HomeMy Public PortalAbout4941 SERENO DR_Building__�� T ��E * 8 0 3 1 2 / 5 9 ) ���� O J I G K t r F E C ; ��/
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IAGJGA CERBO3 3-66APPLICATION FOR BUIL NG PERMIT
COUNTY OF LOS ANGELES BUILDING �Z
DEPARTMENT OF COUNTY ENGINEER ADORES! I
BUILDING AND SAFETY DIVISION LOCALIT
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W Jg NKINSOUP T OF BUILDING CROSS ST
D19T T GROUP TYPE PR E! I Y
FOR APPLICANT TO FILL IN In � CONlr�
B UILDINO STATISTICAL SSI PICA TION SEWER MAP
ADORHSS yy/ N. S'a rrno ,or IY t CLASS NO I> DWELL UNITS BK PO
LOT NO JUT BLOCK USE ZONE I MAP
NO
TRACT R - 1.2 - SPECIAL _
q �� NO OF BLD[B CONDITIONS
SIZE OF LOT d �G✓ NOW ON LOT _
USE OF ti
e BLDGSETBACK FROM
TEL FROM? PROP LIN[OF 20 ;tA (STREET)
OWNER w NO TYPE 01 t%IaTI MG SETBACK HIGHWAY YARD = TOTAL
ADDRESS L I. F M C L
ELTYP
ARCM Ec O TEL BLDG SETBACK FROM
ENGINEER PAC NO BID! PROP LIN[ Of (STREET
TYPE 0P EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM c L
L }
TE _
CONTRACTOR NO
ADDRESS NO I CORNER CUTOFF YES NO
LICCLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS o
DESCRIPTION OF WORK is
a
h
NEW ADD Y ALTER REPAIR DEMOLISH � ?
SO IT NO OF NO OF
812E STORIES FAMILIES )
USE OF
STRUCTURE e'leo"m
1
SIO NATURE OF
APPLIC ANT //���
VALUATIONS I I •00 APPROVALS DATE IMaP[C 1' aIGMATUR!
P C / PMT �S'C) FOUNDATION, LOCATION
FEE PEES FORMS MATERIAL!
FRAME, FIRE STOPS,
I HERIGY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT L
AND STATE TWAT THE ABOVE Ia CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITHALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING OAS VENT DUCT
OUILDI NO CONSTRUCTION I CERTIFY THAT IN DOING THE WORN
AU'THORI'ZED HEREBY 1 WILL NOT EMPLOY ANY PERWN IN VIOLA LATH INT
TION OF THE LABOR CODE OF TN STATE OF CALIFORNIA RELAY
ING TO WORKMEN S COMPENSATION INSURANCE _ r
�j LATH HXT O
SIGNATURE OPyL�L 4YY_ � NO USE NUMBER OR-
PERMITTEE R11T AID POSTED
ADDRESS :/' %' ✓o. .S Hcy lJrT T_�_ FINAL �T ,�-b
1 JOHN F LEWIS PRINCIPAL STRWJ=rURAL ENGINEER
PLAN CHECK VALIDATION CK Mo GASH _ PERMIT VALIDATION ON No CAW
uACo5570z8_ OCT31 1 0 1150,' R
AP4W- 0 �R BUILDING PERMIT
COU "� BDILDIN6 AND SAFETY - -
-WORKER'S COMPENSATION DECLARATION FOR APPLICAMTO FILL BI 11, - eua.aND
BUILDING
I hereby affirm that I Imre a certificate of consent to self Insure,
�ydthwoof Certificate a Y3trtcers Compensation Insurance.or a certlfietl ' ^ \ ZAP mreol(Sec 3800,Lab C)
POUCy NO LOCALITY SIZE 7 of BLD44 NOW ON LOT
❑ Cef fled Copy le hereby furnished k NEAREST CROSS ST r
❑ Cartl9ed copy Is filed with the county building Irmpection TRACT BLO" LOT No
departmentUSE ZONE NAP NO/
Date—ApplffMt ASSESSOR YAP BOOK PAGE O SPE
d /(� 02
7=100)
CATE OF EXEMPTION FROM WORKERS' Mr, ` TEL NO MRTf11N toot P7 OF ecllooLT YES NO
COMPENSATION INSURANCE
(Thiseed not be completed If the permit Is for One
hundred �y� DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
dollarsutitn lets) C ZIP � L f 0.J �S/ 1
I oertfly thef In the a Pstbj
this permd �P •3 y 3
le balled I ahe9 n01 Orrl person nor so sa t ARCHRE QR NFEA TA NO
DIU JQjha CLASS NO -=CLASSIFICATION APT CONDO
p� yAPP CLASS NO L'�DWELL UNITS
NOTICE O APPLICANT f, n the Cenfikate a REOURED TOTAL SETBAcx FlroY IXLRT
Exemption you should a t to the Workers CONT OR TEL SET BACK YARD IIWY PROPANE w'IQM
Compensatlon provisions of the Labor Code you must fortlmlth
oomph with such provisions or is permit shelf be deemed revoked ADDRESSLIC NO Pl.
