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HomeMy Public PortalAbout9067 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N CE 875 (11 84) I Hereby ,I cert that I have a Ceitinipee I,r consent to c ,or (OLWIN OF LOS ANGELI_S BIJI1.1)ING ANI) SAI�FAN I)IVISION ms..rc, or a acrtdic:.itc of Work cis'('umpcuwUun Insurance,or a cd'itdied copy thereof(Sec. 3800,Lab.C). Policy No. Company FOR APPLICANT TO FILL IN ABUILDING DDRESS ElCertified copy is hereby furnished. BUILDING O! / DDRESS lSl L (J V� ALOCALITY ❑ Certified copy is filed With the county building inspection LOCALITYnnq1-7 NEAREiT AIF department. l I`'1" CROSS ST Date Applicant NEAREST DISTRIC NO GRG P TYPE CESSED BY CROSS ST ' rj �/ TlJ�6( CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL L O COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS. 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 certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. I permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. :.AIL OCCUPANCY GROUP OR ESS Date Apphcant a 1 , * 217,00 , NOTICE TO APPLICANT: If, after making this Certificate of CITY �' NOL OCCUPANT LOAD Exemption, you should become subject to the Workers' A PLICATION 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. E] E] No Spec. Knowl. Panic Devices OCCUPANCY INSPECTION ❑ LICENSED CONTRACTORS DECLARATION � I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) a 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is m full force and effect. PARKING SPACES REQ'D PROVIDED 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 OFNO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SI ATURE iness and Professions Code). Lic.or Reg No Date PRESENT USE OF BUILDING FINAL APPROVAL1-71 [O J� /JO HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS puON LOT AND USEI hereby affirm that I am exempt from the Contractor'sYy 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 n I—I for the performance of the work for which this permit is I�I ,� -F issued(Sec. 3097,Civ C.). Lender's Name PROPOSED MAX. OCC. Lender's Address r t PERMIT FEE co F.-I. I certify that 1 have d this application and state that the � above information is rrect I agree to comply with all County ISSUANCE FEE ordinances a t laws lating to building construction, and hereb au !gp, a Uvc of this County to enter I TOTAL FEE –n 1 upon tl} bo e- ntrt o ction purposes r SEE REVERSE I.OR EXPLANATORY LANGUAGE Signature of ermittee Date _� WORKERS' COMPENSATION DECLARATION 0-0063DPW12/90 2MISCELLANEOUS APPLICATION 0-006 I he`r by affirm that•1 have a certificate of consent to sell 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 Company FOR APPLICANT TO FILL IN BUILDING D/ � X BUILDING ADDt�SS ADDRESS CO ❑ Certified copy is hereby furnished gQ1,o V,—C,5 U,•"0.S LOCALITY ❑ Certified copy is filed with the county building inspection Y ZIP��..`K v department a NEARESI CROSS ST Date Applicant SIZE OF LOMS NO OF BLDGS NOW ON LOT DISTRICT NO G O P TYPE P CESSED BY G CONST CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO 1 e C; COMPENSATION INSURANCE MAP HIGHWAY 1„1 NO lCIRCLEI STATE MAJOR SECOND LOCAL (This Section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONC SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) ;7 1 certify that in the performance of the work for which thiSImOWNER TEL NO t , permit is issued, I shall not employ any peison in any anner`` prop�esrty - �� — -ck }- i t so as to become subject to the Workers' Compensation LawsX Amal OCCUPANCY GROUP ® i; Date Applicant _ CITY ZIP — NOTICE TO APPLICANT If, after making this CertificateX r Ce—k a�0 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code,you must forthwith EXIT HARDWARE Comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ Spec pec Knowl ❑ revoked ❑ OCCUPANCY INSPECTION❑ Panic Devices LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a 9(commencing with Section 7000)of Division 3 of the Business NO OF EXITS and Professions Code,and my license is in full force and effect - PARKING REQ'D PROVIDED License Number — Lic Class SPACES Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a FROM DATE TO DATE licensed architect or a registered professional engineer acting in my professional capacity (Section 7051. BLISIneSS SIZE OF NO OF INSPECTOR S and Professions Code) EXISTING BLDG STORIES SIGNATURE Lic or Reg No Date PRESENT USE OF BUILDING FINAL APPROVAL_ —_ HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGSO Ir- ON LOT AND USE r4 -� a- IEE I hereby affirm that I am exempt from the Contractor's License Law [—i_Ii'i�i _ Law for the following reason (Section 70315, Business and Professions Code) NO PARKING 11-1 +t L r f ❑ I, as owner of the property, will do the work and thSPACES PROVIDED eX structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING Business and Professions Code) CONSTRUCTION LENDING AGENCY or�r41� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ' (Sec 3097, Civ C) PROPOSED MAX OCC Lender's Name APPLICANT(PRINT) TEL NO Lender's Address ADDRESS iI certify that I have read this application and state that the 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-mentionedpropertyfor inspection purposes TOTAL FEE X SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date =4)RKLRS' (OMPENSAFION DECL4R411OIv eo-nowoPwl �;, I,I^III MISCELLANEOUS APPLICATION I • �� I hereby affirm that I havcra certificate of u)n,eni u) ,el) COUNTY OF LOS ANGELES BUILDING ,AND SAFETY DIVISION it Insure or a certificate of Workers Compensation Insurance or a certified cop) thereof (Sec 3800 Lab C) Polic) No Company _ TOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS (G ❑ Certified cop) 1, hereh) furnished a067 LAS , TIMES DR LOCALI7Y ❑ Cerufled cap) Is filed with the count) buildimi,tllspection CITY ZIP NEAREST department CROSS -3- Date---- Applicant______________ _ ___ SIZE OF LOT NO OF BLDGS NOW ON LOT Dl:;R C & GR I TYPE .