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HomeMy Public PortalAbout5909-5927 CLOVERLY AVE_Miscellaneous__ �tivl�ncic� �vtwrclsor+llvly I�c�u nrulvn 20-0063DPW12/90 1'VIIIZ-)116►CL—L—i-jiIbI:_%—JLj=0 1AI—r—L—I%-I AkI 1'14.jIN I hereby affirm that I have a certificate of consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure. or a certificate of Workers'Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.) Policy No.tCompany 6i4G � FOR APPLICANT TO FILL IN BUILDING GI UILDING ADDRESS ADDRESS d� Certified copy is hereby furnished. 2-1 Ci0 wt rlj AveLOCALITY ❑ Certified copy is filed with the count� building inspection CITY 11ZIP l p -- ID N1-AREST department. _ T�iM Q CI"t.t 4 CROSS ST. Date pplicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT CIST5.PRI No, G PEDNSYPE CESSED BY - T. �� 0 CE T[ CATS OF EXEMPTION FROM WORKERS TRACT BLOCK LOT NO. t COMPENSATION INSURANCE MAP HIGHWAY NC. 'CIRCLE, STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE r��CONDITICNS by the permit is for one hundred dollars (S100) or less.) R0 I certify that in the performance of the work for which this OWNER TEL NO. {1 permit is issued. 1 shall not employ any person in any manner so as to become subject [o the Workers Compensation Laws. ;ADDRESS OCCUPANCY GROUP i Date Applicant CITY ZIP NOTICENOTICE TO APPLICANT: If. after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATiON FOR EXIT HARDWARE: Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.KaOwl. revoked. I� LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Psnic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT I LIST ITEMS BELOW) F 9(commencing with Section 7000)of Division 3 of the Business No.of Exlrs El and Professions Code. and nTy license is in full force and effect. pq RKwG• II�I License Number Lic. Class SPACES REQ'D I� PROVIDED z �. Contractor Date LIMITED TIME USE DATE DATE ❑ 1 am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF` INSPECTOR'S acting In my professional Capacity (Section 70 1• BusinessEXISTING BLDG. STORIES 5 ATUR 3 and Professions Code). Lic. or Reg. No. Date 'RESENT USE OF BUILDING FINAL APPROVAL 1-t$� Jetr�e c uv�cturre$ {-�rbs e 1,h 1� 4J HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that 1 am exempt from the Contractors License Law for the following reason (Section 7031.5. Business and Professions Code): NO.PARKING ❑ LaSPACES PROVIDED s owner of the property. will do the work and the `` structure is not intended or offered for sale (Section 7044. PROPOSED USE OF BUILDING Business and Professions Code). �. Lrrxw A5, L&ie CONSTRUCTION' LENDING .AGENCY I hereby affirm that there is a construction lending aeency for the performance of the work for which this permit is issued t (Sec. 3097. Civ. C.). PROPOSED MAX.OCC. Lender's Name i PPLICANT(FRIM' TEL NO. Lender's Address D D R E S".---'TW' I certify that I have read this application and state that the �' Vel 'e' T` G above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives Of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE i U 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Sy-nature of Permittee Date WORKERS'COMPENSATION DECLARATI N 761Yt444 CE 875 (11-84) MISCELLANEOUS A P P L I C.A I 1 U N 1.117 1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION s { insure, or a certificate of Workers'Compensation Insurance,or i a certified copy thereof(Sec. 3800,Lab.C.). BUILDING � t ti L=_I Policy No. Company FOR APPLICANT TO FILL IN BUILDIN l Certified copy is hereby furnished. Bu1LDING G �. ADDRESS � 1\ rAve- =JCA LITY Certified copy is filed with the count building ins ection / NEAREST City department. P Y ` Q y p LOCALITY Temple CROSS ST. I Date Applicant NEAREST DIS RI T NQS GR UP TYPE OCESSED BY CROSS ST. LQ am.J JD y CONST l CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY O. OF BLDGS. (CIRCLE) STATE MAJOR SECOND LOCAL N (This S2CtlOn need not be completed if the work involved TRACT NOW ON LOT USE ZONEf SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) I USE of 1 SIZE OF LOT EXISTING BLDG. I } I certify that in the performance of the work for which this proper ty permit is issued, 1 shall not employ any person in any manner X DWNER e o so as to become subject to the tVorkers' Compensation Laws. nL OCCUPANCY GROUP M AIL 2 �l C \•p rl v ADDRESS `3pL7 �' M o,, 7 SA, JU)1�iT �I //J YY 12 M Date Applicant C-3 TEL NOTICE TO APPLICANT: If, after making this Certificate of X CITYA NO. OCCUPANT LOAD i Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- �l with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION dNo Spec. Knowf. deemed revoked. IIIJJJJ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONgffF Panic Devices I herebv affirm that I am Licensed under provisions ofChaptet 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 effect {P"AA CIN S ESREO•D PROVIDED ���------------���� License Number Lie. Class LIMITED TIME USE jj Contractor —Dale DATE DATE L ❑ _ am exempt from the licensing requirements as I am a s— licensed architect or a registered processional engineer szE OF NO. C= INSPECTOR'S Z acting :n Illy professionai lapic:ty (Section 7051, BUS- EXISTING BLDG. I STORIES SIGNATURE o iness and Professions Code). PRESENT USE OF HUILD:NG F;N L APPROVAL Lie.or Reg. No.— Dare I � f HOME 0\'rNER-BUILDER DECLARATION NO, OF EXISTING BUILDINGS ON LOT AND USE v ✓ � ' I herebv affirm that I am exempt from :fie Contractor'_ 1 License Law for the following reason (.Section 7031.5, Busi- ness and Professions Code): NO, PARKING SPACES PROVIDED 1, as owner of the property, will do the work and ❑it: \ / structure is not intended or offered for sale ISectioil. 1 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING AGENCY I herebv affirm that there is a construction lending agenc,' for the performance of the work for which this permit it issued (Sec" 3097.Civ. C.). Lender's Name _ PROPOSED MAX. OCC. ^"J Lender's Address { ) I 00 f "` I certify that I have read this application and state that rile PERMIT FEE 25. above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, •-- and herebv authorize representatives of this County to enterTOTAL FEE 25.00 +. 1 up t ove-mentioned p p rt for inspection purposes. i 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat ;=, 1t`ORKERS' CONIPEN'SATION DECL.1RAfION 84 CE i i aa) M ISCELLANEOUS APPLICATION cE as � I hereby affirm that I have a certificate of consent to sell COUNTY OF LOS .ANGELES BUILDING .AND SAFETY DIVISION insure. or a certificate of tVorkers'Compensation Insurance,or I�(-I a certified cope thereof(Sec. 3801). Lab. C.I. Policy No. _C onlnanx FOR APPLICANT TO FI LL IN❑ BUILDING �p//4D DR ESS 7 Certified copy is hereby furnished. X BUILDINGGLOdE-2L ^.R LOCALITY AD OR E55 1(V I—j 1 I F Certified copy is filed vytth the county Duildim-, Inspection NE LOCALITY AREST department. Temple City CROSS ST. Date ApplicantNEAREST DISTRI N^O /G UP TYPE CESSED BV CROSS ST. LIDS TUµf f%� CONST i CERTIFICATE OF EXEMPTION PRO\I '•IORi:ERS' LEGAL COMPI_NS:t 11ON INS I 1\.\N(!. DESCPIPT:ON LOT N0. 'BLOCK I�nA� IDNw Av ^+o. (C-CL_) STATE MAJOR SECOND LOCAL NO. OF SLDGS. (This section need not he completed if the York involved I711AC7 NOiv ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars 6100) or less.) '. I t (SIZE OF USE OF LOT EXISTING BLDG. 1 certify that in the performance rf '!le .%ork `or 'yhich -11is permit is issued. I ;hall not employ :uiy lersou in any manner OWNER LE; 0-T C U� 4190r,I:, 1 so as m become subject :o the lCorkers' i:, to^ensatic n !-awe u OCCUPaNC': •JROUP I� - MAIL I Dale Applicant ADDRESS '13" E. Mato .ST• kZ/0 NOTICE TO APPLICANT: if. after makinc !us C -r irate ,t xI CIT- ALWA+4$Q4q uc1 L61�,4.�p-, „�. OCCUP-I N- LOAD Exemotio-n. you shoruld become illMect to -he a, 1 4PD L!CATICN cR � I _fir; yp^f�n.:1-c Ccmpens;ition provisions of the Labor )de. v'ou must torth- I ` ( with comnly 17ilh well prolusions c- .hl,; --cr'nit iliac be -RAILER JSE GEOLOGY !NSPECT!CN _ No Soec. =� deemed :v''Oked. LICENSED CONTRACTORS DECL.-tRAT10'� OCCUPANCY INSPECTION$$ Panic Dev res _ I hereby' affirm :hat I am licensed under prCvlsle ll5 lI t1 lDtet SAFETY PERMITu (LIST ITEMS BE;O 1 ' 9 (conimencine with Section %000) of Division 3 .if the Busi- No. OF EXITS ness and P-ofessions Code. and my license is in foil force and effect. PARKING REO O I ?ROVID ED O i SPACES i License Number__—_ f_ic. C!ass LIMITED TIME USE N Contractor Date_ __— DATE DATE W TO: I atm exempt from the licensing ream_*e:rents as I am .I W I licensed architect or a registered o-nfessional engineer SIZE OF NO. OF INSPECTO R's z actino in any prof,,-s iio nail :aril it'•' S _:iu:l 1);1. Bili- EXISTING SLDG, ST ORI _— SIG TURE O — 9 lness aria Pro essicns(:)del. U �4E E^1T USE OF BUILDING FINAL APPROVALLf Lic. or Ree No. — D:i-e -- HOME O\t NI R-BUILDER DECLARAI-ION NO. OF EXISTING BUILDINGS I', ` ON LOT AND USE �{/]' -Js�'-1� '' hereby affirrin that I ani exempt front the Contractor's I�r YYY i License Lava for the following reason (Section -031.5. Busi- ness and P-ofessions Code): NO. PARKING I, as ,owner of the property. will do the work and the SPACES PROVIDED strucnuc is not intended or offered for <ale (Section. 7044.liusi i.U11d Professions Code). CONSTRUCTION LENDING AGENCI X PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency bf-f{c tQ IqTret'iPf ( for the performance of the .cork for which this permit is issued(Sec. 3097.Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address _ ( PERMIT FEE 25.00 I certify that I have read this application and state that the above information is correct. I a^Cee to comply with all Couni,� ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00I upon the above-mentioned property for inspection purposes. • � � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I i WORKERS' COIPLNSATION DECLARATION 76tvtaaa CE 875 ti 84) MISCELLANEOUS APPLICATION r, 1 herebv affirm that I have a certificate of consent to self ' insure. or a certificate of'Workers'Compensation Insurance,or COUNTY OF LOS .ANGELES BUILDING .AND SAFETY DIVISION I�I a certified copy thereci(Sec. 3800. Lab.C.). �" t Policv No. _Gimpan% FOR APPLICANT TO FILL IN BD ORON Ess ����j / Certified copy is herebv furnished. BUILDING ��! ! / LOCALITY _ ADDRESS i Certified copy is filed with [lie county building inspection LOCALITYNEAREST department. Temple City CROSS ST. Date lnpli'.:ant NEAREST DIST N GR P TYP OCESSED BY CROSS ST. a� DD 5 � I CERTIFICATE OF EXEMPTION FROM '.NC)RhE RS LEGAL C OMPENS: TION INSI 1\.