SIDEY
LICENSED CONTRACTORS DECLARATION cfw LIC CLASS
I hereby affirm that 1 em Boensed under Provisions of Chapter 9SEWER YAP '
Cc
(oomeanclrig with Section TODD)a Dhrmlon 3 of the Business and F'f SIZE No OF BroaEs No OF PAtaLIES
Professions Code and my license m In full force and effect - NEW ❑ ax PO
DESOUX"License Number Lb Class x ADD ❑ VALUATION
Q� ► y
Contactor Data G ALTER ❑ _
va
❑ 1 am exempt under See REPAIR ❑ $ —
B&PCforthisreason USE DEMOL ,❑ LOMA Pros
Dat URM ❑ -� -
Signature r NO� LDYAPerms
❑ I, as owner of the prop" or my employees with wages as ' \n-'. , •� _
their vote cornpensatlor%will do the work and the abixAm Is PosIIL DATE
not Intended or offered for sale (Section 7044, Business and G Professions Code) vn,LnFAPPIxwRrwnmsmeulnNoacawANrrwmrcANAwmcuaNcrew✓_ — I - i
C3 I as owner Of the On A Ynmxm wNrAIIarq A IrA:ARGOIm NATEUL fmUN TO nit GIERTER THAN _
Propend, em mmlusively �t�g wM TIE AYOIMe GN TIE NATAImOUa wIEAlAlB niPGRA1ATrOR sumer FMAL ay ;J` • > (�I_t .r
gcensed odrbacbm to construct the Protect Mactlon 7044, vLe❑ No
Business and professions Cods) WxL nE ariETrem use of TNa elxLOOa eY TIE ARlLxwWi OR nLRxs eull]aq ` ' ' 3 1-1 "11. 7
OOQAVrr REOUalAPFAIef Pon WIISTaCt mAQMCq SIM PERMITTING 1Es01RR
CONSTRUCTION LENDING AGENCY An ouALm•.•�•^-•—_omlwcr ecAOAIGI e¢Reaarrsq oeclGsr `I _i�i1_
I hereby affirm that there Is a construction lending agency for ms❑ No I TOTAL I 2
the performance a the work for whkkr this penMt le Issued(Sec ) _T�,_ v.� 4
3097 Civ C) I uAG I s a"Rwn�
A r Ir ' ;��' it �J�, 4
Lerldara Name ARD
LencWs Address
o I owft that I here reed this application and stet that the above o.»a
In correct I agree to oomph with W county PC PEE PERMIT F7>:
noes an stag to building conatnlcf On and
author ti a tlti.County m anti won ISSUANCE FIE ` ��I i nl'I
INVESTIGATION PEE TOTAL v /
a s� rW e
SEE REYEIM FOR EXPLANATORY LAIK1UAO8
WORI(ERS' COMPENSATION DECLARATION
henlby o c%3 that I hove r certificates Come of tion Int ,elf APPLICATION FOR BUILDING PERMIT
rhsuee or a a�irfrcate of Workers' Compensation Insurance, - -
or a�cenifredtcopy thereof (Sec 3BI)O,Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
PolicyNo IL Company
1:1Certrfr {opy is hereby furnished FOR APPLICANT TO FILL IN " CRESS yqy/ to
❑. Certmed copy is filed with the county building rnspec- WILOING L49 y ' � ._
hon department ADDRESSJ O C
-Date Applicant CITY l ZIP 9 11—780
CERTIFICATE OF EXEMPTION FROM WORKERS' o OLR
SIZE OF LOTBGS CROSS KNOW'
sr
I !