-ESSED BY CONST CERTIFICATE OF EXEMPTION FROM \AORLERS TRACT BLOCK ILOTNc COMPENSATION INSURANCE A �I w NO CIRCLE, STATE M-.JOR SECOND LOCAL (This Section need not be completed if flit Mork in\ol\ed ASSESSOR MAP BOOK PAGE ! PARCEL USE ZONE SPECIAL CONDITIONS b% the permit is for. one hundred dollar, (�,100) or less I cerin: mat In ihL peYforni,IIILL ul IhC "011, 1111 MI IJ1 [111,-kroperty WNER TEL NO -1 permll n Issued I shall not emplo\ an) pcl,on in .I n; manner RILL IRISG H 626-451 96 so as io become ,ub)cet to file 1kork-,rs Comper,ano,-, Lak-s,, sill O(CUPANCY GROUP Date Appilcdnt _ Clrl _LzIP NOTICE TO APPLICANT If ilie1 making ,ni, C,rtJllcate}; F NDUSTRY A 91748 OCCUPANT LOAD of Eaemmion )ou should beLome sLIOI t to the \`.or,.ers APPLICATION FOR Comnensauon pro\"Ion.of the Labo.Code IOL' muss forthnith Ef IT HARDWARE comol_. ,Ilin such pro\Islons or this permit ,hall nL ueem,c rRAILEF USE:—' ,EOLOG\ INSPECTION ' re\o�cc NO _ ling IJ I ' I OCCUP.NC\ INSPEC ION L_ Panic De,IC35 J LICENISED C ON TR AC TORS DEC L�R ATU)� I I hefYh\ affirm tndl I dm licensed under pro\1,uxl, of C h.Ipier sAFET, PERMIT LJ LIST ITEMS BELOW, I 1 9(cornmenLln_' \\,fill SeLtlon 70001 01 Dr\I,fon ,o Ill,' Bu,me,, NO of EXI-S and Proies,lonc Cod: and m) hceo,e f, In lull tort-` ,IIIc etl:Ct I PARKING REC D PROVIDED I I' L-fn,: \unlnel LI: (I,I„ SPACES i J I(oil -::o- _ _ - _ __ D,It` LIMITED TIME USE ! DATE CAT- I ani e\enlpi 11,1111 file Ilcellslll,' r,ULm,.*niL:ni, � I .iin FROM TO Jr.imcc, or .I rJ_I,I t'I:t1 pII11L„I \n,l1, :Il CIIIC,I ---- WSPEC TOR S aCIIIIE In nl\ prOIC„1111101 Lap,icll\ (SeLt]0II 70,1 BI1,Inr„ IZE OF No OF XISTING BLDG STORIES SI GI�ij TUBE and Prof,ssual, C ode I LIc or Re,' No I),Ii. -RESENT USE OF BUILDING FINALAPPROVAL 1-10i11E M NLR-BIIILDLR DEC L %1\1 \I IO1' n0 O E"S7'N BUILD'NCS / ��� CN L07 AND USF ' I herein affirm that I .fill c\enlpi from ole C-0iltrdL1111 , LILen,e Law for the follawlne reason (Section 7031 > Bu,In,s, and Profession, Code) NO PARKING , 1 as Owner of the pmpern \\ill do the \koik and thSPACES PROVIDED L structure 1s not intended or ohefed foi salt: (Section 7(144 PROPOSED USE OF BUILDING 1� Business and Professions Code) WEB -DESIGN -H-0-STIN CONSTRUCTION LENDING AGENC) SERVICE I hereD\ affirm that there Is a construction IendlnL aeenC\ fol the performance of the worl for \\high thf, permit 1, Iuued (Sec 3097 Cil C 1 PROPOSED MAX OCC Lenoer S Ndme _____ _ _ APPLICANT(PHIN7, TEL NO Lenders Address _—_—_-_—_ A7DREss 9 cernf\' that I have read this application and state that theL2067 LAS TUNES DR TEMPLE CITY =ove Information is correct I agree to compl\ with all Counn I---I1 FEE os,,�?,lances and State laws relating to building con,iruction-and e her-,:)- authorize representatives of this County to enter upon I'S SUANCE FEE trl�?a Drve-mentioned property for inspection purpose, . I TOTAL FEE - 15-01 `'EE REVERSL FOR E\PL ANATORI LANGI,A(;E Slgndture of Permineee DjIC WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION .✓'� CE CE 875 875 (17-84) 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. ADRESS UILDING 9067 Las Tunas Dr• LOCALITY Certified copy is filed with the county building inspection OC LITY NEAREST department Temple City CROSS ST Date Applicant REST DISTRICT G OUP TYPE PROLES D BY ly CROSS sT Sultana Ave /) cCINST• CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �(/ COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECONqa.CAL NO. OF BLDGS. NO (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.) LIS E 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 W N E R V.R. De Maio D&W o so as to become subject to the Workers' Compensation Laws tA OCCUPANCY GROUPFE o Date Applicant RESS 9067 Las Tunas Dr Ca 9178 3 287 6044 TELTemple Clt OCCUPANT LOADNOTICE TO APPLICANT: If, after making this Certificate s' 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 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. PARKINGREQ'D = PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date Z e 4 W1119M DATE DATE ❑ I am exempt from the licensing requirements as I am a -Z 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 S NATURE iness and Professions Code) FINAL APPROVAL RESENT USE OF BUILDING office f, Lic.or Reg.No. Date v 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 6 2 2 A 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 # • 0 0 • $$ structure is not intended or offered for sale (SectionS r/� o o e o e o o 2 7044,Business and Professions Code). p a CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING office GN, 0 4,0$I $$ 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 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 o dinances and State laws relating to building construction, A hereby authorize represents ' e f this County to enter TOTAL FEE on the above-menti�pr _ nspection purposes. xwSEE REVERSE FOR EXPLANATORY LANGUAGE Sig ermittee D44 WORKERS'COMPENSATION DECLARATION 'CE 875(2-80) MISCELLANEOUS 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 a certified copy thereof(Sec 3800,Lab C.) Policy No Company :5 oe FOR APPLICANT TO FILL IN ABUILDING �7 DDRESS Ce afied copy Is hereby furnished BUILDING ` O0 � t A� ADDRESS C� r--Tlp LOCALITY Certified copy Is filed with the county building inspection LOCALITY NEAREST department v ,Q� CROSS ST. Date=2 '–Si Applicant#,' — Lo ERRE ST •I�,` DISTRICT NO 6 OUP TYPE PROCESSED BY CROSS ST L�I1'N CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS No �7 (CIRCLE) STATE MAJOR SECOND LOCAL CL O ((This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CON0DITIONS V by the permit is for one hundred dollars ($100) or less.) USE OF �. tr SIZE OF LOTS X O♦ EXISTING BLDG G 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 toOWNER so as to become subject to the Workers' Compensation Laws MAIL ���- OCCUPANCY GROUP W • AD ESS 2V7:1 d Date Applicant N NOTICE TO APPLICANT If, after making this Certificate of CITY k ?A rN $"_J"Z I OCCUPANT LOAD 2— TEL 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. iV0 Spec.•Knowl. ❑ - Panic D@VIC@S ET CONTRACTORS DECLARATION OCCUPANCY INSPECTION I heleby•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 p16— SPACES REQ'D O PROVIDED License Number Lic Class ^� LIMITED TIME USE Contractor e gJ�wS Date r1-2— 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). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No Date \ v 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 f �' F1 1, as owner of the property, will do the work and the SPACES PROVIDED, f8 6 8 A structure is not intended or offered for sale (Section # o o o o 88 7044, Business and Professions Code). PROPOSED USE OF BUILDING ! I ' 0 0 0 0 0 0'0 z CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0 2 0 'J'—8 U 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 upo he e-mention property for Inspect purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature of Permittee Dal e WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Insure, or a certificate of Workers'Compensation Insurance,or , a certified copy thereof(Sec 3800,Lab C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADORES ❑ S Qi Certified copy is hereby furnishedBUILRESSDING Od7—0 4 IST AW TAMP�GPJ` LOCALITY /J OCu ADD -certified copy filed with the•county building inspection NEAREST s department LOCALITY D ',A�, #J7 / /�i C CROSS ST. Date Applicant NEAREST M• IV r(�` DISTRICT NO. GROUP TYPE PRO SSED BY CROSS ST. L5- CERTIFICATE CONST.' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ✓ " COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY NO. F BLDGS STATE MAJOR SECOND NO (CIRCLE) LOCAL }•d O (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 I certifythat in the SIZE OF LOT EXISTING BLDG �'�/ performance of the work for which this cr n - permit is issued, I shall not employ any person in any manner X OWNER 0T �� L�� ��N - Q so as to become subject to the Workers' Compensation Laws n MAIL �I,�f. OCCUPANCY GROUP �J V ADDRESS `' Date Applicant c CL to NOTICE TO APPLICANT If, after making this Certificate of CIT J �' kE.L 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. ❑❑ LICENSED CONTRACTORS DECLARATION occuawrvcY INSPEcr1oN� , 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 REQ'D O PROVIDED O License Number Lic Class • - LIMITED TIME USE _ contractor Date DATE DATE FROM TO F-1 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) 2OFg1W1 / ZE FINAL APPROVAL 9(J PRESENT USE OF BUILDING /7 ��O T Lic.or Reg No. Date ED M S*VAIK rs c� cel NO OF EXISTING BUILDINGS •1 p n A HOME OWNER-BUILDER DECLARATION ON LOT AND USE l (�Y I O I hereby affirm that, I am exempt from the Contractor's /-- ,#,o o o'o 8 8 License Law for the following reason (Section 7031 5, Busi- 1 + r ; ness and Professions Code). NO. PARKING - O•O O O O O O,co SPACES PROVIDED , I Z I, as owner of the property, wI i ill do the work and the I) 2 2 —8 4structure is not Intended or offered for sale (Section 7044, Business and Professions Code): PROPOSED USE OF BUILDING ♦ M V•M��G CONSTRUCTION LENDING AGENCY w/`L�� I hereby- affirm that there is a construction lending agency /( r►(J As 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 $25 . 00 (occupancy inspection) I certify that I have read this application and state that the c above informafion Is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25 . 00 made payable to City of Temple City ,the above-mel{tlo`ed pr erty for inspection p rposeS. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(1 1-84) MISCELLANEOUS APPLICATION I heieby 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 u a certified copy thereof(Sec 3800,Lab.C). Policy No Company FOR APPLICANT TO FILL IN BUILDINGq6A -7 ADDRESS Q Certified copy is hereby furnished. ADDRESS 9067 LAS TUNAS DR. , TEMPLE CITY LOCALITY D Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. _ Date Applicant NEAREST �7� DISTRICT NO. RO TYPE PROCESSED BY CROSS ST. SULTANA NST.' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ( __/Jl COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY NO OF BLDGS. NO. (CIRCLE) STATE MAJOR S D LOCAL ' (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) of 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 OWNER VICTOR R. DEMAIO so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o Date Applicant ADDRESS P.O. BOX 688, ALHAMBRA, CA 91802 TEL OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY ALHAMRRA NO. (818)285-6129 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 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 REp'D � 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 3 GNATURE iness and Professions Code). X PRESENT USE OF BUILDING GENERAL OFFICE USE. FINAL APPROVAL Lic.or Reg.No. Date D� HOME OWNER-BUILDER DECLARATION I` 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 I, as owner of the property, will do the work and the SPACES PROVIDED z 1 0 2 3 A structure is not intended or offered for sale (Section # 0'0 o'0 8 8 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING GENERAL OFFICE USE. 0 0 0 0 e o 02 I a28'=88 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 610,0 11V above information is correct.I agree to comply with all County ISSUANCE FEE ordinances nd St to laws re ting to building construction, and her utho e r p s a es of this County to enter TOTAL. FEE p� o>I t ve-m t• e for inspection purposes. p SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P rmittee Date �j WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS A P P L I CIA T I O N 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 UILD ING ly©`� u �� �+�X'��g LOCALITY I - ADDRESS 7 fi YJ� ❑ Certified copy Is filed with the county building Inspection NEAREST ' department LOCALITY �� j i CA 9117E ceoss ST Date Applicant ` AREST ` DISTRICT NOGR�OUP' TYPE PR OCE SED BY Ll CROSS ST. '� Q CONST ` CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCALNOOF } .N O. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ONBLOT LDS USE ZONE SPECIAL CONDITIONS O' by the.permit is for one hundred dollars.($100) or less.) USE OF i U SIZE OF.LOT EXISTING BLDG. /I "� Cr I certify that in the.performance of the work for which'this v permit Is Issued, I'shall not employ any person,in any manner r e �' so as to become subject to the Workers' Compensation Laws. oa LER `O ~` © , OCCUPANCY GROUP V R ' Y1 1 .rfoo2 , w ADDRESS C67 Lis ( 4. Date Applicant 12/tITE Vj NOTICE-TO APPLICANT If,•after making this Certificate of CITY t No� —�.' ] OCCUPANT LOAD Z '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 USE❑• GEOLOGY INSPECTION , deemed revoked. E] No Spee.:Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION P811Ic Devices ❑ ' ' I hereby affirm that I am licensed under provisions of Chapter' SAFETY PERMIT ❑ (LIST ITEMS BELOW) - a 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 REQ'D PROVIDED License Number Lic Class 'I LIMITED TIME USE CJntractor Date DATE DATE FROM TO TiI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE of NO OF INSPECTOR'S J acting m my professional'capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code) ESFINAL APPROVAL ENT USE OF BUILDING L•tc.or Reg No Date N C) C HOME OWNER-BUILDER DECLARATION AND No. of TING 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 Professlons COdel NO. PARKING _ _ 9,9,4'a;5'A ' SPACES'PROVIDED , ❑ 1, as owner of the property, will do the work and the ;a 0''0 structure is not