���1 OESCRIPT:ON LOT NO. BLOCK !MA HIG Hw Av 1 ^+ov ( 1G.—1 STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRAC NOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars 6I00) or less.) —? USE OF t I SIZE OF LOT I EXISTING BLOC. I certify that in the performance of The York .'or •khiCh -hisuJit: ; ILY permit is issued. I shall not ernpley ani' e-son '.n any manner M A l l OWNER so as to become subject to the Workers C, mpen$ation L;nys. �� 7 C S OCCUPANC`' CROUP Date Applicant ADDRESS/ NOTICE TO APPLICANT: if. after nak-inL !Lis �.r* Kate Irl gj CIT' OCCUP N- LOAD Exemmio-i, you should becomz subiect -o -he Ao-kers' l. a Compensation eroyisions of the Labor �._oue. you must ;ort h- I APDL!CATICN EDP _Xi- HA^CE- 1 with coniniv kyith :uch nroyisions his .,ermit shall be — I- -RAILER JSE �—i GEOLOGY :NAPE CT:CN No Soec. K:lC!-ji, deemed reg okzd. — L—. LiCENSEDCONlR.�CTORS DECLARATION 'OCCUPANCY INSPECTIONgg ('3niC Devices ❑ I liereb}• affirm -.hat I am licensed under provisions Of C hauter t 9 tcomen::ing with Ot Dlyl$lOn J -.lt Elie BLl$I' SAFETY PERMIT u (LIST ITEMS BELOW) NO. OF EXITS - ness and P-otessions Code. and my license is in niil force and etlect. PARKING �t SPACESRE0'O I i PROVIDED i License Number Lic. Class -- LIMITED TIME USE N Contractor — Date _--- ,ATE oA,E z Z N El I am exempt from the licensing requirements as I am .t m i licensed architect or a registered professional zneineer 31ZE of NO OF INSPECTORS z actino in my profe ional _ac:cit c:ton 'n;1. Ruff- EXISTING BLDG. -'0R1ES SI ATURE o -- --- -- m iness:ind 1'rofessicns l:rd I. U �RES'cNT USE OF BUILDING FINAL APPROVAL !` Lic.or Re^_. No. HO`,IE OL NI'R-BLILDER DEC'LAR.MON NO. OF EXISTING BUILDINGS Q %' -jZ;M:f= } ON LOT AND USE I liereby affirm that 1 am exempt from the Contractor's i License Laky for the follow ima reason i Section -031.5. Buri- A ness and Professions Code): NO. PARKING �} 1, as o%%ner of the property, will do the work anal the SPACES PROVIDED ll structure is not intended or offered for ;ale ISertion 7044. Business and Professions Code). CONSERLCTION LENDING AGENCY X PROPOSED USE OF BUILDING I herebv affirm that there is a constriction fending :Gcency _ D Clow for the performance of the work I-or wliich this permit is A177-7W Z: issued (Sec. 3097.Civ. C.). Lender's Name PROPOSED MAX. OCC, Lender's Address — I certify that I have read this application and state that the PERMIT FEE 25.00 above information is correct. I g ree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction. and herebv authorize representatives of this County to enter TOTAL FEE 25.00 I upon the above-mPn1jrtud property for inspection purposes. SEE RUVERSE FOR EXPLANATORi' LANGUAGE Signature of Permittee Dae WORK(wR5`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 to self COUNTY OF LOS ANGJLES BUILDING AND SAFETY DIVISION msure,�or a ceAficate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING r �� ADDRESS tJ Certified copy is hereby furnished. BUILDING �y7�- LOCALITY ADDRESS V FCertified copy is filed with the county building inspection _ LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP ITYPE ,/ P CESSED BY CROSS ST. ' -may CONST•T/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v^ J/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLD6S. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I d I certify that in the performance of the work for which this SIZE OF LOT XNG B G permit is issued, I shall not employ any person in any manner OWNER s� so as to become subject to the Workers' Compensation Laws. MAIL (� _ ,/J OCCUPANCY GROUP o DOR ESS VLA � Date Applicant L„ NOTICE TO APPLICANT: If, after making this Certificate of TEL. OCCUPANT LOAD CITY NO. 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 TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices 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 AM`e O� effect. PARKING REQ'D D PROVIDED D SPACES License Number Lic. Class ALelfaLIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES TORE , iness and Professions Code). FINAL AP PRESENT USE OF BUILDINGOVAL �Z Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE j I�,, •,�,j4 I(�.-,; ;_i:I F i G•1"?f I.1' I. 1 ,l I hereby affirm that I am exempt from the Contractor's h License Law for the following reason (Section 7031.5, Busi _• _ !^Eli :_-!•• 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 I certify that I have read this application and state that the PERMIT FEE 00 above information is correct. I agree to comply with all County ISSUANCE FEE ordinanc nd State laws relating to building construction, and Iter y authorize representatives of this County to enter TOTAL FEE UV upon th e-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee batle WORKERS'COMPENSATION DECLARATION CE 8754(2-80) MISCELLANEOUS APPLICATION I hereby affirm' that I have a 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.) BUILDING Policy No. Company FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is hereby furnished. V BUILDING LOCALITY ADDRESS 5911 CLOVFRLY AVF-;TFMPLF CITY, CA Certified copy is filed with the county building inspection NEAREST N11 LA*4/ department. LocALIrY CROSS ST. Date ApplicantEAREST DISTRICT�I GRA TYPE PRO E SED BY 100 CROSS ST. LAS TUNAS /)� /rj_ cONSf CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL LL// . BLOCK STATE MAJOR SEC ND LOCAL COMPENSATION INSURANCE MAP c IwAY NO. OF BLDGS. NO. (CIRCLE) }CL DESCRIPTION LOT NO (This section need not be completed if the work involved TRACT NOW ON LOT USC ZONE-1 SP .IAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) //V/•/] V USE OF / SIZE OF 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 U so as to become subject to the Workers' Compensation Laws. HAAZ DEVELOPMENT CORP-AIL OCCUPANCY GROUP LJJ ADDRESS 21621 Stiii­e #103 CL Date Applicant N TEL. z NOTICE TO APPLICANT: If, after making this Certificate of CITY Chatsworth CA NO. 818-709-4000 OCCUPANT LOAD 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 USEGEOLOGY INSPECTION NO Spec. Knowl. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING. rI�I SPACES REQ'D O PROVIDED L -J License Number Lic.Class LIMITED TIME USE J 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 SI NATURE iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING Real Estate Loan 3roker: - 23 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 r License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING o4 6 a �A SPACES PROVIDED F1I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # � • • • 8 8: same as present 7044, Business and Professions Code). OPOSED USE OF BUILDING o,• • o • • • CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0 S 21 t8 6'` 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 PERMIT FEE Sod I certify that I have read this application and state that the above inf. correct. I agree to comply with all County ISSUANCE FEE Ord' ces and St a laws relating to building construction, d hereby auth ize repr tativ f this County to enter TOTAL FEE upon the abov men tio prop for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -7-86 Sign a of Permittee ate WORKERS'COMPENSATION DECLARATION 7E 87541�s01 MISCELLANEOUS APPLICATION ZhT by affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION or a certificate of Workers'Compensation Insurance,or fied copy thereof(Sec. 3800, Lab.C.) Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. DILDING LOCALITY 06, ll�ADDRESS t Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant AREST (( ` DISTRICT ������ GRJ�/1P TYPE PR SED BY ROSS ST. 44TJ t(( �,5 �� -{/� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V'�// COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NAP �Ati HIGHWAY STATE MAJOR SECON LOCAL } NO. ((/j�V�i (CIRCLE) a (This section need not be completed if the work involved NO. OF BLDGS. O p TRACT NOW ON LOT ULsf ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE OF � I SIZE OF LOT. EXISTING BLDG. cc I certify that in the performance of the work for which this0 permit is issued, I shall not employ any person in any manner OWNER CI1f y Ake � ay�. V so as to become subject to the Workers' Compensation Laws. AIL /en{ � S � �/ L Vc OCCUPANCY GROUP d A r ESS Date Applicant �/;y� to �' ( TEL. c'7y '�'^'[ OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of ry lv No. i�TT 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. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that,I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING SPACES REO'D PROVIDED / License Number Lic. Class LIMITED TIME USE 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 S GNATURE iness and Professions Code). FINAL APPROVAL ESENT USE OF BUILDING Lic.or Reg.No. Date _ rCZ NO. OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's T2Z License Law for the following reason (Section 7031.5, Busi- •'o . NO. PARKING 1 2 2 8-8 4 nCSS and Professions Code): SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY ' I hereby affirm that there is a construction lending agency C7���G'e' 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 PERMIT FEE 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 relatingto building construction, and hereby authorize representatives of,this unty to enter TOTAL FEE up n the above-ment' ned property for insp ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur l o ermitt a Date WORKERS'COMPENSATION DECLARATION (, CE 875(11-84) MISCELLANEOUS APPLICATION Q CE 875 I hereby affirm that I have a certificate of consent telf 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 ADDRESS Certified copy is hereby furnished. BUILDING LO CA LIT DRESS _ Certified copy is filed with the c ty building inspection OCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTIO FROM WORKERS' LEGAL v COMPENSATION IN URANC'E DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE AJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLDGS. (This Section need not be 'comp ted if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hun ed dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performan of the work for which this o permit is issued, I shall not em p oy any person in any manner OWNER so as to become subject to the orkers' Compensation Laws. MAIL OCCUPANCY GROUP �• o ADDRESS Date Applicant L. LO NOTICE TO APPLICANT: If after making this Certificate of CITY No. OCCUPANT LOAD 0- Exemption, you should be ome subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of he Labor Code, you must forth- with comply with such p visions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. K owl. deemed revoked. LICENSED CONT ACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Dev• es I hereby affirm that I am icensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Sect n 7000) of Division 3 of the Busi- NO. OF E ITS ness and Professions Cod ,and my license is in full force and Effect. PARKING RE q D PROVIDED D SPACES License Number Lic. Class ' LIMITED TIME USE Contractor Date �/�1��-mit ' ATE DATE I am exempt fro the licensing requirements.as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my pr essional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professi ns Code). FINAL AP ROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date ) HOME OWN R BUILDER DECLARATION NO.