HomeMy Public PortalAbout4836 RYLAND AVE_Electrical__ 'GAG63-CESOG-10.118 APPLICATION FOR ELECTRIC PERMIT 1
BUILDING AND SAFETY DMSION
Department of County Engineer FADDRESS
/e p y/
County Of LOB AIIg9IE8 7JOHN A.LAMBIE.COUNTY ENGINEER ,;�1 C� /,CASSATT D. GRIFFIN.SUP+T OF BUILDING /11 1 R/—
FOR APPLICANT TO FILL IN cRosss T d, ��PZ UJ
PERMIT FEES OWNER eC, d8O/jNJ'
LIGHTS RECEPTACLES SWITCHES
NUMBERI 1 T E M EACH FEE MAIL D�eGL/ ��'K i/
A, /1
a (
TOTAL OUTLETS S .10 ADDRESS S '
ELEC. RANGES, WATER HEATERS, J� CITY / EL /P�E." TEL.NO.
CLOTHES DRYERS .50 [/
ELEC. SPACE HEATERS, STAT'Y. COOK. ELECTRICIAN
IMG UNITS, CARBA09 DISPOSERS, ADDRESS
AUTO WASHERS, DISHWASHER .25 -
LIGHTING FIXTURES ,.10 CITY TEL NO.
MOTORS STATE
LICENSE NO.
HORSEPOWER
H.P. OVER INC. DISTRIC O. G;A1JP ZONE I READY FOR INSPECTION
Va Be LESS .25 „�
14 — 2 .50 INSPECTION RECORD
2 — 5 1.00
5, 15 1.50
15 50 2.50
50• 200 5.00
MISC.
I do
SIGNS I NO.TRANS -
NO.LAMPS
SERVICE 0-BOOV 1.00
SERVICE OVER GOOV 5.00
WIRING.PERMIT 1.00
FIXTURE PERMIT 1.00
SUPPLEMENTARY PERMIT .50 APPROVALS
TOTAL FEE $ DATE INSPECTOR'S SIGNATURE
1 HEREBY ACKNOWLEDGE THAT I HAVE .READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
ELECTRICANA+ORDINANCES AND STATE LAWS REGULATING
L WRWIRING
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS. ANGELES COUNTY AND STATE OF
CALIFORNIAOR TNA AM THE LEGAL OWNER OF THE ABOVI POWER
DESCRIBED RESIDER ROPERTY.
SIGNATURE ��.yg�/ UTILITY CO.NOTIFIED Ve S
OF PERM ITT FINAL 591
iOHN A LAMBIE. VALIDATION ARTHUR C:yEIT.
:OUNTY 19NOINZER CK MG CASH SUP6RV1>idNG LECTRICAL EN61N6ER
LACO2 0 4cu—, SEP10 2 2.50
76A663 DBS SA- 11-50 APPLICATION FOR PERMIT
DEPF2R`TMENT OF BUILDING AND SAFETY ��
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT
NO. GROUP I ZONE PERMIT NO.
ELECTRICIAN �+�y�✓a yyra �s� S 6S-0-7
ADDRESS RECEIVED BY FIRST INSPECTION
DATE ISSUED
CITY TEL. NOA7Z I
COUNT LICENSE NO. EXPIRES ADUILDING
DRESS
PERMIT tEEd
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS ST.
RECEPTACLES 1 ,,fir(/
WALL SWITCHES J OWNER / iZo !/ .:fifer/. Rr
TOTAL OUTLETS RIP, Sc S I vo MAIL
ELEC. RANGES 25 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES g
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
r 1/2 a LESS S .25 SIGNATURE OF /7�// a +�
1/2 2 .50 PERMITTE /!
v
2 S 1.00 INSPECTION'RECORD
5 15. 1.50
15 so 2.50
so 200 5.00
200 500 10.00 �I
Soo 1000 15.00 Z
OVER 1000 20.00
M. G. SET/FREQ. CHANGER-HP
WELDERS:AC-KVA O
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OF DRIG.)
MOVED MOTORS (75%OFOR7G.)
MISC.
