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HomeMy Public PortalAbout9862 OLIVE ST_Building__ DING ADDREIS9 1C oCsC+Gf.wA. l� NG C �- BUILAPPLYCATI011T LOCALITY NEAREST V DIVISION OF BUILDING AND SAFETY CROSS 9T. Department of County Engineer DISTRICT NO. U RECEIPT NO. PERMIT NO. County of Los Angeles ✓' 7 74 5- WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATEISSEIED CASBATT D. GRIFFIN, Sup-T CF BUILDING 11 S&v1M /n 7' /027-,27- FOR APPLI ANT TO FILL IN TYPE CONST. -/RECEIVED BY 29= OWNERMAP J� STATE MAIL f NUMBER [J HWY YES ADDRESS 6 USE ZONE SPECIAL TEL. CONDITIONS CITY ARCHITECTL ENGINEER O. BUILDING YARD HWY STREET NAME EXIST. ADDRESS,-.'-) SETBACK WIDTH/ EL P LNT a V �js/ CON -- IDE ADDR B •L. BUILDING ATE CORRECTIONS INSPECTOR ADDRESS Fla / I LOT NO. BLOCK r TRACT /�f � .� NO.OF SLOGS. SIZE OF LOT NOW N LOT USE OF FXIRTING BLDG. DESCRIPTION OF WORK O a 0 NEW ADD ALTER REPAIR DEMOLISH Z P.FT. NO.OF NO.OF > SIZE STORIES FAMILIES r USE OF STRUCTURE ONO NO.OF EMPLOYEES 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN IS APPROVALS INSP CTOR'S SIGNATURE DATE CORRECT. IAGREE TO O PLY WITH ALL COUNTY ORDI A CES FOUNDATION: LOCATION AND STATE W9 EGULATING BUILDING CONSTRU ION. FORMS,MATERIALS Gc-.e LI S FRAME: FIRE STOPS, SIGNATU O BRACING,BOLTS PERMITT FURNACE: LOCATION, GAS VENT,DUCTS ADLateE LATH, INT. AUTHORIZED AS �7P. .S O LATH, EXT. $ CJ V FEEHOUSE NUMBER CR- � �� �'� RECTAND POSTED VALUATION FEE 76A638A DB 3 Glb 5-54 Oil 76A888A CEikBDB 8-63APPLICATION FOR BUILDIN/G PERMIT COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY Q/ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. - DISTRICTNO.. G UP TYPE P CE S BY FOR APPLICANT TO FILL IN _ 0�' coH BUILDING / STATISTICAL CLASSIFICATION SEWER MAP ADDRESS ,J 6 a �I CLASS.NO. DWELL.UNIT BK�P LOT NO. '7 BLOCK WATER CERTIFINOT REQUIRED RECEIVEDi-❑ CATE: TRACT — NO OF BLDGS NO. z 0/,6 (IC(CIRCLE)IGHWAY p./) STATE MAJOR SECOND SIZE OF LOT Z , a V NOW ON LOT USE ZONE SPECIAL USE OFt/ CONDITIONS EXISTING BLDG. Z k 9 � B� Z�("41NO.OWNER Q / EXIST. �i I SETBACK YARD HWY STREET NAME WIDTH ADDRESS b z P. oh i Vim' FRONT ARCHITECT OR TEL. P. L. .2- ENGINEER NO. SIDE / _ P. L. L ADDRESS Co TEL CONTRACTOR ( gft) '�bie. NO.33S-7o/� C. gpApp�y V ADDRESS 9 W. ..yA C9 Cbu CP%(�. DRIVAIIk AfPR�Jhl73f7j O DESCRIPTION OF WORK .E v W ..Ptew D ALTER REPAIR DEMOLISH p}e; pe�j}S for curd, gU#ef, nldcnd!i, and drlr®way app� qI" y SQ.FT. c-i NO.OF NO.OF t .r , t- 1% ••a. �9:: ,I ®ryp SIZE ) STORIES FAMILIES / fire. or T. C. Co. G^iaxa•'. ". ;•Ii eel OE � a- .:?• :."••' 1 RE engfhy delay. Survey is C�Etgr, srs�w 4u;.-II 11m o And 'is not stiffed . ,d has .. .,., . syi ay ivi 1. �n u I�� .REHalf.A9Jiifee 22 N $ APPROVALS DATE INSPECT R'S SIGNATURE C. PMT FOUNDATION: LOCATION FEE $ ' ._._ FORMS, MATERIALS FRAME: FIRE STOPS, Y ACKNOWLEDGE•THAT I HAVE READ THIS APPLICATION BRACING. BOLTS THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATIONCOUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS / BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOYANY RSON IN VIOLA- LATH. INT. TION OF THE LABVFNzsON OF THE STATE O CAL FORNIA RELAT- ING TO WORKMEN' NS CE. LATH.EXT. f / i I I� i f/rA."