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HomeMy Public PortalAbout9042-9046 LAS TUNAS DR_Miscellaneous__ L WORKERS'COMPENSATION DECLARATIONCE 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 wooRess �. Certified copy is hereby furnished ILDING /i 'LOCALITY ` ' - •T Certified copy is filed with the county budding inspection ADDRESS L v� Tt"MiaJe CI/ NE'AREST department CALITY cRoss sr Date Applicant N REST DIST$ICT NO. GROUP TYPE P SSED BY, ROSS ST. IP�,Sr .P _ L- ,l� �� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J[v COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK. MAP HIGHWAY • NO (CIRCLE) STATE MAJOR SECO D LOCAL NO. OF BLDGS. O 016 (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS t, by the permit is for one hundred dollars ($100) or less.) /J USE OF SIZE OF LOT EXISTING BLDG ✓/ I certify that In the performance of the work for which this 0 permit is Issued, I shall not employ any person in any manner NER T HN 'Como vele (~j so as to become subject to the Workers' Compensation Laws OCCUPANCY,GROUPDi? u W DRESS �� �Qel d Date Applicant N NOTICE TO APPLICANT If, after making this Certificate of ITY T'eA41t CI-7-Y NO- _ 6 2 OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE. Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked ❑ ❑ No Spec. Knowl. 0 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am,licensed under provisioris of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi ness and Professions Code, and my license Is In full force and PARKING. effect REq'D O PROVIDED D SPACES License Number Lic Class • LIMITED TIME USE • Contractor Date DATE DATE I am exempt from the licensing requirements as I am a licensed architect or a registered professional'.engineer SIZE OF NO OF FROM TO ,INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg No Date HOME OWNER-BUILDER DECLARATION NO O EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's #$ 3 9 O License Law for the following reason (Section 7031 5, Busi- 0-0 • • • • • ness and Professions Code) NO.PARKING - - O �, �•- 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). - P ED 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 aces and S a correct. I agree to t comply with all County ISSUANCE FEE ordinances and State laws relating to building C uonstru enter TOTAL FEE ��yy�� hereby authorize representatives of this County to enter (/moi 6i- and , ,upon the above-mentioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 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 furnishedILDINc 0"� L T LIN 5 DRn. rr LOCALITY ❑ ADDRESS T LE Certified copy is filed with the county building inspection , Cj department LOCALITY NEARESTCROSS ST Date Applicant _11-11 REST �SF ' I+ � /✓� DISTRICT NO. GROUP TYPE JIMRSSED BY CROSS ST. t�0 CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY TATE MAJOR SECOND LOCAL NO OF SLOGS. No (c IRCLE) Sd (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) U USE OF 7 I�j I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. Cr✓✓✓✓✓ permit is issued, I shall not employ any persori in-any manner WNERO so as to become subject to the Workers' Compensation Laws AIL b GDv it 4/O OCCUPANCY GROUPO�GU Date Applicant ADDRESS /�•p • �p LU CL NOTICE TO APPLICANT If, after making this Certificate of CITY C j T NO � ���"_ OCCUPANT LOAD Z_ 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 DBVIC@S ❑ 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 REO'D PROVIDED SPACES JJ 141 cense 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 mess and Professions Code). NT'usE of BUILDING FINAL APPROVAL Lic or Reg.No Date NO OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION 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 3.8 A' SPACES PROVIDED 1, as owner of the property, will do the work and the #�o oto 0 8 8 structure is not intended or offered for sale (Section ` 7044, Business and Professions Code). P SED USE OF BUILDING o 0,0 0 0 0 0 2 CONSTRUCTION LENDING AGENCYn ' I hereby affirm that there is a construction lending agency AL-7- R14-r/O,Y,r/ O./9, l 5�'8 2 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 representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY'LANGUAGE A in Signature of Permittee Date WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION CE 875 f� I hereby affirm CE 875(11 -84)that 1 have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �lulf 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 ADDRESS96 1 Certified copy is hereby furnished. BUILDING qD42 Q. 7EPfU LOCALITY ADDRESS 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST ,/ DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST �O,J( ("1�f•T7✓ p71 V Q a CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NO. MAP c/ / HIGHWAY STATE MAJOR SECOND LOCAL NJQ� 1 OF BLDGS. O. (CIRCLE) (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 / / d 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 �.o �, y so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GkOUP;_'%® o ADDRESSPD 8 Date Applicant LL, rEL. r� Styr Q OCCUPANT LOAD N NOTICE TO APPLICANT If, after makingthis Certificate of clrY NO. 1 C.a� Exemption, you should become subject to the Workers' ppLICATION 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. Know[. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi SAFETY PER MI ❑ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq'D D PROVID 6D O SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a PROM. TO. licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE mess and Professions Code). FINAL APPROVAL _ PRESENT USE OF BUILDING G 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 ❑ 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 agency rl for the performance of the work for which this permit is issued(Sec. 3097,Civ Q. Lender's Name PROPOSED MAX. OCC. Lender's Address O D 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 representat ves of this County to enter TOTAL FEET n the above- entioned prop ty for inspection purposes. EE REVERSE FOR EXPLANATORY LANGUAGE Sig re o ittee e WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hei�bor certificate 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 FI LL IN pD DRESS Q a 0 Certified copy is hereby furnished. BUILDING '` DR ADDRESS T) kAS _ M5 LOCALITY ❑ Certified copy is fled with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NQ. G UP TYPE P CESSED BY CROSS ST. VD .O y _� CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGALO COMPENSATION INSURANCE DESCRIPTION LOT NOAS BLOC" MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT.t' NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF //'/n_ SIZE OF LOT EXISTING BLDG L✓ 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 �ohr� Con pyo, 22:1 so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS Dx U Date Applicant Z3 NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. OCCUPANT LOAD O 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION IV I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT 9 (commencing with Section 7000) of Division 3 of the Busi ❑ (LIST ITEMS BELOW NO. OF EXITS ness and Professions Code,and my license is in full force and �r effectPARKING SPACES REq'D D PROVIDED O License Number Lic. Classes �r—r 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.g STORIES SIGNATURE mess and Professions Code). �Nfs1e -hf- FINAL APPROVAL _� Lic.or Reg.No. Date PRESENT USE OF BUILDING '�J 4�2 HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS } D I/,v �"s_°- FE5::' I hereby affirm that I am exempt from the Contractor's ON LOT AND USE License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) No. PARKING _Iii[ -i„iJti -1;° r ; ` I, as owner of the property, will do the work and the SPACES PROVIDED Pr( i 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 authorize representatives of this County to enter TOTAL, FEE upon th ove-mentioned p 7 for ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 r Signature oKPerKtee Date i WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L LA N EO U S P P L I C AT I O N CE 875 Thereby 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 BUIIb ING ^ 1� ADDRESS �Jl Certified copy is hereby furnished. BUILDINGCt �q`, n LOCALITY 'ADDRESS V l'7- 4 I[„ Certified copy is filed with the county building inspection LOCALITYNEAREST department. TALC Gtr CA CROSS ST Date Applicant NEAREST /n/ DISTRICT NO. GFFF} up TYPE / OCESSED HY CROSS ST. 14� 6 W : !� CONST:!/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY (CIRCLE) STATE MAJOR SECOND LOCAL NO NO OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USEZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) use OF S C:) I certify that in the performance of the work for which this SIZE OF LOT EXITING BLDG. permit is issued, I shall not employ any person in any manner OWNER oft ' C©ti C' so as to become subject to the Workers' Compensation Laws. MAIL o �® OCCUPANCY GROUP ® o ADDRESS Q:Q, Ba)( `J U 8 Date Applicant �,, – TEL. O_ NOTICE TO APPLICANT• If, after making this Certificate of CITYT(5Vq & -i1--qNO. Zg�-_c s� OCCUPANT LOAD y 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 E] 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 andf ` {/c sj/ _ effect. r 5 PARKING • SPACES REp'D D PROVIDED License Number Lic. Class 6Voof_,oG LS deD- LIMITED TIME U E_ e — Contractor Date DATE ° ❑ I am exempt from the licensing requirements as I am a FROM TO PECTOlicensed acting inmytect or a professional registered apacyp(Sechonnal 7051 engineer usr ex STOING BLDG STORIES 4:116 -l3ljNAruR! mess and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE Q ' � I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 70315, 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 �l 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency R C-T-4 y L. U A 3•,1 S 1� for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name Lender's Address PROPOSED MAX. OCC. 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 ordinar•\es and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL. FEE upon the above-mentioned pro pe y for' spection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Permit Date Pu'� !z WORKERS'COMPENSATION DECLARATION 4 CE 875(11-84) MISCELLANEOUS APPLICATION CE 87 I hereby affirm that I have a certificateof 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.). — . 4 'fl Policy No. Company FOR APP LICANTTO FILL IN BUILDING ADDRESS T FICertified copy is hereby furnished. UILDING m� DDRESS J S �tN S Q LOCALITY 0 department is filed with the county building inspection LOCALITY ryp� �� J Gf} gv NEAREST CROSS ST. Date ApplicantDISTRICT NEAREST ICT NO. P TYPECROSS ST Gl L /f / � CONSTCERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �"G:Rr COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO NOOF BLDGS. (CIRCLE) STATE MAJOR SECOND LOCAL . (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. � n/ A` >C:I certify that in the performance of the work for which this -6 011, is issued, I shall not employ any person in any manner 'OWNER Qf d;i(/ - BNS 1!