SIGNS -41
NO. NO.TRANS. I APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 CONDUIT ''nn
FIXTURES $1.00 WIRING
r
SUPPLEMENTARY .50 FIXTURES
POWER
TOTAL FEE Sg UTILITY CO. NOTIFI//ED'. �, A
® FINAL C/ �`✓ 7
WORK€RS'CO.f IPENSATION DECLARATION x'20.0019 DOW 3/87
,I -eb ;Mfirrt9 that I have a certificate of consent to•self CE�806G APPLICATION FOR ELECTRICAL PERMIT
ins e;'or p certificate,of Workers'Compensation-insurance, COUNTY OF LOS ANGELES DEPT.' OF PUBLIC WORKS
or 'ertif)ed copy thereof jSec. 3800, Lab.C.)
Policy`o. Company FOR APPLICANT TO FILL IN JOB ADDRESS . 491 RYUM,AVENUE
❑Certified copy is hereby furnished. New Residential Bldgs. &Pools EACH NO. FEE
❑Certified copy is filed with the.county building.inspec- 1 &2-Family, Sq. Ff. $ -- $ LOCALITY
tion department. Multi-family Sq. Ft. NEAREST
I -
Residential Swimming Pools CROSS ST.
'Date Applicant � OWNE.R OR -
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rer Light Sw MAIL
COMPENSATION INSURANCE - '"�— �- �� O ADDRESS
This•section need not be completed If the work Involved b First 20
( P Y Total No. Additional. •%to CITYTEMI Tel. No. 9_1
;the permit is For one hundred dollars($100)or less.) FLAN CHECK '
.I certify that in the performance of the work fo which this a
APPLICANT'
permit is issued,I shall not emges6biect
' person' manner
so as to become subject.to the..' m. ion Laws. Light ing Fixtures First 20 � ,ADpRESSTotal No. Additional' CITY Tel. No.
Date 9�717A7 ApplicTr� � Fixed Appliances Not.Over'1 HFPERMIT
NOTICE TO APPLICANT: If,'ong this Certificate ofAPPLICATION', BUSY BEE ELECTRIC
Exemption, you should bec to the Workers' Rahge:— Heater—D.W. —
Compensation provisions of the Labor:Code, you must.forth- Oven. Dryer —W.M.—.: ADDRESS
with comply with such,sprovisions or this permit shall be Top FAU � :H. - .
W
deemed revoked. Hood CITY WESTMINSTER Tel. No. gg897-1.525�Fan —
LICENSED CONTRACTORS DECLARATION Other—
.6� LICENSE OR
Disp. Room Air Cond. _ Class _
I hereby affirm that I am licensed under provisions of Chapter 9 REG.NUMBER
,(commencing with Sectlon 7000)of Division 3-of the Business Power Apparatus&Large Appliances- DISTRICT NO, POC SSED BY >;-
,and Professiohs Code,and my license is in full force and effect. a
• . Size.&Type HP,.KW, KVA, or KVAR �� Q
License Number, 41 _ L'ic. ClassC-1(l — AL ti 0.1
sC),
- U to 1 Incl. DAT
P
Over 1 to.1.0 Incl,. E VALIDATION
'ContractorBU YLBEE ELECTRIC 'Date 1/7 /92 O
. Over 10 to 50 Incl. FINAL U
❑• I am exempt under Sec. Over 50 to 100 Inc. BY LV
B.&P.C. for this reason Over 100 a-
"Services,Swbd.;MCC,&Panelboards ' Z
Date: %0-200 Amp. Under 600 V/�' Z
Signature' 201 - 1.000 Amp.' Under 600•V1
,❑ Over 1000 Amp. or Over 600 V
Exemption for Reg. Maint. Elect.
SINGLE FAMILY" Temp. Power Pole&Appurtenances AHOME OWNER=BUILDER DECLARATION Sign`with One Branch Circuit fT•
I hereby affirm that I am exempt from the Contractor's License AC'C', ,.IP
IP
Law for the.fol low!rig,reason (Section'7031.5,.Business and Additional.Sign Branch Circuits
;war'
Professions 15 al.Code): a 1 _
❑ 1, as owner of the property, will do the work and the Misc:Conduits 8 Conductors. `t ITEMS
structure is not intended or offered for sale(Section 7044, Other(See Complete Fee Schedule)_
Business and Professions Code). � pop,..
CONSTRUCTION LENDING AGENCY
I.hereby affirm that there is a construction lending agency for ;Ii��s�
the performance.of the work for which this permit is issued PERMIT FEE (Sub-Total) ` 1`
.(Sec..3097,'Civ. c.).