COMPENSATION INSURANCE t ASSESSOR n�
(This section need not be completed if the permit is for one TRACT BLOCK _ LOT NO MAP BOOK l' PAGE PARCEL
hundred dollars ($100) or leu ) OWNER �R..� NO USE ZONE MAP �(
Y"'\ \ N /•! �� ,
1 certify that in the performance of the work for which this 1 1 1 1 r CONDITIONS�L.. SPKrAL r
NO
permit is issued, I shall not employ any person in any manner ADDRESS 4 L4 V� f= - P CIAL- a
so as to become subject to the Workers Compensation Laws �p
(
+ r CITY Cit ZIP ( /pO
Date ApplicantARCHITECT OR X TEL ce
NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIREWA �COND
CESSED BY O
Exemption, you should become subject to the Workeri 0 c, CONST ZONE r
Compensation provrsroru of the Labor Code, you must forth-
0�0� ^ ✓
with comply with such,provisions w this permit shall be TEL in
STATISTICAL CIASSIFIG4TgN
deemed revoked CONTRACTOR IN CLASS NO �� DWELL UNITS_
- Z
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO
R MAP
(commencing with Section 7000)of Division 3 of the Business
LIC SEWEBusiness
and Professions Code,and my license is in full force and effect CITY CUSS BK,',V PG ��8 1 VALIDATION
SO FT NO OF NO OF CHECK
License Number - Lrc Class SIZE ( NO FAMIOF$ 0 ONE ar `
p�T VALUATION
Contractor - ` Date + DESCRIPTION OF WORK NEW Lal _ CO 33017 195.35 ,
❑I am exempt under Sec '� EJ /� ��O 10, 1 ITEMS
B 8P C for this reason ALTER ❑ TOTAL 196 - 35
REPAIR C3 $
Dote D
USE
BLDG - oEMGL ❑ CHECKHEiCHECK15h. ,`
Signature APPLICANT - TEL FINAL CHANGE - .CCO
OWNER BUILDER DECLARATION (PRINT) NO� DATE
I hereby offirm that I am exempt from the Contractor's License _ _
Law for the following reason (Section 7031 5, Busmen and ADDRESS FINAL ti 0000-1310131 1/1591
Pro anions Code) _ _ _ NT = - By _ „`
as owner of the r BUILDING
property, or my employees with ADADDRESS 51114 1 AN g%51
I,
wages as their sole compensation will do the work and
the structure is not intended or offered for sale(Section LOCALITY
7004, Business and Professions Code ) MOVING _ -- TEL
❑ I, a,owner of the property am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec-, - — - 11,
hon 7044 Business and Professions Code ) r ADDRESS �r T
CONSTRUCTION LENDING AGENCY REQUIRED YARD Hwy OTAL SETBACK FROM EXIST
PROP LINE
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued PL
_ vJ I F, r R
(Sec 3097, Civ C) SIDE r=. UJ r
P L - - _ LJ
C, �.
Lender's Name E�s
y y UAILA ,
PC Fee G• Permitt" o"bS r
lender s Address I certriy that I have rood this application and state that the luaanceF � Law po on is correct I agree to comply with all County Invmtsgonon Fee .�y�dmonces and S laws relating to building construction, Total Fee 77, P
< nd areby you n ere esentahves of this County to enter T t-.)