-OF EXISTING BUILDINGS o ON LOT AND USE �Q r •-I I hereby affirm tha I am exempt from the Contractor's /r, V Vl License Law for the following reason (Section 7031.5, Busi- ness and Professions Ode): NO. PARKING 1;J I, as owner of the property, will do the work and the SPACES PROVIDED ✓ structure is n intended or offered for sale (Section 7044,Business nd Professions Code). CONST UCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm t t there is a construction lending agency for the performa ce of the work for which this permit is I issued(Sec. 3097„Civ.C.). I Lender's Name PROPOSED MAX. OCC. Lender's Address p PERMIT FEE 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, and hereby authorize representatives of this County to enter TOTAL, FEE upon the above-merltioned prop rty for inspection purposes. v ' -t_7-? SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Perm' e l Date WORKERS" COMPENSA1­10N DECLARATION •"rt"I20-npL�DPW t."J(i MISCELLANEOUS APPLICATION I - I herehY affirm,•that I have a certificate of consent to ,cff COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION l� insure.or a certificate of Workers" Compensation Insurance. or l a certified copythereof (Sec. 3800. Lab. C.) Policy No. _ _ Company _ FOR APPL10ANT TO FILL IN BUILDING BUILDING ADDRESS i 1 ADDRESS ❑ "C'ertified copy is hereby furnished. ct C 1 ov(?'v 1 vs-- LOCALITY ❑ Certified cope is filed with the county building inspection CITY �^ ( ZIP11 (�,� d.-part meat. TI , 1 I \ if (A, I I? 6' ! 7 NEAREST C./ 4 CROSS S7. Date Applicant _ SIZE Or LOT NO.Or BLDGS.NOW ON LOT DISTR T Nye GRQJ�P TYPE ESSED BY �� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS TRACT BLOCK LOT NG. COMPENSATION INSURANCE ! No. Ciac�E• STATE MAIOR SECOND LOCAL (This section need not be completed If tine Nork inNolyed ASSESSOR MAP BOOK ;PAGE R'RCEL USE ZONE I SPECIAL CONDITIONS b% the permit is for, one hundred dollars'Is 100) or less.) OWNER L NO. I . I cer!if) th:!! in tits n rfurtn:u,cc n! the work iu!- which Illi, ce� as permit is issued. I shall not emplrn any person in :u,p manner PTOD2rt1 so as to become subject to the � ';siker_ Cmm�ensation L:n:', ADDR S O`C'CUPANCY GROUP ?X mail 13j00 MGU Yl S�- ?[ C� Date _ Applicant CITY A��j ZIP Q� NOTICE TO APPLICANT If afie, mal,inL• ti,i, C. !iiicat ` ' OCCUPANT LOAD of Exemniion. you should become subject lc "he 11br en APPLICATION=0R -onpensa;ior. oro inions of the Labor Code. voc must iorthwit'tt =X1T H.ARD�NAR comply %ki[h such pro%isions or this. nernli: shin he tlreni'C: TRAILER USE_ GEOLOGY INSPECnoN-1 revok d. I NG JpcC Knc v:i. _! OCCUPANCY INSPECT ON Panic Devices I LICENSED CU\TR.-�CTURS DE('L.-\RATIU.1 I hereby affirm that I afn licensed under provisions of C hapl•.'r SAFETY PERMIT!_! usT ITE!•.=BELOW, 9(Colrintencing with Section 70001 o;' Di%isinn I of the Busines> NO.OF EXITS i and Pn,iessrons Cod_. and me license is In lull iorre and eifec. ! PARKING REC'G I I :'IDE•^. I I' License N:.!nbe. fir. C...,. SPAc__ C onuac;I r _-- D:ue LIMITED TIME USE i DATE DATE ! ! am ex::n,n 1!11111 (Ile IICenSl ll_ reUllll C'Il,enl� :I, I ;III) i FROM; TC: en,ed archiieci or re_Isl:r,d !ln,(,,;i;,na! ,n-merr' — - cunc in nl profrsvonai cava n', iSeruolt Tui!_ Busln:ss SIZE OF I NC OF INSPECTOR s I EXISTING BLDG, STORIES SIGNATURE [1 i and rales;Inn; Code). I r I PRESENT USE OF BUILDING -!NAL APPROVAL j Lie or Re_. No. 1);Itr ! (� / b HUAit OWNER-Bi!Ii.DER UEC'l,:\R ,i!ION INo ',F- (ON LO 7. A-:D UsL I hereb;, affirm th:u I ;nn exemp! from tire Con!mcim's L:CClr,e Law for the filllo'.cn,_' reason (Section, 7031.5. Bcuiness and _ Professions (ode): NO.PARKING ^ % SPACES PROVIDED LCI L as owner of the property. \kill do the k+nrl, and th', structure Is not intended or oflered for Safe (Section 7(444 iPROPOSED USE OF BUILDING L00,V1 ovil I y><(, flDo Business and Professions Code). CONSTRUCTION LENDING AGENC) I her.-b% affirm that there is a construction Icndine al_enc', nix the performance of the wort: for which this permit is issued ; (Sec. 3097, Civ. C.). PROPOSED PROPOSED MAX.OCC. Lender's Name ECCE-_.ECCE_-_ .—........... .._ (APPLICANT fPRK✓71 TEL NO. Lender's Address _--__—_.—._._._—_.. `ADDRESS I certify that I have read this application and state that the. above information is correct. I agree to compfY with all C ountl" PERMIT FEE ordinances and State laws relating io.building construction.:rod hereby authorize representatives of this County to enter upon. I!SsuANCE FEE the above-mentioned property for insnection purpose,. r /� rOTAL FEE SEE REVERSE FOR EXPLA!NATORI LANGUAGE Swrla Wre o!' Permitter DaI WORKERS'COMPENSATION DECLARATION 76M444 M I SC E LLA N E,O�,S APPLICATION CE 875(11-84) ' Id ! hereby affirm that I have a certificate of covisent sur tc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION assure, or a certificate of Workers'Compensation Insurance,or • a certified copy thereof(Sec. 3800,Lab.C.). Policy No. _Company FOR APPLICANT TO FILL IN ADDRESS �� ` Certified coy is herebyfurnished. BUILDING 9 �Cl�t� �p XX ADDRESS � 1 � A�/ ;7LOCALITY Te, l'C Certified copy is filed with the county building inspection LOCALITY C /� /� /Jlv r 0 ,61 NEAREST /7 department. 3CY. (� ✓N g cwoss sT. t�`O(/ejj^� Date _Applicant NEAREST DISTRICT NO, GROUP TYPE CESSED Br CROSS ST. C-Jovel' 0 f CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �a..Z/ (f fff COMPENSATION INSURANCE DESCRIPTION Lor .0./,)Z/ BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL (�!1 / NO. OF BLDGS. (This section need not be completed if the work involved TRACT Q to NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) a use OP I certify that in the performance of the work for which this srzE of LOT / (/Yv EXISTING BLDG. p G o_ permit is issued, I shall not employ any person in any manneXX OWNER Of buildin / t' Cf fL✓<- SlJ as to become subject to the Workers' Compensation Laws. MAIL �l /� (� /^• P� OCCUPANCY GROUP Cnf ADDRESS l3ov / /zia J/ '• r? Date Applicant C-' NOTICE TO APPLICANT: If, after makingthis Certificate of CITY TEL �/� // OCCUPANT LOAD D� /flba,"7bra NO. y g- 3-7 3r VJ 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. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices 1 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 anix Name o f business f II�I effect. SPACING REWD � PROVIDED -J svwees J License Number--____--- Lic. Class LIMITED TIME USE Contractor —__ Date_. DATE DATE 1 am exempt from the licensing requirements as I am a PROM: TO: 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 inessand Professions Code)• FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No.— — Date— 2' IIOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ���,//,•, ON LOT AND USB O �• V 1 hereby affirm that I ani exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1, 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 agencyY �� laoY_'1ny e ✓li for the performance of the work for which this permit is 1=i issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. _ Lender's Address ._ PERMIT FEE25.00 :t'; 1 certify that 1 have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE i ordinances and State laws relating to building construction, and hereby a Ihorize representatives of this County to enter TOTAL FEE 25-00 =1: upon the a -mentioned property for inspection p epos s: I S SEE REVERSE FOR EXPLANATORY LANGUAGE 4- XX XX I•.. WORKERS'COMPENSATION DECLARATION 76M444 M I SC E L LA N EO U S APPLICATION I hereby affirm thanCE 875(11-84)I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or"i certificate of Workers'Compensation Insurance,or ,. a certified copy thereof(Sec. 3800,Lab.C.). d /V1�rJ Policy No. Company FOR APPLICANT TO FILL IN BUILDING ` Certified copy is hereby furnished. Bu'LD'NG�:t�z� - vll� ADDRESS LOCALITY ADDRESS✓! Certified copy is filed with the county building inspection J LOCALITY�m / NEAREST department. n VI CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE OC ESSED BY CROSS ST. / �f CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL f P COMPENSA'T'ION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF LDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL . (This section need not be completed if the work involved TRACT NOW ONBLOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this slzE of LOT EXISTING B�G. o permit is issued, I shall not employ any person in any mannerOWNER �j 'rjM so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP �� o E3 E3 Date ADDRESS//Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. OCCUPANT LOAD 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. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ 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 effect. f� PARKING SPACES REQ'D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a PROM. TO. licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES '1,T FLA"TURE iness and Professions Code). a� FINAL APPROVAL Lie.or Reg. No. Date RESENT USE OF BUILDING ter (p /21 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ! _ i 4tn_? ON LOT AND USE I hereby affirm that I am exempt from the Contractor's Q License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING lS/ 0 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). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency st((�� 3ccsiheSs 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 �? PERMIT FEE 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, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for i spection purposes. l SEE REVERSE FOR EXPLANATORY LANGUAGE c Signature ofrmittee I Date I WORKERS'COMPENSATION DECLARATION 76nn444 MISCELLANEOiJS APPLICATION CE 875 (71-84) I insure, o affirm that 1 have a certificate of coInsur c self COUNTY OF LOS ANGELES � BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof tSec. 3800,Lab.C.). -J Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS eJ Certified copy is hereby furnished. pp BUILDIADDRENGS OVQ-Y ( C LOCALITY f` A SV. I Certified copy is filed with the county building inspection X LOCALITY L5 NEAREST ! department. f CROSS ST. Date Applicant NEAREST DISTRICT NO. GROXIP /TYPE CESSED BY � (� C � CERTIFICATE OF EYEMPTION FROM WORKERS' CROSS ST. ONST.LEGAL } COMPENSATION INSURANCE DESCRIPTION LOT No. BLocx MAP RIGMW AY No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (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 (S100) or less.) USE of SIZE OF LOT EXISTIN 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 X OWNER Q( to e, Y-f _ so as to become subject to the Workers' Compensation Laws. g OCCUPANCY GROUP - MAIL ADDRESS Date applicant- NOTICE TO APPLICANT: If, after making this Certificate of g CITY � -�, TNo� �� �� OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code. you must forth I with comply with such provisions or :his Permit shall be TRAILER USE IGEOLOGY INSPECTION _ No Spec. Knows. �12deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION LX I hereby affirm that I am licensed under provisions or: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 effect. PARKIN G y SPACES REO'D PROVIDED License Number Lie. Class LIMITED TIME USE n Contractor Date DATE DATE N .y FROM: !O: ! I am exempt from the licensing requirements is I am a ! licensed architect or a registered professional engineer slzE DF ND. OF INSPECTOR'S Z acting m my oroCeisional cat)acit`: !.See ti on C'J 1. Bus- EXISTING SLOG, i STORIES SIGNATURE iness and Professions Codes. FINAL APPROVAL -��`� PRESENT USE OF BUILDING v Lie.or Ree. No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �1/ -o � a ,i'e 7 ON LOT AND USE V!/�� .7$1 �' 3 •,"' I hereby affirm that i am exempt from the Contractor's '� ( License Law for the following reason (Section 7031.3. Busi- ness and Professions Code): No. PARKING PM 4.44 - 10 [, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale iSection 7044.Business and Professions Cndei. I X PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that here is a construction lending agency for the performance of the work for which this permit is 1 issued (Sec. 3097,Civ.C.). Lender's Name -. PROPOSED MAX. OCC. Lender's Address 25.00 I certify that I have read this application and state that the PERMIT FEE above information is correct. I agree to comply with all Count} ISSUANCE FEE ordut nces and State laws relating to building construction. the It' author' a representatives of this Countv to enter TOTAL FEE 25.00 } upo to a o -In n 'oned pr eIty for inspection purposes. g EE REVERSE FOR EXPLANATORY LANGUAGE X Signatory n('P, nittce Daie ✓ WORI:Eas'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION r I hereby affirm that I Have a certificate of consent to self CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION lull insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company BUILDING FOR APPLICANT TO FILL IN `- ADDRESS Certified copy is hereby furnished. XX ADDRESS r`j `� rte, LOCALITY %�r1 [� �'�T! ��� Certified copy is filed with the county building inspection LOCALITY ? L NEAREST department. gy, / �Wl C1 rr C� <l 7 CROSS ST. �R Date Applicant NEARESTDISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. n G �! CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL !/D /) COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP .-.AY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (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.) USEOF SIZE OF LOT EXISTING BLDG. O r I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manneXX OWNER of building so as to become subject to the Workers' Compensation Laws. MAILI, OCCUPANCY GROUP ® n Date Applicant ADDRESS Y' U NOTICE TO APPLICANT: If, after making this Certificate of CITY�LEl��1 dR� C'�9r�u No� OCCUPANT LOAD C/3Exemption, 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. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION,g Panic Devices ❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code, and my license is in full force anix effect. Name of business PARKING License Number Lic. Class �P //� � SPACES REQ'D E=��� leC �' PROVIDED LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a `ROM` TO: licensed architect or a registered professional engineer SIZEOF NO. OF INSPECTORS acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL / PRESENT USE OF BUILDING �„/t 1 Lic.or Reg. No. Date `�.7 /7 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS I�'' ;4y"N I hereby affirm that I ant exempt from tileON LOT AND USE Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING SPACES PROVIDED Vt 3 i j El1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OP 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_ Lender's Address PROPOSED MAX. OCC. 25 - 00 I certify that 1 have read this application and state that the PERMIT FEE 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- 00i upon the above-mentioned property for inspection purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE XIS ku XX SI rl'11._re of Permiltee Date WORKERS'COMPENSATION DECLARATION 768444. CE 875(11-84) M ISCELLANEOUS APPLICATION I hereby affirm that 1 have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or 0 certified copy thereof(Sec. 3800,Lab.Q. BU LOING Policy No. Company FOR APPLICANT TO FILL IN ADDRESS� // / �� Certified copy is hereby furnished. BUILDING rjgll Clover ` �L'7Se XX ADDRESS LOCALITY Certified copy is filed with the county building inspection LocnuTr NEAREST department. XX �Q in (e C if CROSS ST. Date Applicant NEAREST � L( C DISTRICT NO. GROUP TYPE OCESSED BY CROSS ST. Y�•J Twrt6} v�K,/r _ 11117 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v '? -� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (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 (5100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manneXX OWNER of buildingIt1i125e�,re N1C so as to become subject to the Workers' Compensation Laws, MAIL OCCUPANCY GROUP p�^ ADDRESS V Date _ Applicant LUTEL. OCCUPANT LOAD F 0. NOTICE TO APPLICANT: If, after making this Certificate of clrY No. l0 �� 33 Exemption, you should become subject to the Workers' T _ Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be deemed revoked. TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices 1 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 artX effect. Name of busines5 PARKING REQ'D PROVIDED SPACES 1� License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TD: •i ht{, - licensed architect or a registered professional engineer SIZE OFNo. OF /) INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 0SI ATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING • ROME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE p I I hereby affirm that I am exempt from the Contractor's U e License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING rl F1I, as owner of the property, will do the work and the SPACES PROVIDED I U 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 aglmcy 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 _ 1 certify that I have read this application and state that the PERMIT FEE 25 - 00 above information is correct. 1 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 above-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX + Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) KISCELLANEOUS APPLICATION I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES (BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or it certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING `/ ADDRESS FICertified copy is hereby furnished. XX ADDRESS �/f,IJC1,y AVS LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. ][y, (, CiTy CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUPTYPE CESSED BY CROSS ST. CONST. CE RTI PICATE OF EXEMPTION FROM WORKERS' LEGAL16 1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if die work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) useOF SIZE OF LOT EXISTING BLDG. Or 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 buildin /C..- so as to become suhlect to the Workers' Compensation Laws. MAIL _ OCCUPANCY GROUP ADDRESS,/— / C.] Date_ Applicantw reL. OCCUPANT LOAD NO"flCli TO APPLICANT: If, after making this Certificate of clr NO. —3yL�5— Exemption, you should become subject to the Workers' Compensation provisions o1' the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: 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 El I hereby affirin 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 anix effect. Name of business PARKING REO'D 1 I PROVIDED SPACES License Number _ Lie. Class L V LIMITED TIME USE Contractor Date DATE .ATE 1 am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF IN SPECTOR�S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SI TORE iness and Professions Code): FINAL APPROVAL ///��{ [PRESENT USE OF BUILDING 1/0—Z . Ll Lia or Reg. No.— Date b� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 1 hereby affirm that I am exempt from the Contractor's 10, License Law for the following reason (Section 7031.5, Busi- ness and Professions(..ode): NO. PARKING El1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,13usiness 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 s:,•S is issued(Sec. 3097,Civ.C.). Lender's Name.— ---_-- PROPOSED MAJt'OCC. i.:=; ITt Lender's Address—.------ PERMIT FEE25- 00 I •' :T 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 �^ ore finances andState laws relating to building construction, an hereby authorize representatives of this County to enter TOTAL FEE 25 . 