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Home My Public Portal About10241 LOWER AZUSA RD_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 675 I heret�y affirm that I have a certificate of consent to self insure', r a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certifiediypy thereof(Sec. 3800/,xLab.C.). Policy NO. Company!/IYW\ A �NS FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING i � 1 QWE49— � SA CP ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITYNEAREST department. i tY�P IF C iTXr 1 -1 f� CROSS ST. Date /0--21- 90 Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. �� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD6S. (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. y I certify that in the performance of the work for which this o_ permit is issued, I shall not employ any person in any manner OWNER 6�` S A ( A.Q.I� IJ y so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP L�� MAIL Date Applicant ADDRESS U.t �''�TN �� 4!<QCt�/V4� Ario TS. I� r3 NOTICE TO APPLICANT: If, after making this Certificate of clrY N� j S TN L' �� t) OCCUPANT LOAD C/5 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. Panic Devices El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter a 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 N t1 y� effect. ti� "� y�\/� VJ!5 PARKINGREOD PROVIDED r� �n SPACES I 1 License Number Lie. Class Z ft\J �eN AFc9(D 1� LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect OI a registered professional engineer SIZE OF NO. OF INSPECTOR`S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness t Reg. d Professions Code). ms-T �t7 O� FINAL APPROVAL 13-xil 1�foD- HOME PRESENT USE OF BUILDINGV.Lic.or Reg.No. Date OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS —� 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 �_ �� El 1, as owner of the property, will do the work and the SPACES PROVIDED °?1U � ._.; ' structure is not intended or offered for sale (Section 7044,Business and Professions Code). �( n I CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING*- ST P;0 0� I hereby affirm that there is a construction lending agency (Z// for the performance of the wor for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 5 - 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 relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the e- ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0 -1-- j j .,r.. lz /0-3-F Signature of Permitt e Date u_,nuu> RS'COMPENSATION DECLARATION - 875 (11-84) CE 875 I CE M ISCELLANEOUS APPLICATION I hereby agiethat I Have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or certificate of Workers'Compensation Insurance, e,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 �.G�S ADDRESS LOCALITY Certified copy is filed with the county building inspection ocALIrY NEAREST department. (� cRoss sT. 1-- Date ApplicantAR EST DISTRICT NO. GROUP TYPE PROCESSED By • CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCKM al,3HIGHWAY NO. F BLDGS. NO.144- (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.) US of SIZE OF LOT EXISTING BLDG. r }. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner 115SNER �� g so as to become subject to the Workers' Compensation.Laws. IL P OCCUPANCY GROUP'OA ADDRESS z Date Applicant L~C-:),r NOTICE TO APPLICANT: If, after making this Certificate of ., ED 1 8�o�wj� OCCUPANT LOAD 0- Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- wlth 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 PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- A NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING SPACES REQ'D D PROVIDED D OF License Number Lie. Class =�5 C 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 OF NO. OF INSPE TOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE inessandProfessionsCode). FINAL APPROVAL RESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS NCI 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. PARKING5/22/89 0 I, as owner of the property, will do the work and the SPACES PROVIDED 3456 1 PM 2;43 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 isU issued(Sec. 3097,Civ.C.). U Lender's Name X 4 A K) /� PROPPED MAX. OCC. Lender's Address O PERMIT FEE I certify that I have read t 's applicati and state that the above information is correct. 