HomeMy Public PortalAbout5801-5803-5805 TEMPLE CITY BLVD_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION
20-0063DPW12/90 f
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
inguie or a certificate of Workers'Compensation (nsurancc,or l
a certified copy thereof(Sec. 3800, Lab.C.)
Policy Na Company—_____ __ FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is hereby furnished. BUIL N A R
LOCALITY
Certified copy is filed with the county building inspection �� zl O
department. NEAREST
GROSS ST.
Date Applicant — SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRI DISTRICT
. GRqup TYPE P SE BY
CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LAT NO. A CONST.
COMPENSATION INSURANCE MAP HIGHWAY
NO. ICIRCLEI STATE MAJOR SECOND LOCAL
(This section need not be completed if the Work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS I'
by the permit is for one hundred dollars ($100) or less.) 1
1 certify that in the performance of the work for which tIt[ R R TEL No. ids
I
I permit is issued, I shall not employ any person in any manner t
so as to become subject to the Workers' Compensation Laws.x ADDRESS OCCUPANCY GROUP t'
Date Applicant _— _�i qWY ZIP
NOTICE TO APPLICANT: If, after making this Certificate 7 A OCCUPANT LOAD
of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code,you must forthwith
comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑
revoked. No Spec.Know[. ❑❑
OCCUPANCY INSPECTION❑ Panic Devices
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ ILIST ITEMS BELO
9(commencing with S tion 70 0)of Division 3 of the Business NO.OF EXITS
and Professions Code, nd my nse is in full force and effect. syr
PARKING• REQ•D == PROVIDED
License NuD-1—
ic.Class _ __ SPACES
Contractor ate —__ ___ _ _ LIMITED TIME USE
DATE DATE
Nd
t rom the licensing requirements as 1 am a FROM: TO:
tett or a registered professional engineer rofessional capacity(Section 7051.Business SIZE OF NO.OF INSPOns Code). EXISTING BLDG. STORIES RE
Lia or Reg. No. Date PRESENT USE OF BUILDING FINAL APPROVAL U u.
HOME OWNER-BUILDER DECLARATION No.OF EXISTING BUILDINGS -W-16
ON LOT AND USE
I hereby affirm that 1 am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and
Professions Code): NO.PARKING
� El I. as owner of the property, will do the work and th SPACES PROVIDED
structure is not intended or offered for sale(Section 7044, PROPOSED SE OF BUILDING
Business and Professions Code).
CONSTRUCTION LENDING AGENCY
SLI G
I hereby affirm that there is a construction lending agency for C F—
the performance of the work for which this permit is issued
I (Sea 3097,Civ.Q. PROPOSED MAX.OCC.
Lender's Name *PPLICANT(t1RINTI
Y ! TEL O._�
Lender's Address ADDS SS K ,
I certify that I have read this application and state that the cfz�w AlIvrl c=
above information is correct. I agree to comply with all County PERMIT FEE
ordinances and State laws relating to building construction,and
hereby authorize representatives of this County to enter upon ISSUANCE FEE
the above-mentioned property for inspection purposes.
1 TOTAL FEE
/4 o� 0U
i SEE REVERSE FOR EXPLANATORY LANGUAGE
g�Sig�nat.,. f Permit ee Efate
I I
' ..ORKERS'(,'UMFhNSAl1UN 1A1k LAKAIIUN I 20-OOB30PW72/90 l(�j 4j""rLrL,Hj1IG��..►4.J� E•111—lrll_.lt�tit •a�.l�1l
I hereby'affirm that I have a certificate bf consent to self COUNTY OF LQ3 ANGELES BUILDING AND SAFETY DIVISION
I.djnsureY or a certifieate of,W&Imrs'Compensation Insurance,or ;;•,. w
•a Certified copy thereof (Set:3800,Lab.C.):
pOEcyr'Na _ Company FOR APPLICANT TO FILL IN BUILDING
". .- BUILDING ADDRESS ADDRESS ,
I ❑ Certified copy.is hereby;furnished g O -TEt�-QCF_ C1—I; •'SC u , LOCALITY
' ❑ Certified copy is filed with the county building inspection CITY ZIP NEAREST,
I depat'tmfent. 1�w,eQ. Cg Com' I � g C) CROSS ST.