---=•® SIGNATURE HOUSE NUMBER COR- PERM ITTE OR-PERMITTEE RECT AND POSTED ADDRESS FINALuaodl JOHN F. LEWIS. PRINCIPAL S AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIO S= M.O. CASH L&9027% JUN12 1 0 27.75N C rT y o -7�5F M 1pL_F_ c I-T 76A638A CE#803 5-65 APPLICATION FOR B • I.J UIL�DING PERMIT COUNTY OF LOS ANGELES BUILDING .DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY • — . C, > JOHN A. LAMBIE". COUNTY ENGINEER NEAREST COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. DISTRICT NO. I GROUP TYPE PROCESSED-BY FOR APPLICANT TO FILL IN CONST BBBB BUILDING //r�� STATISTICAL CLASSIFICATION - SEWER MAP ADDRESS (D / f D/f vp CLASS NO. <!t _DWELL UNITS BK _PG LOT NO. BLOCK USE'ZONE 'MAP TRACT SP C/ �J �•� I SPECIAL N0. OF BLDGS. CONDITIONS SIZE OF LOT Now`O LOT USE O'F EXISTING G. BLDG. SETBACK FROM ^ TEL _ 'FRONT PROP. LINE OF ©L-I✓e (STREET) OWNER /. ^/ NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL_ ADDRESS ` [S� O//�� HIGHWAY WIDTH -MOM C.L. CITY �!/ P i- - 6c.A,.- ARCHITECT O TEL. - BLDG. SETBACK FROM A ENGINEER • NO. SIDE PROP. LINE OF hl la (STREET) TYPE OF EXISTING SETBACK - HIGHWAY + YARD = -TOTAL ADDRES .i HIGHWAY WIDTH FROM C.L. ' CONTRACTOR�/ , 1 f "c_ (CIO _ + f� 0 ADDRESS y �c NO zd�sV CORNER CUTOFF YES NO V CITY C'w CL SS SEE REVERSE SIDE FOR SPECIAL APPROVALS O DESCRIPTION OF WORK a NEW ADD ALTER A REPAIR DEMOLISH Z SQ.FT. NO. OF NO. OF z SIZE E. J STORIES FAMILIES USE OF STRUCTURE/7Z , &I/pi�C3 SIGNATURE OF APPLICANT U' JK VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE yFOUNDATION, LOCATION FEE$ FEE$ v� FORMS, MATERIALS , FRAME, FIRE STOPS, / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDI N G• CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK ., AUTHORIZED HEREBY•1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. _ TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANC 4 LATH. EXT. SIGNATURE OF ®� _� HOUSE NUMBER COR-- PERMITTEE ✓c.�� �• I RE T AND POSTED ADDRESS Fl N A L G JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER 'PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CIC. M.O CASH LMLO O 8 6:7 8 f4AR 2 9 1. D DEPARTMENT OF BUILDING AND SAFETY AYYLAWULUN rUli JeZnMi1 COUNTY OF LOS ANGELES ® � �® WM. J. FOX, CHIEF ENGINEER ®� FOR,APPLICANT TO FILL IN FOR OFFICE USE ONLY D l , DISTRIYX�NO. PLAN CK.NO. PERMIT NO.BUILDING / ADDRESS _ A , J ✓ rl7 LOCALITY .P . _ e v CA.U w R EIVED BY DATE FAP L. B ED NEAREST /'; c�� Y V, Y7 CROBB ST. I AA. Jf uJl 4.9 OWNER ( y Vaso BUILDING ADDREBB �' r/ MAIL q a /� /)_ _- LOCALITY . C� ADDRESS sC (I�XJl�F6: a _ q Y �r NEAREST CITY —it ILS_LO L- ( 1 E13 1 4-0 3 .1 BT. FIRE NO.OF TYP_E GROUP ARCHITECT OR V TEL. ZONE PLANE r1V/ ENGINEER NO. BLOSETS. �4 J�/�/ ORD.NO. ADDREBB ` SETBACK LINE TEL. APPROVED CONTRACTOR p. BYE- /+-r`- DATE USE IAPPROVED ADDRESS ZON �/ BY DATE LEGAL CORRECTIONS DESCRIPTION// LOOT NO. 9 BLOCK /�+6,4 q TRACT :2 } . �y S. C! too- SIZE OF LOT �Q � V I USEOF NOW ON LOT EX 9TINB0LD P/�J�- I F M�eB No or / I ROOMBJ� DESCRIPTION OF WORD NEW C -ALTERATION ADDITION O REPAIR MOVING DEMOLISH p S4.FT. L� �j NO.OF Z SIZE ' -j 14 ROOMS STORIES e1.d IL" WALL / ♦ ROOF ))_�, COVERINSC11-4JArw, I COVERING �[3.I!J1lA- USE OF NEW D _ _�IQ v /� BUILDING IA)I�Ilv�. ' wW. �.Li�if.P� �6.,j.iA7 i 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION:LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS / AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE O (/(F `T� ` :}�1 it K y� A �n� BRACING,BOLTS 1i.