'Ig e to co ply with all County ISSUANCE FEE ordinances and State laws re ti to bu ding construction, 0 and hereby authorize relp'tesent ti es of tl1 County to enter TOTAL FEE Upon the ab ve-mentione pe orirr5p ' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE of Permittee Date WORKERS' COMPENSATION DECLARATION /6M444 WIISCELLAIvltvu� f�t't''LIL.HI 1VIV 20-0063DPW 12/90 - 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 BUILDING ADDRESS 2 AODREsS �2(.�I tow v ❑ Certified copy is hereby furnished. Ip l zu E- l P0 LOCALITF Certified copy is filed with the county building inspection CITY ZIP NE 0 C department. CI r7 CR SST. Date Applicant _ SIZE OF LOT NO.OF BLDGS.NOW ON LOT DIST$IC'f O. GROUP TYPE ESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' 1 L of SQ �� . �f CONST. TRACT BLOCK LOT NO ``", �� rVL �-r ,c ktt' COMPENSATION INSURANCE MAP HIGHWAY NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved 9 ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) H I certify that in the performance of �eprort workfor which this` OWNER TEL NO.permit is. issued,I shall not emp in any manner Property � 6�' S�2-�� so as to'become subject to s' Compensation Laws.)ADDRESS D a� OCCUPANCY GROUP DateApplicant ICITY i'NOT TO If, afte making this Certificate OCCUPANT LOAD of Exemption; you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code,you must forthwith EX:T HARDWARE: i comply with such 'provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ NO Spec.KIIOWI. ❑ `revoked. OCCUPANCY INSPECTION LK Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS and Professions Code,and my license is in full force and effect. e PARKING• REQ'D PROVIDED I 1 .License Number Lic. Class Ir sPAces LJ Contractor Date LIMITED TIME USE ' DATE DATE I am exempt from the licensing requirements as I am a 1 FROM: TO: licensed architect or a registered professional engineer actin in m professional capacity(Section 7051, Business SIZE OF NO.OF INSPECTOR'S g y p p y EXISTING BLDG. ( (o�O S0- r STORIES Z SIGN URE and Professions Code). Lica or Reg. No. Date _ PRESENT USE OF BUILDING m� '� � Foo FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS L/�P) 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 -I£ofessions 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 7044X PROPOSED USE OF BUILDING (�N r 3T pv'>z> Business and Professions Code). 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 (See. 3097, Civ.Q. PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINr) TEL NO. it 1 v t_ r N�0 r Lender's Address ADDRESS ; :. r*_': I certify that I have read this application and state that the PD Z'�( lnW F_R. � -u t above information is correct. I agree to comply y with all Count PERMIT FEE I-••`i ordinance d tate1 ws relating to building construction,and '= hereby au o ' rep sentatives of this County to enter upon I ISSUANCE FEE «� the ab I t ne property for inspection purposes. ti i TOTAL FEE -r.1 X SEE REVERSE FOR EXPLANATORY LANGUAGE Signa r of Permittee Date a.l i WORKERS'COMPENSATION DECLARATION ?E sa 5a ;t 1-8MISte.�[ P r L 1 C A T I C l�i 1 herebv affirm chat 1 have a certificate of consent too self BUILDING r rt _ insure, or a c:rti ionto o*Workers'Compensation Insurance.or t OUNT Y OF LOS ANGELES AND SAFLE t DIVISIO N a certified copy thereof(Sec. 3800, Lab.C.I. Policy I\o._ _Com Iny _ a -00RE SS ' Pi FOR APPLICANT TO PILL ;Pi .ADDRESS �e �I Certifir.d copy is herebv furnished. BUILDING gj ADDRESS y / V(/L�C.�/�� fiC.e 0 Certified copy is filed with the county building inspection DEAREST J Temple City n deparUnent. q 7 f/ I _Ross =T. Date Applicant _ )NEAREST I DIS TRI C I GRO"J'P ITYPE P _F-SS ED a 1 CROSS ST. --3 ��(' I /'} Ij CONS".// ' !J �/ CERTIFICATE OF EXEMPTION FROM I�ORitERS'` j LEGAL � ±- I COMPENSATION INSURANTE c DESGRSPTIom LOT NO. i3LOC A HIGHWAY - n, (CIRCLE) E MAJOR :- -ONO LOCAL j"T... NC. OF =L7S. (This Section need not be completed if the work involved TRACT I NOW ON L f O"> E -0NEI SP aL CONDITION- by the permit is for one hundred dollars (5100) or less.