00 - 1 on the abov ientioned property for inspection purposes. ?, SEE REVERSE I-OR EXPLANATORY LANGUAGE x xxl3 � -- Ci� nii nrr n�I'r•i nillr Irate WORKERS'COMPENSATION DECLARATION tE 875(11-84) MISCELLANEOUS APPLICATION - • CE 875 r I hereby affirm that I have a 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 BUILDINc ��� ADDRES Certified copy is hereby furnished. BUILDING n n j r/ LOCALITY XX ADDRESS �I �� �y �� / �L•�I (���" �' / ECertified copy is filed with the county building inspection LOCALITY NEAREST department. xy. cwoss sT. Date Applicant NEAREST DISTRICT NO,,,yyy GROUP TYPE CESSED BY CROSS ST. ' 'JI y I CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MA" HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLOGS. (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 LOT EXISTING BLDG. //Y'. r I certify that in the performance of the work for which this wwwVVV D-• permit is issued, I shall not employ any person in any manne wNER x ofd buil Ling �a so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS 1— Wz Date Applicant --— LFII NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. O OCCUPANT LOAD 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices 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 an - effect. `-'Na.l'Ile_Of_bLlS lnt?S PARKING REq•D PROVIDED 1A t' SP:VCES License Number Lic. Class O�\S rl (2�iS t.ttllti^n +A'(C� LIMITED TIME USE Contractor Date DATE DATE ❑ 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM. To. INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg. No. Date ✓ ! G HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS O �y ON LOT AND USE 1 hereby affirm that I am exempt from the Contractor's b License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING D1, 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 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE 25 . 00 above information is correct. l agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby rthorize representatives of this County to enter TOTAL FEE 25 .'00 upon the abo e-mentioned prop y for inspection purposes. /(� � XX SEE REVERSE FOR EXPLANATORY LANGUAGE XX Si iature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) WSCELANEOUS APPUCAT�ON I hereby affirm that I have a. certificate of consent to self COUI�TY ®F' LOS ANGELUS 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. BUILDING LOCALITY Ess ❑ Certified copy is filed with the county building inspecti NEAREST lry department._ LOCALITY CROSS ST. Date Applicant NEAREST � A DIST CT NR GROUP TYPE PROCESSED BY CROSS ST. �'�L� ' D X CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (� DESCRIPTION LOT NO. BLOCK MwP HIGHWAY COMPENSATION INSURANCE STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved NO. OF LOT USE ZONE SPECIAL CONDITIONS _ d l p TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) USE OF V SIZE OF LOT EXITING BLDG. �. S I certify that in the performance of the work for which this = permit is issued, [ shall not employ any person in any mannerWNER ` ' l- .110 so as to become subject to the Workers' Compensation Laws. M OCCUPANCY GROUP _� U DRESS UJ Date Applicant CL TEL. NOTICE TO APPLICANT: If, after making this Certificate of CITY No affOCCUPANT LOAD z Exemptionyou should become subject to the Workers' Compensation provisions of the Labor Code, you musi forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE[] GEOLOGY INSPECTION NO Spec. KnOWi. Eldeemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) ❑ NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and ' t'S Name - f effect. can PARKING REq'D PROVIDED SPACES License Number Lic.class Home Address — 06 LIMITED TIME USE n Contractor Date GJ N i z 471 /7 DATE DATE ❑ .y n �./ FROM: T O: I am exempt from the licensing requirements as I am a P�14 - vG licensed architect or a registered professional engineer SIZE of NO. OF INSPECTOR'S acting In my professional capacity (Section.7051, Bus- EXISTING BLDG. O06 27 STORIES SIGPIATURE iness and Professions Code). f,-SENT USE OF BUILDING /ANr„ FINAL APPROVAL �O -off 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 2 2 4 2;7 A SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the # 0,0 0.040. structure is not intended or offered for sale (Section 7044, Business and Professions Code). I o o O 0 0 10 0 OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I Q Q 2=$0 I hereby affirm that there is a construction lending agency Ox 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 PERMIT FEE 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, and hereby iorize representat'ves of this County to enter TOTAL FEE urtdn the e-menti n d pr y for,ins tion purposes. SEE REVERSE OR E PLANATORY LANGUAGE 000 9 of�a alure of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N I y affirm that 1 have a certificate of consent tself CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING j��� ADDRESS Certified copy is hereby furnished. BU'LDINS clUVerl ADDRESS 1 ��I I �� •� LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. _ s� ICO N X" CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /1` f D 1, �C � COMPENSATION INSURANCE DESCRIPTION LOT NO. I L BLOCK MAP HIGHWAY NOOF BLDGS. N NO. (CIRCLE) STATE MAJOR SECOND LOCAL (� . (This section need not be completed if the work involved TRACT b NOW OLOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT o EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER sl, so as to become subject to the rkers' Compen o Laws. MAIL e/y'� L�/� �/j� rl OCCUPANCY GROUP2i] c= b ADDRESS I��O V 11`ai n / �' V O Dat An plican rEL. OCCUPANT LOAD i NOTICE T APPLICANT: If, afte a • g this Certificate of CITY No. C/3Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. E] ElNo Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices E] I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT'Ef (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 ��p)�,�� i effect, (�I► PARKING SPACES REO'D C� PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: 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 �/ZZ �3 PRESENT USE OR BUILDING Lie.or Reg.No. Date /y/ HOME OWNER-BUILDER DECLARATION NO, OF EXISTING BUILDINGS V A� N C3 FEE 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- ) 3 1Ei4� ness and Professions Code): NO. PARKING 3U00- - 1131 El I, as owner of theproperty, will do the work and the SPACES PROVIDED �-31 1 AM11:,r 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 I certify that I have read this application and state that the PERMIT FEE above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and reby orize representatives of this County to enter TOTAL FEE u the e-mentio ed pr ert r pection purposes. G SEE REVERSE FOR EXPLANATORY LANGUAGE a r of Permi tee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION hereby affirm that I have certificate of consent self insure, OF or a certificate of Workers' rs'Compensation Insurance,e,or a certified copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN ABUILDING DDRESS Certified copy is hereby furnished. ABUILDING DDRESS �q�i(IV A,fQ i1 LOCALITY J Certified copy is filed with the county building inspection NEAREST departbment. LOCALITY �t `� cRoss ST. Date ,—, m Appllcan — NEAREST DISTRICT GR UP TYPE PRO ESSED BY CROSS ST. CONS CERTIFICATE OF EX PT N FROM WOR ERS' LEGAL a COMPENSATION NSURANCE DESCRIPTION LOT NO. BLOCK MAP RIGR NO. (CIRCLELE) STATE MA 04—S IF"ON D LOCAL - NO. OF BLDGS. I_ (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) V USE OF �+ 11 SIZE OF LOT EXISTING BLDG. /�, 'I Cr I certify that in the performance of the work for which this C permit is issued, I shall not employ any person in any mannerr G r 'MAILOWN so as.to become subject to the Workers' Compensation Laws. ER i V GOCCUPANCY GROUP. U ADDRESS G� Date Applicant TE Zr �J 2 ra NOTICE TO APPLICANT: If, after making this Certificate of cITY'� n �_ C- •� t NOI. Zai &_3 �% OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICA ON FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION deemed revoked. ❑ ❑ NO Spec. Knowl. ❑� LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ ' I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. REO'D E= PROVIDED SPACES L'irense Number Lic.Class LIMITED TIME USE Cant-actor Date DATE DATE FROM: TO: N I am exempt from the licensing requirements as I am a. licensed architect or a registered professional engineer SIZE OF , INSPECTOR'S acting In my professional capacity (Section 7051, Bus- XISTING BLDG. 1S� 1,I ' STORIES ` SIGNATURE iness and Professions Code). FINAL APPROVAL �y r / RESENT USE OF BUILDING �o� ��"/` C..J G-'I— 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 .2:0 4 1. R License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING SPACES PROVIDED 4 O O D O 88 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section o D.o o D o D 7044, Business and Professions Code). ROPOSED USE OF BUILDING 0 3 1 4-8 3 CONSTRUCTION LENDING AGENCY tS,2r�l c� is hf�r I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ( �II pp ��L ®� issued (Sec. 3097,Civ.C.). Li (+� d" (tk , A.l'.,� �f r7 Lender's Name PROPOSED MAX. OCC.?.-/0 %i Lender's Address - PERMIT FEE 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 d hereby authorize resentatives of this County to enter pon thea ned prop ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3 3-P3 Sig to of ermlttee Date 4,1" Ci WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION ' CE 875 I hereby affirm that I have a 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.) TCORC.ASS ING Policy o. Company FOR APPLICANT TO FILL IN ESS ❑ Certified copy is hereby furnished. BUILDING ADDRESS V ITY ❑ Certified copy is filed with the county building inspection G/ LOCALITY / ST department. ST. Date ApplicantNEAREST DISTRICT NO GROUP TYPE PROCESSED BY CROSS ST. .� /(}{? D� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL irA COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. VAP�7(CIRCLE) STATE MAJOR SECOND LOCAL CL CL (This section need not be completed if the work involved NO. OF LOT USE ZONE SPECIAL CONDITIONS 0 P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) OU USE OF �/� I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. tr/ permit is issued, I shall not employ any person in any manner owNER,J,irnes Cws-1 44 �.T �YylI 0 so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP U .ADDRESS ' LU Date Applicant / / a_ g r TEL. p�j 3(0J� OCCUPANT LOAD Z NOTICE TO APPLICANT: If, after making this Certificate of CITY � � �d (e No. 0 e 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 deemed revoked. [_ Cl No Spec. Knowl. El LICENSED CONTRACTORS DECLARATION- OCCUPANCY INSPECTION❑ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the. Busi- ness and Professions Code, and my license is in full force and . effe.Ct. PARKING SPACES REO'D O PROVIDED O i License Number Lic.Class LIMITED TIME USE Ccvtractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a: FROM: TO: 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). 