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HomeMy Public PortalAbout9726 WOOLLEY ST_Building__ 78A888A D 98�9�: kP P L I CATION FOR BUILDING PERMIT It•59 '� • DIVISION OF BUILDING AND SAFETY BUILDING Deparbnent of County Engineer ADDRESS County of Los Angeles - LOCALITY JOHN A.LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. P. -FOR APPLICANT TO.FILL IN DISTRIcr No. GROUP .TYPE SE BK WER MA PG .< CONST. BUILDING �j'� ADDRESS NUMBER HWY MAP STATE YES LOT NO. tz akvkX 9 BLOCK USE ZONE SPECIAL ' J .CONDITIONS r�rT VqO.OF BLDGS. SIZE OF LOT Gi I NOW ON LOT BUILDING EXIST. SETBACK YARD HWY STREET-NAME WIDTH USE OF EXISTING BLDG. 'FRONT P.L. I OWNERSIDE P.L. MAIL Z,� �'/f ' ADDRESS �p W O .TRACT DWELL. 1 UNIT ' TEL 5 INDUSTRIAL CITY NO. 1 .DWELL. I UNIT ��C•�7 6 PUBLIC BLDG.' ARCHITECT Off TEL. 2 DUPLFJC 2 UNITS ENGINEER NO. 7 ADDN..ALT.,.ETC. 3 APT. UNITS 8 MISCEL. ADDRESS 42 4 COMMERCIAL TEL. INSPECTION RECORD CONTRACTOR f ' /'NO. ZI ADDRESS 2-4,Q C� , DESCRIPTION OF WOR EW ADD ALTER REPAIR DEMOLISH SO.FT. © NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT APPROVALS ADDRESS DATE INSPECTORS SIGNATURE FOUNDATION:LOCATION • $ �J /.1/°�J P.C. $ FORMS.MATERIALS O 6 -�1 f [/ V FEE FRAME: FIRE STOPS. A� VALUATION $ BRACING.%OLTS 'CJ—/ri �- FEE "� FURNACE: LOCATION.. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT.DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT. _ AND STATE LAWS REGULA G BUI G CONSTRUC- TION. LATH. EXT. -z SIGNATURE'OF HOUSE NUMBER COR. PERMITTEE J l RECT AND POSTED ADDRESS FINAL ✓ ZiM �TiliLE��wtii JOHN.A.LAMBIE,COUNTY ENGINEER VALWATM CLYDE N.DIRLAM, CHIEF BLDG. INSPECTOR CK NO SH �_;�U0 9 9 0,1 L-r-. JUL 3 1 m \� �kPPLICArl..ON FOROVNTY.QF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN ADIDRESS ` L r ` r BUILDING ADDRESS 7,t Woolley SY, LOCALITYNEAREST 'j- CITY �•�f'/1 ! ZIP ` O O CROSS ST.ASSSSOR •I SIZE OF LOT V XIyo NOWOONBLOTS MAP BOOK 3'38 3 PAGE / 7 PARCEL 1 �� L `l pn L.� DISTRICT GR P TYPE FIRE PROFSED BY TRACT L„}}-- C BLOCK 1 LOT NC�O//. / p jn�J�� CONST. ZoNg 22r OWNER /"•IO 46 r C •s No. •> �7/ STATISTICAL CLASSIFICATION �' R P /' �� ff SEWER MAP ADDRESS 97a ( GCW oU //'e - CLASS NO. DWELL.UNITS BK PG/,00 ea 'USE ZONE MAP CITY �.. C � ZIP � D U � NO. ARCHITECT OR TEL. /do SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO TEL. BLDG.SETBACK FROM CONTRACTOR F NO LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO. HIGHWAY + YARD - TA SETBACK FROM HEXISTING LIC. F NT PROP. LINE IGHWAY TH CITY CLASS _ CONSTRUCTION LENDER + - yy NAME AND BRANCH BLDG.SETBACK FROM Q ADDRESS CITY SIDE PROP.LINEOF (STREET) v SQ. FT NO. OF I NO. OF CHECK HIGHWAY + YARD = TOTAL SE BACK FROM TYPE OF EXISTING LY. SIZE /. STORIES FAMILIES ONE SIDE PR P. LINE HIGHWAY WIDTH DESCRIPTION OF WORK NEW ❑ + _ ti 3 ADD CORNER CUTOFF YES ❑ NO ❑ Z�•� ALTER ❑ 'o REPAIR IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG•. ��S f/GI•Lo�Rn� G DEMOL [3AP PRINT N) /" L (y I BY (SIGNATURE I HEREBY ACKNOWLEDGE THAOI HAVE READ THIS P ION AND STATE THAT THE ABOVE IS CORRECT AND AGR TO OMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF� FINAL y��7 BY PERMITTEE DATE ADDRESS L f TEL . 2 P.C. Fee$ Permit Fee �f V � Issuance FeeON•P •may ��';J� ,�..✓✓✓ V Total Fee ' Q 0 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 0 2.0 0 All-0 76AGSBA CE#BOSB 12/79 ' 58 16A686A DDS-2 •AP■APPLICATION FOR BUILDING ■ ERMIT " 1 DIVISION OF BUILDING'AND SAFETY BUILDINRESS Deportment of County Engineer ADDE88 II�� c•9 L�z County of Los Angeles LOCALITY • s�/� C�i.C� WM.J.FOX. COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. / c DISTRICT NO. GROUPSTYPE E BER MAP PG /FOR � APPLICANT TO FILL IN S !h ICONS —' BUILDISS '1 /2 (�Y/t Z Woo Ito-5/ S7 NUMBER 4- STATE ADD EER 4, ✓ HWY cI�EB t�• LOT NO. .