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HomeMy Public PortalAbout9528 LIVE OAK AVE_Building__ WORKERS'COMPENSATION DECLARATION nsureborIT' h yaafEertif cane of Workers' Comtpensation ensuran e, APPLICATION. FOR BUILDING PERM I T ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING f� `+ ADDRESS U ElCertified copy is filed with the county building inspec- BUILDING L~r tion department. ADDRESS LISD-% u L) Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' N . OF BLDGS. NEAREST r -,COMPENSATION INSURANCE SIZE OF LOT X . N WON LOT CROSS SL (This section need not be•completed if the permit is for one ASSESSOR TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars($1,00)or. less.) TEL. /� L USE PONE MAP �) I certify'that in the.-performance of the work for which this OWNER �� _ NO. J' - 1 NO. (1 > permit is issued, I shall not employ any person in any manner (� l/ SPECIAL IL so,as to become subject To the Workers'Compensation Laws. ADDRESS"l� p CONDITIONS u CITY ��.+ ZIP ( OC Date Applicant O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP. TYPE FIRE PRO SSED BY Exemption, .you should become subject to the Workers' ENGINEER NO. CONST.`` ZONE W Compensation provisions of the Labor Code, you must forth- ADDRESS ��/ V 13 y with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIF CATION APT. C NDO. Z deemed revoked,. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.. DWELL. UNITS hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code, and my license is in full'force and'effect. CITY CLASS BK � PG Z7 VALIDATION SO. FT.1�- � NO. OF ` NO. OF CHECK License Number Lic.Class SIZE K;�� STORIES \ FAMILIES ONE t VALUATION Contractor Date DESCRIPTION OF WORK NEW D O $ 2 yo I am exempt under Sec. �J V , ALTER B.BP.C. for this reason REPAIR- $ USE OF Date: / DEMOL EXISTING BLDG. S Signature APPLICANTTEL. Cy FINAL PRINT) > `V • NO. t� �, OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's Licenseo Law for the following reason (Section 7031.5, Business and ADDRESS L�l)' Q'� \�-_ FINAL Pr fessioM Code): PRESENT BY BUILDING I, as owner of The property, or my employees with ADDRESS wages as their sole compensation,will do the work and , the structure is not intended or offered for sale(Section LOCALITY ; 1 7 4,9A 7044, Business and Professions Code). I I MOVING TEL. ElI, as owner of The property, am exclusively contracting CONTRACTOR A NO. # 0 0 0 o 0 1 with licensed contractors To construct the project (Sec- ADDRESS I ° 06&6 3 tion 7044,-Business and Professions Code). _ CONSTRUCTION LENDING AGENCY SETT BACKD YARD HWY TOTAPROP.SETBLINECK FROM WIDTH a"0 ° 6&6 3 v 1 hereby affirm that there is a construction lending agency.for FRONT 0327-8.5 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE ^ P.L. Lender's Name m LDMA Ref. # P.C. Fee$ - 'Permit Fee - -t 3 ' - Lender's Address certify that.) have read this application and state that.the Issuance Fee ! Or�O LDMA-P/C# / a above information is correct. I agree To comply with all County Investigation Fee ordinances and State laws relating to building construction, _ _ Total fee• X 1 -3 LDMA Perm. # U and hereby authorize representatives of this County to enter pon the above-mentioned property for inspection purposes. , i '— SEE REVERSE FOR EXPLANATORY LANGUAGE Si Lure of App ca r Age ate ,WORKERS' COMPENSATION DECLARATION nsurebo acertifiatteo Wokeve a ertCompensatonInsuraneificate of consent to lf APPLICATI®•N FOR BUILDING PERMIT ' or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company O f �`t BUILDING �,"/ ❑ Certified copy is hereby furnished. FOR APPLICANT TO'FILL IN ADDRESS �W /tle �/� /,' e ❑ Certified copy is filed with the county building inspec- BUILDINGC�AG+ /V G /, j, Vew uC CITY ADDRESS (i Z4 tion department. �/� _ Date Applicant '� /e. �I ZIP LOCALITY _` NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT /v NOW ON LOT o? CROSS ST. COMPENSATION INSURANCE / _q / ASSESSOR (This section need not be completed if the permit is for one TRACT / BLOCK LOT NO. Sm MAP BOOK PAGE (o PARCEL v ,� hundred dollars ($100) or less.) t /�/ TEL W-31"36 OWNER Yne /�'l� "ONO. pUSE ZONE MAP I certify that in the performance of the work for which this /, NO. permit is issued, I shall not employ an erson in an manner ADDRESS �f¢ 0GtK e*.1 SPECIAL } P P Y Y P Y '^V ��� � L � / CONDITIONS w so as to become subject to the Workers'Compensation Laws. O CITY 7ele ZIP Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O CX NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE U Exemption, you should become subject to the Workers' �j � w Compensation provisions of the Labor Code, you must forth- ADDRESS Jk /\ N with comply with such provisions or this permit shall beTEL STATISTICAL CLASS TION APT. CONDO. Z deemed revoked. CONTRACTOR � NO. _ LICENSED CONTRACTORS DECLARATION _/ LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS lib— NO. (commencing with Section 7000)of.Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE ElVALUATIJONN Contractor Date DESCRIPTIO OF WORK NEW E ElI am exempt under Sec. `WADD r• loop.❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. I ATZ DEMOL ❑ Signature APPLICANT TEL.. � FINAL OWNER-BUILDER DECLARATION (PRINT) DATE Z•.- 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL M Professions Code): PRESENT / d ��VP Yem, BY LIQ I, as owner of,theproperty, or m em to employees with BUILDING jj _a_ •, / Y P Y ADDRESS wages as Their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , 7044, Business and Professions Code.) MOVING TEL. ❑ ` I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors To construct the.project (Sec- tion 7044, Business and Professions Code.) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. j t•, _ . CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT -'';•�"�. the performance of the work for which this'permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # J - - P.C. Fee$ Permit Fee _ • ; I' Lender's Address 1 certify that I have read this application and state that the Issuance Fee � LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee. 8 ordinances Te laws relating to building construction, Total Fee LDMA Perm. # a and h y authori arepresenkatives of this.County to.enter up the ob en Toned property for inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE gnat a of A icant or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm that 1 have a cer ccate of consent to.Self APPLICATION FOR BUILDING. PERMIT C1 insure, or a certificate of Workers, omr ensation Insurance, or'a certified copy thereof (Sec`+,s800, Lab. C.) , ' _ - -,• COUNTY OF LOS ANGELES BUILDING.AND SAFE Y Policy No. Company BUILDING G ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN - ADDRESS ,5 � 0 ElCertified copy is filed with the county building inspec- BUILDING born department. ADDRESS Date Applicant. CITY' /P— L ZIP 1'(7 LOCALITY' CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST _ COMPENSATION INSURANCE SIZE OF LOT 3 O NOW ON LOT CROSS ST. . (This 'section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.,) TRACT BL CK LOT NO. MAP BOOK ' PAGE PARCEL TEL.OWNER USE ZONE MAP ,( I certify that in the performance of the work for which this �"A NO� �" � � NO. permit is issued, I shall not employ any person in any mariner SPECIAL so as to become subject to the-Wo ers'Compensation Laws. ADDRESS C>I%C CONDITIONS OQd Date f I Applicant. CITY $iA- �' zf- ZIP. PROC SSED BY NOTICE A PLICANTi If, after making this Ce ARCHITECT O TEL. DISTRICT GROUP TYPE FIRE ficate of � CONST. ZONE � Exemption, you should become subject to the Workers' ENGINEER NO. Compensation provisions of the Labor Code, you must forth- ADDRESS "'V ✓ EL with comply with such provisions or this permit shall be to deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. JCJNDO:- Z CONTRACTOR NO. yy ll LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that Iam licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK VALIDATION SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE f VALUATION .._ DESCRIPTION OF WORK —S NEW ❑ Contractor' Date ; / � ❑ El ADD I am exempt under Sec. ❑ , ;2221L 1_A ALTER B.BP.C. for this reason REPAIR ❑ $ # 0 0 0 0-'0 USE OF �£S1 ' Date: EXISTING BLDG. �P DEMO" ❑ �I o o 49.88 • Signature APPLICANT .TEL. FINAL OWNER-BUILDER DECLARATION PRINT) NO. DATE " �� x I hereby affirm that I am exempt from the Contractor's License o 0 0 4 q Law for the fol low:16g•reason (Section 7031.5, Business and ADDRESS FIN Profess' ns Code): PRESENT By 06,11 -8-5 BUILDING as owner of the property, or my employees with ADDRESS _ wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to'construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED YARD HWY TOTAL SETBACK FROM I T. CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH - I hereby affirm that there is a construction lending agency for FRONT the performance of the work for-which this permit is issued P.L. - (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name P.C. Fee$ Permit fee LDMA Ref. # - • — Lender's Address certify that.l have read this application and state that the - Issuance Fee PDA P/C•# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relatingto_building construction, '� . ti_V _ w 9. Total Fee q LDMq'Perm.'