PLAN CHECKING FEE
Lender's Name_ •• vl_I:�;_I—r) L. 'lev;, r,+,
PERMIT ISSUING.FEE V.
Lender's AddressI.lK:I;;'_
I certify that I have read this application and state that the TOTAL FEE!
above information is correct. I agree to comply with all County J;
ordinances and State Paws regulatingeElectrical wiring, .and
hereby authorize representatives of this County to enter upon
the above-mentioned property for inspection purposes; SEE REVERSE FOR.EXPLANATORY LANGUAGE >
Signature of Per,miftee - - Date
l IDs
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ELECTRICAL PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
EL 0508 1005030029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 17107 LT: 37 I 4836 RYLAND AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 917804032
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA
18585-011-017 ]A1 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY, Cl
I IG1 OUTLETS-LGT,SW,RECP 20.00 OUT 39.00 I ]
ITT: ]G2 LIGHTING FIXTURES 16.00 LGT 31.20 (ISSUED ON: PROCESSED BY: PLAN BY: ]
I ]H2 RES GRBG DISP LT 3HP 1.00 DIS 10.95 105/03/10 SR ]
I 1H3 RES DISHWASHR LT 3HP 1.00 DIS 10.95 1
(OWNER: TEL. N0: 1H4 RES RANGE HDS LT 3HP 1.00 HOO 10.95 IF FINAL Y: CODE:
(SEAN, DUONG (626) 374-8488- IH5 RES WASH MACH LT 3HP 1.00 WAS 10.95
14836 RYLAND AV 1H7 RES EXHAUST FANS 1.00 EX 10.95 ] y
(TEMP 917804032 I TOTAL FEES 152.70 ILMSCRIPTION OF WORK ]
I 1ELECTRICAL FOR KITCHEN AND BATHROOM REMODEL 1
(APPLICANT: TEL. NO: ]
I I
(KYLE LUQ (626) 374-8488-
18802 GUESS STREET I ]SPECIAL CONDITIONS: I
IROSEMEAD, CA 91770
I �
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ]
ILW. KYLE (626) 374-8488- ] I I
18802 GUESS STREET LIC. NO ITEMPOPARY POWER POLE I ]
IROSEMEAD, CA 93.770 942174 B ]
II (UNDERGROUND CONDUIT ] I
(ARCHITECT OR ENGINEER: TEL. NO: I UFER GROUND
I _ I I I I
LIC. NO: ] ]ROUGH CONDUIT I I I
1 IROUGH WIRING
MAIN WATER LINE
I ] IPLASTIC YIN METAL YIN I I
(UTILITY COMPANY NOTIFIED] I I
I I I I I I
I ] I I I I
I I I I I I
I I ] I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I
I I
I I I
] I I
] 1REPORT ID: DPR265 ROUTE T0: BS0508 I
I I I I I I
7SA888 DBS SA 11-50 APPLICATION FOR PERMIT
DFVART COUNTY
OF BUILDING AND SAFETY ELECTRIC 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
ELECTRICIAN
�
ADDRESS /'/j 7 A,� ry, ,��y,� RECEiIVEpDnBY FIRST INSPECTION /�READY FOR DATE ISSUED
CITY TEL. NO / * I! I 1
COUNT LICENSE NO. EXPIRESBUILDING ,s�
PERMIT FEE ADDRESS I/ v aoiy
FEE
NUMBER EACH LOCALITY
LIGHT OUTLETS NEAREST
CROSS T.
RECEPTACLES a
WALL SWITCHES OWNER 'yrP24
,terry
TOTAL OUTLETS sc $ O MAIL
ELEC. RANGES P9 ADDRESS
ELEC. HEATERS 25 CITY TEL. NO.
FIXTURES g
1• HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
MISC. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
NUMBER OF LIGHT CIRCUITS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
NUMBER OF RECEPTACLE CIRCUITS -3 I AND STATE LAWS REGULATING ELECTRICAL WIRING.
MOTORS I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
NUMBER HORSEPOWERANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
FEE
NEW MVD. HP OVER INC. EACH OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
I/2 a LESS $ .25 SIGNATURE OF
1/2 2 •50 PERMITTE
2 s 1.00 INSPECTIOW RECORD
s is 1 1.50
1s 90 2.50 y /
so 200 5.00
200 Soo A20.00
A J
500 1000 15.00
OVER 1000
M. G. SET/FREQ. CHANGER-HP (* `1� b
WELDERS:AC-KVA 0
GENERATORS-KW
TRANSFORMERS-KVA
TEMP. MOTORS (75%OFCRIS.