} SIZE: o= LOT Exie I certify that in the performance of the work for which theP. LY - _- permit is issued. I shall net employ any person in any manner I OWNER so as to become subject to the Workers' Compensation Laws. ? OCCUPANCY GRC ADDRE UP MAIL SS — —! Date Applicant ` - NOTICE. TO APPLICANT: If, after makims this Certificate o $j 1 =G UP.':i 1T !CAu Exemption. you should become =ubiect .o the 1Vorkers Compensation provisions o the Labor Code, you must torn- L1 L. O ,PPLiCATIGN =GR I =YIT i�Ai�4'idF.c: with comply with such provisions or [his permit shall- be -RASLERaEOLOGr ..._. -._ ._. - No Spec. K^,et,di. deemed revoked. _ _ ' OCCJPANCY INSPECTION ' FaliiC Devices L"10ENSED CONTRACTORS DECLARATION ) _ I herebv affirm that ` am licensed tender pro%isions of Chapter SAFETY PERMIT , - ,_ Z30 7) 9 icominencina with Section 7000) of Division o; the sus: - o Ex,Ts ness and P::.i'ess.ons roue ,id my license is in rull orcz and 1 =ARKi!JG QI�QC�. REO'D ?ROV IG License Number_—.-- Lic. Class t ) — —_---- LIMITED 't YE USE n Crnractot--- --. Date-- _ATE rE i 1 LJ i am e.xzmpt from rite licensing recl:Lements as I am a —� .r 4 licensed aichntecT or a regisierec protessional engineer oR's 6 uR- - 1CL1P.2 in 7??V UIOSeS$lOnal Capacity !SeCtiUn 705 1, Rns; I Exls':'iNG B L iness and 'roiessionsCod°1. C IFINAPPROVAL;L APPROVAL !2RESENT Jac ..-' i3UiLOlNG l ry` ic.or Re_. No. Date i ®RE Li HOE OCv17EIZ-BL.ILDER DECLARATION ' NO. OF Exis-:C:G 6UILDINGS i _ ON LOT AN I hereby affirm that I am exempt trth onl e Contractors — License Law for 'the followinv reason .'Section 7031.3, Btlsi _ = �3'� ness and Professions Code): - Ni o. pAK I, as owner of the property, will do the Nvork and the SPACES P.•_•;!=ED I V 7044,urQ is not iJProfe s or offered for sale (Section j �0 ; V 1044,i3usiness and Professions Code). f PROPOSED JS2 OP BUILDING CONSTRUCTION LENDING AGENCY t�v I hereby affirm that there is a construction lending agency 3 I for the performance of the work for which this permit is issued(Sec. 3097,Civ,C.). Lender's Name PROPOSED `-,:,X. OCC. Lender's Address _ i, ) �PERMIT F.E 25.Q� I cez?ify that I have read this application and s ate that the I- - 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- entioned property for in taction purposes. SEE REVERSE FOR EXPLANATORY LANG;_-AGE Signature of Permittee Date WORKERS COMPENSAIION DECLARA ION MISCELLANEOUS APPLICATION 20-ilUi� UPA^„''!ill I 'lereby affirm that I have it ceLuficate of conscn( to sch COUNtY OF LOS ANG141S BUILDING AND SAFETY DIVISION Ij insure,or a certificate of Workers' Conlpenswion Insurance. or a certified copy thereof (Sec. 3800. Lah. C.) j Policy No. _ Company FOR APPLICANT TO FILL IN BUILDING BUILDING AOD ES t ff1 ADDRESS ❑ Certified copy is hereby furnished. 1 n � �r" 12� LOCALITY ❑ Certified cope is filed with the count)' building iIIS;K:.:tion /`') zIP (//fit 1 %/J��\^9, NEAREST department. v - 1 i' V— CROSS ST. Applicant SIZE OF LOT Y40.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. L' CERIILICAIL OF EXEMPTION FROM WORKLR. TRACT BLOCK LOT No. COMPENSATION INSURANCE MAP HIGHWAY ../ Ho. Iclwc", STATE MAJOR SECOND LOCAL (This section need 1101 be completed if the vtork Imoked ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is fo(":one hundred dollars (SI00) or Ic%%.) certify that in the performance of the work Illi which (hi> owN �� •1\ ` - TEL No, permit is issued. I shall not employ any person nt ;In)' nunulcr r,. so as to become subject to the Workers' C2lmprn.nIion Laws. A-DDWSS . OCCUPANCY GROUP Date-------.. V V W0.I Applicant CITY ,^^ , h zlP CA i NOTICE TO APPLICANT: If, after making this Ccrtiiicate ��' OCCUPANT LOAD of Exemption, you Should become SUhject to the Workcrs' APPLICATION FOR Compensation pro\'isions of (he Labor Code you must fOrlh"itll 1 EXIT HARDWARE: comply with such provisions or tllil 1)0'111It s11a11 lll' deemed TR.'111 FR USE L..1 GEOLOGY INSPECTION I No Spec.Knowl. ❑ revoked. — -1----- OCCUPANCY INSPECTIONN Panic Devices ❑ LICENSED CONTRACTORS DECLARAfh)N 2 I hereby affirm that I ail licensed tinder provisions 01 Chapter SAFETY PERMIT❑ ILIST ITEMS BELOW I • 1 9(commencing with Sector 7000)of Di%islon 3 of till' Business NO.OF EXITS and Professions Code.and my license is in full force and cIfect. ' -- PARKING• REO'D I I PROVIDED I I License Number Lic. (lass SPACES U LLL--111 Contractor 111tc LIMITED TIME USE DATE DATE ❑ I ani exempt from the licensing requiiemellts as I L:I11 8 - FROM: TO: licensed architect or it registered professional engineer - actin 111 Ill' professional cal 1clt (Scciion 705 1. Busincss SIZE OF NO.OF- INSPE TOR'S ! I g p p` ) EXISNG BLDG. STORILS ATURE and Pi esslons Code). TI --- PRESENT USE OF BUILDING FINAL APPROVAL Lic. or Reg. No. Date IIONII. OWNER-BIIII.DI:R DI'.