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Home My Public Portal About5540-5542-5544 SULTANA AVE_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF L08 ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN "LDING ADDRESS I herby affirm Nat I have a o1 consent to sell Insure J� Pf or a cer"caft of Wbrkere'Com of, o e copy thereof(Sec 3900 lab J ,yL - --r ZIP C policy No pert' g IG(! OF LOT f OF BL DGS NOW ON LOT NEAREST CI7089 ST (' V ❑ cer9nea copy a IaMrl ❑ Certified Copy is filed WIN the coumyu Inapadkn MOCK ANO USE2 MAP No department 4 + HaO Date 0-4- ASSESSOR(� 'Ric iMOE � SPEGAL CONOmoNS CERTIFICATE OF EXEMPTION FROM WORKERS' l� OWN� YES No COMPENSATION INSURANCEr wrtwN tole FT OF SCHDOLT (Tho sactfon need not be Completed it the permit is for one hundred G ft.(Z DISTRICT GROUP ITYPECONST FIRE ZONE dollars($10D)or lees) ZIP '7 e✓ 1/V1 I ceNy that In the performance of the work for which this permit 0 is spied. I shall not emptily erry pawn in ernY manner w es foale ri EIIO NO p become subject to the MUrkefe Compensation Laws ? JV � SrATISTICAL CLASSIFICATION AGf CONDO Dale—Applicant CLASS NO ILLL DWELL UNITS NOTICE TO APPLICANT ft after making Nle Certificate ofVAIL RED TOTAL SETBACK FROM E%1ST Exemption, you should become subject to the NbrkBro' e �OrLDMWA ACK YARD FI1VY PROP LINE WIDTH Compensation prwislae of the Labor Cod% you must forthwith Comply with such provisions or the permit dell be deemed revoked I' UC Z LICENSED CONTRACTORS DECLARATION CrTY LIC 23 _ I hereby affirm that I am ticennsed under provisions of Chapter 9 SEWERAP .r (commencing Pr feaebna Code Ikwith Section srei b InpNllforceandof deBrtsa arltl OF STORES No oP rlwuEB NEW BXPQ ► 3307 527.2-1 License Number L Lrc Clsee DESCRwrION OF ADD ❑ CN g Conv.ctor�oae l ITEM a a—� —9 �0 u ALTER ❑ ? TOTAL 527.21E ❑ l aRn"i pt urntler sec , REPAIR ❑ CHEN 527.21 B BPC forthureawn V DEMOL ❑ o � CHANGEUSE OF ODSTING BLDG URM ❑41u tj SignatureAPPLICANT(PRINT) TEL NO ma �• I '_ E] I,i, m owner of PmpemY. w y employees with wages as O 1 UrO�cW��rJ,r'rW�l 4/12/90 thdr sole compensation.will do the wok and the structures ADDRESS FLAIL DAT) Q �liCltll� 1 Aft:14'+�y, not Intended or ofered for sale (Section 7044, Business and QIl Profeeebrs Code) rnunE.APucvrtoRnmAseuio.aocwwrtRANOKeAlwiwouaaMAreay.L Z'l, D _T r D ❑ 1 ea owner of the property am exclusively ConbecWg WdhMAy srasA®orl Tra!NA roomWi auiaroA�aconr ouoer FOAL BY �,� AL F 'i Scenwd contractors to cortstrW the project (SOCUM 7011, vEa❑ ND❑ T ' 1i:,S, -HUK Business and professions Code) ' waL TIE nnvnom LAE aF Tile eKwselo ar TIe AIPLJCAr!era nmwa euaaslo '; CONSTRUCTION LENDING AGENCYcweT AnuAPFAarrplC DISTRicICr 1I1e0c1AQMMOOeD19a IRCATwi011 maMTalsceaaumrHr .l_(I I hereby affirm that there Is a canewctkn lending agency for Vro❑ Ro❑ /D mac%r1/ ( the performance of Nework forwhich the permit is' (Sec I RAVE afro TIE IwAnDad UATERIN2 MrareIATICN QUIDS AI0 T erworm 3097,CN C) vERrlrrnvlo nlaiosr I UIO6erAlO w BFAUOR]fQ1}a IamFa TIu roe AMORE9 1 �L�I j—i 11_I r g CQUMYCDOCTmIa;CI4V161]ateFLRIQNerA ter1W10lgRt211gWNCFJelllq Yy pG •l Lenders Mama RATAvaam NArovua BSFamwQ AMD rap acrde.