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Home My Public Portal About8912 & 8912 1/2 BROADWAY_Miscellaneous__ 110Rl:LRS COMPENSATION DE(L-\R.\TIO` a CE 87s t� aa1 M ISCELLANEOJS APPLICATION ce as � I hereby affirm that I have a certificate of consent to self ' insure. ')r a certificate uf1\orkers'Cunwensarion Insurance.or CO LINTY OF LOS ANGELES BUILDING .AND SAFETY DIVISION J�I a certified copy thereof (Sec. 3800. Lab C I Policy No. _(^+)nlnanl — BUILDING FOR'"APPLICANT TO FILL IN ADDRESS d9�a �Z Certified cop} is hereby lurmshed BUILDING ADDRESS LOCALITY �J 1 El Certified Copy is filed Mill the count, ouildine Inspection LOCALITY department. Temple City NEAREST CROSS ST Date \onlicant NEAREST DISTRICT Ng P TYPE ROCESSED BY CROSS ST CONST > I CLRTiFIC\TE OF EXEMPTION FROM '1QRKERS LEGAL ✓ (70\1PLNS MON I\SL R\\(!_ � DESCRIPTION LOT NO 'BLOCK !MAP +G Rw wv 1 +o (c+RCL�l STATE MAJOR SECOND LOCAL NO JF BLDGS (This section need not he comvleted if the %%ork Involvrd -RAC NOw ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars 6100) or less.) I ! SIZE: OF LOT I USE I Certify that In the r+erforman:e rf -he -to.L. 'o- •s Hell -IllsPLUPR- EXISTING BwG. Ly permit iN asuCLI. I ,hall not Cmplo, :u)% person n dm•manner OWNER so as Io become ,tlh!ect to the Rorkers• Fonirensation !_.ms. "L ti•AIL �`�, OCCUPANC`' •3ROUP I _ Date \policant �ADORESS�/�4�Aaj)L jL j NOTICE F(� \PPLIC\NT If. af•er :nakmL -I:1: i;r•'!icate it gl CI��r/�N0` OCCUPaN- LOAD Exempt,(,i you dimild become Siwiect -he �11,rke;: l_ompensfnun ern•.isinns of :hc I_dbl�r�.�.�ue. ,oil must turt_r APD!!CATICv - F ?X r- y o, I` a i ,kith Cmmm% ,�Ith ,uch :)rmis;on, er An, -ernill shdl I,c ^RAILER DSE GEOLOGY NSPECrcN — No SDeC. '<nC'vl. 11 deemed L_ - L[C rNSCD CO\1 R\CTORS DF_CL\R.\TIO\ OCCUPANCY INSPECTIONgg f 3mc Ce`/'Ce5 I hereb% dtfirm :fiat 1 am licensed under previsions of Chant_�r / I C SAF ETY�P ER NIT ' (LIST ITE).75 ELO'.Y' 9 !commencing with _ec:ion -000) of Di%ision 3 of the Bu-,i- NO OF EXITS ness and P-nfesstuns Code. and m% license is In -till lnrce and S eller:. ✓✓ ✓ PARKING REO'D �R O'J ID ED y � 5P4 CES _ Licenw \umber-- — I_,c C!d„ LIMITED TIME USE Contractor _ Date ❑Are 1 am exempt from the licensing reautren)ents as I am d �'" TO m 1 licensed architect or a rezistered nr�tessional engineer ;IZE of No• o< INSPECTOR'S Z actlnc in Tiv prL`f,•.gi ii.il nl.,ti•. \�;;111;7 -I)51 BIT EXISTING BLDG 570P1 SI NATURE —T v InesSdndl'rntcyocln(.)dLI RESENT USE OF BUILDING tAFINL PDROVAL Lie or Re \l, -- - I /� IIWiC Ot1\! R-131 ILUER DFU 0 \i'ION NO OF EXISTING BUILDINGS t0 ON LOT AND USE \� 1 hereby affirm That l dm exempt from the G)ntractul s License La,s fo- t:-.0 folo\s tin_ reason (Section -1131.E BLISI- ness and Professions Code). NO. PARKING SPACES PROVIDED D I, as owner of the property- will du the %wrk and the struc;ure is not intended or (1ftered for ..fie (Section 7044• BU,IIle<S dnd PnilesswnSCode). CONSTRUCTION LENDING -\GI:\C`T X PROPOSED USE OF BUILDING I hereb% affirm that there is a constniction lending .Igenc-N, for the performance of the cork for sShlch this permit is4- 1--,�� Lan issued iSec 3(97,Civ. ('.). t..: I=:If°A'f ff Lender's Name X-1 lJ PROPOSED MAX. OCC Lender's \ddress PERMIT FEE 25.00 `�''" certify that I have read this application and state that the above Information is u)rrect. I agree to comply \%ilh all Count' ISSUANCE FEE CT ordinances and State lairs relating to building construction. and hereby authorize representativ t this County to enter TOTAL FEE25. upon the abo% mentioned )per r insp ion purposes. , 'FL REVERSE FOR EYPL;,ANATORI' LANGUAGE Si azure of Permittee Date • 1l'ORhLRS'('OAIPENSATION DECLARATION CE 875(11-t34) MISCELLANEOUS APPLICATION CE 875 1 hereby affirm that 1 have certificate of consent to.self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.). Policy No —_ Company FOR APPLICANT TO FILL IN BUILDING �a ADDRESS FICertified copy is hereby furnished. BUILDING LOCALITY XX ADDRESS Certified Copy is filed with the county building inspection LOCALITY NEAREST department. 