intended or offered for sale ( 0 88 Section ,' , it I, 7044, Business and Professions'Code) 0 0 0 0 0 0 0 OPOSED USE OF BUILDING , CONSTRUCTION LENDING AGENCY 0`3 0,7'_8'4' 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 v above information is correct I agree to comply with all County ISSUANCE FEE ` ordinances and State laws relating to building,construction, TOTAL FEE 2- Signa hereby authorize re resentatives of this County to enter the above- ent ed property for Inspe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE j Permittee ate WORKERS'COMPENSATION DECLARATION CE 875 M I SC E L LA N.EO U S APPLICATION � CE 875(11-84) I hereby affirm that i have a ceCompte o£ 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.). I , s Policy No Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS ADDRESS Certified copy is hereby furnished. BUILDING O E- . L aS LOCALITY ADDRESS TC 0 Certified copy is filed with the county building inspection LOCALITYNEAREST department TaMPLEF 0 CROSS ST. Date Applicant NEAREST DISTRICT NO. G UP TYPE P ESSED BY CROSS ST. ��� � CONST;/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I 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 I certify that in the performance of the work for which this slzE of LOT EXISTING BLDG. O so as to become subject to the Workers' Compensation Laws. MAIL permit is issued, I shall,not employ any person in any manner OWNER =' OCCUPANCY GROUP �� o ADDRES ~ Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY C7 ;O. 7� OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICA ION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑- deemed revoked. ❑ ❑ No Spec. Know]. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El I hereby affirm that I 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 and effect. SPACES _. PARKING REQ'O ( � PROVIDED License Number Lie. Class L S JJ LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM TO licensed architect ora registered professional engineer SIZE OF NO. OF INSPECTORS 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 �l R _ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ��� ON LOT AND USE rC I hereby affirm that I am exempt from the Contractor's I License Law for the following reason (Section 7031.5, Busi- �( v (ll3l _l�l�l31 c;ji Hess and Professions Code) NO. PARKING I, as owner of the property,p p ,-will do the work and the c 1 AM 9:2? 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 C (� t♦`� for the performance of the work for which this permit is issued(Sec. 3097,Civ C.). O Sq , FT - Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE o DO above information is correct I agree to comply with all County ISSUANCE FEE 'ordinances and State laws relating to building construction, �o 100and hereby authorize representatives of this County to enter TOTAL. FEE upon t above-mentionedpr perty f r inspection purposes. ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION 1 I hereby affirm that I have a certificate•of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION inspire, 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 r>' ADDRESS / ❑ Certified copy is hereby furnished. uILDING — LOCALITY • .DRESStUSCDP ❑ Certified copy Is'filed with the county building Inspection NEAREST department LOCALITY CROSS ST Date - Applicant NEAREST - DISTRICT NO7.I GRO TYPE PROCESSED BY CROSS ST. j-�• �•� i CONST CERTIFICATE OF'EXEMPTION•FROM WORKERS' LEGAL J (J DESCRIPTION LOT NO BLOCK NOP HIGHWAY STATE MAJOR SECOND LOCAL a COMPENSATION INSURANCE +�f��j NO. OF BLD65. V'v (CIRCLE) (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.) V" USE OFL _ i' SIZE OF LOT EXISTING BLDG. - tr I certify that in the performance of the work for which thisL0' permit is Issued, I shall not employ any person in any manner OWNER F 6 bV 1 Id IU so as to become subject to the Workers' Compensation Laws MAIL M b� ` 1 OCCUPANCY GROUP LL DDRESS �. CA- U)Date Applicant TEL. Z NOTICE TO APPLICANT. If, after making this Certificate of CITY NO. OCCUPANT LOAD Exemption, 'you should become subject to the WorkersAPPLICATION 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. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices ❑ I•hereby affirm that Lam licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS - 19 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and ` effect PARKING _ REO'D SPACES D PROVIDED_ License Number Lic Class + LIMITED TIME USE Contractor Date i DATE OATS . ❑ f ' FROM' TOT- _- 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- XISTING BLDG. STORIES SIGNATURE iness and Professions Code). RESENT USE OF BUILDING' r FINAL APPROVAL 2—A ' - Lic or Reg.No Date t 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 F1 - SPACES PROVIDED I, as owner of the property,'will do the work and'the # D °1040 structure Is not intended or 'offered for sale (Section 41 7044, Business and Professions Code). 0 0 0 0 0 0 0.� PROPOSED USE'OF BUILDING � � _ CONSTRUCTION LENDING AGENCY a ('; 0 2 0 3'-8 1 I hereby affirm that there is a construction lending agency IF 1 �0 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 ordmanc and State laws relating to building construction, and a authorize ep tative 'of this County to enter TOTAL FEE pon a bove-mento opert for inspection purposes. SEE REVERSE OR EXPLANATORY LANGUAGE -PIP go, Signature of Permittee Date 1 - c! WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U'S APPLICATION CE 875 I hereby affirm that I have a certificate of consent 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 BAUILDING DDRESS (O Certified copy is hereby furnished ILD ING � L -Tv/-1A,_5 �lLi LOCALITY ADDRESS FICertified copy is filed with the county building inspection cALITY NEAREST department. —�'h�( C� CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUPTYPE P CESSED BY o CROSS ST. •'D / L CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO OF LDG (This section need not be completed if the work involved TRACT NOWv ON LOT S 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. CD permit is issued, I shall not employ any person in any mannerWNER «0� �� 1 =' so as to become subject to the Workers' Compensation Laws. A, T'l A/-�1w�� OCCUPANCY GROUP �a ce MAIL �' 1 `�V_• Or Date ADDRESSq' -Wo Applicant � L�L1 NOTICE TO APPLICANT: If, after making this Certificate ofclr�'�_,�/��(,� C ( N . Z —_]O-7 9 OCCUPANT LOAD Cl- Exemption, you should become subject the WorkersAPPLICATION 