� BLOCK USE ZONE SPECIAL CONDITIONS TRACT 13 eG ,dfGl:� y �7 0 NO.OF BLDd .';� BUILDING EXIST. SIZE OF LOT'JrO /1 NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF EXISTING C..�BLDG. /� P.LFRONT OWNER , C► f V Baie� SIDE MAIL P.L. O TRA CT DWELL. t UNIT & / C7 �- 5 INDUSTRIAL �' TEL. „�. 1 /DWELL. I UNIT CITY �./bv'„�.' / N NO. 6 PUBLIC BLDG. ARCHITECT ECT TEL. 2 DUPLEX I UNIT 7 ADDN..ALT.. ETC. ENGINEER ;./ NO. 3 APT. UNITS 8 MISCEL. ADDRE88 4 COMMERCIAL CONTRACTOR (SQ//wA� �j� /T EL,eh ry,;`g INSPECTION RECORD ADDRESS L'hW Fa O (�- DESCRIPTION OF WORK NEW V/ADD ALTER REPAIR DEMOLISH �Q f 14/ — 80.FT. NO.OF NO.OF r SIZE �D STORIES FAMiLIEB USE OF STRUCTUREIi%�:Ff,' tlrrl f I4%T i .'NV' e e. ' SIGNATURE OF� APPLICANT APPROVALS ADDRESS DATE INSPECTORS SIGNATURE FOUNDATION:LeGATION / f'I P.C. FORMS.MATERIALS O Fs� l�i9 �C FEE S. r I / VALUATION (' J✓ �� $ '� D� BRACING.BOLTS ' REB FURNACE:LOCATION. w -A4 " l )�iy.. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT.DUCTS r �- LIA l f f C L Ti.. APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT. AND STATE LAWS REGULATING BUILDING, CONSTRUC- v/ J�[•,I j1�3:4G s1�. TION. LATH.EXT. l// SIGNATURE OF HOUSE NUMBER COR- Ion PERMITTEE RECT AND POSTED ADDRES FINAL WM.J.FOX,COUNTY ENGINEER VALIDATION C.N.DIRLAM.CHIEF BLDG. INSPECTOR C04 1 1 1 un� PEAR 14 1 6 1 1 .0 0 A M NZO 4 2 2.00 ,n 2 1 1 ��AR 16 1 . PA . 4WAPPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, BUILDING,ALDD ESS / n ,V/e or a certificate of Workers'Compensation Insurance,or a certified 1/0 e /� copy thereof(Sec.3800,Lab.C.) CITY �n� LOCALITY 71 GI' ZIP 9100, Policy No. Company SIZE OF LOT NO.OF BLDG&NOW ON LOT e i ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS'. OWNER TEL NO. COMPENSATION INSURANCECA n — A u//Q �� S� ��r�6��77� WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS D D(�e /� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED 13Y dollars($100)or less.) CITY T ZIP I certify that in the performance of the work for which this permit I Q l f C( O �e is issued, I shall not employ any person in any manner so as to D O ARCHITECT ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. -2-1 DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become' subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith d /Lf FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL >- LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL PILE U 1 hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG O License Number Lic.Class DESCf�IPTION OF WORK App ❑ VALUATION , U n U I r k iA�$(.(. ►IJ Q� P C4 w Contractor Date ALTER $ .O O N ❑ 1 am exempt under Sec. REPAIR ❑ $ Z B.BP.C.for this reason DEMOL ❑ LDMA P/C# Signature Date: USE OF EXISTING BLDG. TEL NO. URM 11LDMA Perm# APPLICANT(PRINT) 23 ❑ I, as owner of the property, or my employees with wages as Z ACCT.T their sole compensation, will do the'work and the structure is ADDRESS O �� 5�, �_ not intended or offered for sale (Section 7044, Business and FINAL DATE 15-C X303 .5 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL -7-f-3`4 �` J I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE — to Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YESACCT..