3[y CROSS ST. Date _Applicant NEAREST DISTRICT NR. G1�9UP TYPE CESSED BY CROSS ST. CONST. CP,R"f Il]CA'PE OF EXEMPTION FROM WORKERS' c LEGAL .COMPENSATION INSURANCE DESCRIPTION T. NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (fills 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 SIZE OF LOT EXISTING BLDG. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manneXX OWNER Of building co ac to become cuhlect to the Workers Compensation Laws. MAIL OCCUPANCY GROUP �a o ADDRESS Date Applicant I TEL' OCCUPANT LOAD NOTICIi -1"O APPLICANT- If, after making this Certificate of CITY /r� No. vim,. Lxemption, )-on should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply alth such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. I.ICL NSF.0 CON"1 RAC FORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices ❑ I hereby affirm that I ani licensed under provisions of Chapter - SAFETY PERMIT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS mess and Profecsionc Code, and my license is in full force an�X effect- Name of business PARKING C Q SPACES REO�D D PROVIDED D License Number _ Lie. Class �—J� / CC LIMITED TIME USE Contractor__—> >__ Date DATE DATE 1 am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSP TORS acting in my professional capacity (Section 7051, Bus_ EXISTING BLDG, STORIES SI RE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg No.__ _ Date '• r .. HOME OWNER-131111-DER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE O / hereby affirm that I am exempt from the Contractor's �0 r� 0000-000i Licence Law for the following reason (Section 7031.5, Busi- I _ , I• ne,s and ProfessionsCode)• NO. PARKING �i••i�� -' SPACES PROVIDED 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,13uciness arid Professions Code). CONS]RUCI ION LENDING AGENCY PROPOSED USE of BUILDING 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.). Lender's Name PROPOSED MAx.'OC C. Lender's Address_-- __ certify that I have read this application and state that the PERMIT FEE 5 . 00 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 25- 00 Upon the 4ahovmentione�propcfor on purposes. SEE REVERSE POR EXPLANATORY LANGUAGE XXnc 0*PcImillc!• Datc WORKLRS (ONiI)LNSAlION DL( L \RAlION "M111 MISCELLANEOUS APPLICATION 'Il U(u 'snf";lt iN hereby afflrnl that I I.1%C a ccluflL,Lle 01 Lonlelll 11) 1e11 (_OLIN LY 01 1 O ANG1-1 CS BUILDING AND SAFETY DIVISION it Insure,of a certillcate of Wul kers, (onlpens,uloll Inlulml(c of I}, ,t cernfled coli) thereol (See }800 Lah ( ) Policy No C onlpdny _ F OIC Af ILICAN I 10 FILL IN_ BUILDING BUILDING ADDRESS ADOREss.89j� BROAD WAY ❑ Certified cop) ns hfrfhy funnllhed � , I Locn[-Iry ' �9-L-- -�RQADwR - - ----------- SAN MS)VEL eA ❑ Certll led Coll\ 11 I fled wl III the Cotllll\ hl11111111e In•.11cLl loll CITY G ZIP -'— depart lllenl AN W L CA 9/776 NEAREST /)aM Y Adi ST _ CROSS ST /1 Dale __ Applicant SIZE OF LOT NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CONST 1 ( L-_R"III K /),I. Of- EXLMPIION I RONI \AOK•hl R; I--11AC T BLOCK — NO MHIGHWAY(ONII)LNSAIION INSIJR,aN( I- J0 (CIxcLE1 STATE MAJOR SECOND LOCAL (This til'l'llUll need11(11 he court 11 [lie \\'fill 111\111\e(l (ASSESSOR MAP BOOK — PAGE PARCEL IISEZONE SPECIAL