MOVED MOTORS (75%oFORIG.)
MISC.
SIGNS
NO. NO.TRANS. I APPROVALS
NO. NO. LAMPS
FOR EACH PERMIT: DATE INSPECTOR'S NAME
WIRING $1.00 1 OQ CONDUIT
FIXTURES $1.00 Q 0 WIRING
SUPPLEMENTARY •5O FIXTURES
bb POWER
TOTAL FEE $ 8wool UTILITYCO. NOTIFIED
® FINAL i4/lr -�.�
i
WORKERS'COMPENSATION DECLARATION CE-806G
10/81 APPA CAT' ®EAy FOR
ELECTRICAL
L ®ERM 1
I hereby affirm that I have a certificate of consent to self insure, CE-aoBG li�lf°L� Y� IT 1� /'�9 PERMIT
or a cerVioate of Workers'Compensation Insurance, or a certified t„COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800.Lab.C.)
ADDRESS
Policy No. Company FOR APPLICANT TO FILL IN JOB I` i
❑ '� )� /\) ,,, /le .
Certified copy is hereby furnished. New Residential Bldgs.&Pools EACH NO. FEE
❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. $ _ $ LOCALITY f / , ,%
department. Multi-family Sq.Ft. NEAREST
Residential Swimming Pools CROSS ST.
Date Applicant OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' Outlets:Rao Light_Sw.— MAIL , 7
COMPENSATION INSURANCE ADDRESS f >r k(Z/CJS
(This section need not be completed If the work involved by the First 20 CITY / Tel.No.4t`�
permit is for one hundred dollars($100)or less.) Total No. Additional C�;• ?+1 l' r_
I certify that in'the performance of the work for which this permit PLAN CHECK ,
APPLICANT
is issued, I shall not employ any person in any manner so as to
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
Additional
Total No. CITY Tel.No.
Date Applicant Fixed Appliances Not Over 1 HP PERMIT
NOTICE TO APPLICANT: If, after making this Certificate of
APPLICANT
Exemption,you should become subject to the Workers'Compensation Range_ Heater D.W. _
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer_ W.M._ ADDRESS
provisions or this permit shall be deemed revoked. Top — FAU _ W.H. _
CITY Tel.No.
LICENSED CONTRACTORS DECLARATION Hood — Fan _ Other_
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. _ Room Air Cond. LICENSE OR Class.
(commencing with Section 7000)of Division 3 of the Business and REG.NUMBER
Professions Code,and my licenseis in full force and effect. Power Apparatus&Large Appliances DISTRICT NO. RRrSED BY
Size&Type HP,KW,KVA,or KVAR
License Number Lic.Class Up to 1 Incl. FINAL
Over 1 to 10 Incl. DATE VALIDATION
Contractor Date Over 10 to 50 Incl.
FINAL V
❑ I am exempt under Sec. Over 50 to 100 Inc. BY W
B.&P.C.for this reason Over 100 + Z
Servic , anelboards
Date: 00 V
Signature 000 Amp.Under 600 V
❑ Over 000 Amp.or Over 600 V
Exemption for Reg.Maint.Elect.
SINGLE FAMILY Temp.Power Pole&Appurtenances
HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit 2
1 hereby.affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5,Business and Professions Additional Sign Branch Circuits ACCT.0,
Go). Misc.Conduits&Conductors 3= 6o
X I,as owner of the property,will do the work and the structure ,
is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ITENS
and Professions Code). ® TOTAL 65-61
CONSTRUCTION LENDING AGENCY SCK X06
I hereby affirm that there is a construction lending agency for the
Performance of the work for which this permit is issued(Sec.3097, PERMIT FEE (Sub-Total) ceO NNE
{�;1 E
Civ.C.). .0
PLAN CHECKING FEE f���orn,
Lender's Name PERMIT ISSUING FEE X 7 O au —mol 9/19/9,
Lender's Address / O 2
I certify that I have read this application and state that the above TOTAL FEE
information is correct.I agree to comply with all County ordinances
and State laws regulating Electrical wiring, and hereby authorize
representatives of this County to enter upon the above-mentioned
property f inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign of Permittee Date
WORKERS'COMPENSATION DECLARATION CE-880B63
tD/St APPUCA` TON FOR ELECTRICAL PERMIT
I hereby affirm that I have a certificate of consent to self insure,
or itcertificate of Workers'Compensation Insurance, or a certified COUNTY OF LOS ANGELES BUILDING AND SAFETY
copy thereof(Sec.3800.Lab.C.)
