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HomeMy Public PortalAbout5547-5547 1/2 SANTA ANITA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY � APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 9 14B U I L D I N G WM. J. FOX, CHIEF ENGINEER FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN PERMIT NO. DISTRICT NO. PLANZO �0.� BUILDING r 7 ADDRESS O !i - LOCALITY 1' I R/ EIVED BY DATE OF APPL. DATEISSUED oolNEAREST .S ( 3'3 - CROSS ST. L I U ADDRESS S ( BLS OWNER LOCALITY MAIL ADDRESS NEAREST / /�E ©� / TEL CROSS ST. , 4- l� CITY 51-M / I NO. FIRE NO. OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS Z ENGINEER NO. BLDG. � �• SETBACK LINE ADDRESS APPROVED BY DATE CONTRACTOR USE USE APPROVED ZONE L BY DATE ADDRESS :z• - `Q v� HOUSE NUMBERING LEGAL -'5-0-'5-0FIELD CHECK BY DESCRIPTION LOT NO. BLOCK MAP NUMBER TRACT 0 NO. ASSIGNED BY sad ATF r _ NO. OF BLDGS. / CORRECTIONS SIZE OF LOT LS I NOW ON LOT USE NO. OF EXISTING BLDG, _>� � � �� FAMILIES � DESCRIPTION OF WORK NEW I ALTERATION I I ADDITION O REPAIR I I DEMOLITION O Sq, FT. NO. OF SIZE i STORIES ROOMS Z D EXT- W WALL I ROOF r COVERING (_ f ( COVERING USE OF STRUCTURE -4/v I:Arf; APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION .! i ,�•� .t_ PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. 1 AGREETO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS r b/ LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, - SIGNATURE OF GAS VENT, DUCTS 3 ) !;- � "` � _ PERMITTE • LATH, INT. ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 76A638A, DOSS 10-80 .S P. C. B S d FEE PLASTER, EXT. VALUATION FEE $ O FINAL ' •` "�` ` I I DEPARTMENT OF BUILDING AND SA PLICATION FOR PERMIT COURTY 6r LOS ANGELES fm O . WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ) I DISTRICT NO. PLAN CC ADDRESS K.. NO. P�ERRMMIITT NO. ISS '/�D� � �& I ! .. S ` LOCALITY 'r h• �+ TV RECEIVED BY DATE OF APPL. DAT-7E ISSUED - NEAREST J /A� `3 CROSSST. +� I l�lT \sIG ADD RE SS T s �<7 Uhf G� OWNER MAIL LOCALITY ADDRESS L/ y '_, f06 O f tiA C- Oh ' NEAREST TEL CROSS ST. CITY 7.07A) ,'-'J -r- (- r NO. FIRE NO. OF Z I TYP rf� I GROUP.R-- ARCHITECT OR TEL. �� , ZONE PLANS �D�� �� ENGINEER NO. BLDG. ! O D O. t SETBACK LINE or ADDRESS — APPROVED 7 ��s)y`�l: ,F TEL �: + BY DATE CONTRACTOR 9 _ _ NO. -L )7," r USEj/J APPROVED +^ r+I+—v t ZONE J(// BY DATE ADDRESS/n RO L OvwF -R' A - SA 411: HOUSE NUMBERING I LEGAL DESCRIPTION I LOT NO. oA I BLOCK MAP NUMBER ����0 FIELD CHECK BY + TRACT NO. ASSIGNED BY .`�`�d ATE NO. OF BLDGS. / CORRECTIONS — SIZE OF LOT �-)• 3 `�;j I NOW ON LOT USE OF NO. OF I vwcE EXISTING BLDG, f^ +) i I FAMILIES r DESCRIPTION OF WORK NEW I 1---I'ALTERATION I I ADDITION I 0 REPAIR I I DEMOLITION 6Q. FT. NO. OF B SIZE /'�'C ROOMS ,� STORIES / Y EXT. WALL C ROOF ` I' COVERING ,J C i t I COVERING USE OF STRUCTURE i Iq c r /0 x AC S. `&-/1.4, A s~ APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- 5 FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN 1S t FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATIN{6 BUILDING CONSTRUCTION. FURNACE: LOCATION, SIGNATURE OF j• II GAS VENT, DUCTS /^ , PERMITTER ! /�/ f I / / i r' i r LATH, INT. r ADDRE89 LATH, EXT. AUTHORIZED AGT. i ,wa moi' PLASTER, INT. 76A078A•D883 10-80 $ , P. C. $ ® ZQ ` FEE PLASTER, EXT. �1.. VALUATION _ FEE -G FINAL I DEPARTMENT OF<-BUILDING AND SAFETYA� . APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 9!! q I 'W ®I M. J. FOX, CHIEF ENGINR BUILDING EE FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS Qv ! - 3 Z-0 7 Z 3 H rd-d" LOCALITY �^;� T REEIVED BY )DATE OF ADPL. DATEISSUED NEAREST !!