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 01, 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 D PROVIDED SPACES License Number Lic Class �� S A141I LIMITED TIME USE • Contractor Date D ATE DATE I am exempt from the licensing requirements as I am a FROM TO M SIGN E licensed architect or a registered professional engineer SIZE OF NO. OF 8326CSPE CT E acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES 't lir] e mess and Professions Code). • • 1 j LIC or Reg No. Date PRESENT USE OF BUILDING _ICE S � FINAL APPROVAL O / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS I 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)• 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 R.POSED USE OF BUILDING ) hereby affirm that there is a construction lending agency L,&T Q �- c s p/ArC—� 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 ov above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State ws relating to building construction, B b and h e authorize a 'relating of this County to enter TOTAL FEE , upon h ove e ti n roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �L�s1ZL Signature of Permittee Date WO$KERS'COMPENSATION DECLARATION 76M444 M I SC I,.A N E O U S APPLICATION I refiaffirm that I 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. CompanyFOR APPLICANT TO FILL IN ADDRESS `, �,,t 0 Certified copy is hereby furnished. UILDING / ADDRESS U LOCALITY El Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant ,.' NEAREST DISTRI T NQ. JeUP TYPE CESSED BY .1 CROSS ST. D (/� CONS' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO. 0F BLD(This section need not be completed if the work involved TRACT NOW ON LOT S 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 O permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS Ea� F--- Date Applicant e� uLLi I- TE NOTICE TO APPLICANT• If, after making this Certificate of CITY �Dbs" /,c N0� 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. 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 and effect. 7TH PARK 1 N G SPACES REq'D D PROVIDED License Number Lic. Class Gveeo 0 Lewl, CeX le 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 SIG TORE mess and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date FE HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS /`� ON LOT AND USE c'I 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 6y7 t i i1 MI' ❑ 1, as owner of the property, will do the work and the SPACES PROVIDED i(� structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING e I 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 O'er 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 upbn the above-merktioned property for inspection-purposes. ✓- SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date WORKERS'COMPENSATION DECLARATION 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 a certified copy thereof(Sec. 3800,Lab.C.). � Policy No Company FOR APPLICANT TO FILL IN BUILDING AD DR E83 Certified copy is hereby furnished. XX wooRess �O S �(/ a LPCALIT Certified copy is filed with the county building inspection LOCALITY NEAREST department. 3M '� / CROSS ST Date Applicant NEAREST DISTRI$,SiNO OUP TYPE 1��SED BY CR08S ST. CONST, CERTWICATE OF EXEMPTION FROM WORKERS' LEGAL ` /(/� COMPENSATION INSURANCE DESCRIPTION TLOT NO. BLOCK MAP HIG..AY NO. ICIRCLC) STATE MAJOR SECOND LOCAL NO. OF BLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONfi SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USESIZE OF LOT IffXIS TING BLDG.OF �� Or 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manneikX OWNER of building &– so as to become subject to the Workers' Compensation Laws. qT Ar Pr .DDR SS 7 / ? -I OCCUPANCY GROUPMAIL Date Applicant 4, L. NOTICE TO APPLICANT If, after making this Certificate of CITY e (q" NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' IAPPL 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 I ICENSLD CON I RAC'I ORS 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 r� effect. Name Of business PARKING SPA a:CB REO`D I I PROVIDED llJJ License Number _—_— Lic. Class Mee&140ty rZaCTY UAf LIMITED TIME USE Contractor Date r DATE DATE 1, am exempt from the licensing requirements as 1 am a icensed architect or a registered professional engineer SIZE OF NO. OF FROM: TO INSPECTOR ` acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES sI Tu E iness and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL F7 /, Lic.or Reg No _ Date _/({ HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS n ON LOT AND USC hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness ustnese and Professions Code): NO. PARKING r�r t j P", y �' 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 USC OF BUILDING hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.CA. Lender's Name PROPOSED MAX. OCC. Lender's Address _ certify that I have read this application and state that the PERMIT FEE 25.00 above information is correct.I agree to comply with all County ISSUANCE FEE ' ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter .TOTAL FEE 25-00 upon the above-me`tioned operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX 11'ORKLRS•CONIPENSATIONDCCLARATION 76M444 MISCELLANEOUS APPLICATION t� 1 uraffirm that I have a certificate of consent to self CE 875 (11 84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure. e, o or a-certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No —Company FOR APPLICANT TO FILL IN BUILDING DORESS ❑ ADDwE9s Cv Certified copy is hereby furnished. euILD(NGS U , F� D� { XXAD DRElS \ 0 LOCALITY Certified copy Is tiled with the county building inspection LOCALITY ,�(�/.'1 NEAREST department xy. TV- GI Ch ql 1 p V CROSS ST Date_ __Apph(ant NEAREST /�� DISTRICT NO GRgyP TYPE / P :SEED BY CROSS ST SUL_ 1'1tV 'O� �( CONST 1 / G ( CR 1 II IC VIE OF EXEMPTION FROM WORKERS' LEGAL /y f� C7 C'OMPENS.XTION INSURANCE DESCRIPTION LOT NO BLOCK MwP wNw.Y `�O, lCiw CLL) NO OF BLDGS STATE MAJOR SECOND LOCAL (This tiectlon need not he Lompleted if the work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit Is for One hundred dollars (S100) or less.) USEOF I ^•rtfv that In the perfornlallLe Of the work for wnlch this SIZE OF LOT EXISTING BLDG pernnt IS Issued, I shill not employ any person In any manne3CX OWNER of building DATLFaN- ao is III betonic uhic(t nl the Workers' Compensation I.aws MAIL OCCUPANCY GROUP � ADDRESS Dale ------ -\PPIILant j L NOTICL 1-0 -\PPLI( ANT If, after making