+QArvelmmoMTwerwam d�/�// 1��:_ Lender.Aaareea 9 •�_•_ 1 nM 1tJ:-rf' GNF1141.OMf �/ o I Carty OW I have read tide application and state that the above PC FEE PEIW rt FEE 3 C Information Is correct I agree to Comply with all county ordinances and Sere laws relating to budding corWrucHom and hereby wtho ere en fives of the County to enter upon ISSUANCE FEE () 3 7 the lab s Dne rep for Inspection pu �_ INYEanGAnoN TOPILFEE SEE REVERSE FOR EXPLANATORY LANGUAGE c4L WORKERSCOMPENSATION DECLARATION y affirm that I have a certificate of consent to self ins or a certificate ofWorkenCompemcrpnInsurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec 3800 Lob C ) COUNTY OF LOS ANGELES ' ' _ --BUILDING AND SAFETY Policy No Company BUILD NG .�I C@mfled copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS • LJ Certified copy is filed with the county building Inspec- - ADDRESS hon department ADDRESS Date Applicant CITY Zip LOCALITY NO BLDGS NEAREST - - - ` CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT NOW ON LOT CROSS ST ' COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT - BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100)or less ) ` / L - OWNER - IN t USE ZONE MAP6 I certify that in the performance of the work for which this t' NO 117171, >_permit is Issued, 1311011 not employ any person to any manner ADDRESS b Oistjrc Ave 9ISPECIAL CONDITIONS O so as to become subject to the Worm'Co n n Laws , _ ,L Cm ZIP U Date 2— Applicant �— ARCHI OR TEL - DISTRICT GROUP TYPE FIRE D BY NOTICE TO AP (CANT If aft m mg this Certificate of ENGPlEER NO CONST E .Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS - - - • ' J y with comply with such provisions w this permit shall be TEL ZLt ; TATISTICAL�Nr ONDO deemed revoked T CONTRACTOR / NO z LICENSED CONTRACTORS DECLARATION , ADDRESS IS en 4Y0 LK S'Sy OASS NO I hereby offlrm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC ' and Professions Code,and my license Is In full force and aff CITY 44 CLASS G SK PGION �•� �I SO FT NO OF NO OF CHECK , License Number `sv Z Llc Class `� SIZE S STORIES ,— FAMILIES ONE 3� s lA �`' ALUATION —*1 • a I Contractor �✓. E ��%Dote �� DESCRIPTION aF WORK / /wT NEW $ d 1114.4 ❑I am exempt under Sec fi �lC ADD ❑ ? ALTER ❑ B 8P C for this reason �! [ REPAIR ❑ $LISE OF - EXISTING BLDG N DEMOL ❑ Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT) y NO DATEDATEI herebyaffvm that I am exempt from the Contmdors Ucense Law for the following reason (Section 7031 5, Business and ADDRESS FINALProfassiom Code) BY -BUILDING ❑ I, as owner of the property, or my employees with AppRE� _ .�l is� - _ (��(.F,r wages as their sole compensation will do the work and Yfd the structure Is not Intended or offered far sale(Section LOCALITY ►�C001]7 9E.K 41 70 , Business and Professions Code ) /.WING TEL ElJJ�o _ 1,as owner of the property,am exclusively contracting CONTRACTOR NO i ITEMS EMS - with licensed contractors to construct the project (Sec- ADbRE55 TCITrfL 933 - 63 non 7044 Business and Professions Code ) IRED AL CK FROM - p (7 CONSTRUCTION LENDING AGENCY YARD HwV p IN // LHE�N, gv.:! I hereby affirm that there Is a construction lending agency for FRONT _ F� I_HAGE the performance of the work for which this permit Is Issued PL (Sec 3D97, Qv C) SIDE , - -P L —' Lender's NameJ( /n LDMA Ref E !1000-0 11 4/17/K " P C Fee S ✓ Paan,,Fee v , Z Lenders Address �8P7 1 AM E:14 g I certify that I have read this application and state that the Isswnce Fee 1g LDMA PEC 1 above mformanon nicorrect I agree to comply with all County InvesngMan Fee ordinances and State laws relating to building construction, Total Fee V✓ LDMA Perm Y and h eby ouch nze re sentahves of this County to enter - n u e a en property for Irupection py� , - iRiK REVERE FOR EXPLANATORY LANGUAGE nature of Applicant or Agent WORKERS COMPENSATION DECLARATION n y affirm flim I have r certificate ns tionconsent to self APPLICATION FOR BUILDING PERMIT !