# 'l u and hereby authorize representatives of this County to enter Ithe above-m ntioned property for inspection purposes. o S� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A*licant or-Agent WORKERS' COMPENSATION DECLARATION- 7/- ( / � °✓ 1I hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING. FOR APPLICANT TO FILL IN ADDRESS C,S do- crJ Certified copy is filed with the county building inspec- BUILDING �f tion department. ADDRESS95 L LOCALITY NEAREST � Date Applicant CIT �' ZIP CROSS ST., CERTIFICATE OF EXEMPTION FROM WORKERS' 22^� NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT .JCS NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP NO. �V hundred dollars ($100) or less.) TRACT BLOCK LOT NO. TEL. �iJ SPECIAL CL ' I certify that in the performance of the work for which this OWNER "441 ,-ot NO. CONDITIONS O permit is issued, I shall not employ an person in any manner //�� DISTRICT, GROUP TYPE FIRE PRO SSED BY V ADDRESS J CONST. ZONE129 so as to become subject to the Wore 'Compe tion Laws. ,^ b (J ) ! O .1 4 Date_ -�pplicant �e CITY �l ZIP STATISTICAL CLASSIFICATION APT. CONDO. V ARCHITECT O TEL. �y q gg NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. Exemption, you should become subject to the Workers' CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP e with comply with such provisions or this permit shall be TEL."7i q deemed revoked. �^ gK. pG,lac 7 VALIDATION CONTRACTOR NO. Cry LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS N6.2 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY-OP.AAJG. CLASS SQ. FT. NO. OF NO. OF CHECK License Numb 3 �� Lic.Class SIZE Q STORIES FAMILIES ONE Coniracto Date �,14-" DESCRIPTION OF WORK 2 Ca Q NEW _ UL.v ADD I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer ALTER FINAL g acting in my professional capacity (Section 7051, ❑ DATE Business and Professions Code). USE OF REPAIR � EXISTING BLDG. r E DEMOL FINAL Lic.or Reg. No. _Date APPLICANT, TEL. By OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS A RJ'ti= ' f Professions Code): PRESENT �J ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. z 3 6 G,5 A 1, as owner of the property, am exclusively contracting CONTRACTOR NO. 0 0 0 0 0 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. 2 -,a I O, O O CONSTRUCTION LENDING AGENCY SET BACK YARD HWY.. PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT ad Q / l o.10 o']Q,Q 0 2 the performance of the work for which this permit is issued P.L. (dv (Sec. 3097, Civ. c:>. SIDE 0 [t 1 '4'—8.2 P.L. Lender's Name m Lender's Address P.C. Fee$ Permit Fee i w I certify that I have read this application and state that theIssuance Fee a above information is correct. I agree to comply with all County Investigation Fee 10 ordinar ces and State laws relating to building construction, Total Fee 7d andher by authorize representatives of this County to enter a u,po above- ntioned property for inspection purposes. m a ` -��j SEE REVERSE FOR EXPLANATORY LANGUAGE -Signature of Applicant or Agent Date ©s WORKERS'COMPENSATION DECLARATION hereby a cer that I haver certificate of consent to self � APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, d or a cEtified copy thereof ec. 3800, Lab. C.) /n COUNTY OF LOS ANGELES BUILDING AND SAFETY -Policy N2 ,2- 0�' ofnpany BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING /p tion department. ADDRESS ©meq LOCALITY NEAREST DatApplicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION OM WORKERS' O. F BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT O ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP �Q hundred dollars ($100)or less.) TRACT I BLOCK LOT NO. NO. % TEL. 1G — SPECIAL I certify that in the performance of the work for which this OWNER N 1 CONDITIONS 9L DISTRICT .GROUP TYPE FIRE �XPR;OC",SED BY permit is issued, I shall not employ any person in any manner r CONST. ZONE 0 so as to become subject to the Workers'Compensation Laws. ADDRESS _ /{ A�z A8 Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. � NOTICE TO APPLICANT: If; after making this Certificate of ARCHITECT OIC TEL. Exemption, you should become subject to the Workers' ENGINEER ( NO. CLASS NO. Q DWELL. UNITS W Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. _17L' �O BK. PG, VALIDATION CONTRACTOR �/ N d LICENSED CONTRACTORS DECLARATION11 LIC, ` I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES NO. & VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $C2) , SQ. FT NO.OF O.NOF CHECK License Number 32 Lic.Class SIZE STORIES FAMILIES ONE .7 AAt S&,& „ DESCRIPTION OF WORK NEW E] $ Contractor T to ❑ 1 am exempt under Sec. ADD l ALTER M FINAL e B.