Date +' Applicant SIZE OF LOT NO.OF.BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY
• CONST. O
CERTIFIC&E OF•EXEMPTION FROM WORKERS' I TRACT 'BLOCK LOT NO.
r4"P (CSRCL"r
COMPENSATION INSURANCE V
y0: IeIRCLBI STATE MAJOR SECOND LOCAL..
(This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USEZONE SPECIAL CONDITIONS RIG
by the permit is for one hundred 4ollars ($100) or less.)
.s+pggr er TEL NO,
L certlfy'that in the performapce.of the work for which this. n+. S� 1oa6• f 3
permit is issued:I-Shall not employ'kny person in any manner ADDRESS C.
so as to become subject to the Workers' Compensation Laws. 1K=.& e h_ OCCUPANCY GROUP
Z
Date Applicant . I CITY zIP
NOTICE TO APPLICANT. If.' after making this Certificate %. OCCUPANT LOAD
of Exemption. you•should become subject to the Workers' APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the-Labor Code.you must forthwith
comply with Such provisions Or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑
revoked.
i OCCUPANCY INSPECTION Panic Devices ❑
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am.licensed under provisions Of Chapter* SAFETY PERMIT❑ (LIST ITEMS BELOW) NO.OF EXITS
9(commencing with Section 7000)of Division 3 of the Business' . . •ame O tls!Eess "'❑
and Professions Code•and my license is in.full force and effect.
• PARKING• REQ'O O PROVIDED D
License Number Lia Class SPACES
I Contractor Date LIMITED TIME USE
i
DATE DATE
El am'exempt from the licensing requirements as I am al , , FROM: TO.
licensed'architect or a'registered professional engineer
acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S
and Professions Code). EXISTING BLDG. STORIES
SIGNATURE.
I
PRESENT USE OF BUILDING FINALAPPROVAL
Lic.or Reg.Na - Date
HOME OWNER-BUILDER DECLARATION No.OF EXISTING BUILDINGS
1 ON LOT AND USE ,
I hereby affirm that I am'exempt from the Contractor's License
Law for the following reason (Section 7031.5• Business and
Professions Code): No.PARKING
.SPACES PROVIDED ,
i El I, as owner.of the property, will do the work and the,I
structure is ndt intended or offered for sale(Section 7044,)l PROPOSED USE OF BUILDING
Business and Professions Code).
�C) S P, O
i CONSTRUCTION LENDING AGENCY _
Thereby affirm that there is a construction lending agency ford
the performance of the work for which this permit is issued '
(Sea 3097,Civ.Q.
PROPOSED MAX.OCC.
'Lender's Name I• APPLICANT(FRIT) TEL NO. •-
Z �.'va. J`'V t7k_ .
Lender's Address ADDRESS
I certify that I have read this application and state that the' REo�owll, ALV IaQT_ �6g
above information.is correct I agree to comply with all County PERMIT FEE
ordinances and State laws relating'to building construction,and
hereby authorize'representatives.of this County to enter upon ISSUANCE FEE
i the above-mentioned property for inspection purposes. •• --• �`'
TOTAL FEE
g SEE REVERSE.FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
t I ! WORKERS'COMPENSATION DECLARATION I 200063DP. /90 MISCELLANEOUS' APPLICATION
- ry
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING•AND SAFETY DIVISION
'inure,or a certificate of.Wdrlcers'Compensation Insurance,or ,y:
a certi.•fied copy thereof(get;.3800, Lab.C.)• '
t Policy'No. Company FOR APPLICANT TO FILL.IN BUILDING
i BUILDING AODR� r 1 ADDRESS
I, ❑ Certified copy.is hereby;furnished g �^ff p� /Cir+^ ly�, LOCALITY
{ I ❑ Certified copy is filed with the county building inspection CITYzIP C, NEAREST
I department e/rr G/, 7V — CROSS ST.
Date '' ` ' Applicant SIZE O LOT NO.OF SLOGS.NOWONLOT DISTRICT NO. GROUP TYPE PROCESSED BY a
CERTIFICATE OF EXEMPTION FROM WORKERS' �/ CONST.
( I TRACT BLOCK LOT NO
COMPENSATION INSURANCE . MAP HIGHWAY V
NO. (CIRCLE) STATE MAJOR SECOND LOCAL.