*.tor a certificate of Workers Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C ) - COUNTY OF LOS ANGELES BUILDING AND SAFETY - Policy No Compcny ❑ Cgrnfied copy is hereby furnished FOR APPLICANT TO FILL IN AADDIDRESSSS y ElCertified copy s filed with the county building inspec- - 'S•'S"' 444 SHA OW/ " tion department I /1 Dote Appbcant CITY ZIP LOCALITY N0 OF BLDG NEAREST CERTIFICATE OF D(EMPTION FROM WORKERS' SIZE OF LOT" NOW ON LOT - CROSS ST ' COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACE BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or leu ) // TEL OWNER 7 NO- -� USE ZONE MAP 11V 7 I certify that in the performance of the work for which this ,r/ Fo permit is issued, I shall not employ any person in any manner ADDRESS �� •/7 IY CONDITIONS 13 SPECIAL O so as to become subject to the Wor Com naan Laws ''D CITU Iv / ' - U t DaApplicant ARCHITECT OR TEL DISTRICT P TYPE FI BV Q NOTICE TOAPPLICANT If, aft m mg this Certificate of ENGINEER NO CONSTor CE G Exemption, you should become subject to the Worker¢ /�j I/ Compensation provisions of the Labode you must forth- ADDRESS 'ApO V N with comply with such provisions or this permit shall be` TEL STATISTICAL ILAS C DON CONDO Z deemed revoked OOMRACTOR NO - L LICENSED CONTRACTORS DECLARATION - ADDRESS ; ,�� • �..y CLASS NO - I hereby affirm that I om licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 700D)of Division 3 of the Business LIC /- ' and Professions Code,and m license is in full force and eff CITY �j CLASS If-I� BK PG VALIDATION rr ,r 50 NO OF NO OF CHECK License NumberJ S2 ^^a Lic Clany' SIZE SZ- STORIES Z FAMILIES ONE VAWATION ' Contractor AW57AA F /MC�Dale DESCRIPTION OF woRI( i o� o NEW S O.OB ❑1 am exempt under Sec S s ADO ❑ , ALTER ❑ - - B BP C for this reason I /�� REPAIR ❑ _$ Date EXISTING ,Y TING BLDG P44"O wN DEMOL ❑ Signature APPLICANT TEL FINAL OWNER BUILDER DECLARATION (FR NT) /�� NO DATE I hereby affirm that I am exempt from the Contractor's License - ! Law for the following reason (Section 7031 5, Business and ADDRESS FINAL Professions Code) • - - By ❑ I, as owner of the property, or my employees with BUILDINGaC CI .v ges as wotheir sole compensation,will do the work and �� ?,�O - S _ the structure is not Intended or offered for sale(Section LOCALITY /3 - , 3• 7044, Business and Professions Code ) MOVING - - TEL- 1 ITE7C ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- TOTAL 98 . 6:3 non 7044, Business and Professions Code ) ADDRESS ��r / c•, Pg;UI D TAL CK FROM IT � CHE-fK �'-•�� CONSTRUCTION LENDING AGENCY ILa. YARD HWY I t hereby affirm that There Is a consiruclionwhich t is per agency far FROM C HMGE the performance of the work for which the permit s lowed P L - (Sec 3097, Civ C ) - SIDE PL Lender's Name - d130110-11001 -t/1719- PermLDMA Ref it Fee e/ tr- 'Q Lender s Address O I certify that I have LDM read this application and state that the - Inuance Fee 7� A P/C N above Informations correct I agree to comply with ail County mvesogouon Fee O L ordinances and State jaws relating to building construction, Total Fee 7,11, LDMA Perm N and here uthoriz representatives of this County to enter .. - ,and v hone rfy for Inspection purposes ^ A 7 1,'EE tlVDISB FOR E%►IANATONY LANGUAGE _ Srgnot a of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOB APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to gaff Insure