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Home My Public Portal About9037 CALLITA ST_Miscellaneous__ W(7RKERS'COJIPENSATION DECLARATION 76M444 87544 (11-841 % • MISCELLANEOUS APPLICATION {� ,' LJ I sure,hereby1. 4 cr-t that 1 have a certificate of consent to sell COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,� p ttCvtiticate of Workers'Compensation Insurance,or a certified cipy thereof(Sec. 3800, Lab.C.). _ Policy No. Company Certified copy is hereby furnished. BFOR APPLICANT TO FILL IN Bu1LDIry ADO DRESS G wODRE55 m LOCALITY E55 D / S. C 0 Certified copy is filed with the county building inspection Loc AuNEAREST r department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. ZJ y V / CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCR IPTJON I LOT No. BLOCKiDNwA NOP IC, CLEC STATE MAJOR SECOND LOCAL �` NO. OF BLOGS. _ (This section need not be completed If the work Involved TRACT `9� !� NOW ON LOT ` USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) �4 J jq ' USE OF I"certify that in the performance of the work for which this size of Lo /� 7 EX,srINe BLDG. o permit is issued, I shall not employ any person in any manner OWNER ph] =' so as to become subject to the Workers' Compensation Laws. ROUP MAIL mO Dale Applicant ADDRESS Tj>e /V7TV NOTICE TO APPLICANT: If, after making this Certificate of CITY eo�, 12 Q' OCCUPANT LOAD Exemption, you should become subject to the Workers' gppLICA ION 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. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I] 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 JI/l effect. I /VflAce— C PARKING I I SPACES REO.O = PROVIDED D License Number Lic. Class DP AM6 LIMITED TIME USE Contractor Date DATE DATE El1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE ofrvo. of .. INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL FINAL APPROVAL �S � 7r—�� Lic.or Reg.No. Dale PRESENT USE OF BUILDING Cl v (Nh&t/ LGti 5 HOME OWNER-BUILDER DECLARATION No. DP EXISTING Bu u.mrvG ON LOT AND USE ' I hereby affirm that 1 am exempt from the Contractor's q 30License Law for the following reason (Section 7031.5, Busi- ONa Ge "ness and Professions Code): NO. PARKING .... ..:AAAA y F11, as owner of the property, will do the work and the SPACES PROVIDED ACCT.T v structure is not intended or offered for sale (Section _ 33 7 80.513 7044,Business and Professions Code). " 1 ITEMS CONSTRUCTION LENDING AGENCY PROPOSED USE-OF BUILDING TOTAL HO _50 I hereby affirm that [here is a construction lending agency D } Phc for the performance of the work for which this permit is CHECK 89,50 issued(Sec. 3097,Civ.C.). .. Lender's Name _ CHANGE AO MAX. OCC. AAAA. ...._- Lender's Address PERMIT FEE :70/ I certify that 1 have read this application and state that the Q _000I 9/27/85' above noes And a correct.1 agree to t Amply with all County ISSUANCE FEE D ordinances d State laws relating to building my to enter , 0 5932 1 PM12:03 and e auth a representati sof is County [o enter TOTAL FEE ` U bove- entio pr r f A p tion purposes. REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D—ate 7 0a, � �/ �_ D, J / WORKERS'COMPENSATION DECLARATION CE87a -5111-84) MISCELLANEOUS APPLICATION CE 87 , 1 hereby affirm that I have a certificate of consent to self COUNTY-OF LOS ANGELES - BUILDING AND SAFETY DIVISION insure, or acertifiGate of Workers'Compensation Insurance,or a,certified copy thereof(Sec.-3800,Lab.Q. Policy No. Com any BUILD]aFOR APPLICANT TO FILL IN ADDRE %'•r— - :;F-1Certified copy is hereby furnished: r wo owess' {� ? p/ [ -rlf j,.7 ,`'y t+'ty-: Locw LlrY'-'�`��4_ •F-1 Certified copy is filed with the county building inspectionN LOCALITY / NEAREST ,_departmen[. � - � r'';/Yr .l �+!