�� �/445-s a ( —� /'-?'3 CROSS ST, L%UF_ r/A`K BUILDING ' + ADDRESS OWNER C Aq MAIL / LOCALITY T� ADDRESS ;J I S. C>Ul� !1'/(J� NEAREST E L f JjE ®� �G TEL. CROSS ST. CITY I,_, M .�,6 C I TY NO. FIRE NO. OF�i TYPE GROU ARCHITECT OR / TEL. ZONE PLANS L� I ENGINEER -L NO. �'�- BLDG. SETBACK LINE ADDRESS APPROVED �- =Am PEF�,ipr--BL'y�T;E•L � , BY DATE CONTRACTOR J1 .s f' USE APPROVED ADDRESSf�� D�7 h LOVI/L�� f�SC�' �tN�i� ZONE DATE BY HOUSE NUMBERING Z LEGAL ��-0 DESCRIPTION LdT NO. 1 BLOCK MAP NUMBER FIELD CHECK BY TRACT NO. ASSIGNED BYATE iNO. OF BLDGS. CORRECTIONS SIZE OF LOT LS- I NOW ON LOT f USE OF �� NO. OF EXISTING BLDG,-S. F. ( V . lI F S, I FAMILIES / Q 11-11-ALTERATION OF WORK NEW I Y I ALTERATION I I ADDITION I REPAIR I I DEMOLITION SQ. FT. NO. OF t SIZE ~ ROOMS L� STORIES I 9 EXT. WALL ROOF r COVERING J 7�� u., o I COVERING USE OF STRUCTURE / S/��CTL hA JET APPROVALS INSPEC R'S SIGNATURE DATE I•HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. - 1. AGREE TO COMPLY WITH THE CORRECTIONS LISTED + FRAME: FIRE STOPS, d c� HEREON AND WITH ALL COUNTY ORDINANCES AND STATE + BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, SIGNATURE OF �aG, ��J) / /,r a j J GAS VENT, DUCTS 3 PERMITTE S �. (l f/vo!.fw .te! e --- v - W �° v I ""'`V LATH, INT. f ADDRESS LATH, EXT. 4�1 f"` ?+ AUTHORIZ D AGT. PLASTER, INT. AesSA•Dess 10-50 $ d s P. C. ; FEE FF PLASTER, EXT. / VALUATION FEE $ �i c-.Q FINAL ; /ZZ�'°`' ( i�I i o DEPARTMENT OF BUILDING ANDS �) 19� PLICATION FOR PERMIT COURT :W LOS ANGELES BUILDING®� . t WM. J. FOX, CHIEF ENGINEER L FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING / r DISTRICT O PLAN CK. NO IT NO. ADDRESS DD(/_/7,L t►! I�E. W -LOCALI RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST Ir, Ar J . � `p TV (JS.SL1 D - 1-17-3 CROSS ST. y. I Vr-- OA,14' f9. AUILDINIG DDRESS : (J(/ G� OWNER A L' HAIA Q MAILrl LOCALITY �t clj ADDRESS 2 3 5 rpig u - t`!r� 6 �>�!� NEAREST A, TEL. CROSS ST. CITY %�/ ] ptg: it I 'T NO. Oe` FIRE NO. OF TYPE• GROUP ARCHITECT OR TEL. ZONE I PLANS Z ' ENGINEER NO. BLDG. X ! t O D °• SETBACK LINE G C/ ADDRESS r� - APPROVED BY DATE CONTRACTOR ��',/ _ NO. f19 $���(� USE APPROVED ZONE 0/ BY DATE } ADDRESS * A P--' L 0Vll1,.R A-.0 SA Ru .t' IY14L HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. I BLOCK MAP NUMBER `����d FIELD CHECK BY TRACT '� NO. ASSIGNED BY • dS`�d ATE p NO. OF BLDGS. CORRECTIONS SIZE OF LOT 1L, X .3 ` � I NOW ON LOT USE OF r NO. OF EXISTING BLDG, , , 5. I FAMILIES I } DESCRIPTION OF WORK NEW - I ALTERATION I I ADDITION I i REPAIR I I DEMOLITION 3 ZE r 00 ROOMOF SSTORIES Z D EXT.WALL f � COVERING -$T oc c o I COVERING A ,%Y4/ r r USE OF STRUCTURE 119 ACT. r , APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED r FRAME:FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATIN�s BUILDING CONSTRUCTION. FURNACE:LOCATION, - �G �a SIGNATURE OF �a f A GAS VENT, DUCTS -1 -.' PERMITTE 1-_.E !ir/_t.