__� //SllJ PERMITTEA ( l 1 1 YLsi/► LATH,INT.: / AUTHORIZED AS LATH,EXT.: DBS-3 SOM SETS 1-48 $ P.C.4 PLASTER,INT. FEE PLASTER,EXT. VALUATION FEE ��^ FINAL /LS/[-I '�///" J. P WORKERS'COMPENSATION DECLARATION f / • ( } APPLICATION FOR BUILDING PERMIT LLLSSS I. hereby affirm that I have a certificate of consent to self „ rtsure,,or a certificate of-Workers'Colcate cion Insurance,or 1: a certified copy there6f,(Sec.•3800, Lab. C.) f ' COUNTY OF LOS ANGELES BUILDING AND SAFETY ,Policy No.• - Company F71.• Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy.is filed with the county'building inspec- I BUILDING b6. d/.I vL S-r �\ tion department. ADDRESS a LOCALITY Date Applicant CITY (7 LP7 .0 l T,� D NEAREST � � �•ZIP /�' CROSSIST. ;CERTIFICATE'OF EXEMPTION FROM WORKERS' 1 J�J 'NO.OF BLDGS. ASSESSOR r COMPENSATION INSURANCE 1 SIZE OF LOT ��X ' NOW ON LOT / MAO IBOOK. PAGE PARCEL (This-section need not be completed if the permit is for one I, �� -USE ZONE MAP hundre'd,dollars,($1.00)or less.) ITRACT IZ BLOCK LOT NO. p I, No . i OWNER ✓S ICI [3OCLLTc�TEL.2-g_(.--14 I YC / SPECIAL r 0 I,certify,that,in the perforAa.nce of the work for which'this c owG�No, / CONDITIONS permit,is issued, f shall not,employ any person,in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY_. U. I ADDRESS lj OI/VL✓1� ' I' r� CONST. ' ZONEad so as to become subject to th'e Workers'Compensation Laws. d 3 O Date �) �� Applicant y�M e °Wan- �'t' CITY - ZIP STATISTICAL CLASSIFICATION APT. CONDO. U' NOTICE TO APPLICANT: If, after making this Certificate of , ARCHITECT OR• TEL. tei ENGINEER NO. CLASS NO: DWELL. UNITS IZ Exemption, you should become subiect to.the Workers' _ t/1 Compensation pio-visioris of the Labor Code, you must forth- ADDRESS "SEWER MAP with comply with such provisions br this permit shall be )'. G, .3 VALIDATION ✓ : TEL. !! BK. PG, . dee.rried revoked.-.., +� � .., � � CONTRACTOR NO. LICENSED'CONTRACTORS DECLARATION / LIC. I hereby affirm that I am Licensed under provisions of Chapter 9 •y, ADDRESS NO. VALUATION (commencing wit}t Section 7000)of Division•3 of the Business and LIC. I 1 , Professions Code,•and my license.is in fall force and effect. Ir CITY, CLASS $.• . . r•.- ; SQ.F . NO.OF NO.OF CHECK License Number Lic..Clbss j SIZE STORIES FAMILIES ONE' 4 DESCRIPTION OF WORKCIG S t x 6 NEW ❑ r ${ Contractor Date: I . ADD ElI am exempt from the licensing requirements as'I am a �� licensed architect or a registered professional engineer ;rALTER ❑ FINALDATE acting in my professional capacity (Section 7051, ! d =Aih itkv ( rvPar. REPAIR ❑ r Business and Professions Code). USE OF d.. {- EXISTING BLDG. Y.GY tl/ *YQr/Y•+[ W�tiCX dEMOI ❑ FI11 NAL APPLICANT TEL.s By ' �Lic:or Reg.No.