7 PRESENT USE OF BUILDING Q INIAL APPROVAL 7—IF� �,• Lic.or Reg.No. Date 'J HOME OWNER-BUILDER DECLARATION ON of EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's '5021 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # o O o o 4.0 SPACES PROVIDED1 . ❑ I, as owner of the property, will do the work and the .0 00 0 0 0'0 In structure is not intended or offered for sale (Section t . . . . .z. 7044, Business and Professions Code). PROPOSED USE OF BUILDING O !, 1 9;—8 2 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.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the ff above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter GGw upon th�ab a-m itione prope y for inspection pur uses. SEE REVERSE FOR EXPLANATORY LANGUAGE Agrtedture o ittee D e 1� WORKERS'COMPENSATION DECLARATION CE 84 6(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent nc 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. Companyr y- BUILDING FOR APPLICANT TO FILL IN ADDRESS ✓ lr ✓' ❑ Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS ' .._� (✓ '� /� ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PR.OJCESSED BY CROSS ST. CONST.' 'JJ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY CJ STATE MAJOR SECOND LOCAL NO. OF BLD S. NO. (CIRCLE) UJI (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS J by the permit is for one hundred dollars ($100) or less.) USE OF � I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. permit is issued, I shall not employ any person in any manner OWNER cc so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP < '-ADDRESS Date Applicant CL TEL. C NOTICE TO APPLICANT: If, after making this Certificate of cITY NO. OCCUPANT LOAD Ill 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 TRAILER USE GEOLOGY INSPECTION N ❑ deemed revoked. o Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 0 Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT E] (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING effect. REQ O PROVIDED SPACES License Number Lic.Class � LIMITED TIME USE Contractor Date DATE DATE FROM: T I am exempt from the licensing requirements as I am licensed architect or a registered professional engineer SIZE OF a NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING 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 I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED Y 6 111, 111 ❑ I, as owner of the property, will do the work and the • e , structure is not intended or offered for sale (Section 7044, Business and Professions Code). ><RoaosED USE of BUILDING 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.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 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, fco, hereby authorize representatives of this County to enterTOTAL FEE n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. u1LDING �- - ADDRES , LOCALITY 1 Certified copy is filed with the county building inspection LOCALITY NEAREST department, CROSS ST. IVt4Date Applicant EAR EST D I S T R L=Z 7041 GR TYPE PR SSED BY CROSS ST..AZ _ CO ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1h 1(1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE) STATE MAJOR S ND LOCAL (This section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT EXISTING BLD . }. I certify that in the performance of the work for which this o_ permit is issued, I shall not employ any person in any manner LjADDRESS R y so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP o Date Applicant l e TEL OCCUPANT LOAD a NOTICE TO APPLICANT: If, after making this Certificate of cl No Exemption, you should become subject to the Workers' APPL ATION FOR EXIT HARDWARE: z 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ 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 . effect. PARKING REq D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE F] I am exempt from the licensing requirements as I am a FROM: TO: licensed architect oI a registered professional engineer SIZE OF NO. CF INSPECTORS acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES s NATURE iness.and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING Lic.or Reg.No. Date J I)/ HOME OWNER-BUILDER DECLARATION NO. OF E STING 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 -I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section $5,�,2 A 7044,Business and Professions Code). \ A CONSTRUCTION LENDING AGENCY IV PROPOSqD USE OF BUILDING !�, • ° o0 l I hereby affirm that there is a construction lending agency o 0 0 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 1206.-87 Lender's Name Lender's Address PROPOSED MAX. OCC. 0a I certify that I have read this application and state that the PERMIT FEE 5/ above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, �� 0 and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection r rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION l-1 CE 875 I hereby affirm that I have a 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.). PolicyNo.-Company BUILDING 9i9 P Y FOR APPLICANT TO FILL IN ADDRESS ILDIN FICertified copy is hereby furnished. BUILDING � 'q ( QvG n LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. 1 GROUP TYPE P CESSED BY CROSS ST. 'D v �7 CONST.// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a e'' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (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 LOT EXISTING BLDG. d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner X OWNER y so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP AO I Date Applicant IDR EssQI C�pIIPT' /7V� _ c3 NOTICE TO APPLICANT: If, after making this Certificate of crcY e noL 2 OCCUPANT LOAD C/5 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 TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices 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 �C �5 n�ss `, effect. U PARKING REQ'D PROVIDED 1 _JJJ License Number Lic. Class D SPACES LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZEOF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG)ATURE inessand Professions Code). FINAL APPROVAL L y��/✓>/ PRESENT USE OF BUILDING rJ 77 Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.100 EXISTING BUILDINGS ON LOT AND USE -- I hereby affirm that I am exempt from the Contractor's j License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ElI, as owner of the property, will do the work and the 'PACES PROVIDED ✓ �s;`_ HIM 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 6 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 I certify that I have read this application and state that the PERMIT FEE 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 upon 1e above-mentioned�roperty for inspection purposes. U r SEE REVERSE FOR EXPLANATORY LANGUAGE �ure of P rmitteeof P rmittee Date WORKERS'COMPENSATION DECLARATION 8 CE (2-80) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a 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 ADDRESS ❑ Certified copy is hereby furnished. V BU ILDI;; / LOCALITY AD,DRE f. Certified copy is filed with the county building inspection NEAREST department. LocwLlrY 10991 l cRoss ST. Date Applicant ARES DISTRICT GROUP TYPE PRO ESSED BY CROSS ST. .S /+ CONST. .CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL BLOCK DESCRIPTION LOT NO COMPENSATION INSURANCE "'AP (CIR"AY STATE MAJOR SECOND LOCAL This section need' not be completed if the work involved NO. OF BLDGS. USE ZONE SPECIAL CONDITIONS d ( p TRACT � NOW ON LOT O by the permit is for one hundred dollars ($100) or less.) USE OF • SIZE.OF LOT EXISTIN BLDG. i cc I certify that in the performance of the work for whichthis 0 permit is issued, I shall not employ any person in any manner Ow ER T F- so as to become subject to the Workers' Compensation Laws. AIL e � � OCCUPANCY GROUP �_ U DDRESS W Date ApplicantLaw T0- EL. NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLI ATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE El GEOLOGY INSPECTION❑ No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi= No. of EXITS ners and Professions Code, and my license is in full force and PARKING effect. SPACES REq'D O PROVIDED D Lic.,nse Number Lic.Class •� � LIMITED TIME USE 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). USE OF BUILDING.ESFINAL APPROVAL E T o 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 f 93 Q rJ A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # OO O O SPACES PROVIDED 8,8 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 0100 0 0 0 o z 7044, Business and Professions Code). OPZ OSED USE OF BUILDING Q 3, q I 4'-8 4 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for wJiich this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 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 and hereby auth epresentatives of this unty to enter upon thea e- ntio pro for os s s coon p rp . SEE REVERSE FOR EXPLANATORY LANGUAGE t// re of tee VatV-1 WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a 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 _ ADDRESS ❑ Certified copy Is hereby furnished. ADDRESG LOCALITY _ F-1Certifiedcopy is filed with the county building inspection �• NEAREST department. LITY CROSS ST. Date Applicant EARES DISTRICT O. GROUP TYPE PROCESSED BY CROSS ST. CONST. 1 1424 CERTIFICATE OF.EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP IGRWAV NO. )- OLS (CIRCLE) STATE MAJOR SECOND LOCAL, •'� NO- OF BLDGS. (This section need not be completed if the Work involved TRACT NOW ON LOT USE'ZO NE SPEFCIAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) I USE OF SIZE OF LOT EXISTING BLDG. �� M: I certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner NrR l so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP U D DRES59 WDate - Applicant TEL. Z NOTICE TO APPLICANT: If, after making this Certificate of IITT �� No. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPL ATION FOR EXIT HARDWARE: Compensation provisions of the Labor.Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTIONO No $pec. Knowl. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION N I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and t effect. PARKING ' SPACES REq•D O PROVIDED O License Number Lie.Class LIMITED TIME USE "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 ARIFINAL APPROVAL ESENT USE OF BUILDINGp� Lie.or Reg.No. Date q Sd l �7 f� HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE 9 3 21 A I hereby affirm that, I am exempt from the Contractor's # o o o D 8 8 License Law for the following reason.