BUILDING ADDRESS or a certnfmte of Workers'Compensetlon Irsurartca or a cemnetl . i LP a fJL A policy tlNreW(Sac 3800 Lab C) b•�. [�- LOCALITY �L �,/�ogcy No company CY(�hW'0� tazE OF OF BLDG&NOW ON LOT Sqwcopy"is hereby furnished f=10 3 VArrm NEAREST CROSS ST ❑ Certified copy Is filed with the Ildbq Inspecnan MOM LOT NO USE ZONE aIAPNG14 H O= `-�� \ 7BOOK PARCELP BPECLIL CONDITI s,6 CERTIFICATE OF EI(EMPTION FiIOM WORI�RS' � OWNER /a 17-56 1gHrA TA-4,j d NG -6 ^ YES NO COMPENSATION INSURANCE ADDr' 'K Q wrrNlN taco Fr of scifooLx (Tulle section need net be eompbed H the permit le for one hundred 0 /.{G•� f'!2 p a9771ICr GROUP iwE CONST FwE zolE BY damn({100)or ism) )//1 I oertily that In the performance of the work for which Oft permit Orn LC � 17 5 I`3 Is i®ued. I shall not employ any person M any manner so as to TTECT OR TEL NG become subject to the ft*&W Companaallon Lowe _ O STA71ST1G1L FICTION APT CONDO Dab Applicant aAasNG DWELL UNITS NOTICE TO APPLICANT If after melting this Certificate of REOUIRED TOTAL SETBACK FROM DUST Exemption, you should become subject to the Worker NG a SETBACK YARD I I11VY PROP LITTt E WIO Compamodon provisions of the Labor Code you must fortnwrth compy,with such provisions or this permit shall be deemed revoked ADDIR �(� LIC NO I3)- PPL �� LICENSED CONTRACTORS DECLARATION LIC PDE ,tr i I hereby athmn Bet I am licensed under provisions of Chapter B mo"Tw FBf- OF uEs SEWER MAP •+i8 (corrrnueruclnp with Section TOW)of DMslon 3 of the Business and NEW BK ILO 1. ITEMS Professions Code,and my Ilcants is in fug force effect Number ;1 Date�'��; O OF o b' ADD ;Ttow.PS �. , TdTAL 527 . 21. Contractor 1 ALTER ❑ GHECK 527.21k ❑ laexempt under J REPAIR ❑ ; m B BPC foretlersason DEMOL ❑ LDMAP/C� gCpp ate USE OF EwsnNG elm URM ❑ , dpOp-Od<11 4I12/911 Signage APPLICANT(PRINT) TFL NO LDatA Penn I 1 ` •1\ ❑ 1 m owner of tit, reperry or my employees with wpm m C \ s 1 API 9:_7 their sole compensation,will do the work and the atnlcture Is tO ADDRESS F •° not Intended or offered for sale (Section TO" Brmnem and FINAL DATE ProMebm Cods) ORL*IEAPPLM.V/roR RnwEeuLn�RaaaaaMl.rWwaE To OROO1MMA,BWL OR A unrns+E coRouara• WTEIMI EIXI�L to os,oRErmrn Trnuu a 11m i I, owner of the Property, am exGueivey contracting with Tie Asrolxns ertxs®wne - she MAreaus aarororArgR ouoLT 1oML BY > Ikensed conbectors a construct the protect (Section 70/1 rrn❑ Mo❑ {Q I nL •a ` ,,,I Business and Profession Code) waL �use of TIa eumq sY tRE AwLrGRr aR nmLw aun000 , occuwMr REprseArEmrrFoa couerwcrwK as uooatTwnon moMTlseaurl } :NET .i�f,,_!i CONSTRUCTION LENDING AGENCY o_aer ANG ouwTY MArnAoamrt ommcr tef:tOMDI 6EE rEWsrtavo oeaamr I hereby affirm tlat there Is a construction lending agency for to❑ No❑ - /p /- 9/� �v f)';'Y C HArJ�E ,rI i the performance,of the work for whrh this permit le Issued(Sac i KrME raAo Tus RAZAroous MATveua eaoaui aumE Aro THE eowrD ` ��"' g 3087,Ch C) rnaurrTea oax;nrsr,urmERsrArm My aanamne umw t�Los AMoaEa 2 Lasers Nametour+Y000e.tmEsawrrnxseEcroMszawoTrxouoMamtawKTorrmlo _gr^1y y� Ir -"[01 rMLW00rm "m' ^AETVIIPq ANG fDa OtuDmlO ArBwar RIDYTIY erwom 'OQlol Lenders Address e 1 tartly that I have rad this application and state tial the above Y/ P i4Stl mfamebon Is correct I agree to comply with all county PC FEE PErwrt FEE 2 3 G ordinances,end Sage laws relating to building construction.andISSUANCESUANCE FEE tho3 9 7 hereby authorize remnetivm of this County to enter upon R the Inspection w 1 TOTAL E / / f /, s, SEE RIVERSE