• .: •�' � -' —Date � s 'i � , OWNER-BU,ILDER'DECLARATION ;I PRINT NO.' K' I hereby affirm that I am exempt from the Contractor's License 1 Law for the'following-reason (Section 7031.5,,Business and I ADDRESS 1 Professions Code):. r PRESENT, - i BUILDING I,. as-owner,bf the property, dr'my 'employees with j, ADDRESS wages.as their sole compensation,will do the work and n ' the structure is not intended.or offered for sole(Section = i j :LOCALITY 7044,,Business and-Professions Code).• MOVING TEL. ` _ 1 i CONTRACTOR. NO. t o o a o o �, •I, as owner df'the property;am exclusively contracting } 'With licensed contractors to construct the'project (Sec- ADDRESS / ' I -.2 0 o 34,0 0 tion 7044, Business and Professions Code). i REQUIREDTOTAL-SETBACK FROM EXIST. a o CONSTRUCTION LENDING AGENCY ! SET BACK YARD- HWY PROP. LINE WIDTH a. 3:� 0 �` I hereby affirm'that there is a construction lending,agency for.• FRONT i ihe-performance of the work for which this permit is issued P.L. - I d'2 C 31'"8 I (Sec. 3097,•Civ. C.).. SIDE' r+ ' P.L. Lender's Name - Lender's Address' - P.C. Fee$ Permit Fee L I certify that I have read this application and state that the , t Issuance Fee r above information is correct.-I agree to comply with all-Count 9 P Y Y� Investigation Fee• ? ordinances and State-laws relating to building construction; Total Fee J and hereby authorize representatives of'this County to eater ^-upon the above-mentioned orooerty for inspection purposes. $; /�j�jy�G• /�,_e Z��—�( SEE REVERSE FOR EXPLANATORY LANGUAGE , ®s ' Signature,of Appli t or-Y4gent - Dote _ , f COUNTY OF IAS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1211080079 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 6755 LT: 4 I SQ. FT STORIES TYPE I 9862 OLIVE ST I '(STRUCTURE: V-B I TEMP CA 917803236 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ACNES J 18589-004-016 IPI I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI ITENANT: ,(EXIST BLDG USE: GARAG USE ZONE: R-1 IISSUED ON: PROCESSED BY: I EXIST OCC GRP: 11/08/12 SR J (OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: IF NAL E FINAL BY: CODE: I JESPARZA, PEARL C (626) 285-1170- 150 1 71 19862 OLIVE ST ITEMP 917803236 1 FEES PAID JD SCRI TION OF WORK 1 1 IDRYWALLL ON GARAGE WALLS J I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I (APPLICANT: TEL. NO: I I ISAME AS OWNER - 'IAA BLDG PERMIT ISSUANCE 27.80 1 I I IAB STATE GREEN BLDG FEE 150.00 VAL 1.00 ISPECIAL CONDITIONS: J IAC STRONG MOTION RESID 150.00 VAL 0.50 J JB2 PERMIT W/ENERGY 150.00 VAL 48.10 I _JFR INV WORK W/O PERMIT 169.70 DOL 169.70 I J ICONTRACTOR: TEL. NO: I TOTAL FEES 247.10 JAPPROVALS DATE INSPECTOR SIGNATURE I (SAME AS OWNER I LIC. NO ILOCATION AND SETBACKS I I I I II i I 1SOILS ENGINEER APPROVAL J I IARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I - LIC. N0: I ISLAB�UNDER FLOOR 1 IRAISED FLOOR FRAMING I I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J JUNDERFLOOR INSULATION I J I I I I 1147H269 300 IFLOOR. SHEATHING J J I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I 1 0 NO 21 ( IROOFISHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I I I I JAIR QUALITY: 1000 FEET MATERIALS 1 I I J I NO NO NO IFRAME INSPECTION I I I IFIRE SPRINKLER HANGERS 1 1 I ' IINSIII��P,TION/WEATHER STRIP( I _ I I J NTERIOR LATH/DRYWALL I I J 1 I JEXTERIOR LATH IRATED FLOOR/CEIL ASSEM. I I IRATED WALL ASSEMBLIES I JRATED SHAFTS/OPENINGS