(Section 7031.5, Busi- II I , ness and Professions Code): No. PARKING D) SPACES PROVIDED O O.O O O O O � ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , 7044, Business and Professions Code). OPOSED USE OF BUILDING 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.). Lender's Name - PROPOSED MAX. OCC. Lender's Address PERMIT FEE 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 and hereby authorize representative this County to enter up above-menti o pro ert for inspection, purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig atANQ Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 1 hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES.- BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or " a certified copy thereof(Sec. 3800,Lab.Q. 'fl Poli.y No. Company BUILDING FOR APP LI CANT TO FILL IN "�J� �i'9i7 � ADORES Certified copy is hereby furnished. ILDING j�_j�r )�/ ►L f C ADDRESS V LOCALITY ElCertified copy is filed with the county building inspection LOCALITY 72j 7 1f7L r-- Gfly NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE ff CES5ED BY CROSS ST. C[jf/lb9::S ` D p _ �) CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed i( the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF }. I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. °- permit is issued, I shall not employ any person in any manner ' OWNER so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP o MAIL ADDRESmaid2-1 Date Applicant l > — 2�::] t; WJ NOTICE TO APPLICANT: If, after making this Certificate of \ CITY OCCUPANT LOAD Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ 1 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 . effect, PARKING REQ'D PROVIDED I — I p� SPACES License Number Lic. Class /WS ��N/�Co Q 1 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 3- q-F R'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I_I g- u E iness and Professions Code). FINAL APPROVAL ' PRESENT USE OF BUILDING 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 El1, 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 agent FFI C& for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address5,� I certify that I have read this application and state that the PERMIT FEE 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 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Da e WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION �--I - CE 875 I hereby affirm that I have a 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.Q. BUILDING Policy No. Company FOR APPLICANT TO FILL IN ADDRE Certified copy hereby is heb furnished. BUILDING LOCALITY �GJ_ G dyer( Ve ADDRESS ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST '/ Aveam DISTRICT NO. G UP TYPE PRO ESSED BY CROSS ST. C((�ver� �C.- Q�d S l✓�QS '�� �J CONST. CERTIFICATE OF EXEMPTION OM WORKERS' LEGAL COMPENSATION INS RANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND'LOCAL NO. OF BLD S. (This section need not be complet if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. 1 certify that in the performance of he work for which this titin l„� o permit is issued, I shall not employ a y person in any manner OWNER ; —( C, C�V�-fLCr vwre s' so as to become subject to the Work rs' Compensation Laws. AMAIL �7� 1� _ OCCUPANCY GROUP ADDRESS f O fJV,C (�7p�, A�lcxA Lct— Date Applicant rEL. OCCUPANT LOAD n- NOTICE TO APPLICANT: If, after aking this Certificate of CITY N. ��$�1{L{{j—Ogg v� Exemption, you should become bject to the Workers' z Compensation provisions of the Lab r Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. of,0 LICENSED CONTRACTOR DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed rider 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 m license is in full force and effect. t7T `�(/fJ PARKING REQ'O PROVIDED _ SPACES License Number ic. Class SUVA Ir(der C-ertke,C LIMITED TIME USE Contractor ate DATE DATE FROM: TO: El I am exempt from the lice sing requirements as I am a licensed architect or a re 'stered professional engineerSIZE OF NO. OF INSPECTOR'S acting in my professional apacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). IFINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING ' _Ce FEE HOME OWNER-BUIL ER DECLARATION NO. OF EXISTING BUILDINGS ! 1—� ON LOT AND USE I hereby affirm that I am a empt from the Contractor's License Law for the following reason (Section 7031.5, Busi r;- );;' ' <`Q i ness and Professions Code): NO. PARKING i 4LI )I_, l( i J`. s SPACES PROVIDED1 't pm 4.l_(,il . I, as owner of the prope ty, will do the work and the O t='4 t structure is not intende or offered for sale (Section }� 7044,Business and Profess ons Code). CONSTRUCTION L NDING AGENCY PROPOSED USE of BUILDING}- I hereby affirm that there is construction lending agency for the performance of the work for which this permit is Hea issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE Q s- 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, and hereby authorize representatives of this County to enter TOTAL FEE upon thea entioned property for inspection purposes. Z_i SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date WORKERS'COMPENSATION DECLARATION cE 845875 (11-84) a4)4p���p � � �g BU� ����I����oAl I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No: Company FOR APPLICANT TO FILL IN BUILDING ADDRESS 5915-5917 Cl=ov�erl Certified copy is hereby furnished. BUILDING Temple City LOCALITY L-�L ADDRESS 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESS6D BY CROSS ST. Los Tunas Cloverl © D CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD S. (This Section need not be completed if the work involved TRACT NOW ON LOT two USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF / SIZE OF LOT 49 r 000 Sf EXISTING BLDG, retail]/—/-;/ I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER Tmple City Century Square so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS 1300 E. Main st #210 Date Applicant LO NOTICE TO APPLICANT: If, after making this Certificate of CITY Alhambra TEL 818-458-3435 OCCUPANT LOAD 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. KnowL deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that-1 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 tress and Professions Code, and my license is in full force and effect. iV��DC PARKING SPACES REQ'D D PROVIDED D License Number Lie. Class • LIMITED TIME USE Contractor Date QW4,hDATE DATE 0 I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO.'OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 1 7' 45 .Sf STORIES one SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Ip Lie.or Reg.No. Date �" • HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE san ng 1 \ 4 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- with most1y office and retail S e �J 9/ /92 ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED _ =2 1 FIM1);?; structure is not intended or offered for sale (Section I' y 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 I certify that I have read this application and state that the PERMIT FEE 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 u�theent�7d property for inspection purposes. f SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermitt C1 WQRKERS'COMPENSATION DECLARATION 76 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that-I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insl;,ve, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) Policy No. Company FOR APPLICANT TO FILL IN BUDRESS ILDING /� ElADCertified copy is hereby furnished. u1LDING / LOCALITY ❑ DDRESS Certified copy is filed with the county building inspection NEAREST ` department. LOCALITY _ �O CROSS ST. ltQj Date Applicant NEAREST �[ DISTRICT NOGROUP TYPE PROCE SED B CROSS ST. CONST., / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ti ` L COMPENSATION INSURANCE DESCRIPTION TLOT NO. BLOCK NO. (CIRCLE) STATE MAJOR SECOND LOCAL } NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS A by the permit is for one hundred dollars ($100) or less.) USE OF /' V SIZE OF LOT EXISTING BLDG. G •- Icertify that in the performance of the work for which thi � O permit is issued, I shall not employ any person in any manner OWNER bUl)Id(1n 1-- so so as to become subject to the Workers' Compensation Laws. V OCCUPANCY GROUP —Z U MAIL I.t1 tAasD DRES Date Applicant 2 W TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after.making;this Certificate of Iry No. Exemption, you should become subject to the Workers' AP (CATION 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. OCCUPANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. SPACES REO'D == PROVIDED License Number Lic.Class LIMITED TIME USE 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 ]STING BLDG. STORIES SIGNATURE: iness and Professions Code). FINAL APPROVAL /'PRESENT USE OF BUILDING Y 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 Z 0.0 3.7 A ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Sectio # D D D D [l:0 7044, Business and Professions Code). RO POSED USE OF GUILD ING 0 0 0 0 0 0 O (T) CONSTRUCTION LENDING AGENCY I hereby affirm that'there is a construction lending agency �'6 2 2'—8 1 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 PERMIT FEE 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 1 ordinances and State laws relating to building construction, an hereby authorize representatives of this County to enter TOTAL FEE In th l bove- en ' ned property for inspection purposes. SEE REVERSE -OR EXPLANATORY LANGUAGE Signature of Permittee Date WCiRKERS'COMPENSATION DECLARATION CE 875(2-8d) MISCELLANEOUS A® PLICTI®N I hereby affirm that I have a certificate of consent to self COUNTX OF LOS ANGELES BUILDING AND SAFETY DIVISION insurF/, 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. UILDINs �/ LOCALITY J ❑ JO N Certified copy is filed with the county building inspection NEAREST department. LOCALITY CRoss sr. Date Applicant AR EST �� DISTRICT N�9. G OUP TYPE PRO E SED BY CROSS ST. L,�Lj Ov. R. /I �/ - CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 10 L{ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECON -CAL(This section need not be completed if the work involved No. OF BLDGs. NO. (CIRCLE) t3_ ( p TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) USE OF V SI OF LOT 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 o ER so as to become subject to the Workers' Compensation Laws. MAIL /f /` /y OCCUPANCY GROUPFT��:J V AD ESS G( L,CGl/L/ /%1.z-� -.