HomeMy Public PortalAbout5521 PARMERTON AVE_Miscellaneous_11/19/1993_patio enclosure N'O)tKLRS'COMPLNSATION DECLARATION
CE 675 (11 94) M ISCELLANEOUS APPLICATION {�
CE 875 lJ
1 hereby a mrtLfihat I have a certificate o8 consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
instlre, or a cert�cate of Workers'Compensation Insurance,or
a certified copy thereof(Sec 3800, Lab C)
Policy No CompanyUILDIFOR APPLICANT TO LL IN ADDR N
O FG
(❑ Certified copy is hereby furnished BUILDING �szL f Q/�
ADDRESS LOCALITY
Certified copy rs filed with the county building inspection
LouurY Ni
department c.oas ST
Date Applicant NEAREST DIST NO GROUP TYPE PRO 9 Y
CR099 ST g JPO - CONST
CERTIFICATE OF EXEMPTION FROM WORKERS' HGwL 0
COMPENSATION INSURANCE DESCRIPTION Lor No BLocKIF
- MGA ;CIGNCL�� $TINTS MAJOR SECOND LOCAL
NO OP GLD08
(This $eChOn need not be completed If 1the WOtk Ir1VOIVCd TRACT NOW ON LOT USE 2ONE ar6CIwL CONDITIONS
by the permit is for one hundred dollars (4100) or less) use of
SIZE Or LOT EXISTING BLDG
I certify that in the performance of the work for which this
permit Is Issued, I shall not employ any person in any manner OWNER - o
so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP - o
ADDRESS V
Date Applicant L,J
NOTICE TO APPLICANT If, after making this Certificate of CITY - TEL
- OCCUPANT LOAD - D-
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE
with comply with such provisions or this permit shall be TRAILS. USITE] GEOLOGY INSPECTION ❑ ' No Spec Know[
deemed revoked - -
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices
1 hereby affirrn 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 i
effect 12 sPARK IN
wccG REQ o � r r oa�aD eD �I I
License Number Lic Class LIMITED TIME USE
Contractor Date G"r` TO
ElI am exempt from the licensing requirements as I am a `� 1
licensed architect or a registered professional engmeer SIZE OF NO ow' 1 INAPEcfdh:'s; [Ili
. acting m my professional capacity (Section 7051, Bus- EXISTING BLDG ero.lea _ 6NA
_ mess and Professions Cade) FINAL APPROVAL
Lm or Reg No Date PRESENT USE OF BUILDING - p 7
1J �
HOML OWNER BUILDER DECLARATION No OF ExISTING�DUILDINGS _IJ
ON LOT AND VEE
I hereby affum that I am exempt from the Contractor's
License Law for the following reason (Section 7031 5, Bust _yl7 _rt_'Y:
ness and Professions Code) No PARKING
SPwc _
E211, i PROVIDED ITEM--
I, as owner of the property, will do the work and the - y ,t
structure Is not intended or offered for sale (Section
7044,Business and Professions Code) (Cl I 111_ 243 - 45
CONSTRUCTION LENDING AGENCY PROPOSED use OF BUILDING, ta�E1 _i4 4"I
1 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) HEN
Lender's Name _
PROPOSED MAX OCC
Lender's Address Q e
PERMIT PEE '
I certify that 1 have read application and state that the
above information is torr 1 agree to comply with all County ISSUANCE FEE .40
Ord
and ate 1 relLatulg [o building construction, 40
and hereb [h rize t se tat Ives of this County to enter TOTAL FEE
upon t ve enti ed r perry for inspection purposes '
I I !R 1�3 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perm tee Date