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Home My Public Portal About9416 GIDLEY ST_Miscellaneous__ woRifERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E LLA N EO U S APPLICATION �( CE 876 � I I hereby affirm that I have a certificate of consent to self COUNT( OF LOS ANGELES BIb'ILDING AND SAFETY DIVISION IIL JII insure or a certificate of workers'Compensation Insurance,or - a cert�fiod y thereof(Sec. 3800, C.). Policy No.� n1' FOR APPLICANT TO FILL IN AUDI ADDRKSS[// FICertified copy Is hereby furnished. BUILDING ADDR[/S LO CA LI L Certified copy Is filed with the county building inspectioncwLrrY (:x � NKARKBT department CROSS ST. Date Applicant XXAR[ST DISTRICT HO. GROUT TYPE CKS■[D BY CROSS I7. .D ry /1 COM vy CERTIFICATE OF EXEMPTION FROM WORKERS' Li ST. d CJJ� `►-. +2- COMPENSATION INSURANCE D[SORIPTIOH LOT NO. ■LOCK NOO. ( IR�� /TATs MAJOR fi COHD LOCAL NO. OF ■LD 6S. U/[ ZOHi SP[CIAL CONDITIONS (Thai LOCtIOII need not be COn]ppinted if time wOtf 1II10iPed TRACT NOW ON LOT by the permit is for one hnadred dollars (;100) or less.) u/i of SIZ[ OF LOT [XI/TING BLDG. �. I certify that in the performance of the work for which this C3 permit Is issued, I shall not employ any person In any manIIea o.N[R so as to become subject to the Workers' Compensation Laws_ MAIL OCCUPANCY GROUP o ADDR[S■ Date Applicant TiL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of clrY Ho. 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 oI this permit {hall be TRAIL[R US[ ❑ G[OLoGY IHSP[CTIoN ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY IN/PKCTION ❑ Panic Devices El I hereby affirm that I am licensed under provigions of Chapter 9 (commencing with Section 7000) of D on 3 of the Basi /wFirY P[RMIT E] (LIST rriM■ B[Lo>.) NO. OF iXITB nets and Profeadom Code, and my licenm Is in full force and effect PARKING R[q'D 1-14011.13[.. ■PACis Licence Number Lic. Class 5 - LIMITED TIME USE Contractor Date DAT. DAT ElI am exempt from the licensing requirements as I am a Fwo�I TOI licensed architect or a registered professional engineer BIZ[ of n0. OF INS1-i CTOR'S acting in my professional capacity (Section 7051, Bur iXISTIN6 ■LD 6. BTORI[■ /.GHwruRi mess and Professions Code). PR[■i NT US[ OF BUILDING FINAL APPROVAL Lia or Reg.No. Data D FE HOME OWNER-BUILDER DECLARATION No. of [XIrrIN6 BUILDINGS '�/ ON LOT AND USK I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 70315, Buil- 9 C_ }.12/5 y, nets and Professions Code): RO. PARKING n, El I, as owner of the pro , will do the work and the /rwci/ PRo11In[D 'il perry �� 1 F11structure Is not Intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOS[. US[ OF BUILDING I hereby afilrm that there is a construction lending agency for the.performance of the work for which this permit is istuod'�Sea 3097,CIv.C.). Loader s Name PROPOS[D MAX. OCC. Lender's Address PERMIT PKi I aQtify that I have read this application and state that the above Information is correct I agree to comply with all County Iaauwn CK FKK ordinances and tate laws relatita to building construction, and hereby s resell es Of this County to enter TOTAL FK< upon the o fro for inspection purpopm . SEE REVERSE FOR EXPLANATORY LANGUAGE tore of Permittee Date woRKF�Rs'COMPENSATION DECLARATION CE 875 (1 1�4) MISCELLANEOUS APPLICATION CE 876 I beieby affirm that I have a ec. Compensation certificateof consent t ,elf COUNTY OF LOS ANGE"S BUILDING AND SAFETY DIVISION frltaro -or ante of wor3cert'Compensation Insurancc e,or 4- .; 'fl a cert�flod copy thereof(S3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN ■UfLJ]1X6 ADDRX/■ FICertifled copy is hereby furnished U 1 LD 1 N G LO CA LrTY ADDRXII _Fy C HEM de C4 Certified copy is filed with the county building inspectioIINXARX■T department LOCALITY '1 O r CROP/ /T. Data Applicant NXARXIT DI/TRI T NO. 6 U X PROCK@SXD ■Y CROSS /T. F0, /T. CERTTFIGATE OF EXEMPTION FROM WORKERS' LXGAL (/a TT COMPENSATION INSURANCE D[/CRI?TION LOT NO. ■LO QK YwP H"H AY No. (DIRDLi) 1TATX MAJOR /XCOND LOCAL (ThisNO. OF ■IDG/. rection need