(This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS 9Z
by the permit is for one hundred dollars ($100) or less.) C
( I.certify that in the performance.of the work for which thisy er TEL No.
permit is issued:1 shall not employ any person in any manner n.
so as to become subject to the Workers' Compensation Laws ADOREss� U I o OCCUPANCY GROUP tn
( I Date Applicant . CITY /,, zip `�, C�
NOTICE TO APPLICANT: If. after making this Certificate `te�`^� � a v OCCUPANT LOAD
of Exemption. you should become subject to the Workers' APPLICATION FOR
Compensation provisions of the-labor Code,you must forthwith EXIT HARDWARE:
comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑
' revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[% Panic Devices ❑
1 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW)
{ F 9(commencing with Section 7000)of Division 3 of the Business ame O u8 eSs NO.OF EXITS
and Professions Code•and my license is in full force and effect.
PARKING- REWD O PROVIDED O
License Number Lic.Classn.,n� U SPACES
[ I I Contractor Date 5c LIMITED TIME USE
DATE DATE
I am exempt from the licensing requirements as I am a
El To:
FROM:
' licensed architect or a registered professional engineer
{ acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S
S
1 ` I and PfOfeSS10RS Code). EXISTING BLDG. TORIES SIGNATURE.
Lic or Reg No Date PRESENT USE OF BUILDING IFINAL APPROVAL -/9 Z
' HOME OWNER-BUILDER DECLARATION NO.OFEXISTING BUILDINGS
ON LOT AND USE
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and
( ' I Professions Code): NO.PARKING
SPACES PROVIDED
i ❑ I• as owner of the property, will do the work and the
structure is not intended or offered for sale(Section 7044,11 PROPOSED USE OF BUILDING
Business and Professions Code).
{
I CONSTRUCTION LENDING AGENCY
iI hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued '
( I (Sec. 3097,Civ.Q. PROPOSED MAX.OCC.
j Lender's Name A—P� ICA NT r (q b
) /eA / TEL�O.
0 y
Lender's Address A DR S
! I
I certify that I have read this application and state that the I�� ti. /10 Zboy
above information is correct I agree to comply with all County PERMIT FEE
ordinances and State laws relating to building construction,and
hereby authorize representatives.of this County to enter upon ISSUANCE FEE
t7y,l the ab a property for inspection purposes - "
S 1 TOTAL FEE
% SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature Permittee Date
WORKERS'COMPENSATION DECLARATION CE B75(71.84) M ISCELLANEOUS APPLICATION
CE 875
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,or ► COUNTY OF LOS ANtEL'ES BUILDING AND SAFETY DIVISION
a certified copy thereof(Sec.3800,Lab.C.).
Policy No.--__Company FOR APPLICANT TO FILL IN BUILDING r Cj%
� n ADDRESS
C.erllflC(1 Copy IS IICICi)y CUInISIled. X BUILNG- ff
..v 3 LOCALITY
Ap5
❑ Certified copy is filed with the county building inspection L-OCA LITYjI� �!. ����h NEAREST
department. 1]li - r (�' I-e I V cENa 9r.
Date __Applicant ___ NEAREST DISTRICT NO; GROUP CONST. PROCESSED BY
CROSS ST. CITY
C'ERT'IFICATE OF EXEMPTION FROM WORKERS' F LEGAL
C'OAIPENSATION INSURANCE DESCRIPTION TLoTma. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL
NO.OF BLOCS. NO. (CIRCLE)
(This -section need not be completed if (lie work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one Hundred dollars ($100) or less.) USE DF
SIZE OF LOT .� EXISTING BLDG.
1 certify that in the performance of the work for which this,,-
permit
his J
permit is issued, I shall fiat employ any person in any manned o`ER p.f htid111 •® De
SII as to became subject to Workers 'n pensation Laws. MAIL /f/� j A Q.�, -y ,��j OCCUPANCY GROUP c�
ADDRESS o-/0 E. LA:3 �lV.A• �.� ✓!` V
Applican 4I
NOTICE TO APPLICANT: If,after making this Certificate of CITY-SAA _ NO. OCCUPANT LOAD N
Exemption, you should become subject to the Workers r APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code,you must forth- ❑
with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec. Knowl.
deemed revoked.