CONDITIONS by the pernlil i, for one hundred doll,us 11,100) of Icss.) I — — OWNER /�/� TEL NO I certify that fitd, the ll not empl of the \\011 fol 11 bleb this Eb��1ARDU 42; _��S - t permit is issued. I shall not employ any pelum til •Im m,uuter l-�Q � so as to become subject to the W4lilfrl ( onlpcn,uuoll I,nv1 ADDRESS OCCUPANCY GROUP �o-o A hcant Z HWAN TE H. I Date�- __ 1 pp /t/e � CITY @CITY ZIP NOTICE TO APPLIC'ANF If Am makrig Ihn ( ettlll(ate I &ANQ L CA /17 _ OCCUPANT LOAD of EXenlptlon VOil shoul(I become 4tlhlect to the Woll,cls I` APPLICATION FOfZ Coin pensauoll provIvonsol(he Labor Code you must t�)lthvvllll 1. EXIT HARDWARE i comply wl(h ltich pill\1111)111 of fill, pe111111 1h.11 hl• II(•(•I,,C( I IRnILF_R DsE I_-� GEOI_c)GY INSPEC I ION�_� No Spec: Knowl ❑ revoked _-I LICENSED CONTR,\C 10RS I I AR'\I ION' OCCUPANCY INSPECIIONX Panic Devices ❑ I hereby atf Trill that I am licensed Under l)I0YIU0l11 of ( Idplel SAFETY PERMIT ❑ (LIST ITEMS BELOW 1 ,'•i 1 9(commencing with Section 7000)(11 Df\1,,1811 1111 the 11111111f11 NO OF EXITS and Prolesslons Code and my keno n ill full Iolce ,Incl elfect — — Hnt-\(, t✓� ��.(\:-.1[ir'") — - PARKING: 'J License Number LTL• Ch ,, •,/ _SPACES REO'D PROVIDED (onLi.lctol D,IIL I i LIMITED TIME USE -- t �------- ---------- DATE DATE ❑ I am exempt front the Ilcemmg iclllnlrinentl a1 I fill a FROM TO licensed architect of d regntcic(I plofelslorul Ell L!llleL'I- ��--!E�-'� L --y /77,6 - —_ ' acting In Ill) piolfssional capaclly (ti(Lnon 70 1 It111111e11 SIZFOF NO OF ,INSPECTOR'S I _XIS I ING BL UO ----______--_-- -- I GRIL bGNATURE and Pndcslltnls C Udc I — ---- ----- 't/ l_Ic or Reg No I),Ite --RESENT USE OF BUILDING - FINAL APPROVAL _Beauty Salon - ------------------------------------- ------ ----- IION1L OWNI_R-111111 DI R DI ( I ARAI ION :It) or t-XI1IING,BUILUINGS ONLOT AND USE 1 hereby afinin that I ,tin c\cmpt from the (oini-iclol - Law for the following ie.lson (Section 7011 5 liimnc11 mid � Professions (ode) NO PARKING Q SPACES PROVIDED U ❑ 1 as ownef of .tile piopen ly \\111 do life l\of k and III - ------— - -- - ----- -- ltllll'llllc 11 not intended of ollcicd 1n1 1,Ilc (SL�LIIou ;0111 P ROPOSED USE OF BUILDING llumnels ,uld 11o4elslons (ode) (ONS IRLA I 10 LI.NDIN(1 A(II-N( 1 hereby aldrin that there n a consuucuon Icnding •illcll(\ fol the perlorntance of the \\oik lot \\Inch thtl pcllnrt n nsued ---- ---------- -- - -- (Sec. 3097, Civ ( ) PROPOSED MAX OCC I eiidei s Name APPLICANI WONT) TEL NO X TERRI H, W AA146 9�g�► Lender's Addlcls r,DDRESS I certrly that I have read this application and \(ate thm the Led At. SARTLE AV SAN L CA /7Zr 1 above information is correct. I agree to comply w nth all (otilm PERMir FEE ordinances and State laws tclating to building conlun trtlCo ,,Ind hereby authorize reprclentati\es of till (otnily to enter upon rasuANCE FEE the above-mentiated property for inspection purpolcl -- t TOTAL FEE 1 f X / (/V� cjL(IJ �b oU� ,EI REVERSE FOR EXPLANATORY IANGUAGF 'i Slgmiture til Pernnnee Date ( I WORKBKS' (.UMFtIN6A11U1N 11Ct.LAKA11UlN 20-0063OPW12/90 M I Z>k r_L.L _,R N r,U UZ-) H t-tLI t..H I I V IN _ I-hereby affirm.that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION ' .'rjnsmre,or a certificate of.Workers'Compensation Insurance, or _ A,certified copy thereof (Sec. 3800, Lab.C.)