- .d.;i/ / h'-d '% (-a' ✓ „_'e; r v , r• , 1 LATH, INT. ADDRESS i ''r r. v gar - !' LATH, EXT. AUTHORIZED AGT. - ! PLASTER, INT. 76AGSBA•DOES 10-50P.P. C. $ ® �` FEE PLASTER, EXT. . . VALUATION FEE $ � FINAL -f�t ale 'f it WORKERS'COMPENSATION DECLARATION '{ hereby affirm that I have a certificate of consent to self APPLICATION F O I L D I N G 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 EJ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ABUILDING DDRESS ` r Certified copy is filed with the county building inspec- FDID NG - n tion department. SS y , /� f lf�. LOCALITY 110-7 NEAREST c Date Applicant 'G yl ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP•BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP 1 hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. TEL. p �� SPECIAL d I certify that in the performance of the work for which this OWNER r [7 NOWT/ '-� .� CONDITIONS permit is issued, I shall not employ any person in any manner o + DISTRICT GROUP TYPE FIRE VC BYADDRESS; 7 �+� ,so as to become subject to the Workers'Compensation Laws.• _� CONST. Z CITY c^,1? L ZIP �/t7 F I :J CO Date Applicant STATISTICAL CLA95jFICATION CONDO. (� ARCHITECT OR TEL. �� NOTICE TO APPLICANT: If, after makingthis Certificate of. � Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS tZ P Y I � Compensation provisions of the Labor Code, you must forth- ADDRESSmmmmi 1 �•'�C/ SEWER MAP with comply with such provisions or this permit shall be TEL .1 - deemed revoked. CONTRACTOR ' NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VA DATION (commencing with Section 7000)of Division 3 of the Business and LIC. CP I Professions Code, and my license is in full force and effect. CITY CLASS $ r SQ. FT. NO.OF NO.OF CHECK License Number' Lic.Class' SIZE STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW $ El I am exempt from the licensing requirements as I am a Mal•^ � , �1i w ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, 'l REPAIR DATE Business and Professions Code). USE ❑ FINAL EX NG BLDG. DEMOL ❑; By Lic.or R&g.No. Date APPLICANT TEL. 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 Prof eons Code): PRESENT ®/ BUILDING I, as owner of the property, or my employees with ADDRESS ., wages as their sole compensation.,will do the work and ff -C 1 .�• �• the structure is not intended or oered 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- 2 ° c 97 0 n tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. r. o o 97 G T L 0=- CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH _ I hereby affirm that there is a construction lending agency for FRONT 12 0 2-8 1 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name L� o 049 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 ordinaD.ces.and State laws relating to building construction, Total Fee 's and hereby authorize-representatives of this County to enter u on borened property for inspection purposes.. [ �,L�✓l�u gt,�! o �5- •� SEE REVERSE FOR EXPLANATORY LANGUAGE TSignature of Applicant or Agent ote ®s WORKERS"COMRENSATION DECLARATION d hereby affiant that I have a certificate of consent to self A P P L,I CATION: F OR WILDING P E RM I T i inwre,;er a,certificate of