Policy No. Company FOR APPLICANT TO FILL IN JOB
❑ Certified copy is hereby furnished. EACH NO. FEE ADDRESS
New Residential Bldgs.&Pools
$ _ $ LOCALITY
❑ Certified copy is filed with the county building inspection 1 & 2-Family,Sq.Ft. — CiCc
department. Multi-family Sq.Ft. NEAREST
CROSS ST.
Date Applicant Residential Swimming Pools OWNER OR
FIRM NAME
CERTIFICATE OF EXEMPTION FROM WORKERS' � MAIL
Outlets:Rec—Light Sw.
COMPENSATION INSURANCE bG� ADDRESS41 k76
(This section need not be completed if the work involved by the First 20
permit is for one hundred dollars($100)or less.)
Total No. J Additional CITY d y-y„p&t �, Tel.No.
I certify that in the performance of the work for which this permit PLAN CHECK
APPLICANT
is issued, I shall not employ any person in any manner so as
become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS
C.- .- •J Total No. Additional CITY Tel.No.
Date Applicant
NOTICE TO APPLICANT: If, of m ng s r ' to of Fixed Appliances Not Over 1 HP PERMIT
Range— Heater D.W. _ CQlrru
Exemption,you should becomes lect to the rkers'Compensation 9
provisions of the Labor Code,you must forthwith comply with such Oven _ Dryer W.M._ ADDRESSt1
provisions or this permit shall be deemed revoked. Top _ FAU T_ W.H.
LICENSED CONTRACTORS DECLARATION Hood _ Fan _ Other_ CITY j�� /G Tei.No
I hereby affirm that I am licensed under provisions of Chapter 9 Disp. — Room Air Cond. D O uCENSE OR
(commencing with Section 7000)of Division 3 of the Business and
NUMBER
Professions Code,and my license is in full force and effect. DISTRICT NO. P SSED BY
Power Apparatus&Large Appliances
_ Size&Type HP,KW,KVA,or KVAR -r C
License Number ^� GLic.Cies. Up to 1 Inc]. FINAL U
i
f�� p X11 ✓ate �y�S'� Over 1 to 10 Incl. 0 DATE VALIDATION 0
Contractor ,— i'�* Over 10 to 50 Incl. ( J
FINAL U
❑ I am exempt under Sec. Over 50 to 100 Inc. BY ( a
BAP.C.for this reason Over 100 fn
Services,Swbd.,MCC&Panelboards Z
Date: 0-200 Amp.Under 600 V
Signature 201 - 1000 Amp.Under 600 V
❑
Exemption for Reg.Maint.Elect. Over 1000 Amp.or Over 600 V 2
SINGLE FAMILY Temp.Power Pole&Appurtenances ACCT A
HOME OWNER-BUILDER DECLARATION Sign with One Branch CircuitEta,40
1 hereby affirm that I am exempt from the Contractor's License Law 3303
Additional Sign Branch Circuits
for the following reason(Section 7031.5,Business and Professions 1 ITEMS
Code):
❑ I,as owner of the property,will do the work and the structure Misc.Conduits&Conductors TOTAL 63.40
Is not intended or offered for sale (Section 7044, Business Other(See Complete Fee Schedule) _ ® MCK 63°40
and Professions Code).
R �� o
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(Sec.3097, PERMIT FEE (Sub-Total) Q QIIIIO-OD01 10/2 /9
Civ.C.).
PLAN CHECKING FEE 2986 1 AN 7057
Lender's Name q
PERMIT ISSUING FEE v�/
Lender's Address
I certify that I have read this.application and We that the above TOTAL FEE (�oJ
information is correct.I agree to comply wi County ordinances
and State laws regulatin lectrical wi' and hereby authorize
representatives of this o t n on the above-mentioned
property spec' r . SEE REVERSE FOR EXPLANATORY LANGUAGE
S' ature of
PernfitteglK Date