� '' t LLLIII t Policy No. Company FOR APPLICANT TO FILL IN BUILDING < iBUILDING ADDRUS .ADDRESS El Certified copy.is hereby:furnished. g A- LOCALITY ❑ Certified copy is filed with the county building inspection CITY / Zip I ' department. j(/ �/'r IkL- A 91 ` 'NEAREST , G CROSS ST. Date ' Applicant SIZE OF LOT, NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. a CERTIFICATE OF EXEMPTION FROM WORKERS` TRACT BLOCK LOT NO. C I COMPENSATION INSURANCE MAP HIGHWAY 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 by the permit is for one hundred dollars ($100) or less.) O I certify that in the performance.of the work for which this cif? l�rfy ei TEL No. `' permit is issued. I shall not employ any person in any manner ARapt) y Zp LU so as to become subject to the Workers' Compensation Laws. ADDRESS OCCUPANCY GROUP tr (� Date Applicant . CITY SAN �} /�L NOTICE TO APPLICANT: If, after making this Certificate 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 U5E❑ GEOLOGY INSPECTION❑ l ' No Spec:Knowl. revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONEX Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a PARKING t I ' 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS and Professions Code,and my license is in full force and effect. Name O us=es MAsO License Number- Lic. Class SPACES REO'D PROVIDED I LL�� = ( I Contractor Date LIMITED TIME USE I ❑ I am exempt from the licensing requirements as I am aDATE DATE licensed architect or a registered professional engineer FROM TO: ( acting.in my professional capacity (Section 7051, Business sIzIE OF OF ,NOINSPECTOR'S and Professions Code). I EXISTING BLDG STORIE ,rM� SIGNATURE. LIC. OC Reg. NODale PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING 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 ( Professions Code): NO.PARKING ___ _I, i ❑ as owner of -property,propePty, will"do the-work- and-the- SPACES PROVIDED structure is not intended or offered for sale(Section 7044,X PROPOSED USE OF BUILDING Business and Professions Code). f � I CONSTRUCTION LENDING AGENCY 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.). PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINT) � � TF=j NO. Lender's Address ADDRESS ( iI certify that I have read this application and state that the //(Zf—S A SA A ��C above informat' ' orrect. I agree to comply with all County PERMIT FEE ' ordinances and tate aws relating to building construction,and hereby authori re esentatives of this County to enter upon ISSUANCE FEE the above-m rt io d pro a inspection purposes. s: ,% TOTAL FEE X SEE REVERSE FOR EXPLANATORY LANGUAGE IgA cure of Perad e Date • WORKERS'COMPENSATION DECLARATION, 76 44 (2-80) -MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTW OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof-(Sec. 3800,Lab. C.) :. 'Policy No. Company FOR APPLICANT TO FILL IN BUILDING' ADDRESS ❑ Certified copy is hereby furnished. GILDING �Q/n �1 LOCALITY • ADDRESS _ ❑ Certified copy-is filed with the county building inspection NEARES department. ocwLirY ;. G' F cROSE T. Date Applicant ARES; DISTRICT NO. ROUP TYPE PROCESSED BY ' CROSS ST.' CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL •DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE ryo` (CIRCLE) STATE MAJOR SECOND LOCAL a (Th1S 58CtlOn need not be completed'if the work involved NO. OF BLDGS. TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) • - .• USE OF �—� • ' - tr I certify that SIZE OF LOT EXISTING BLDG.in the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner o A ►— so as to become subject to the Workers' Compensation Laws. M OCCUPANCY GROUP /Q w DRESS I � a Date Applicant S- S 7 TEL. NOTICE TO APPLICANT: If, after making'this 6y Certificate of CITY N1 NEO 5 OCCUPANT LOAD -Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the,Labor Code, you must forth- withcomply with' such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ No Spec: Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic D2VIC@5 ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) No. OF Exlrs 9 (commencing with'Section 7000) of Division 3.of the Busi- -•. ne't and Professions-Codi„and'my license is in full force and PnRKING. effect. SPACES REO'D O PROVIDED D License,Number' Lic.Class - , LIMITED TIME USE ' Contractor Date DATE DATE. Ela I am exempt from.the licensing requirements'as"I am ' • = licensed architect or a registered professional engineer SIZE OF NO. OF FROM To: INSPECTOR'S acting in my professional capacity (Section 7t051,,!BuS; , EXISTING-BLDG. STORIES SIGNATURE iness and Professions Code). SENT IisE of BUILDING0K 1 FINAL APPROVAL Lic.or Reg.No. Date ✓ , HOME OWNER-BUILDER DECLARATION NO. OF EXISTING 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, 'Busi- ness and Professions Code): NO. PARKING __- -____--__ SPACES PROVIDED ❑ I, as owner 'of-the property, will do the work and -the' o o,o.0 8.8 structure is not intended or offered for sale" Section 7044, Business and Professions Code). ( m,o o e o 0 o z OPOSED USE OF BUILDING I ' ' CONSTRUCTION LENDING AGENCY .0,5,11,.0.—8 4 I.Ihereby 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 P I certify that I have read this application and state that the above information is correct.I agree to comply with all County - ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE 2 L o Ind hereby authorize representatives of this County to'enter �� TM�I�.� ,up o he abo e- entioned"pror .for'inspection purposes. SEE REVERSE FOR EXPLANATORI LANGUAGE ++++ ►' 9 Signature o Permittee D e WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION CE 875 I hereby affirm that I have a certificate of consent self COUNTY OF L+JS ,�N'GELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FI LL IN BUILDING ADDRESS d Certified cop}' is herebyfurnished. BUILDING S/ 1 �7 fit _ ADDRESS O ` Q LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT 0 1 GROUP ITYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL `� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF OLD S. (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 —� SIZE OF Lor EXISTING BLDG. I certify that in the performance of the work for which this � 0 permit is issued, I shall not employ any person in any manner OWNER { L. ' r S cc so as to become subject to the Workers' Compensation Laws. MAIL % OCCUPANCY GROUP p . I ADDRESS r Date Applicant f UULO NOTICE TO APPLICANT: If, after making this Certificate of CITY'�00 b No� �� _ `� OCCUPANT LOAD z 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 or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know[. deemed revoked. OCCUPANCY INSPECTION ❑ Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) E'� -- - 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 �/, �/A effect. � Cr ' I Y PARKING REQ'D ,,,ROV-ID ED �� - t SPACES .� License Number Lie. Class LIMITED TIMEj.tUSE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING o .. Lie.or Reg.No. Date � _rVV � ZHOME OWNER-BUILDER DECLARATION NO. OF EXISTIG BUILDINGS OON LOT AND USE 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031:5, Busi- ness and Professions Code): NO. PARKING I, 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). 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 .O I certify that I have read this application and state that the PERMITFEE above information isLned .I agree to comply With all County ISSUANCE FEE ordinances d Starelating to building construction, and here utl rizsentatives of this County to enter TOTAL FEE C9b, upon the?' ve enroperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �,0 o -27-g ignature of Permittee Date