& r Business and Professions Code.) WIL ❑ No❑ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ua30.J' 92.25 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ITEMS GUIDELINES r.. 1T l i I hereby affirm that.there is a construction lending agency for YES❑ NO❑ T-I ITL �'`�. o 75 the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHECK 1/-1.-71r TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. CHANGE coo RLender's Address OWNER OR AGENT I'IiR47 3 I certify that I have read this application and state under penalty o P.C.FEE PERMIT FEE -+ C 0 of perjury that the above information is correct.I agree to comply O 0000-0001 3/ 5/96 y with all county ordinances and State laws relating to building M construction, and hereby authorize representatives of this County ISSUANCE FEE �j y 5151 1 PM 6:13 dt enrr upT the ove-mentio property for inspection purposes. o�/ 8� ♦7� D -� INVESTIGATION FEE TOTAL FEE N CI . Ao I 4 Data .a 11 SEE REVERSE FOR EXPLANATORY LANGUAGE �. .r -� - 'APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL?pIG ADDRE S I hereby affirm that I have a certificate of consent to self insure, BUILDING A[`�DR SS ���.y� or a certificate of Workers'Compensation Insurance,or a certified �+' ' ��""L� gr ' copy thereof(Sec.3800,Lab.C.) CI1Y Y, 1;' ZIP �� 1 • LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS,NOW ON LOT ❑ Certified copy is hereby furnished. dS NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. P4G Date Applicant ASSESSQ)3 A�Bf;OK e PARCEL . e•�F/4 ,��''�� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER o (� COMPENSATION INSURANCE SI 0 fid- WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred jD7,72— � _ v S DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) "[ � ! CITY `/ ZIP ^ f I certify that in the performance Of the work for which this per v,'7 d f T J is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO.p q 4C •j/� zz, become subject t0 the Workers'Compensation Laws. _..0 4497 7�DS STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRES7g t,-7,pp.,,,,, //�� ''i�POLE CLASS NO._L— DWELL UNITS NOTICE 70 APPLICANT.• If, after making this Certificate of /� Al.APSt � /7WO I�. '`r l` !• REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and SQ. T I NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force and effect. NEW ❑ BK PG , a License Number LIC.Class DESCRIPTION OF WORK all /970 / � ppp X VALUATION U Contractor Date I;•v%! ALTER ❑ $ 1906—F.—Jor cc ❑ I am exempt under Sec. REPAIR 11 $ !� �'0a0 BAP.C.for this reason DEMOL ❑ 0 LDMA P/C## j Date: USE OF EXISTING BLDG. rL� URM ❑ n- Signature w 23 z APPLICA�1T.Jp�INT) TESL NO n LDMA Perm# ACCT.g ❑ I, as owner of the property, or my employees with wages as (�� Y T Z their sole compensation, will do the work and the structure is ADDRESS �7� t / O 3303 50.5(Y not intended or offered for sale (Section 7044, Business and O ���S�M�� #L W l w+ `c FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Z-q 1X OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J I.,�I, as owner of the property, am exclusively contracting with OR SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � ACCT.JL 'w ICensed contractors to construct the project (Section 7044, YES❑ No❑ 3�, 3 �t�° � Business and Professions Code.) LI O WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 2 ITEMS GUIDELINES I hereby affirm that there is a construction lending agency for YES 11NO❑ TOTAL -5n 17 - 87 N the performance Of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECK C W .3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. CHANGE •117.87 C', TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 4HtIH47E °d� E Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address OWNER OR AGENT !i O P(O I certify that I have read this application and state under penalty r. n of perjury that the above information is correct.I agree to comply P.C.FEE r� �o PERMIT FEE 000101 0OU1 12115/9 awith all county ordinances and State laws relating to building - �� � 1 A�1�°+�� co construction, and hereby authorize representatives of this County ISSUANCE FEE ° upon the above-me oned prop y for Inspection p rp es. m � e er � ! L�6a�b - nw // a�r� INVESTIGATION FEE TOTAL FEE a .o a Aaem ow i•. SEE REVERSE FOR EXPLANATORY LANG i 7. 7 ^ WORKERS'COMPENSATION DECLARATION herebyiaiffirm that I have a certificate of consent to self APPLICATION F OR BUILDING PERMIT inature,dra certificate of Workers'Compenstion Insurance,or a c ,lified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY .. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ ' Certified copy is filed with the county building inspec- BUILDING 9 tion department. ADDRESS 786 Lt/DOLLE' S7 LOCALITY NEAREST Date Applicant CITY ��/w L E Ci r-- ziP / 8d caoss sr. CERTIFICATE OF EXEMPTION FROM WORKERS' de " NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT (y �S NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one Gz?ti .c✓ ✓w< eta USE ZONE MAPa hundred dollars ($100)or less.) TRACT B_ K LOT NUJ" NO. !;L_a3 y, TEL. SPECIAL t1 I certify that in the performance of the work for which this OWNER, p <9 /GGS NO.*V7-9 28'': CONDITIONS O permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE �CCEED BY U so as to become subject to the,Workers Compensation Laws. ADDRESS E S )/E z�L� /t •} CONST Z�IE Date Applicant CITY ZIP STATISTICAL CLASSIFICATION .15T. IBJ NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ys Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS H Compensation provisions of the Labor Corte, you must forth- ADDRESS SEWER MAP � with comply with such provisions or this permit shall be deemed revoked. TEL' .� VALIDATION CONTRACTOR � NO, BK. , LICENSED CCiNTRACTORS.DECLARATION - LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ SQ. FT. NO.OF NO.OF ` CHECK License Number Lic.Class SIZE FT= STORIES,' FAMILIES / ONE Contractor ' Date DESCRIPTION OF WORK NEW ❑ ❑ I am exempt from the licensing requirements as I am a . E /eO dM ADD licensed architect or a registered professional engineer ALTER ❑ FINAL7 acting in my professional capacity (Section 7051, DATE Business and Professions Code). USE OF REPAIR ❑ EXISTING BLDG. DEMOL FINAL , ❑' By Lic.or Reg.No. Date APPLICANT �• TEL. OWNER-BUILDER DECLARATION (PRINT) /—1O D G,1/CGS NO.A14(7—IFY21 I hereby affirm that I am exempt from the Contractor's License ADDRESS Zlo f/(JO 6��E S T Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT \ / �lBUILDING �) -I,'as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and professions Code). - MOVING TEL. F] I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 9 G,6 A' REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 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. i (Sec. 3097, Civ. C.). SIDE Lender's Name o o ]G 0 P.C. Fee$ Permit Fee Lender's Address ) 0 a Z 9_8.0 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 Investigotion Fee ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter Total Fee upon the above-mentioned property for inspection purposes. g `�n. 8'faa/�I� SEE REVERSE FOR EXPLANATORY LANGUAGE SigurVafAppbcanl Dote i ®s