this Certificate of CITY NOL OCCUPANT LOAD 1 eniption, you should be(onle subject to the Workers' APPLICATION FOR EXIT HARDWARE (onipensation provisions Ot the Labor Code, ,you must forth- %%uh compty %tith iudi pro%islons or this permit shall be TRAILER USE GEOLOGY INSPECTION No Spec Knowl deenied rc%ok,�d I I( I-NSI D(ON I R,1( IORS DELL\RATION OCCUPANCY INSPECTION C] Panic Devices I hcr(•h1 affirm that I aril hLensed under provisions of Chip ter SAFETY PERMIT (LIST ITEMS BELOW) a (Conrinenung with Section 7000) of Division 3 of the Bust- NO OF EXITS ness and Protessione Code and m} license Is tit full force an Y � i•tIL•�( Name of businessPARKING REOD PROVIDED I� C,� SPwCES I� IL (lass �/LiL I -- - LIMITED TIME USE Date_ D.T. DA re FROM TO t 1111 e-,enlpt iron the IILensine requirements as I am a h(ensed archlteLt or a registered professional engineer SIZE OF No of NSPficroR s aLtlne In I11V professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE InessandProfessions(ode) Date FINAL APPROVAL LIL or Ree No _ _ _ —__—___ PRESENT USE ar BUILDING p 110U1 OWNCR-RI'ILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE O^� - I herchy affirm that I .un exempt from the Contractor's i I ILense I .Iw for the tolltming rcison (Se(tion 7031 5, Bust- ness and Professions(-ode, No. PARKING SPACES PROVIDED 17 1, 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) (ONSI IZLI( ZION 1 ENDING AGENCY PROPOSED USt OF BUILDING I hereby affirm that there Is a construction lending agency for the perfonuanLe of the work for which this permit is Issued (See 3097,Civ C) 1 ender's Name_—__--_ • PROFOSFD MAX OCC. I ender s Address Lertlfy that 1 hast read this appll(.111U❑ and SlalC 11111 the PERMIT FEE 25 . 00 , r above Information h LorreLt I agree to comply with all County ISSUANCE FEE ordinances and State lass relating to budding construction, and hereby a ize epresentattves oC this County to enter TOTAL FEE 25. 00 upon t ah v - ent ned property f r Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE M ISCELLANEGUIS ter LIC ATHUN I hereby affLrrn that ! have , :,-.titicate of conscrit ,f, st-J, 'T"tGi- LOS ANGE'SLS ' BU1LDfNG ,kND SAFETY DIVISION tnsi2ae.-or I certffiLate of Workers'Compensiiion Insurance 03 UN :i cc,-.if.ed copy thereof(Sec �80J. Lab C ?311cy No ---Company ;MOR -PPL iC�,,IT C F1,-L N ❑ Ce-tffit�d cop� s hereby f,.riushea X-K t7ZZe5-;7 ZX 1� Z�- Certified copy is filed«i-di the counri builldiniz msplcllc 11 i L 0 C A T Y NEAREST department XX I Date—Avplic,,int NMA RL �T-PE SSED BY -; CrCSS I CONST CT-RTIFiCATE OF EXEMr-TION -R1--\l-\VORKER`,' COMPENSATIoN INS��PA-NCI: SCRIPT L.T SLOC, HIG HWAY ! STATE MAJOR SECOND LOCAL ,10 OF _-1-0G5I (This section need not be com-pietea if rhe wor-k invoitied IPACT NOW 0- :-3T SE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ISM) or less.) LSa �F I certify that in the performance of the \ork Jor WtIlLh 01-IS S.Z E OG c11 r EXIS ING OLDG permit is issued. I shallI iot Ernplov ariv person in any manne-,,xowNEa of b u i 1 d i n so as to become Subject to 'Llic Workers' Compensation LaN\s r,� ANCY GROUP MAI��—��� ESSr-1 � 5 7— Date— Applicant OCCUPANT LOAD NOTICE TO APPLICANT If, after makin2 tris Cer-,""I"ate , 0 1 E\emption. you should bco-IiE subject to the Work-e-s i Cornpen,�ition provisions cf the Labor Code you must -D-T:I- APPLiCa-,;O[\J FOR E,XIT HARDWARE with comply k1lith Nucli rr�, !'ions or this permit ue deemed revoked.ked No Spec KnoM Panic Dev,ces LiCI-N Si:1)COI\,71).-,CIORS DECLARATION 1 herchy -7,ri,i -nLl, i am `i-,2nned under nrm,:sioiis SAFETY FE111IT r7 I1-'Sr iTEM. 5E,Ov) 9 (c,)Iimem-na vvit;i Secz.-nn -,(:00) )C Division 3 "1 Cle -30Ir NO OF EXITS ness and Professions Coce nr-, license is ol III'] at 1Xxlliame of business -ARKNG I effect R E O'D I P R 0 V,L E7 !AC'-A�e \LIrV;er T PPE USE ContraCTOr---- Dai,� —TE am e\erript rrori, tt,.e licTi-mig equjcnwri, as l ani IlLenSeQ ar(-nitecr or a ie,,isiered tlroi-.?;�,oiial enKme,- SIZE 0- 1 Ii,-0F1NSPFCT'�R 9 iii TX STING SLDI S SIGNATURE actin, in m, L.01' 104! ines�and ilrolessions Code) L !C ;NAL 4P�V, O�v A- USE: 0- SUILJ�NG Lic Or Ret NO HOME O\1NER-BIIILDEP DECLARA110\ ON 0r4 LOP E'<ISTINC- EiUILDINGS LOT AND L,S E I lierew, affirm that I ani- e,.tnupt from f,e _Optrl -,.I License Law lot the foflov.uiL reason iSe,-tion 7031 :, -Bus- ness and Professions Code) NO PARKING J SPACES PROVIDED 1, as o\t net of tl,,e 1p,operz% ,ill do :he work Tne III, r 17 structure is not m.endea of offereci lar sale 7044, Business and P,otessions Code) I CONSTRUCTION LfNDI\. G -\GE�`!C� PROPOSED USE OF BUILDING I hereb,, atfirm that there Is � consLrUt,tj0j,. 1-ejjdjIjI:: aLelj(.. :or the perfornidrite of the \-)it: ffor this t—ina issuedISec 3097 Ci% C) Lender s Name PROPOSED MAx OCC Lender's Address I certif-, that I hese read iliaapplication and state :1,LI1 th- �ERMIT FEE 25 - 00 above information is correct I agree to comok %%ith all Coun, I ISSUANCE FEE oidinances and State la\\s rcla�-iing to building conSLruction, z 25 - 00 and hereby authorize representatives of 0in Count, to ent,-i TOTAL FEE upon the a bov, mentioned piope-t-% for or inspection purposes SEE REVERSE FOR EXPLANIATORN L-kNGUAGE xx L�� xx STf5a'—ture of Permittee Date' \\'ORfa`.RS'('ODIPT:NSA'IION DECLARATION CE 875(11-841 MISCELLANEOUS APPLICATION l CE 875 C_ I h; affirm that I have a certificate of consent self U ' insure. , o or a certificate of Workers'Compensation Insurance, COUNTY OF LOS ANCE-1-4.5 BUILDING AND SAFETY DIVISIONe,or .. � a certified ropy thereof(Sec. 3800, Lab.C.). Policy No. _"._.__ _--('ompany_— FOR APPLICANT TO FILL IN BUILDING / ADDRESS �o Certified ropy is hereby furnished. XX BUILDING ADDRESS vlo L,,fT, 4 / -, _r 2r LOCALITY G� , ElCertified copy is filed with the county building inspection LOCALITY NEAREST department. M.3 E h' i CROSS ST. Applicant.—___—____ NEAREST / �J DISTRICT NO. GRO P TYPE CESSED BY CROSS ST. Y[J J� ri f/� �y CONST.- ChRTII ICATE OF EXEMPTION FROM WORKERS' LEGAL I CON1Pf:NSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HlcRwwY No. (clR CLe) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (rhis 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. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any marine" OWNS of buildin /lei/S� so as to become subject to the Workers' Compensation Laws. MAIL C-y' OCCUPANCY GROUP -i ADDRESS ,/vv /Vr�,- Date_-----___-- Applicant --- — LJ f TEL' Z j/3 OCCUPANT LOAD NOTICE F0 APPLICANT: If, after making this Certificate of CITU N . J v, Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- ❑ with comply with stich provisions lir this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. ❑ 1,1('I{NSL:D CON'l RACI ORS 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�X effect. Name of business PARKING REO•D 1 PROVIDED LL.�� License Number —___.____ Lic. Class �L�s �'y /�ff�Gi� SPACES ll��f LIMITED TIME USE Contractor. -_ __________.-_ ____ Dale ___ DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer 813E OF NO. OFSP ATURE CTOR S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES / SI iness and Professions Code). O Fr/C s<.S FINAL APPROVAL In PRESENT USE OF BUILDING . Lic.or Reg. Date_ — (/ IIOMf: OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 1 �� ��r ON LOT AND USE 1 hereby affirm that I and exempt from the Contractor's trt(Ij3,_ttit { License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions COLIC): NO. PARKING __ i ::I•. „ SPACES PROVIDED F1 I, ;Is 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._ 1 certify that I have read this application and state that the PERMIT FEE 25- 00 above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives this County to enter TOTAL, FEE 25-00 • upon Ile abov -nie t' red proper r i pection purposes. XX _ _ — X � SEE REVERSE FOR EXPLANATORY LANGUAGE - - i�•I,II11,• „rP:•I ,itl,•• f .Ifc G J^— ( i WORKERS' COMPENSATION DECLARATION 6M444 20-006DPW 12/90 MISCELLANEOUS APPLICATION 2 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 (� I a certified copy thereof (Sec 3800, Lab.C) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ' BU IN DR S ADDRESS El Certified copy is hereby furnished. J� LOCALITY ❑ Certified copy is filed with the county building Inspection CI t departmentel—C- - 7 ZIP 9(� O NEAREST i ( CROSS ST. Date Applicant SIZE OF LOT NO.OF BLOGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CONST O CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT ` O� BLOCK LOT NO. MAP HIGHWAY V I 1 COMPENSATION INSURANCE -1 No (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL usE zoNE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) 0 s I certify that in the performance of the work for which this j'Ver� er TEL NO. permit is issued. I shall not employ any person in any manner Al ILL let 51;E G(b :Z2i-A c6xh)5111-14 A ORE55 [L so as to become subject to the Workers' Compensation Laws a" OCCUPANCY GROUP 0) ( Date Applicant CITY ZIP NOTICE TO APPLICANT If. after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code,you must forthwith EXIT HARDWARE comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ � revoked. OCCUPANCY INSPECTION[J Panic Devices E-1LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) t 1 9(commencing with Section 7000)of Division 3 of the Business NO OF EXITS and Professions Code,and my license Is in full force and effect ame ot Bustness PARKING• REO'D D PROVIDED D i License Number Ltc.Class ! SPACES t I I Contractor Date U( LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE FROM To licensed architect or a registered professional engineer acting in my professional capacity(Section 7051, Business SIZE OF t NO OF INSPECTOR'S 't and Professions Code). EXISTING BLDG STORIES SIGNATU E. PRESENT USE OF BUILDING �/ O�•L Ltc. or Reg No Date FINAL APPROVAL 'Z HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and { Professions Code): NO PARKING El has owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044,1 PROPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY Ce I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued ( 1 (.Sec 3097, CIV C). PROPOSED MAX OCC Lender's Name APPLICANT(PRINT TEL NO 00 Lender's Address A R s �c _� I certify that I have read this application and state that the °b L hS 7- " &5 DP— . 7"'-I C-C ( above Information is correct I agree to comply with all County I ordinances and State laws relating to building construction,and PERMIT FEE � — g r 7ko hereby authorize representatives of this County to enter upon ISSUANCE FEE jv I the above-mentioned property for inspection purposes. i S" �I TOTAL FEE a, I _ SEE REVERSE FOR EXPLANATORY LANGUAGE r Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 hereby^affirm that i have a certificate o£ consent tself 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 FlCertified copy is hereby furnished. wooeess LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY n NEAREST department. CROSS ST Date Applicant NEAREST DISTRICT NO. 14.., TYPE / P ESSED BY CROSS ST UL ��� '—�I CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL yy� COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO RO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOF BLDGS.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 slzE of LOT EXISTING BLDG. 0 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 ADDRES Date Applicant MAIL ^7�/lI C3 NOTICE TO APPLICANT• If, after making this Certificate of CIT NOL. 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. 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 REgD PROVIDED License Number Lic. Class / l n 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 engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE mess and Professions Code). FINAL APPROVAL YE`z PRESENT USE OF BUILDING Lic.or Reg.No. Date Aja HOME OWNER-BUILDER DECLARATION No. of EXISTING BUILDINGS FE 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- /o IC I—I f�I"D' I LIQ ness and Professions Code): NO.PARKING _,=?c 4 F] 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 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. qr /� 13 SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturekbf Permittee Date I %VORI:LRS COMPENSATION DCCL\R.