`. C.c. s T.J cwoss sr. Date Applicant NEAREST I•J iI ��, I1 DISTRICT No. GROUP TYPE PROCESSED BY CROSS ST. ��- �,�C Srf I ..1. / i V C , - CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE, DESCRIPTION LOT NO. f BLOCK HIGHWAY '• t' v NOP STATE MAJOR(SECOND LOCAL NO. OF BLDG a, (This section need not be completed if the work involved TRACT - ...j"`.T. , NOW ON LOT / VSE 20NE SPECIA LRCONDITIONS by the permit is for one hundred dollars (5100) or less.) OF B \ �" •�" \ - SIZE OF LOTSJ.y 1. rJ J"IV EXIESTING BLDG. fj �.'O� C2, I ceriify that in,the performance of the work for which this ,�y _ -permit is issued, I shall not employ any persowin any manner OWNER A'" /"( ..1"J fl p_n ,r'.1 Ij�;q )✓`/ - UJ iso as to become subject to the Workers' Compensation Laws: MAIL t / I / -y r - OCCUPANCY GROUP LL \ ' ADDRESS �. 1 Date Applicant - - - `:r NOTICE TO APPLICANT: If; after makingthis Certificate of IT; ,j / eo� / - 7 j C. OCCUPANT-LOAD m C.- . , C I � Al, r � J Exemption, you provisions become subject to the Workers' Compensation provisions of the Labor Code, you mus[ forth- _ APPLICATION FOR - EXIT HARDWARE: With comply With $UCII pCOV]$IOnS OI this Permit shall be ❑TRAILER USE GEOLOGY INSPECTION r_ adeemed revoked. � ❑ ❑ No'SpeC. Knowl. • ' �'' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION DevicesoN - •1 hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEME-BE LOW) 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 eand ? ' effct. �1 t 1)!V 00 ICY A1� 11 PARKING ( SPACES REO.O PROVIDED License Number- Lic. Class d'N I/ I r - _ LIMITED TIME USE Contractor w`•' Date - - - DATE DATE b ;-\ ElI am exempt:from the licensing requirements as 1 am a • ` licensed architect or a registered professional engineer SIZE of y INSPECTOR'S -acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. ^- (�/�. ,.� ` 7^ sroRlEs slGNwrunE i iness and Professions Code). I` - � FINAL APPROVAL - 14 � t.�-.$ J`.4+ (r-�, i. Lic.or Reg.No. PRESENT USE OF BUILDING Date ' �C HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS' - ON LOT AND USE hereby affirm that I am exempt fron .the Contractor's - - Licerise Law for the following reason (Section 7031.5, Busi- ;--,1,A/ .1,Tt •- ness and Professions Code): NO. PARKING t ❑ 1, as owner of the property, will.do the work and the srwces PROVIDED y. structure is not intended or offered for sale (Section --7044,Business arid.Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1•��'M� I hereby affirm that there is a construction lending agency f' ,�y'j,j 3 r'�='1 rt .'�.'>'7 C for the performance of the work for which this permit is • r:lE l.iF ' r: issued(Sec. 3097,Civ.Q. Lender's Name ! fih�alaL PROPOSED MAX.MAX. OCC. , Lender's Address [,/� /t . PERMIT FEE .�'Fr / ( I/ V fYI III-I"I iIPI J iii 1�1 I certify that I have read this application and state that the _ - .1. �. r 17e r•I I'. above information incorrect.I agree to comply with all County ISSUANCE FEE ordinances jidd State laws relating to building construction, / •-n .iK.n. and heieb authoLixe representatives of this County to enter TOTAL FEE upgn�li above-rti�ntio prope7rt fo P petition purposes. !! EEREVERSE FOR EXPLANATORY LANGUAGE ZO i /yy Signature of Permittee Date a LOry y " COUNTY OF LOS ANGELES * DEPARTMENT OF PUBLIC WORKS MICROFILM INFORMATION G Record Search _C\ � A ` Building Address Sn� Cla . \� �X� Locality-1�Ie`1�� )e C Tract No. \'1S LZ Lot No. Lot Size � t� b P Building Permit # W q 2 Issue Date Z�1 / final Date 6 6 Description of work \ "(�jQ\Qkj Sq. Ft. g Building Permit Issue Date11 Final Date 5 Zi Z Description of work gen\&Q,V&_ Gy� 3-WCtP'V-e Sq. Ft. p ) 3 Building Permit # Issue Date Final Date Description of work Sq. Ft. Building Permit # Issue Date Final Date Description of work Sq. Ft. Building Permit # Issue Date Final Date Description of work Sg. Ft. Note: The information given is taken from Building Permit Records. Unless an Occupancy Inspection is requested and the fee for this inspection is paid, no ,investigation of the property will be made by this Department. Sewer Permit # Issue Date Connected to sewer in street : Inspection Date 8eTai�oerk �