPANT LOAD O_ ficate of CITY No.rjG Exemption, you should become subject to the Workers' Mn 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 El 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 aR�t effect. "XX Name of business j+`./' ,fiJ1JR� �' PARKING REO'D D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a / FROM: TO: - licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. i0 X STORIES SIG URE iness and Professions Code). ,4411,J/ FINAL APPROVAL 3-rrt PRESENT USE OF BUILDING �c7' Lic.or Reg.No. Date J HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS t - ' ON LOT AND USE � .. -..._ ... .... a.,i. .. I hereby affirm that I am exempt from the Contractor's _ License Law for the following reason (Section 7031.5, Busi- ness usi 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). 4 /f _ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING _S7--11,CC14/-J7 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 PROPOSED MAX. OCC. Lender's Address 1 certify that I have read this application and state that the PERMIT FEE 25 . 00 above information is correct. 1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize repr sentatives of this County to enter TOTAL, FEE E25 .1 upon above-me tione prop for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE � XX ��� Signature of Permittee Date WORKERS' COMPENSATION DECLARATION )bM444 MISCELLANEOUS APPLICATION 20-0063DPWi2/90 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING.AND SAFETY DIVISION :insure,or a cert ifieate of.Wdrkers'Compensation Insurance,or Ll a certified coPy thereof (Sec. 3800, Lab.C.) { Policy:No Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ElCertified copy-is hereby:furnished. Ik 1 53 LAS TUNAS AR. LOCALITY ❑ Certified copy is filed with the county building inspection CITY ^ ZIP n department. T M P L E 0A `L y 7$0 NEAREST CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY n CONST. CERTIFICT\TE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT No COMPENSATION INSURANCE . MAP HIGHWAY l No. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section heed not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCELusE ZONE SPECIAL CONDITIONS Ck by the permit is for one hundred dollars ($100) or less.) sy*er€yUtmer TEL NO. s I.certify that in the performance.of the work for which this permit is issued. I shall not employ any person in any manner O T MUM NLT WORK EIV - b26 44U Wo a so as to become subject to the Workers' Compensation Laws. ADDRESS 11 35 E.RUSH ST 4'F5 OCCUPANCY GROUP { Date Applicant . CITY NOTICE TO APPLICANT: If; after making this Certificate 50 EL MoNjl zIPg173� OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of theLaborCode,you must forthwith EXIT HARDWARE: comply with such provisions OC this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ {" revoked. _ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION EX 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 Business game o uslness No.of EXITS and Professions Code,and my license is in full force and effect. PARKING• REO'D D PROVIDED O License Number Lic. Class CR L)M 8 S AN D C O F F E C SPACES i Contractor — Date LIMITED TIME USE i DATE DATE El am exem rt from the licensing requirements as I am a FROM: TO licensed architect or a registered professional engineer { acting in my professional capacity (Section 7051,Business EXISTING BLDG. STOR ES SZEOF INS GNATURE. and Professions Code). LIC, Or Reg. NO._ - Date PRESENT USE OF BUILDING FINAL APPROVAL 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, Business and { PIofessions Codi:.): NO.PARKING SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044,1 PROPOSED USE OF BUILDING Business ant Professions Code). 0-0FFa6 SHOV CONSTRUCTION LENDING AGENCY Ihereby 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. t` Lender's Name _ APPLICANT/PRINT) - TE N RANGSI U &PHAKDfLN ONIO.fg2 7ggg 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 State laws relating to building construction,and hereby au hor' representatives.of this County to enter upon ISSUANCE FEE the above- tic red pro erty for inspection purposes. I TOTAL FEE - = O� SEE REVERSE FOR EXPLANATORY LANGUAGE /11 natu e of Permittee Date