18R e a -m r n ion rpoee C'a� ) r k
n �// _Stl MVftl!FOR EXPLANATORY LANGUAGE _ _ � 'v `�y �l
gnature Applicant or Agent Date - - _� r_.. -�—�' �1 ry
t , WORKERS'COMPEy DECLARATION ' i • / L - t-j _ �;, ' - _T- v r
,I he;eay,aD t I hie• rtfi opens consent to sell , _�pp�ICATIONu FOR BUILDING -PERMIT, ,
i msere`or c f Workers Compensation Insurance
i or d certl�led t (Sec 3800 Lob C ) , ♦ -
r _ _ _ _ ! COUNTY OFrLOS ANGELES, BUILDING•AND SAFETY
Policy No 1 Company 'r l• - — -
Certified copy is hereby furnishedFOR,AF'PLICANT TO FILL IN . BUILDING
AS
Certified copy is filed with the county building inspec-
tion department _ ADDRESS �{_- C�0 LOCALITVI
Dote Applicant CITY ZIP Cis T{ /
CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF&DGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT Q NOW ON LOT MAP BOOK I PAGE PARCEL
(This section need not be completed If the permit Is for one BLOCK LOT NO NO USE ZONE
hundred dollars ($100)or less I
TFL_ SPECIAL Y
I certify that in the performance of the work for which this OWNER W a 6 NO O R 12 -1 CONDITIONS d
permit in Issued, I shall not employ any person in any manner •-- DISTRICT GROUP 1YPE FIRE B 0
so as to become s'`uubjjje(ect to the W�o�rke�rrs Compensation Laws ADDRESS 9 y/ rSIl I(sL N �v CONS ZONE
Date L.�G�LApplirnnir�'• ARCHITECT OR ZIP TEL STATISTICAL CLASSIFICATION CONDO O
NOTICE TO APPLICANT If, ober making this Certificate of iJ
Exemption you should become subject to the Workers' NGINEER O/✓L NO CLASS NO DWELL UNITS_ d
Compensation provisions of the Labor Code, you must forth ADDRESS _ SEW'ER MAP Vl
with comply with such provisions or this permit shall be Z
deemed revoked CONTRACTOR NO BK - PG VALIDATION -
LICENSED CONTRACTORS DECLARATION - LIC -
I hereby affirm that I am licensed under provisions of Chopter 9 ADDRESS NO VALUATION
(commencing with Section 7000)of Division 3 of the Business and LIC _2
Professions Code, and my license Is in full force and effect CITY CLASS $
I, r SD FT fJC OF NO OF CHECK
It License Number Ln Class— SIZE STORIES FAMILIE5 ONE
JI(! S
Contractor Date DESCRIPTION OF WORK NEW ❑ 1 • • 4 9 8 8
ADD
I am exempt under Sec ALTER ❑ FINAL . - . 49,881
B&P C for this reason REPAIR C] DATE
Date USE mint ❑' H 11.01 -84
EXISTING BLDG BY
Signature 6��= �w.O - PRINiT NO TEL O �— �� /
OWt I am exempt
DEC noN •,
I hereby affirm that I am exempt from the Contractor's Ucense ,
Low for the following reason (Section 7031 S, Business and ADDRESSy s4 g _ _ f
Professions Code) +r—/3-
�✓ I, m owner of the Y employees BUILDING
property, or m do to with ADDRESS , 1
wages m thea sole compensation,will do the work and '
-)
the structure is not intended or offered far sale(Section LOCALITY
Li .s 1 i� i• '
7041, Business and Professions Code) MOVING TEL
F1 I as owner of the property,am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- ADDRESS 111 i
tion 7044, Businea and Professions Code)
CONSTRUCTION LENDING AGENCY MUD YARD HWY TOT PRS LINE
FROM EXIST
I hereby affirm that there in o construction lending agency for _ FILONT - ► -
the performance of the work for which thin permit is Issued P L
tsec 309/,Ctv C ) SIDE_ _
PL
Lender's Name
$
Lenders Address P C Fees Permit Fee
-
I certify that I have rood this application and state that the issuance Fee '-
S above information n correct I agree to comply with all County Investtgotlon Fee _
ILII ordinances and State lows reloting to budding construction, Taal Fee_
and hereby authorize representatives of this County to enter
upon the obovertnemioned property for Inspection purposes 1
l✓,&., l✓-
—_ ria wtrsi FOR EXPuuurotLti LANGILAOI _
r e.