I IT-BAR CEILINGS 1 (LOT DRAINAGE I J 1 (REPORT ID: DPR261 ROUTE TO: BS0508 1 1 J I I • !' WORKERS'COMPENSATION DECLARATION I / 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.) j COUNTY OF LOS ANGELES I BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING 6 r tion department. ADDRESS 7 0 6' �[ ' �7LI Vt sr LOCALITY NEARE Date Applicant j CITY (- C 1 r`� *7•ZIP t�0 CROSS 5T. -CERTIFICATE OF EXEMPTION FROM WORKERS' i &�k f J� NOW ON LOT MAP:BOOK PARCEL NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT PAGE (Th! 'section need not be completed if the permit is for one i s USE ZONE MAP hundred dollars ($100)or less.) TRACT�2 BLOCK LOT NO. N0. 624 y, �A //�� R TEL q / SPECIAL M OWNER K njOELTC�N0. 6Jy I r�' I CONDITIONS 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 /Llc V014144 YL DISTRICT I GROUP I TYPE FIRE PROCESSED BY- 1,) ADDRESS ;�tn�• CONST. ' ZONE 19 ' so as to become subject to the Workers'Compensation Laws`._ '' _ i 1 '�I P'1„1'l� �DW[t11-IL3t� � CITY ZIP - iu •J I! -3 Date Applicant STATISTICAL CLASSIFICATION APT. ICONDO. U NOTICE TO APPLICANT: If,"after making this Certificate-of ARCHITECT OR TEL. LU Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO: 22 1 DWELL. UNITS 4A Compensation provisions of the Labor Code, you must forth- ADDRESSSEWER MAP Z with comply with such provisions or this permit shall be deemed revoked. TEL' CONTRACTOR BK. PG, .� VALIDATION NO. LICENSED'CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division'3 of the Business and LIC r� Do Professions Code,'and my license is in full force and effect. CITY. CLASS rt SQ. NO.OF NO.OF CHECK License Number Lic.Class SIZE© STORIES FAMILIES ONE I I DESCRIPTION OF WORK r k Ip A S t x E7 t NEW t $ Contractor Date ❑ I am exempt from the licensing requirements as I am a Wim/ _ ADD licensed architect or a registered professional engineer p' 1lX/� ALTER Ej FINAL r `� acting in my professional capacity (Section 7051, d �t�-0 •j�ll�t 4 CvrQ REPAIR DATE i Business and Professions Code). USE OF q EXISTING BLDG. C IOU&� e/,JZ " DEMOL Q By AL Lic.or Reg.No. Date APPLICANT ! TEL.. t OWNER-BUILDER DECLARATION (PRINT)•/ NO.' i I hereby affirm that•I am exempt from the Contractor's License ' Law for the following reason (Section 7031.5, Business and ADDRESS I Professions Code): PRESENT, - I � - ® , I, as owner,of the BUILDING property, or my employees with I 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 t 2 tion 7044, Business and Professions Code). 3 1 C fQ CONSTRUCTION LENDING AGENCY I REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. 0 1(� 1 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. 0 L•C — ; (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ' Lender's Address P.C. Fee$ Permit Fee ' I certify that I have read this application and state that the Issuance Fee above information is correct.•I agree to comply with all County Investigation Fee ordinances and State-laws relating to building construction, I Total Fee f and hereby authorize representatives of this County to enter t upon the above-mentioned roperty for inspection purposes. j SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ApplicVnt or•l4gent _ Date � � � ®s i