OCCUPANCY INSPECTION❑ Panic Devices ❑
1.1('1:NSE•:D CONTRACTORS DECLARATION
I hereby affirin that I am licensed under provisions oCChapter SAFETY PERMIT❑ (LIST ITEMS BELOW' '
No. of EXITS
9 (commencing with Section 7000) of Division 3 of the Busi-
ness and Professions Code,and my license is in full force arijk' ~ �---�-
effect. M1_Name -Gf bu-� $•S v PAIIKING REQ'D PROVIDED 1 1
SPACES 11 ....JJ
Licensc Nunibcr-_ Lic.Class
� LIMITED TIME USE
Contra Ctar _.___._.-____--_-Date_ _- DATE DATE
' FROM. TOC
ElI airs exempt fromthe licensing requirements as I am a
CTO
licensed architect or a registered professional engineer SIZE OF NO.OF IN
sg NATUR S
acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES
iness and Professions Code). FINAL APPROVAL
' PRESENT USE OR BUILDING
Lic.or Reg.Na._ .______.— _Date 17 l 1 -
II()Afl:OWNER-BUILDER DECLARATION I NO. OF EXISTING BUILDINGS
L'I � C
ON LOT AND USE I
I Hereby affirin that I am exempt from the Contractor's �: i1 d/ItG G�1j�lf�.��,(itlj
License Law for the following reason (Section 7031.5. Busi-
ness and Professions Code): NO. PARKING
F11, as owner of the property, will do the work and the SPACES PROVIDED
structure is not intended or-offered for sale (Section
7044,Business and Professions Code).
CONST'RUCHON LENDING AGENCY PROPOSED USE OF BUILDING
I Hereby affirin that there is a construction lending agency
for the performance of the work•for which this permit is
issued(Sec. 3097,Civ.C.).
Lender's Name——_-- ,
PROPOSED MAA-OCC.
Lender's Address.---•-.-.---__-._-- — '
95.0
1 certify that i have read this application and slate that the PERMIT FEE
above infuriation is correct. I agree to conipiy with all County I ISSUANCE FEE
ordinances and State laws relating to building construction,
and Hereby authorize representatives of this County to enter TOTAL FEE 25.00
u a the above- elr med�firclaerty for inspection purposes.
1 ` /_�� XX SEE REVERSE FOR EXPLANATORY LANGUAGE
WORKERS'COMPENSATION DECLARATION . 76M4"
I CEE875(11-84) MISCELLANEOUS APPLICATION
�j
I hereby affirm that I have a certificate of consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION IuI
m:.=-% or a certificate of Workers'Compensation insurance,or
a certified copy thereof(Sea 3800,Lab.Q. �
L_I Policy.No.—Company FOR APPLICANT TO FILL-IN i/U iLDEING
/tU DRSS
Certified copy is hereby furnished. BUILDING
ADDRESS LOCALITY or
❑-Certified copy is filed with the county building inspection LOCALITY •I AEAREST
em l
Te Cit (:ROSS ST.
department. P OISTRICT NO. GRO P TYPE P SSED BY
Date Applicant NEAREST l�
CROSS ST.. (% CONST.
CERTIFICATE OF EXEMPTION FROM WORKERS' ! LEGAL a
1 COMPENSATION INSURANCE I DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL
"`1tlND. (CIRCLe)
. .
(This section need not be completed if the work involved' TRACT NONOW OF BLDGS
ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars (SI00) or less.) USE OF
SIZE OF LOT EXISTING BLDG.
I certify that in the performance of the ork for which this
permit is issued,I shall not employ any son in any manner i OWNER G� G,jo�( '_
so as to become subject to the Workers' oDpenation Laws., MAIL c OCCUPANCY GROUP
ADDRESS ` y
1 Date Applicant
NOTICE TO APPLICAA'T: If,after making this Certificate of CITY ,� ,/� G�. NO. a ' OCCUPANT LOAD
Exemption, you should become subject to the Workers'I APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code,you must forth-
with comply with such provisions or this permit shall be! TRAILER USE GEOLOGY INSPECTION _ No Spec. Knowl.
deemed revoked. i
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONS Panic Devices
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS SELOY.'�
I 9 (commencing with Section 7000) of Division 3 of the Busi-j — No. OF EXITS � I
ness and Professions Code.and my license is in full force and
effect. IRKING R&Q,O D PROVIDED
SP,A S ll��J
License Number Lic. Class I LIMITED TIME USE
f Date f;-..Z..