SprgNre of Apokont or Agent Dab
WORKERS'COMPENSATION DECLARATION _
hereby affirm that I hove a certificate of consent to self APPLICATION FOR BUILDING PERMIT
insure or a cerrWorker;Compensation of Workompensation Insurance,
or a certified copy thereof(Sec 3900 Lab C )
� COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
n Certified copy is hereby furnished BUILDING
FOR APPLICANT TO FILL IN ADDRESS
F1Certifiedcopy a filed with the county budding mspec- BUILDING �L
tion department ADDRESS -f I SG rGNo Dr, LOCALITY
NEARESrl
Date Applicant CITU G C C-1 ZIP-(�j 1780 CROSS Sr
CERTIFICATE OF EXEMPTION FROM WORKERSNO OF BLDGS 3 1ASSESSOR
PAGE PARCEL
COMPENSATION INSURANCE SIZE OF LOT O Y7S NOW ON LOT MA BOOK
(Thu ameUSE ZONE MAn need not be completed If the permit in for one TRACT BLOCK LO7 NO
hundred dollars(6100)or less ) Wit
/ '
NO gW
I certify that in the performance of the work for which this OWNER f I bLkr V V NVQ.. NO 7-k ST"/Z -A, I CONDMONS d
permit is Issued, I shall not employ any person m any manner T� - - - - DISTRICT GROUP TYPE FIRE PROCESSED BY
w as to become subject to the Workers Compensation Laws ADDRESS Q�� 5P T1GN0 V r CONST Z
i�M re- sit ZIP o _ _ _ 0
Date '7 y p Applicant AR�('}fIIECT TFl STATISTICAL C1A551FICATION APT DO U
/ 1 NOTICE O PPLICANT If offer making this Cortifid6te of ENGINEER NO CLASS NODWEU. UNITS_ W
Exemption you should become subject to the Worker; d
Compensation provisions of the Labor Code you must forth- ADDRESS _ SEWER MAP
with comply with such provisions or this permit shall be Z
deemed revoked CONTRACTOR NL
OBK PG VALIDATION
LICENSED CONTRACTORS DECLARATION LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO N&LIATION
(commencing with Section 7ODD)of Division 3 of the Business and LIC
Profsnions Code, and my license Is in full force and effect CITY CLASS 00 Poo'i SO FT NO OF- NO OF CHECK
License Number Lic Class SIZE STORIES FAMILIES ONE
Contractor Date DESCRIPTION OF WORK Pi Ir f'bO -- NEW ❑
ADD ❑
1 am exempt under Sec ALTER ❑ FINAL /
B 6P C for this reason REPAIR
DATE Ce
pate USE OF (7
EXISTING BLDG Re-6ijeN GCC - DEMOL E] FFINAL �•J v-•c+.�
Signature APPLICY
ANT _/� NF�� f�JO
OWNER-BUILDER DECLARATION PRINr S Gll2 Vr
1 hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031 5, Business and N1 SGrtiAAO r _
13 1,
Code) a O
1 n I, as-owner of the property, or my employees with BUILDING
T' wages as their sole compensation,will do the work and f�'•
the structure is not intended or offered for sale(Section LOCALITY
7O", Business and Professions Code) MOVING TEL 2 •'6 a 6.3
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO 1 '
with licensed contractors to construct the protect (Sec- ADDRESS e • - 6 e 63
tion 701, Business and Professions,Code) _
REO�IIN TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY MIN YARD ' PROP LIN WIDTH , S Q Z—$Q
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
PL
Lender's Name
9 P C Fee S Permit Fee -
Lender's Address
�T I certify that I have read this application and stats that the hsuar,cs Fee -
above information is correct 1 ogres to comply with oil County Invenigerlon Fee _
ordinances and State laws relating to building construction, Total Fee `
and hereby authorize representatives of this County to enter
i uPon the above-mentioned property for inspection purposes