�-•dF Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate of CITY (J�. ' ITv0. OCCUPANT LOAD Exemption, you should become subject to the Workers' AP LICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION No Spec. Know]. [] deemed revoked. ID LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) No. of EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING SPACES REO'D O PROVIDED License Number Lic.Class LIMITED TIME USE 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- E STING BLDG. STORIES S NAT.. iness and Professions Code). to, FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date a STING HOME OWNER-BUILDER DECLARATION ON LOT NO. OF,EXANID USE USE BUILDINGS I hereby affirm that, I am exempt from the Contractor's 1 0 Z 1 A License Law for the following reason (Section 70 31.5, Busi- ING ness and Professions Code): NO. PAR PROVIDED P ) SPACES PRO # '0 0 0 0 8 8 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 0 0 0 0 0.o O 7044, Business and Professions Code). PROPOSED USE OF BUILDING I 1 .1 (i $(( CONSTRUCTION LENDING AGENCY // C% 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 PERMIT FEE 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, and hereby authorize representatives of this County to enter TOTAL FEE v4J CC%� upon the above-mention property for inspection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE err//—/3-ft Signature Qf.Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION CE 875(11-84) hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIV,IIION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING Al C d rJC� � � LOCALITY ADDRESS Certified copy is filed with the county building inspection eLOCALITYNEAREST department. - m //s '-" / / CROSS ST. �(/J Date Applicant AEAREST y�I DISTRICT GRQ�1 TYPE PRO 5E • BY CROSS ST. 01YRS D c^ /yl- CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SEC ND LOCAL NO. OF BLDGS. (This section- need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. �� d 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 s� so as to become subject to the Workers' Compensation Laws. MAIL _ OCCUPANCY GROUP —27�1 � f n �! Jl P]� 0 ADDRESS �IO J R/� VC��1/SIAI L J / �O� 8 Date Applicant UJ r TEL' OCCUPANT LOAD O_ NOTICE TO APPLICANT: If, after making this Certificate of clrY�'j j;�sw T NO. Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (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 effect. PARKING REQ'D = PROVIDED .� SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus XISTING BLDG. STORIES SI ATURE iness and Professions Code). PRESENT USE OF BUILDING � •� FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS r 9 0 0 0 A ON LOT AND USE 0000-88 ., I hereby affirm that I am exempt from the Contractor's 0 0.00-88 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). r �( PROPOSED USE OF BUILDING I c CONSTRUCTION LENDING AGENCY S N�� 9,0 O.ol A I hereby affirm that there is a construction lending agency for the performance of the work for which this permit i #e o 0 0.0 88 issued(Sec. 3097,Civ.C.). 0 0 0 0 to 0 o z Lender's Name PROPOSED MAX. OCC. 0.0.00-88 Lender's Address n PERMIT FEE 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, and hereby authorize representatives of this County to enter TOTAL FEE ` u on the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permi e Date WRK 1-RSCOMPENSATION DE(CLARA F10\ 76M444 CE 875 11 811) MISCELLANEOUS APPLICATION ti>,,reby affirmthat I have a certificate of consent to se.�f insure.a certified c.''It a certificate ot"Work-ers'Conwensation Insurance.or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �y ihereot'iSec. '3800. Lab*C.I. 4 Policy No. FOR APPLICANT TO FILL IN RU I LID ING F i%DORESS ❑ Certified copy is hereby furnished, X BUILDING SS oVarl LOCALITY ADORE 0 Certified copy is filled„ith the inspection LOCALITY4EAREST department. Temple City ROSS ST. rt.4 n o­ T N Date NEAREST OISTR P ESSED By TYPE _CROSS ST Las Ton 4UP CONS je&;� CERFIFICATE OF EXEMPTION FROM ' (-, \ RKERS- LEGAL C(C)NIPENSATION INSL*RAWE DESCRIPTION LOT NO. BLOCK STATE MAJOR SECOND LOCAL tCIRCL_j INO. -IF B1­DGE. (This section need n,)t he e:onmleted if the x%ork I j,nv,1,,,,e,I NOW ON LOT r"S E TONE SPECIAL CONDITIONS by the permit is for one hundred dollars 6100) or es.'. SIZZ :)F LOT Z7113TIN. BLDG. I :ertif%, that in Jie tlerformanl-c --lie ko.-!-. -0ich -.hisJF 77 FLUPIt--L 4-y ow 1.1 5qqarQ- permit Is iSSUCLi. I shall not employ' any �,e.so:i :.,i-in%.manner NER so as to become ubiect :o the �korke.s' I- XL ..�!n:)ensition !-:i,% OCCIJPA.'\IC'' 3ROUP AD DR ooF-, Kim) 5r. 0 :7 Date *oplican-, NOTICE To APPLICANT: If. au`cr nakir,c :Iiisiicate _,• X]c]T­RLW#mORA Z4 9/9 C1 C C U P N D EXernDtiO-1. k-01! ;iiould becom..- subiecz -,, -lie I" Compensation provNions nf -he 1-:01or ..-,)do. vou must lor-L APD L!C A 71 C\! D P ZX.!,- -i AiR r-�-%"­P F with coimli% -,0111 .tech -'er'llif ;hail he 7 _ N — JIE EOLOry :N�­,:7101 O soec. K:'C'..;i.deened 7:­kCJ. Pan�c Devir-, LI( :-NSFD CONIRACTORS DEICLAI�.aTlk)'., DCCJPANCI( iNSPEC-TONXX I-, I lie-ebv aifirm :hat I jn 'ieLnsed unde-, Provisions ofChanter SAFETY PERMIT (LIST IT E'.15 3F1­O'.'/) 9 (Cmlitnenuina Ntith Section 7()()0) ,t' Di%kion ' .)i :he !3u s:- NO. OF EXIT' ness and 'ind !I"% !ice:Ise i ;it :uA :,,rc,- ind ROVIDED PARKING el 4 R E O'D License Numbere-7 LIMITED TIME USE Contractor ...­--­­-.-----­­-.- I)aic ini exempt ;rom :he ':icLmsirw Tequuenient. as I ajn licensed jrchiicct or ,I re--nsiercd orniessional em:ine,-' ;zE of, No. C,- IrISPE T R EXISTING BLDG. 3 0 R I S11 R iness and !'-ofossicns 'RESENT USE OF BUILDING -INAL. APPROVAL P Lie. or Re Vg,. D:i:c -------- — ;F n ? o HOME- 0kNNi-R-III- ILDER DF(:I-ARAlI()N NO. OF EXISTING BUILDINGS I hereby afftrin that I amexempt from the Contractor',; ON LOT AND USEf�� � / Ilese.'.3_jny, y..,a wl/YV'l jA�!I License Law for the f(Alowinu, reason 'Section Busi, ness and P-oiessions Code): NO. PARKING I. as owner of the property, will do :he %vork and ili:, SPACES PROVIDED _- stricture is not intended or offered for ;ale tSectioc. 7044. BUSiuCiS:111d I'Toi*essions Code). CONSTRUCTION LENDING 1611-NU� X PROPOSED USE OF BUILDING I hereby affirm that there is a construction IendinL, :wcncy flaj�h dl/Kd 6qJ17,r-taf1-- C4(WIC- • 0 hT;C-P- for the pertorinance of the '.Fork for ,which ;his permit i:. issued (Sec. 3097. Civ. C.). Lender's Nance PROPOSED MAX. OCC. Lender's.Address-,-�,--F, 1 certify that I have read this application and state that tht: PERMIT FEE 25.00 above information is correct. I aRree to comply with all Count, ISSUANCE FEE ordinances and State laws relining to buildim., construction. TOTAL FEE and hereby authorize representatives of this County to enter 25.00 upon thebove-Inentioned property for jnspectl,?nyurp�ses. SEE REVERSE FOR EXPLANATORY LANGUAGE SiPna1LIr(/f 10, ti tee WORKERS'COMPENSATION DECLARATION 76M444 Ibl I SC E L LA N E .P P L I C ATION CE 875(11-84) I hereby affiejt that I have a certificate of consent to c self COUNTY OF LOS ANGELES JUILDING AND SAFETY DIVISION insurer.or-a.ce,�tificate of Workers'Compensation Insurance,or ' a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING a DDRESS1 ADIJR ESS Certified copy is hereby furnished. BUILDING .1 LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GFJOUP TYPE PO ESSED BY CROSS ST. D� _� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. - (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This Section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this cc permit is issued, I shall not employ any person in any manner OWNER y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS Date Applicant LU TEL. OCCUPANT LOAD O__ NOTICE TO APPLICANT: If, after making this Certificate of CITY ps No. &CP _ D p v, Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: 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 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 ' ' effect. PARKING REq'D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a FROM: TO: 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 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 �j License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING SPACES PROVIDED tI t''''.' 0 I, as owner of the property, will do the work and the ? 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 I certify that I have read this application and state that the PERMIT FEE above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby thorize representatives of this County to enter TOTAL FEE upon the a e-mentioned p erty for inspection purposes. Imo' SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Date COUNTY.DF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1402050003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I ITR: 8526 LT: 10 BL: .001 1 SQ. FT STORIES TYPE OCCUP GROUPI 5915 5917 CLOVERLY AV I I (STRUCTURE: 1 V-B C I TEMP CA 917802126 I 1ASSESSOR INFORMATION NUMBER: L I NEAREST CROSS STREET: LAS TUNAS I 18587-008-017 (EXIST BLDG USE: I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI I IEXIST OCC GRP: USE ZONE: I I (TENANT: I (ISSUED ON: PROCESSED BY: I ILIN'S EDUCATION 1BLDGS. NOW ON LOT: VALUATION: 102/05/14 SR I I 1 0 1 I 10WNER: TEL. NO: I IFINAL DZLTE FI CODE: I (ERIC STRAUSS (626) 807-0712- ILIST ITEMS: 1 I 15919 SULTANA AVE I 1 I ITEMPLE CITY CA 91780 I IDESCRIPTION OF WORK 1 I I IREMOVE TEMPORARY WALLS REMO HOT WATER HEATER RETURN I I IOCCUP LOAD EXIST: ILOCATION TO CODE 1 (APPLICANT: TEL. NO: IOCCUP LOAD NEW: I 1 ISAME AS OWNER - I I I I IPARKING SPACES REQUIRED: ISPECIAL CONDITIONS: 1 IPARKING SPACES PROVIDED: I 1 I I I I I _-(EXIT HARDWARE: I 1 (CONTRACTOR: TEL. NO: I I LIMITED TIME USE ISAME AS OWNER - INBR OF EXITS: I FROM TO 1 LIC. NO I I I I FEES PAID I 1 I 1APPROVALS DATE INSPECTOR SIGNATURE IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 I (ARCHITECT OR ENGINEER: TEL. NO: I !TRAILER USE I I 1 10A PERMIT ISSUANCE 27.80 1 I I I LIC. NO: 101 R/M OCC/USE INSPECT 146.00 (SAFETY PERMIT I I I TOTAL FEES 173.80 1 1I I I I 1TEMP. STRUCT. APPROVED I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 (TEMP. STRUCT. REMOVED I I I I I I I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I NO I I I I I I I I SCHOOL WITHIN HAZARDOUS I I I I 1 1AIR QUALITY: 1000 FEET MATERIALS I I I I I I NO NO NO 1 1 I I 1 I I i I I I I I i I I I I I i I I I I I i I I I I I ! I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR267 ROUTE TO: BS0508 1 1 I I I I I I