Contractor DATE
FRIM: � TO:-1 1 am exempt from the licensing -equirements as I am 1'licensed architect or a rezigered professional enggineer OF INO. OFISIDE ATUREacting in m}- professional capacit} SecTion '051. Bus- sTING SLOG. STORIES 1
inessand Professions Codel. FINAL APPROVAL I �.. �.�
I PRESENT USE OF BUILDING
Lic.or Reg.No. ." Date 1-e
I
I
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
I ON LOT AND USE
I hereby affirm that I am exempt from the Contractors,, �
�11/L A _U.-InAt}E- 4.`,'4
i License Law for the following reason (Section '031.5. Busi-'
nese and Professions Code): NO. PARKING
1, as owner of the property. will do the work and the'( SPACES PROVIDED
structure is not intended or offered for sale (Section'
7044,Business and Professions Code).
PROPOSED USE OF BUILDING
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency,
t for the performance of the work for which this permit is'
issued(Sec.3097,Civ.C.). l
Lender's Name
PROPOSED MAX. OCC.
Lender's Address
! I PERMIT FEE 25.00
I certify that I have read this application and state that the i
above information is correct.1 agree to comply with all County ISSUANCE FEE
ordfnanc d State laws relating to building construction.
t �l and here y uthorize representatives of this County to enter] TOTAL FEE 25.00
upon the b do ied property for inspection p rposes. I
e n ,SEE REVERSE FOR EXPLANATORY LANGUAGECJ !�j
Ir, ignat 'e of isermittee Date
WORKERS'COMPENSATION DECLARATIONCE 8754(11-84) MISCELLANEOUS APPLICATION
I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure, or a certificate of Workers'Compensation Insurance,
e,or
a certified copy thereof(Sec.3800,Lab.C.). �-'-fy
Policy No. Company -+ r 190ILDING
FOR APPLICANT TO FILL IN ptiORES.
FlCertified copy is hereby furnished. BUILDINGa 11q LOCALITY
ADDRESS
❑ Certified copy is filed with the county building inspectionLOCALITY / NEAREST
department. 1. Cr OSS ST. .
Date Applicant NEAREST DIISTRICT No. I GROUP ITYPE PROCESSED BY
CROSS ST. �D' O CONST.
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a
COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY A
ND. HIGHW(CIRCY STATE MAJOR SECOND LOCAL
NO. OF BLDGS.
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) USE OF
I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. /1 IR o
permit is issued,I shall not employ any person in any manner OWNER QF igv%/ j� UliE (7 k
so as to become subject to the Workers' Compensation Laws. MAIL //'1L)n �, �R„� r,, . OCCUPANCY GROUP �a o
ADDRESS
{•�IJTr✓ ilio WAS ~'
Date Applicant Q LLIJ
NOTICE TO APPLICANT: If, after making this Certificate of CITY n NO 1� _� OCCUPANT LOAD
Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code,you must forth-
with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl.
deemed revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW)
9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS
ness and Professions Code,and my license is in full force and �(��n/J
effect. 19 (J`�^2 PARKING REQ'D PROVID EO
SPACES
License Number Lic. Class
LIMITED TIME USE
Contractor Date DATE DATE
❑ 1 am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer SIZE OF NO. OF FROM: To: INSPECTOR'S
acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE
iness and Professions Code).
�•'
PRESENT USE OF BUILDING IFINAL APPROVAL
Lic.or Reg.No. Date &
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND USE l �}
I hereby affirm that I am exempt from the Contractor's � 7/231/93
License Law for the following reason (Section 7031.5, Busi- 1'13(=1'1—( (3(31
ness and Professions Code): NO. PARKING J, 10977 j AM 9-015
1, as owner of the property, will do the work and the SPACES PROVIDED y�r/
structure is not intended or offered for sale (Section 1'
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
issued(Sec. 3097,Civ.C.).
Lender's Name
PROPOSED MAX. OCC.
Lender's Address
I certify that I have read this application and state that the PERMIT FEE
above information is correct.I agree to comply with all County ISSUANCE FEE
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter TOTAL FEE
upo lte above-m tone woperty for' spection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date