not be COlDpleted if the work fIIVOtved TRACT NOW ON LOT U/[ ZOXX ■PX CIwL CONDITION/ by the permit is for one hundred dollen ($100) or Less.) USX OF _ a) ■IZX OF LOT [XI/TING ■Lp G. O" I certify that in the performance of the work for which this permit L inued, I shall not employ any person in sny meaner OWN[R v Iig so as to become subject to the Workers'Compensation L.awL MAIL OCCUPANCY GROUP o Date Applicant DR[1/ L3 NOTICE TO APPLICANT: If, after making this Certificate of arrY NXL 196Q OCCUPANT LOAD Cn CL- Exemption, you should become tnbject to the Workers' R z Compenialion provisions of the Labor Code,you mutt forth- APPLICATION FOEXIT HARDWARE: with comply with nick providons or this permit than be TRAILXR USX ❑ G[OLoGY INsruaT1oN ❑ No Spec. Knowl. El deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INIPXCTION ❑ Panic Devices I hereby affirm that I am licensed under}rp1rrovisions ofChap ter 9 (Commenckg with Section 7000) of Df Z n 3 Of the Buri- /AF[TY PXRYrr E] (LIST ITXY•1XLort) No. of XxIT■ mu and Professions Code,and my license is in AL11 force and 1/ of act. tla T S• PARKING RXQ'D PRQVIDXD 1PACX■ License Number Lia Clare t Date - LIMITED TIME USE Contractor Date DAT■ OAT■ ❑ I am exempt from the Licendng requirements as I am a licensed architect or a registered profbsdonal engineer six OF No. of FSOYI TD. IN1PXaTOR K acting In my profeuional Capacity (.Section 7051, Bur XXIITING BLDG, I.t- �D )� ■TORIX■Q ,_ ■I6 NwTURX frets and Profetdons Code). FINAL APPROVAL Lia or Reg.No. Date RX■Xnr USX of ■ulLnlxG l HOME OWNER-BUILDER DECLARATION NO. OF XxI/TING I@UtLDINGSIU ON LOT AND USX I hereby off rm that I am exempt from the Contractor's 1� 00IDO-90D 1 5/10/93 Licenso Law for the following reason (Section 70315, Butt , nen and Prof"Aons Code): NO. PARKING 9623 1 AM $:43 I, as owner of the ro ■PwaX. PROVID/D p Irty, will do the �vorix and the structure Is trot intended or offered for talc (Section 7044,Budness and Profetdons Code). CONSTRUCTION LENDING AGENCY PR OPo1Xo-USX of BUILDING I hereby of Irm that there Is a construction lending agency r for the performance of the work for which this permit Is imued(Sea 3097,Civ.C.). Lender's Name PROPO■XD MAX. OCC. Landes Addrots I certify that I have read this application and state that the P[RMIT FEE above information is correct I agree to oomply with all County ISSUANCE FE[ • mdhrancet and State laws relating to building construction, and hereby authorize aprosentativot Of this County to enter TOTAL F[[ upon the abovo-men property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittoe D i ! WORKERS' COMPENSATION DECLARATION MISCELLANEOUS APPLICATION 20-0003CF W 121W - hereby'affirm that I have.a certificate of consent to self COUNTY OF LOS§-ANGE!LM BUILDING>AND SAFETY DIVISION .: ihare,or a certificate of, Compmtim Ingi:r ance, or t Certified c thereof 53800 aa12h C},�` _ Policy No. A. Bt��WG)w 1 Y 3 1 �i>�1 • ��, FOR APPLICANT TO FILL LN ❑ Certified copy.is li=W,furnished Certified�copy is flied with the county buil inspection /( Gtmt �Q ZIP 97 NeARKST Date) Cltosa ST IPA Applicant sa LOT No.OIA F BLDGB.NOW ON T on Rlcr NodROUP Type PROCXssm my. } D S / CERTCATE OF F}CQvtPTION FR WORKS CONBT. IFI i COMPENSATION R�URANCE TCT eLocx LOT No. tcwbcxjn STATH MAJOR acorro LOCAL.. (This section Reed not be completed If the work involved ASSES 0R MAP BOOK PAGE PARCEL GG I by the permit is fot one hundred dollars ($100) or less.) �`zo Na Grecs^�C°'''DfT70N1 r L certify that In the porformance.of the work for which this TEL NO. permit is issued I'shall not empl any person In any manner � 7-Cf7 so ea to become subject to the GRV+orkers Compensation Laws RE, �/ /,_„{— a- t7e%I OCCUPANCY GROUP Dau Applicant . ZIP NOTICE TO APPLICANT: lf, after making this Certificate -181-no G ql 7 OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of tho-.L.taliof Code.you must forthwith EXIT HARDWARE: comply with such provisions or'this permit shall be doomed TRAIL MR UW E] aEOLoav irnPrrnoN ElNo SWI El OCCUPANCY LNSPXCTKM Panic Devlcea