Workers'Compensation Insurance, ora certifigd copythereof(Sec' 3800, Lob. C.) N © _ COUNT,$ OF L10S,ANGE�S•'Y BUILDING AND S. FETY Policy Nop. Zpc'✓r��� w� [Company Certified copy is hereby furnished. ` FOR APPLICANT TO FILL IN BUILDING ADDRESS L.t..J 111 Certified copy is filed'with the county building inspec- • BUILDING laY tion department. r ti ADDRESS 5547 1/2 Santa Anita Ave. Dare 7 l�: 0.6Applicant CITY Temple Cit zip 91780' LOCALITY CERTIFICATE OF EXEMPTION FROM WORK S' -NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need-not be completed if the permit is for oneLil}3]9 ASSESSOR "" • ''! hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ONE MAP nn I certify that in.the Performance of the work for which this OWNER J.E. PlOunt �! CO. N0576-8.737 N0. "AL 7 permit is issued, I shall not employ'dny person in any manner 217 W. Las 'Tunas Dr. i3 SPECIAL to as'to become subject to the'Workers'Compensation-Laws. ADDRESS CONDITIONS V c,rr San Gabriel ZIP 91776 Date Applicant ARCHITECT OR TEL. NOTICE TO'APPLICANT: If,'after making this Certificate of ENGINEER Neil Esurki NO.576-745.6 DISTRICT GROUP TYPE FIRE PRO SED BY Exemption, you'should become subject to -the Workers' CONST. ZONE . Compensation provisions of.the Labor Code, you must forth- ADDRESS ``"' R� y with comply with .'such-provisions or this permit shall be TEL, STATISTICAL CLASSIFICATION / APT.. tVDO.' Z deemed revoked. CONTRACTOR same as owner NO. rY LICENSED CONTRACTORS DECLARATION, , LIC: GLASS NO. �/ DWELL. UNITS -LL 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 CLASSBKPG8'Sd VALIDATION 1.FT. NO OF NO OF CHE . . CK License Number �� S�" Lic.Class / SIZE 1417` STORIES 2 FAMILIES ONE s VALUATION ContractorTh� - DESCRIPIrION-OF WORK -NEW Date $ 90 single family detached ADD U/ ;14326-A- I am exempt'under Sec. ALTER ❑ B.BP.C. for this reason condominiums!ti' llUf EPAIR ❑ $' # o a .o o.2 USE OF Date: ❑ ° EXISTING BLDG. DEMOI ,j�';I Signature APPLT John Plount o. 576-8737 . FINAL PRINT �/ � ���-"�U OWNER-BUILDER DECLARATION DATE ZZ -1 hereby affirm that I am exempt from the Contractor's License' ADDRESS FI Law for the following reason (Section 7031.5, Business and Ole e Professions Code): , PRESENT B BUILDING ❑ I, as owner of the property, or my employees with ADDRESS ; wages as,their s6le 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 ` A 5 0 3 2 A tion 7044, Business and Professions Code). -CONSTRUCTION LENDING AGENCY " SETT BACK YARD HWY TOTAPROP.LINE WIDTBACK FROM. H # 0 0 0 0 0 I hereby affirm that there is a construction lending agency for FRONT ( - 667.50. . the performance of the work-for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE _ f �"0 o667.5 a P.L. 00 a Lender''s Name \ 0 7, 1 5-86 /t ll LDMA.Ref.' `,5, t P.C.Fee 6` U(f - $ (,J fJ � Permit Fee t - Lender's _ rI certify. that I have read this application and state that the Issuance Fee D S kLD P/C# '• above information is correct. I agree to comply with all County Investig�Fee J� ordinances and State laws relating to building construction, Total Fee V LDMA perm. ff and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. c. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature qPApplicantor Agent Date ®I MIORKERS;-COM('ENSATIOk4 DECLARATION i hereby•a i that 1-have certificate of consent to self ,FOR. �U I L D I N G'' P ERM I T . insure, or a,c ertificate of Workers'Compensation Insurance, ' APPLICATION or a certifigd copy fheieof(Sec. 3800, Lab:C:) ;K ' . COUNTY OFACIS ANGELES BUILDING.AND SAFETY 3a6 Policy Not1W �Bv Company_ 'BUILDING �I'� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 55 l.Y�(�`C- Certified copy is filed with the county building inspec- BUILDING tion department. --. ADDRESS 5547 -Santa Date '" O � Applicant' , CITY ZIP 91780 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKER ' NO.OF-BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one 44319 ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify_tKat in the performance. of the work for which this OWNER J.E. Plount & CO. No.576-8737 NO. 1.5-0-27-1 `•� permit is issued, I shall not employ any person in ciny,manner — SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS'217 W. Las Tunas 'Dr' CONDITIONS U. Date `Applicant CITY 9,qn (1n h-ri P1 ARCHITECT OR ZIP TEL. - 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER Neil Esurki No. 576-7456 DISTRICT GROUP TYPE FIRE ReROSSED BY . Exemption, you should become'subject to the Workers' �ao U CONST ZONE W Compensation provisions of the Labor Code, you must forth- gDDRESS !�• V y with comply with such provisions or this permit shall be TEL. STATISTICAL CLASS IF TION API. JPNDO. - fA deemed revoked. CONTRACTOR same as oTaner NO. �� •t'/ LICENSED CONTRACTORS DECLARATION LIC. CLASS NO LL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of.Division 3 of the Business and LIC, Q /) Professions Code, and'my'license is in full force and effect. CITY CLASS HECK BK. PG. /J -6 - . VALIDATION /s'Z9/r SQ.Fr' 1613 srooR�s = 2 FAN110L•IES CONE'.. Ljcense Numbpper P Lic.Class VALUATION 4 rrt� Contractor Iii e Y�uM CDate DESCRIPTION OF WORK NEW" ; dO #•�o ❑ ADD ❑ I am exempt under Sec. single f� mil detached _.TER ❑ 03.31 -86•• ' • 'B.BP.C.for this reason REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. Signature APPLICANT TEL. FINAL Z OWNER-BUILDER DECLARATION PRINT John NO. 976-8. DATE I hereby affirm that I am exempt from the Contractor's License _ Law for the following reason ,(Section 7031.5, Business and ADDRESS FI Professions Code): PRESENT BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wades as their sole compensation,will do the wo'r'k and the structure is not intended of 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 dnd Professions Code). REQUIRED TOTAL SETBACK F --A.503, 1 A CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT ;#'o'0 0 0 0 1 the-performance of the-work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE ••j o721.50 P.L. `e Lender's Name N1 ' P.C.Fee$ A0q. as"Permit Fee 1 t LDMA Ref. # r _ :,o - Lender's Address x I certify. that I have read this application and state that the Issuance Fee �V.�i✓ LDMA P/G# �- above information is correct. I agree to comply with all County Investigation Feex ordinances and State laws relating to building construction, Total Fee SZS LDMA Perm. # and hereby authorize representatives of this County to enter 3 upon the above-mentioned operty for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of A scant or Agent Date