\TION' 76M444 MISCELLANEOUS APPLICATION ' I I hereby affirm that ! have a certificate of consent to self CE 875 11 1 Bal COUNTY OF COS 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 Bu"­-V- s. 7 Certified copy is hereby furnished S BUILDING cl06••7 I ��� ,{�2- a ADDRESS lJ0 I La,O Y { Z ( LOCALITY 1 0 Certified copy is tiled with the county building inspection X LOCALITY NEARESTI(j department. CROSS ST 9 v Date -kpplicant NEAREST t� �IAJ n` �fL �/� DISTRICT NO GROUP TYPfi PROCESSED BY CROSS ST IJ�K ✓U �G(.Irry /IV CONST t CERTiFIC ATE OF EXEMPTION FROM 110RI:ERS' LEGAL COMPENSATION INSUR kNCE DESCRIPTION LOT NO BLOCK MwP aIc wwr NO NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not he completed If the work involved TRACT NO ON SLOGS ON LOT USE :ONE SPECIAL CONDITIONS by the permit Is for one hundred doll its IS I()()) or less ) USE OF ' [ :ertify that in •he oer:urmance of ane •%nrti :or '%filch 'his SIZE OF LOT EXISTING BLDG permit is Issued. I ,hall not employ ani person :n inv, manner X OWNER T ` so as to become �uhlecr •o the 'N rkers omeensanon La%%s g Q f�Z � Q�( OCCL'PaNCY GROUP I � RAIL l l7 J IBJ AD OR ESS � Datc B aonc�ant X /1, NOTiC TO -\PPLIC ANT If, uter making :his .:ertLncaie of CIT- �, moo- OCCUP4IVT LOAD E%emption, you Jhoulc become subject -o the Workers appLlC>TION FOR E,(IT HARCWARE Comcensation Dro%isions of the Laoor Coae 'ou must torth %still comnk, 'titl, c.•i o-misiuns r ris emw ,nall he -R AIL.R JSE GEOLOGY GY INSPEC"ON — Ito Spec Knowl 1 deemed re%nke:l OCC'JPA.VC INSPECTION B Panic Devices I f LICENSED( ONTR.aCTORS DLCL kR kr101 T 1 I Inerebv at`um that I im licensed under provisions of LliaDiCr SAFETY PERMIT J (LIST ITEMS 9E LO%V) 9 (commencine %%ith Section 7000) of Di%nsion 3 or the Bust- NO OF EXITS ness and Prnfessions Code, and m% license :s in 'till •orce and e! CLt PARKING REOD PROVIDED I n SPACES LL .. License Number — L:L Class LIMITED TIME USE n 1_J nrraLtor Da[a DATE DA rE n I rill e`erupt roti 11C Illetls1nL1 :euuire:nent� :% i al:i a hLensed archltel[ or i :e2isterid -im•:sston.11 31ZE ofi'>05 t vD OF '_ INSPECTOR s- ? actinin "1% Droie,lional �aoal:[ �zL:ICI1 'I_ l BLIG- ZXIS' NG St LOG I?,c) - '>OS F+ OF I IGNATURE mess and P-otessions Code) -RESFINAL APPROVAL E'IT 'JSC OF 3UILDING 1t!(,/v Lnc or Rc- No -- ---- Da,c _— --- IUU Ft HO\IE O)�N'LR-BLILDER DECL NR \1710`. NO OF EXISTING BUILDINGS !! . I lI-1-00011 ON LOT AND > 1 1 'lig USE f(77 [ hereby attum that t un z%empt rim :he Contraltor 1 LILense La%% for :lie clio,%iiry -eason 'Se,:ion -031 : Busi- ness and Protessions Codei NO PARKING SPACES 'ROVIDED El 1, as a%%ner of :he omperty till do 'he %ori. Ind he structure is not Intended or offered 'or .tie Se,:-,rot I I -044 Business ind Protessionst-)del C ONSTRL CTIO\ LLNDING uJLNC i X PROPOSED USE OF BUILDING I hereb% affirm that :here is a construction lendms agency 1 for the performance of the work for %%1111_11 this pernut ns issued I Sec 309- CI% C I Lender's Name PROPOSED MAX OCC Lender s address 25.00 I [ certify ilia[ l Ita%e read this application and stale rho[ the PERMIT F« abo%e information 1s correct I agree to Lomph %%till 311 C OUntV ISSUANCE FEE . _ ordinances and State lav s relating to buildme construction. and h rehv authorize representatives of this County to enter TOTAL FEE 25.00 t upon he abo e Znentione proven) Ior mspeLtion purposes I X g SEE RE,ERSE FOR EXPLANATORY LANGUAGE WORK LRS (OMPLNSAIION DL( L,%RvIION ;, ; , MISCELLA-NEONS APPLICATION 1r;. I hereby A111`111 that I have d CCIIIIILAIC oI Lon,enl III NLll COVIN'Il' Of IOS AN ,l=l FS, BUILDING AND SAFETY DIVISION I Insure of a LCltillcatC of WoII�CIs (onlpulSatinn IIINIII•IIILC 01 II .I Lertllled Lop) IIICIM (See 1800 I db ( ) Policy No _ (ompally FOR APPLICAN I TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified LOP) IS hereby Iul nlshe(I Qb17 LAS AS D� LOCALITY 1 ❑ (ertil led cop) is I Iled With the LOLIIIt\ building 1n,,prLuun CITY' ZIP department 1e C_ tp I NEAREST CROSS ST Date 'Xpplicaill SIZE OF COT NO OF BLDGS NOW ON LOTTYPE PROCESSED BY DISTRICT NO GROUP CONST ( LRIII K All- OF I.XLMPIION I ROM \4ORK1 R'' TRACT BLOCK LOT NO COMI'LNSAIION INSURAN( l MAF MIOHWAY 1. -` 140 ICIRCLEI STATE MAJOR SECOND LOCAL (This Section need not be completed It the Nolte in%ol\ed ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS I " by the permit is for one hundred doll.ns IS100) of less.) — ( , Leiuly lh,1i ul the Perlolm,uuC nt thL \\o1I. IuI \00i ih1N OWNER TEL NO perms IS Issued. I shall not enlplm ,in) pennn UI •In) m,Innel — I kIld-t-cl t -tib so as to become SLlbjeLl to the Wo11.eis (onlpemation t,iws ADDRESS OCCUPANCY GROUP Date ApphOdnl CITY ztP NOTICE TO APPI I(ANT II ,Incl nlal.Ulg Ihls ( eitil FLate OCCUPANT LOAD of Lxemption you should bCL11111C SuhICLI to the WOIkCIS' APPLICATION FOR Compensation pro\lsionsol the Laboi Code you mtist butlmllll EXIT HARDWARE COnIPI) With SLICII pro\isions or this peinlll shill be d(Cilled TRAILER USE GEOLOGY iNSPEClION I-1 No Spec Knowl ❑ 1 revoked �'I LICLNSLD CONTRA( 1ORS IN ( I AR \[[ON OCCUPANCYINSPECTION�� Panic Devices ❑ I hereby affirm that I ,Illi hLensed Lmdei piovisionN 111 ( ll,iplel SAFETY PERMIT❑ ILIST ITEMS BELOW, � 9(commencing with Sect ion 7000)of Dl\Islon 3 of I 1 Business No of Exlrs El i I and Proles-sions Code and m) IiceIISC is ul lull IoILL .,nd elICLI r PARKING. REO•D D LILense Nunlbel t IL ( LISS SPACES PROVIDE - I I I Contlactol D,IIr - -- -- — ----- ------ --- - -- ------ LIMITED TIME USE DATE DATE ❑ I ant exempt from the licensing re Ll Lincnicnis ds I dill a FROM 1 TO licensed architect or .I registered piolession.11 engineer acting in Ill) piotessional capaut) Itilltion 70SI linslllLss SIZE OF NO OF INSPECTOR S �1 I E%ISrINGBLOC ,— STORIES SIGNATURE and Piolcsstons (ode) LIC 011 Reg No 0,110 PRESENT N7 USE OF BUILDING FIN L PROM `� al 7 L 0I IION11. OWNI R-131111 DI R IN ( I AR MON 'Al) OF I%ISI=.,BUILDINGS 1)N l_O, AND 1Jt C hereby dllnin that 1 .1111 C\CIIII71 110111 the( 01111,1(101 + I I(LIINC ----------- ---------- - -- b Law RIF the 1011OWing IedSon ISLLuI)n 1031 i 1111N10eN, ,u1d _ -- Professions (ode) NO PARKING SPACES PROVIDED El IaS ownci of the plopCll\ \\111 Iti, 11r \\x,11, and III. — - --- - -- ------ --- Sti uUu1C IN not Intended oI UI IL1G1 Iol N,dL l tiL L I nI /I I I PROFUSED USE OF Him DING 13usiness and Plolessions (odes - - ---- e WA, ik e. s w CA- CONSTRU(TION I LNDIN(I •x(11 N( 1 /, herch) dlllrnl that II1CIC Is a L01IS 000011 ILlldlllg ,1"CII(\ I,,I JN2�� �r Wpb hes .+-� OLGST'� - tlle PellonnanLe of the \\oil. IDI \01101 this IICIn1It IN 1sSUCd Y— u`----V— (See 3097, (I\, C ) U Y PROPOSED MAX OCC �t t 1 Lender's Name _ _ -_ X gPPL CANT IPHP,TI � TEL NO Lenders Address ADDRESS I certily that I have read tluS .IPPIILation and SI,IIC 111,11 the 0 e e_ above information Is corrCLI I agree to LOmPI)'\\1111 d11(Ount) PERMIT FEE ordinances and State laws relating to building constrULtinn and hereby authorise Iepresentatl\es of this Count) to Cnlu upon ISSUANCE FEE the abov -mentioned property for inSpeulon PulpoSLN TOTAL FEE X SLI RI-y'LRSL 1-OR LXPLANATORY LANGUA(jL i SI Ire ul PrnnulCC Dale L 1