( LARAIION No.OFI:XISIINGBUILDINGS ON LOT AND USE L, hereby affirm that I ion exempt front the C'ontractor's Lic cnsc Law for the following reason (Section 70315. Busines:c and Professions Code): NO.PARKING SPACES PROVIDED `� Ij El 1. its owner of the pmpert). \\ill do mud ll�ak Thr — --------- y�� StILICtirC' IS not intended or oIIC'I'ell Iol Sille (Sccllull (114, PROPOSED USE OF BUILDING Business and Professions Code) CONSTRUCTION LENDING AGENCY hereby aff irnl that there is it construction Ielldi Ig :1g1'lIC\ Int' the perlormance of the \cork Ior %khich this permit is issued - -.-- -------- - -- I (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. ;{ Lenders Name -- ._..._.__ .--__.._-_ _ .. ... APP (CANT UP�1 T) { TEL NQ. X I Ic3�✓� t �� Z� � ,�.sC�,Z,,�,, Lender's Address A Ess V certify that I have read this application and state (hill the above information is correct. I agree to comply with illi C Ullnly PEP.?.+IT FEE ordinances and State laws relimn building construction,and hereby authorize rep sentu iv of this Count}' to enter U!"l' ISSUANCE FEE the above-mentione Tpr y for inspection purpoSeS. _ �.' TOTAL FEE � I �( SEF. REVERSE FOR EXPLANATORY LANGUAGE i igneture of ernlirten Dalc i WORKERS' COMPENSATION DECLARATION za oos DPW?2/90 MISCELLANEOUS APPLICATION I. I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION r =insure,or a certificate of.Workers'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) t J Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS - ❑ Certified copy.is hereby;furnished. X oda � �O/,(J l/L 42v$,4 /?` LOCALITY ❑ Certified copy is filed with the county building inspection ci ZIP department. �l/�t. IC /7 �a NEAREST CROSS ST. Date - Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY } CERTIFICATE OF EXEMPTION FROM WORKERS' ONS-- coNST. C t 1 COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP - HIGHWAY NO. (CIRCLET STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL i by the permit is for one hundred dollars ($100) or less.) USE ZONE SPECIAL CONDITIONS O s I certify that in the performance.of the work for which this sx�g�trfy er TEL No. U permit is issued.I shall not employ any person in any manner Q d�t7 t . Z�G-SSG tit so as to become subject to the Workers' Compensation Laws. ADDRESS .34 FF,Q/ d OCCUPANCY GROUP z ! Date Applicant . CITY �+ ZIP i NOTICE TO APPLICANT: If. after making this Certificate 540'J �A�J f r eL. �- F/77 of Exemption. you should become subject to the Workers' APPLICATION FOR OCCUPANT LOAD Compensation provisions of the Labor Code,you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ 1. No Spec.Knowl. revoked. ❑ OCCUPANCY INSPECTION[ Panic Devices ElLICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) ❑ I 9(commencing with Section 7000)of Division 3 of the Business Name o uslness NO.OF EXITS and Professions Code.and my license is in full force and effect. .. License Number Lic. Class (� SPACESG' REO'D PROVIDED Sva4,. leu�� -rte Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer FROM: To: EXISd acting in my professional capacity(Section 7051,Business SIZE OF BLDG. ><a� NO.OF �7 INSPECTOR'S and Professions Code). STORIES L• SIGNATURE. PRESENT USE OF BUILDING Lic. or Reg. No. Date F 7 A INAL APPROVAL q.•J J iZ Q.o 7�c!Jteyv f HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS j ON LOT AND USE QN� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and d 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,X PROPOSED USE OF BUILDING Business and Professions Code). t � � 5.0�✓ut a.v �J2�7'cr.0 2,An.� r - CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( I (Sec. 3097, Civ.C.). PROPOSED MAX.OCC. Lender's Name APPLICANT(PAINT) TEL NO. Lender's Address AD ss fd� I certify that I have read this application and state that the .QLD X le 64 above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. 7 TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE Sienature of ViTAttee Date