• GdN� y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP �a o ADDRESS �•d � H Date Applicant TE W NOTICE TO APPLICANT: If, after making this Certificate of clTv '7611-f NOL F ?LF_ C4 8/ �2$$— S I OCCUPANT LOAD D- 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 �� �t,,s�neSS PARKING effect. REQ•DPROVIDED License Number Lie Class KANl–,55P SPACES LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a PROM' TO: licensed architect or a registered professional engineer SIZE OF NO. OF CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES @_I ATURE mess and Professions Code). Lie.or Reg.No. Date PRESENT USE OF BUILDING �/�/L $Ta�� FINAL APPROVAL -_ J Jr., HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ✓//�3 �'= j {+� t q ON LOT AND USE I 7•hitt' I. A7'10 li 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 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 1 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. 31T Q _a9 SEE REVERSE FOR EXPLANATORY LANGUAGE �( Signature of P�- Date WORKERS'COMPENSATION DECLARATION CE 875 (1 1-84)a MISCELLANEOUS APPLICATION J� CE 87 1 hereby affirm' that 1 nave a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or a ocstified copy thereof(Sec. 3800,Lab.C.). Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS / p Certified copy is hereby furnishedBUILDING / / LOCALITY XX ADDRESS 5 G/ f Certified copy is filed with the county building inspection LOCALITY NEAREST department. xx CROSS ST Date Applicant NEAREST DISTRICT o GRO P TYPE P ESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLOCS. (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 I certify that in the performance of the work for which this SIZE OF Lor EXISTING BLDG. 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. MAIL OCCUPANCY GROUPE�::] ADDRESS r Date Applicant C- NOTICE TO APPLICANT If, after making this Certificate of CITY C.41 No. – L/L/ OCCUPANT LOAD C' Exemption, you should become subject to the Workers' APPL CATION 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 F] ` deemed revoked E] ❑ No Spec. Knowl. "y 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 anix effect 1� Name of business PARKING r� SPACES REQ D D I PROVIDED 1 1 License Number — Lie Class LIMITED TIME USE Contractor Date DAT. DATE FROM: TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE of NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE! iness and Professions Code). FINAL APPROVAL Lie or Reg No Date PRESENT USE OF BUILDING _ - IIOMI?OWNFR-BUILDER DECLARATION NO OF EXISTING BUILDINGS t/{(� ■� y/j ON LOT AND USIt v/•ti 1 hereby affirm that I am exempt from the Contractor's I � Licence Law for the following reason (Section 7031.5, Busi- ness and Professions Code) NO. PARKING 1 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). QQ . CONSTRUCTION LENDING AGENCY PROPOSED uss 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.CJ. 4.. Lender's Name I ,! PROPOSED MAX. OCC. Lender's Address = PERMIT FEE 'c! I certify that I have read this application and state that the 25.00 above information is correct 1 agree to comply with all County ISSUANCE FEE I ordinances and State laws relating to building construction, and hereby authorize representatives t ' County to enter TOTAL FEE - 25 . 00 upon the -mentioned prop ty s ction pur se =- I SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX = Slgnalur f Pcnn Dat WORKERS'COMPENSATION DECLARATION CE 8754(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 C.). Policy No Company FOR APPLICANT TO FILL IN ADDRESS _ _ n ADDRd� Certified copy is hereby furnished BUILDING N�S E ADDRESSLAS LOCALITY FICertified copy is filed with the county building inspecti • OCALITY NEAREST department. �} ti✓ Cf (�. '91780 CROSS sr. Date Applicant NEAREST DISTRICT NO G UP TYPE CESSED BY CROSS ST � al CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 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. I certify that in the performance of the work for which t is I C3 permit is issued, 1 shall not employ any person in any ma ekX OWNER of building2-1 so as to become subject to the Workers' Compensation La OCCUPANCY GROUP L "_J Date Applicant U.3 NOTICE TO APPLICANT- If, after making this Certificate of CITY ( k,JS NO. ( 72 OCCUPANT LOAD 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. E] Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chaptera SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the B sig No. of EXITS ness and Professions Code, and my license is in full force ax'y effect. Dame of business PARKING � SPACES R6Q'D E::= PROVIDED License Number Lia Class ���5 ��� ��� LIMITED TIME USE Contractor Date DATE DATE - ❑ I am exempt from the licensing requirements as I am a PROM' TO' licensed architect or a registered professional engineerslzE of No. of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 316 TORE iness and Professions Code) FINAL APPROVAL �f�n; Lic.or Reg.No Date PRESENT USE OF BUILDING - - v l- 65!1 rr, HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ��/ ON LOT AND USE I � C��j,��r I hereby affirm that I am exempt from the Contractor's ` 001 —000 License Law for the following reason (Section 7031.5, Busi- ness usi 0525 1 I 18:06ness and Professions Code) NO. PARKING W 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 agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX OCC. Lender's Address PERMIT FEE 25. 65 I certify that I have read this application and state that the above information i correct I agree to comply with all County ISSUANCE FEE ordinances and St a laws relating to building construction, and hereby author a rep ese iv of this County to enter TOTAL FEE 25 - 00 on the above-m tione pr or nspecti n X119—cls— poses. XX XX� SEE REVERSE FOR EXPLANATORY LANGUAGE Sign u c m Date