ElLICENSED CONTRACTnRS DECLARATION L I hereby affirm that I am Licensed under provisions of Chapter sArrry PERmrr❑ (LLirt'mEMe BELOW) •El i 9(commencing with Section 7000)of Division 3 of the Business d us 8 No.or oa-r■ and Professions Code,and my License is in full force and effect A Name PARKING• R=,O E= PROVIDE � License Number Lic Class •� erAcsl ' I Contractor Date LIMrTED TIME USE ❑ I am exempt from the llceffing requirements as I am a DATIt DATE licensed architect or a registered professional engineer FROM' 1Oi actii4 in my profemiooal capacity (Section 7051,Business e7g OF �S� NO.or and Professions Code). �'nNa BLDG. UTORM* �ZKWATTURN- L a or Reg. No. - Date PW13UCNr LIVE OF DUR--DQl6 FINAL APPROVAL f. � C�LJ Y Aq C077 4atjo Y' HOME OWNER-BUILDER DECLARATION No.of KXL2rnNa eua.mr4as ON LAT AND Ula 1 I hereby affirm that I am.exempt [rem the Contractor's License Law for the following reason (Section 70315, Business and Professions Code} No.P'km ❑ raDvrDm L as owner of the property, will do the work and the aFAC" structure is not intended or offered for sale(Section 7044.1 PFZOPo&m use or m-nLoiNa Business and Professions Code). cc/t n CONSTRUCTION LENDING AGENCY iI hereby aiftrm that there is a construction lending money for - - the performance of the work for which this permit Is issued i (SSec� 3097, Civ. C.). PRoroarD MAX.Oce L.tntleI's Name Arr"CXW(8Wr ,5 TFl No. OAQIA 0C Lender's Address Rase `�-i i I carttfy that I have read this application and state that the above information is correct I agree to comply with all County mumm ran ordinances and State laws relating to building coaatructim and - hereby authorize representatives.of this County to enter upon WeuArCX Fe= the above-mentloned property for inspection purpoaaz TOTAL Tea LSEE REVERSE FOR EXPLANATORY LANGUAGE z Signature of Wrinfuee Nic WORKERS'COMPENSATION DECLARATION 7eM"4. CE 976 (11$4) M I SC E LLA N E O U S APPLICATION I•hereby ef�lrm that I have a certificate of intent to c ,self or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION lnsuro ':ir a�tfflaste of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR ARP LICANTTO FILL IN ■uII�ING 1 �}arYl • wonRX�/ Certified copy is hereby furnWiod. 1 woowE/s ` � 6 LocALrry 11 depaxtrrient. :3 �-Mv�Certified copy is Mod with the county building taspecti NEARX/T QALTTY awo// WT. R•YYL' Date Applicant w[ARs/T G� taTRICT No. Ono ur TY s cs/ssD BY CROSS ST. � O CONT. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL " a COMPENSATION INSURANCE DX■CRI"ION LOT NO. ■LOCK MAP HMG AY No. (CIRCO/) /TAT[ MAJOR SECOND LOCAL NO. OR ■LDO■. (This section need not be empfeted If the work involved TRACT NOW ON LOT USX IONS SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) U■s Or I certify that in the performance of the work for which SIZE OR LOT KXISTIPIG ■LDG. o permit v blued,1 >tmll not employ any person in say .NER of buildin �' q v to become abject to the Workers Compensation La MAIL -- - -r✓ 0 PANCY GROUP `� AD OWES _ Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITYIy OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you meat forth- APPLIC^N FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USX ❑ GEOLOGY IN/rucTION ❑ No Spec. Knowl. ❑ deemed revoked LICENSED CONTRACTORS DECLARATION OaaUPANQY IN/PEcrnom ❑ Panic Devices I hereby affiffi that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the BIIE SAFETY PERYIT E] (LIST rrXY■ RXLO�) NO. Or EXITS mss and Professions Code,and my license is in fall force erect. =e of business PARKING RKQ'D PROVIDED t License Number Lia Clara ■PaaX■��' LIMITED TIME USE Contractor Date DAT: DATi 0 1 am exempt from the licensing requirements as I am a snow[ Tot licensed architect or a registered profoalonal engineerSIZE or, No. or IN■PscTow'/ acting in my professional capacity (Section 7051, Bus- XXI/TING ■LDG. /TORIX■ /I NATURE Iness and Professions Code). FINAL APPROVAL Lia or Reg.No. Date ]PRESENT USX Or BUILDING HOME OWNER-BUILDER DECLARATION NO. or XXIETINOBUILDING■ ��0 ON LOT AND [ _U/ / I hereby