&P.C. for this reason [:] DATE REPAIR USE OF F Date: F',O DEMOL [:]EXISTING BLDG. APPLICANT ,., TEL. ..��((-y1 ` 7 2 7.b A Signature PRINT �' N OWNER-BUILDER DECLARATION , # 0,0 0 0 0 1 hereby affirm that I am exempt from the Contractor's License s+� ` / Law for the following reason (Section 7031.5, Business and ADDRESSOwZ/1 LL V L � j Professions Code): PRESENT ;I a 059,25/°' ❑ BUILDING r 1, as owner of the property, omy employees with ADDRESS z o 0 0 5 9.2 5 5 wages as their sole compensation,will do the work and sY ' the structure is not intended or offered for sale(Section LOCALITY /� (� 18-87 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH pill. " I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. ec. iv. C.). SIDE P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee V > 0 I rtify that I ve.read this application and'state that the Issuance Fee abo ation is correct. I agree to comply with,all County Investigation Fee $ ordina ces and State laws relating to building construction, Total Fee �G 2 u and h eby authori r sentat' es of this County To enter upon a above- t' pro ty for inspection purposes. f1L�= SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur nt Age Date ®_ WORKERS' COMPENSATION DECLARATION .4ar�bq Affirm that I have a certificate of consent to Self APPLICATION FOR BUILDING PERMIT !insure, ox a certificate of:Workers Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING El Certified Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS �.� ❑ Certified copy is filed with the county building inspec- BUILDING J �1K �N — tion department. ADDRESS ; CITY ►rt' ZIP �7 LOCALITY k Date Applicant NO. OF BLDGS. /J CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT X 12,0 =� NOW ON LOT 2 NEAREST CROSS SL COMPENSATION INSURANCE ASSESSOR p�j (This section need not be completed if the permit is far one TRACT BLOCK I LOT NO. �` MAP BOOK AGE PARCEL/� hundred dollars ($100) or less.) L' �f 2�^ f OWNER �1qq����Q� - rY G* TSO, �I3Cv USE ZONE O. (® I certify that in the performance of the work for which this ?vK� I �� `� / SPECIAL permit is issued, I shall not employ any person in any manner ADDRESSVL CONDITIONS so as to become subject To the Workers'Compensation Laws. In^ r CLO CITY 'Y 1�r ZIP U Date Applicant ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE_ PROCESSED BY CONST. ZQtyE � Exemption, you.should become subject to the Workers' (j , / U Compensation provisions of the Labor Code, you must forth- ADDRESS. �(J '-3 (� � with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. �. Z ;{; n'r deemed revoked. CONTRACTOR ' NO. CLASS NO442� DWELL. UNITS } i , LICENSED CONTRACTORS DECLARATION . - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO- (commencing with Section 7000)of Division.3 of the Business LIC. SEWER MAP e.E.9..,. � m Ya and Professions Code,and my license is in full force and effect. CITY CLASS BK �/ALIDATION SQ. FT.. NO. OF NO. OF a CHHE EK t:' License Number Lic. Class SIZE n Z STORIES f FAMILIES 1 VALUATION s;-�( ^{tjP Contractor Date DESCRIPTION OF W✓O�RK� D NEW ❑ $��/ G�aQ ❑I am exempt under Sec. (+�tLt= �� � j ADD p. \� t yt c ALTER ❑ ► 9 :._°srl S_ii i(- _. . .. B.&P.C. for this reason u Cha+AP- - REPAIR ut/ $ R ❑ USE OFt�'t1t rat€ Date: EXISTING BLDG. jdha DEMOL APPLICANT (PRINT) (_Ikod TEL.. �sm� ''-tM r Signature � SDNOC(� W 377E FINAL OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License _ Law for the following ADDRESS reason (Section 7031.5, Business and FINAL Profe ns Code): PRESENT By _- BUILDING U JF �� A� I, as owner of the property, or my employees with ADDRESS ` wages as their sole compensation,will do the work and (� n /�� �}`ry t tr1 LOCALITY T!Pl Ci (J1 llrr / / the structure is not intended or offered for sale(Section S 7044, Business and Professions Code.) MOVING TEL. , ❑ I, as owner of the CONTRACTOR NO.property, am exclusively contracting � �' . with licensed contractors to construct the project (Sec- ADDRESS • . ,...� tion 7044, Business and Professions Code. --- I. - ''''`a i€I` ED CONSTRUCTION LENDING AGENCY SETT REQBACK YARD HWY TOTAPROPLINEFROM WIDTH I hereby affirm that there is a construction lending agency for FRONT ` 'the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE. P.L. Lender's Name LDMA Ref. # P.C. Fee$ Permit Fee /Q i Lender's Address , o I certify that I have read this application and state that the Issuance Fee 7.5 LDMA P/C# S above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee a and hereby authorize representatives of this County to enter u e a ve-merxioned property for inspection purposes. Q g / nSEE REVERSE FOR EXPLANATORY LANGUAGE at. of Applicant or Agent Date