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NORTHERN JILEA ISPF)CE SOUTHERN AREA OFNCE Stale of CdltfOrntil ID No.—A <br /> u` <br /> M P!Q_0"1467 2636 lawe Ave.,Suite 102 <br /> m 8411 Folsoat'BTvd. — _ __. Bu4ness,Ttansporlation-and limsigg Agency <br /> t Svcramrxgo,a:, 12-1457 Riverside,CA 92507-2435 - WAI[TMENT OF HOUSING Airco COMMUNITY DEME_UDPMENT <br /> CN V1 61 255. 501 [714}702.4420 <br /> C D1VI%OH OF QODE5 AND STANDARDS <br /> i1NSTRU El mp CCIS El MHl <br /> w �, APPLICATION FOR PERMIT TO CONSTRUCT <br /> Q A. A&ESSORY STRLFCTURES COMPIETE RMS 1,2,d, b 3 'Deirgrtion of 1Nyrk f CLOSED BY <br /> 4 B_ MOB1LEHOMt INSTALLATION COMPLETE ITEMS 1, 2,5,-b � f <br /> DATE CLOSED <br /> C.PARK UTILITIES ALTERATION AND ADDIFYJtJS COMPLETE ITEMS 1, 2, 3,6,SUPPL@itlEhfT <br /> 0:14EW PARKS AND PfR&"ENT BUR DINGS COMPLETE LTEM5 1, 2, 3,b,Sifftll m <br /> E_ RETURN ALL Coms WIN REQUIRED FEES. <br /> iIL <br /> ark Nome is ef U /J IJL%l ! Aj CP,$ _.. _ ValUorier DIVISION USE ONLY <br /> Park Address 1 - — ► a MONUNOMS AOCESSORY STRUCTURES <br /> { f _ <br /> Un6x. Inc-- CiTy/Caurrty —� ZIP� � PP f 7 <br /> �f�l�,�� 1l�C' >`r'v�!I,Q ❑ New Reinstall Standard Plan Ap�ro+ral Nom_y, COL, I��,��� �Jy� <br /> Z ark i7wner?F`�f� Q.a.* �Tel_Nq / f wninga rt f❑ o G Err e_ Tot No_€ FEE RECrO <br /> H f DwrrcrJTenanl f f� /s <br /> Address r YEP1610 <br /> O <br /> f"'Rcan1 State kc.ND. ROUTE TO <br /> O 'iddress PC2 Tel. MOMI,EHOIM 111VALIAXION <br /> ROUTED BY <br /> IL <br /> W Atchilect/Engineer sp''ijE_Ipv_ <br /> ' <br /> A Address Tel.No. <br /> Owner/Tenant Lot No. D E e? <br /> Lender's Name Branch SERIAL NO: DATE OF hSFGR. . <br /> Address DE5CRIPTIDN UPON DEPARTMENT APPROVAL TO PWASi <br /> INSIGNIA OR HUD LABEL NO. uta PAYmEm W F$3,THS PIHbW 15 ISSUE <br /> ONLY Fal YENS VJIJUMTED BELOW <br /> 2 CONTRACTOR/OWNER BUILDER <br /> - certify ihat The fallo,ring Contraoor's ticease No. and Clos!Aka- PERMIT NO. <br /> lion it in Tull force and effect. <br /> 1 certify that 1 am exempt from Section 7031.5 of the Business and Profesmans AA}{ <br /> Code, Division 3,Chop CoMrodors' License law,under the following rection: Appra.ed { " �t�—' ACCJS <br /> Owner:$eciion 704-4 Minor vrork under $100;Sed'eoa 7048 <br /> Mobilehome Pork Owner/Operater{Manager <br /> cr Fmplayee working for wages only;Section 7053 d 4SIGNATURF REQUIRED) MP <br /> Others <br /> `T <br /> t- WORKERS' COMPENSATION REQU1REMENTS BLRG <br /> tf7 State Compensation 0 Cerrificole On File with HCD DIOSION PROCESS REOORD <br /> N Nsvtance Policy No. Expiration Dole MHL <br /> LD <br /> � <br /> EXEMPTION <br /> IjKtertify their in the performance of the work far which this permit is issued, I APPLICATION MISC, <br /> shall not employ any person in any mmuwr so as to become subject to Hie LOCAL APPiiflYALS <br /> V2orkers' Cornpentation lours of Califomia, <br /> TE:If,offer making such cedificale.Mo.applicant for.the.peamil should.beconee_ PLANNING PLC'K <br /> sublecr to the Workers'Carnpensolion provisions of chis code,he shall fatthwith FIRE <br /> I7 Comply with The pro.isions of Section 37DD or his permit siholl be deemed revnkeed. S.M.I. <br /> I hereby ockrtawledge thin the information I have provided is correct and agree HEALTH <br /> their all cansiraction shall be in accordance wAh applicable provisions vi the Health PUBLIC WORK <br /> and Safety Cade, Labor Code, Conlroclors' License Law, and rolaled Rules and' DATE ISSUE <br /> Regulations of the Stora of California, and I acknowledge it a my responsibility to <br /> raque i all necessary inspections incident to the issuance of this permit and allaw ISSUED BY TOTAL <br /> IT <br /> entry of oath cited personnel to provide such ins ertiotts EXPIRES <br /> DQIe APP1ICAW <br /> 00m <br /> DISTHWTION'ORIG. TO AP1r11CANT,2• AREA OFFLCE; 3, DR; 4, A55ES509 9345dHCD 50(REV. 12/91isti <br />