affirm that I am exempt from the Contractor's (/��.71� License Law for the following reason (Section 7031.5, Busi- ma and Professions Code): No. PARKING 1, as owner of the property, will do the work and the SPACES PROVILIXD structure L not intended or offered for ale (Section 7044,Bustlers and Professions Code). CONSTRUCTION LENDING AGENCY PworosXD u/E or BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued(Sea 3097,Civ.C.). I I Leader's Name PROPOSED MAX. OCC. Lender's Address I certify that 1 have read this application and state that the PERMIT F[[ above information is correct.1 agree to comply with all County ISSUANCE F[[ ordinances and State laws relating to building contraction, and hereby autho epresentatives of this County to enter TOTAL FEE 25.00 on t m o property+for purposes XX X9 / _ �. SEE REVERSE FOR EXPLANATORY LANGUAGE p Si re Permittee Date Ca 1-n r WORKERS'COMPENSATIONDECLARATION CE 875(11-84) M ISCELLANEOUS APPLICATION CE 876 I hereby„affirm that I have a certificate of coal nt`to ielf COLTNZ-Y OF LOS ANGELES BUILDING AND SAFETY DIVISION nr�or �,certtg�'ee of Worimrs'Compensation Insurance,or ace in fled copy thoi`eof(Sec.3800,Lab.C.). Polley No. Company FOR APPLICANT TO FI LL IN BUILDING wDDR//f ❑ Certified copy is hereby furnished. ■uILDINo 1 �7' LO CA L rf Y ADDR/f■ ❑ Certifled department. -is glad with the county building inspection LOCALITY r cRo,s /r. Date Applicant NUA R t ST D1 C XO O TYPE P3.0 ■f IAL CRO/■ ■T. -3 COH/T. CERTIFICATE OF EXEMPTION FROM WORKERS' LKS AL COMFENSATION INSURANCE DKf CRIPTION LOT No. ■LocK NO. IceH AY NO. (ou�CL/) fTATt MAJOR /��-�,,��”" NO. OP 1LDSf. CMig lection need not be Completed If the work involved TRACT Iio1r ON LOT USK ZONK •r[CIAL CONDITION■ by the permit L for one hundred dollars ($100) or lea.) USK or elxK or Lor sJCIsrINo ■LD G. I certify that in the performance of the work for which this CZ) permit is issued, I shall not employ any person In any manner OWNSR R SCdI� s' so as to become subject to the Worker/' Compensation Laws. MAIL OCCUPANCY GROUP o Date Applicant ADDR//■ Z 3 �-' i Dig. LU PPLU NOTICE TO APPLICANT: If, after making this Certificate of CrrY LJ//.1/Q NOI 3 ;Z,— g OCCUPANT LOAD i Exemption, you should become subject to the Worker' -. Compenntion provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILiR USX ❑ oxoLooY IN/PSCTION ❑ No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSrKCTlo Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter ■AFtrY PIIRMIT ❑ (LIST rrKme ■[LOW) ❑ 9 (commencing with Section 7000) of Division 3 of the Rusi- NO. OF XXIT■ nes and Profusions Code,and my license is in fall force and effect. _ PAAQ1■ JJ RKINS RKQ,D PROVID LD Contractor Number Lia or Czar' LIMITED TIME USE Contractor Date DAT/ DATA ❑ I am exempt from the Licensing requirements as I am a FROYI TDI licensed architect or a registered profbsdonal engineer ■aa OF No. of 'A. ss cro R' acting in my professional capacity (Section 7051, But XxI/TING ■LDo. 4-coe) sTORIs■ ' I Xwru isles and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PR i/i Nr uft of BUILDING I V9 HOME OWNER-BUILDER DECLARATION No. OF XXIfTING BUIL-DINGS OX LOT AND U// I hereby affirm that I am exempt from the Contractor's CT. License Law for the following reason (Section 7031.5, ss , Bu - I� 73.00 nes and Professions Code): NO. PARKING ElI, as owner of the property, will do the work and the /PACs. PROVIDUD 1 IT^ structure is not intended or offered for sale (Section TOTAL 93- IDO 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSKD USK OF BUILDING OPEC{, Q 3.00 I hereby affirm that there is a construction lending agency .00 for the performance of the work for which this permit is issued(Sea 3097,Clv.C.). Lender's Name I� 16/29/9] PR OP Of tD MAX. OCC. Lender's Address 1576 1 AN 1Q:36 PXRMIT PHK I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCK FKK ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FrKK upon the above-mentioned property for inspection purposes SEE REVERSE F R EXPLANATORY LANGUAGE d Slinature of Date