FOR EXPLANATORY LANGUAGE a s 9 WORKERS COMPENSATION DECLARATION -affirm that I have a certificate of consent to self - APPLICATIONTOR F.OR BUILDING PERMIT 'mu or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C ) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY _ Policy No Company ` ❑ Cgirt'f'ed copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS �❑ G73Cetion department I BUILD rttfted copy Is filed with the county building vtspec- BUILDING CITY PifM Cin ZIP I - - ' Date Applicant LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST - CROSS ST COMPENSATION INSURANCE ASSESSOR(This seaters need not be completed ifthe permit is for one TRACT LOT NO MAP BOOK PAGE PARCEL - �- hundred dollars ($100)or leu ) OWNER •L> N NO USE ZONE MAP _ I certify that in the performance of the work for which this p SPECIALSPECIAL _ } permit is issued,I shall not employ any person in any manner ADDRESS/0S n• N i MI y L' CONDRIONS Il so as to become subject to the Work Com 'o sys �f O q CITY V' ZIP `T - k pate `Apphcan ARCHITECT OR TEL DI RIOT GROUP TYPE - _ FIRE PROCESSED BY O NOTICE TO APDL T If, after mak' is Certificate of ENGINEER NO CONST ZONE el Exemptton, you should becom subj to the Workers /1 , / Compensation provisions of the Labor Code, you must forth- ADDRESS .!/ V with comply with such provisions or this permit shall be MISTK'AL :F IDL4 CONDO deemed revoked CONTRACTOR �7/A / �/^=IV K/��' 7 - ? LICENSED CONTRACTORS DECLARATION �^S- �� LIC J^.r.Z pi/ CIATS No L uNl I hereby affirm that I am licensed under provisions of Chapter 9 �� OV SEWER MAP (commencing with Section 7000)of Division 3 of the Business Ple / U� G'/ and Professions Code and my license is in full force and a CITY 6 BK PG VALIDATION ' 6_16 + f/fit SO FT - NO OF NO OF ( CHECK License Number 'rr27y�O° L'c Clap G 1 V SIZE `r STORIErSL- y FAMILIES ONE 1 /sw �sagat -'Z- �/ DESCR GN� RK f,?-AL4*TJ0A NEW vAliAno�N Contractor _ e C 4 ADD ❑ $ O.p�O , ❑I am exempt under Sec r ALTER ❑ B 8P C for this reason - - `� REPAIR'❑ $ Date OF EXISTING BLDG f(b lf/ Of1AOl ❑ Signature APPLICANT TEL _ _ FINAL OWNER-BUILDER DECLARATION - (PRZT) NO DATE I hereby off vm that I am exempt from the Contractor's License - _ - Low for the following reason (Section 7031 5 Business and ADDRESS FINAL �1 , Professions Code) PRESENT B - - ` p ❑ I as owner of the property or my employees with BUILDINGESS Y - Ar 1. 1 .i wag as as their sole compensation,will do the work and - - - - 3 23137 ��.�� the structure's 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 TO IAL 98E with licensed contractors to construct the project (Sec - AM" tion 7044, Business and Professions Code ) [ r r` D 7 CONSTRUCTION LENDING AGENCY - I YARD HWY OTAL ROP LIC FROM IST _ y I hereby affvm that there u o construction lending agency for FRONT _ UiAN�S ' ,. .01?the performance of the work for which this permit 's issued PL-. - - - (Sec 3097 Civ C ) SIDE ` - PL Lender's Name Lender's Address PC Fee 3 Permit Fee �.O-O TDMA Ref Y - i��y i �{(� P:It I certify that I have read this application and state that the Imonce Fee 75' JPLVDMA P/C 0 ► , a above information's correct I agree to comply with all County Invesnganon Fee ordconstruction,mances and State laws relating to building constrtion, Total Fee- s LDMA Perm If t and hereby outhonze representatives of this County to enter TnYq u the obRve-m oned property for inspection u aQ REVERES FOR EXPLANATORY LANGUAGE - igrgture of Applicant or Agent Dol _ 3 �S--5--036 APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY - WOAkERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I fatally amain that I hers a certinaae of consent m sen insure euLDI or a certificate of Nbrkera'compensation insur{ancc`ee or auowtifiedcopy , ZIP= T,5 O U Policy No ( --COmpan, J of L/p7 w No of SLOGS NOW ON LOT LaXm • PLC Cartirktd COPY Is hereby hurnis isd V 3 � NEAREST CROSS ST �/ ❑ Certified Copy Int Pled with the co1lrb Shcr INpaabn TRACE_ BLOCKLOT No Q N _ `. USE ZONE t1AP NO 14:7- ill JO oil Aooh-art IN MAP BOGa c PAS A CONDfrIONS o ' CERTIFICATE OF EXEMPTION FROM WORIIERS' ``ate' ✓ TEL NO •^\ COMPENSATION INSURANCE WITHIN B10UFrOFSCHOOL? 6A YES No IThla section deed not be Completed it the perms Is for one hundred -p 06MCT P TYPE FIRE PROCESSED BY dal e0(Ifor lees) 5 0� �� I maria(that t M the performance of the wodc for which this lertnn CITY allT to issued, 1 shall not employ any pence In any merrier so as to IN TEL NO become subject l0 the Workers Compemedon Lags 0 S7AT197M.V.CIAW WCATION CONDO Date—Applicant Iy CLASS NO fi2dQ1 O'WELL U NITS NOTICE TO APPLICANT If after making tills Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the Workers' , /t ( J,�I SETBACK YARD HW PROP LINE WIDTH Compenseocn Provisions a the Labor Code you must forthwith U Y Comply With such provisions or this parmn shall be deemed revoked ADOR uC FRONT o >J Yne3 � n 4;q;12. PL LICENSED CONTRACTORS DECLARATION �' uQ CL,a- P°E ^ I busby affirm that I em Iimrsed under provWom d ClmpOer B ^ OF 3TOIl64 NO OF FAMIUEs V SEWER MAP AiiT.A. z (comm 0113 C with Section My l Tens Is Division 3 a the Bualress end IQ Pro 0113 Code end my Ik»nes b In full force and 2 NEW BK PG , l7 �� U NumNumber ; L- C� ADD ❑ VALUATION g :, _,iV.J`+ YI a Ho -E ALTER ❑ 5 � &O. ! ITEMS I DWI Z ❑ I am WWro under Sec RLTE R ❑ = T0TAL 5:38 _ 69 - BBPC for the reason DEMOL ❑ l.F(Eik r4'.i,.t9 DaftUSE OF E70STING BLDG URM ❑ LDMA PA: CHANGE .tu"I S'Wme°'re NO I—b LMA Pam. - f1 ❑ 1 as owner of the Property, or my employees with wages ea 1]l " then sole compensation.WIti do the Work and the etrtrchus N YI ]1 nor intended or oflared for gale (Section Tae. Buslneas and D CA 1 FatAL DATE c DC45 ' 1 'W?",- not f_ Professions Code) �ranAs corrt°N"Nnwo A a cUlW JA eouAL io' 's� �•� I�i— '�-� ❑ I. as owner a the property em eacluswely corltracwg with TIG AMouNT9 eras®aN tie IAnwoasMEIVALB oMMoRi hosimesid to construct the protect (Section 7M4 wOuL oTHAE iNRrEeOoIAIEEo Ause or TFrOEr1eClllnare1CeTrgTlMfmi APR1GNi aWnNgRrgwMaT:HeE118¢0DUemra F]eftAAL e Business andl PrOlemans Code) m No !�Yi'+_` CONSTRUCTION LENDING AGENCY COAST R� i,ioDIST]w (xwoD)SEE (, !C 1J" �, _• ra.rnTan arcrasr ((� FJ f: r I hereby aflkm Pat Mere Is a conabuctim lending agency,forrEa❑ No❑ /�'aZ/-lj "^ J . m the parfosnce a the work for whk:h this permitle fegued(Sec 90W,CNC) ok i NNE READ THE NArARoms MATE L$srwwaTON aloe AlO TML Srwarm g •fFAlaTare p6R.T IAleaerAAD Mr REQIIRB1ENre uNeai Tr@ LOe ANOEIFB r7 5 Lenders Name CWNTYCCOE,mlesowrws�acc*roras�rmTanaloNxmincaxcaaarn `�ilz�7,C�d 4 ��.1_IJ-iJ1_I,i !„ _i '7i rNiMO01A YRaaM81®mIWOAIQirOROBPINIMOAlEA1Ir Ri0YlME gCA01D 7 d' _ ` Lenders Address I canny that I here read this applimbon and Stals that the abare information in coned I agree to comply with all county PC FEE ¢ , PEFMTFEE ordinances and State laws retati g to building constnw9on,end (� �3 a� v� III enter upon ISSUANCE FEE �'authorize M �rInspx+ INVESTIGATION FEE TOTAL FEE / WE REVERSE FOR eKPLALuroRr IA116UAgE