SEE EfVBL FOR EXPLANATORY LANGUAGE
Signature of licont or tj6srif I Owe 4%
iWORKERS COMPENSATION DECLARATION
hereby affirm that I haver certificate of tion Ins to ,elf APPLICATION FOR:BUILDING PERMIT
insure, or a certificate of Workers Compensation Insurance -
or a certified copy thereof (Sec 3BOO, Lab C )
r COUNTY OF LOS ANGELES-- BUILDING AND SAFETY
Policy No PCompany' BUILDING
❑ Certified copy a hereby furnished FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy Is filed with the county building Inspec- - BUILDING Li9LI
tion deportment ADDRESS JC.�..4_
.Dme Applicant OTY c CCS ZIP- LOCALITY
sd 'macZ2� OF BLDGS NEAREST _
CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT X NOW ON LOT - CROSS ST
`- COMPENSATION INSURANCE I ASSESSOR /�t �i
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP of✓Oo Q^ PAGE ��� PARCEL zon/&
hundred dollars ($100) or less ) "
OWNER USE ZONE MAP JA-1-1
I comfy that m the performance of the work for which the
IAL
permit is issued, I shall not employ any person in any manner ADDRESS C-T3 - .ill 19 CONCDITIONS T
so as to become subject to the Workers Compensation Lows
CITY ZIP li-• _ "• U
Date Applicant ARCHITECT OR TEL ' ce
AaP DISTRICT GROUP TYPE FIRE PROCESSED BY O
NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO _ _ CYONST
Z E G
Exemption, you should become subject to the Workers ' �'{
Compensation provisions of the Labors Code you must forth r ADDRESS •0® - ✓ �`
with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION 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 NO SEWER MAP
,
(commencing with Section 7000)of Division 3 of the Business UC
and Professions Code,and my license is in full force and effect CITY _ � BK/ PG J VALIDATION
50 FT L'�SS ORIES FAMINO LIES ONSS CHECE J
License Number Lic Class S1ZE
VALUATION
Contractor Date DESCRIPTION OF WORK' 1 ADD O
❑1 am exempt under Sec l J ,
ALTER ❑
B 8P C for this reason - - REPAIR ❑ $ -
Date USE OF
EXISTING BLDG CEMOL ❑
Signature ' APPLICANT NO_ t�J FINAL
OWNER-BUILDER DECLARATION DATE 116•
I hereby affirm that I am exempt from the Contractor's License - -
Law for the following reason (Section 7031 5, Business and ADDREss FINAL (`r i - _ --
Prof Ions Code) NT
I, ss owner of the property, BUILDING
p party, or m employees ees with
wages as their sole compensation,will do he work and ADDRESS - - •- - - ` - -I' T�e T'
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 `-_ _ n
Y
with licensed contractors to construct the project (Sec- - -
tion 70Business and Professions Code ) ADDRESS
44 % ,�741 J:
CONSTRUCTION LENDING AGENCY SET BACUIREK YARD HWY AL L K E WIDTH
FROM EXIST
I hereby affirm that there Is a construction lending agency for FRONT _ ''EfI-,
the performance of the work for which this permit is issued P l. - ill `7p--,
(Sec 3097, Civ C ) SIDE - lam(- L-� X 23
P L
Lenders Name - p
- P C Fee f O 7� Permit Fee p.�(/ LDrAA Ref
Lender's Address
a I certify that I hove read this application and state that the Issuance Fee c3[7• O LDMA P/C q Pilo
above Information is correct I agree to comply with all CountyInvesn on Fee _
a9 PY
ordmonc to laws relating to budding construction, Total Fee ✓ L)MA P«m
and h author a sentahves of the County to enter _ - - - _ - - - �y4 j n7
UT a ve-m t n Ion purposes
_3�[61gZ EEE REVERSE FOR EXPLANATORY LANGUAGE -
SigltV of Appliclint ok Agent ee -