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HomeMy Public PortalAbout9093 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION'DECL.ARATION \ ,�� pp7" ISCELLANES APP LICpp TQ®NE87 (2-80) "fl 1 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. u1LDlry Q/f / �y �j A DR ES S%� �, LOCALITY Certified copy•Is filed with the county building inspection .�7 / dNEAREST 0— department LOCALITY /(,77& G1�/ G� /nd CROSS ST Date Applicant NEAREST �� r- DISTRI NO GROUP TYPE PR ESSED BY CROSS ST ^� CONST` CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /T!/ — COMPENSATION INSURANCE -DESCRIPTION LOT NO BLOCK MAP HIGHWAY No (CIRCLE) STATE MAJOR SECOND LOCAL(This section need not be completed if the work involved NO. OF LOT USE ZONE SPECIAL CONDITIONS 0 l p TRACT NOW ON LOT by the permit' is for one hundred dollars ($100) or less.) ' (> USE OF S E OF LOT EXISTING BLDG. I certify that in the,performance of the work for which this permit is issued, I shall not employ any person in any manner A1KNERr so as to become subject to the Workers' Compensation Laws MAIL ,I Q OCCUPANCY GROUP IL ESS�2- / !�A/� �T � CIL Date Applicant laA R,P.fiyL. z NOTICE TO APPLICANT If, after making this Certificate of ry TEL. 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 deemed revoked ❑ . Cl No Spec. Knowl. LICENSED CONTRACTORS DECLARATION occuawrvcY INSPECTION ElPanic 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 Busl- ne&s and Professions Code, and my license is in full force and PARKING. effect SPACES REQ'D D PROVIDED D License Number Lie Class LIMITED TIME USE Contractor Date- DATE DATE FROM TO I am exempt from the licensing requirements as I am a, licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING / tf Q f+_ FINAL APPROVAL Lie,or Reg.No Date P6-07 ^fORIT NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that I am exempt from the Contractor's -3.3,0 A License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO PARKING i O G O O I, as owner of the property, will do the work and the SPACES PROVIDED ' 88 structureis not intended or offered for sale (Section o 0 0 ,0 a o D z 7044, Business and Professions Code) ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE d hereby authorize represen Ives of this County to enter on the above"_ ed p erty for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of rmi tee Date WORKERS'COMPENSATION DECLARATION CE 876(2-80) �� �� I t! ®�.J 6. �° i d ®1 I sure, o affirm that I have a certificate of consent nc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or , a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnishedUILDINs LOCALITY D ❑ Certified copy is filed with the county building inspection rvewREsr department Lo ALITY /J r / ASV J CROSS ST Date Applicant 'NEAREST ( DISTRICT NO G OUP• TYPE 11R.. D BY CROSS ST /7� /, CONST- CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �( COMPENSATION INSURANCE DESCRIPTION Lor NO BLOCK MAP HIGHWAY AL L' NO NOON LOT (CIRCLE) STATE MAJOR SECOND LO AL P TRACT a This section need not be completed if the work involved NO W OF BLDGS USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) USE•OF SIZE OF LOT EXISTING BLDG. - cc I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner oerINER so as to become subject to the Workers' Compensation LawsIL OCCUPANCY GROUP U ADDRESS• A /- _.,Vj, " I V7 Date Applicant TEL ,/y Z .' DF. �V NOTICE TO APPLICANT If, after making this Certificate of ITYr rvo J 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 deemed revoked ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ; Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (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 _ PARKING effect SPACES REQ'D � PROVIDED D License Number Lie.Class LIMITED TIME USE Contractor Date DATE DATE a • I am exempt from the licensing requirements as I am a FROM TO f licensed architect or a registered professional engineer SIZE OF NO of INSP CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES ( ATURE iness and Professions Code). FINAL APPROVAL - NT USE OF BUILDING &w d-49 Lie or Reg.No Date � � _ HOME OWNER-BUILDER DECLARATION No O EXISTING BUILDINGS ON LOT AND USE , qb8 �ee 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 lSPACES PROVIDED E] 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). OPOSED USE OF'BUILDING CONSTRUCTION LENDING AGENCY h�vd R (�L 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 ordinances a d S a correct I agree to t comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and he y authorize re rese tives of this County to enter I upon abq�ve-menti ed, r erty for inspect purposes SEE REVERSE FOR EXPLANATORY LANGUAGE / r L4 a c of Permittee Date WOR:fERS'COMPENSATION DECLARATION MISCELLANEOUS A P P L I C A/�T 9®N CE 875 (1 1-84)875 '.y CE 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 ADDRESS Certified copy is hereby furnished. BUILDING O 3PAL hR LOCALITY `C , ADDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department cRoss sr Date Applicant NEAREST ��� DI RICCCT 6 UP TYPE PROC E BY CROSS ST // CONS y,/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` (// COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SE CO D LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER ,S,,, - so as to become subject to the Workers' Compensation Laws. MAIL �W g ����� ; , OCCUPANCY GROUP:'- a C` v Date Applicant ADDRESS - x � NOTICE TO APPLICANT If, after making this Certificate of CITY P •� k ryol. 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 El No Spec. KnowL deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. �O T�—� 2t3 /tel PARKING SPACES REQ'D PROVIDED O License Number Lic. Class pI�F s S LIMITED TIME USE Contractor Date S• O DATE DATE PROM' TO I am exempt from the licensing requirements as I am a V� T licensed architect or a registered professional engineerSIZE of No OF INSP TOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). 1_j C, LIC or Reg.No. Date PRESENT USE OF BUILDING � 1�� S�OI?i�� FINAL APPROVAL 0 HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's $ t8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code). NO. PARKING ElI, as owner of the property, will do the work and the SPACES PROVIDED O 9.2 0—,8 8 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 PERMIT FEE i 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, anhereby authorize representatives of this County to enter TOTAL FEE O n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee t Date WORKERS'COMPENSATION DECLARATION 76104 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) FOR APPLICANT TO FILL IN BUILDING © d� ' Policy No Company BUILDING j ❑ Certified copy is hereby furnished AILDING SS 6 � 7v�Q� / jL/ T LOCALITY DRESS ❑ Certified copy is filed with the county building Inspection NEAREST department. LOCALITY CROSS ST Date Applicant NEAREST DISTRICT NO. GROUP I TYPE PRO SSED BY CROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL —[ Q COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAAp H16HWAi STATE MA OR SECOND LOCAL d (CIRCLE NO OF BLDGS. (This section need not be completed if the work Involved TRACT NOW ON LOT USE ZONE ffCIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE OF �{ PSJZE OF LOT EXISTING BLDG / _/7� (c I certify that In the performance of the work for which this V /�� Q permit is issued, I shall not employ any person in any manner NER •7;XIOAf'AS so as to become subject to the Workers' Compensation Laws AIL DDR ESS�JL N J I,v� 4� J CL Date Applicant !, ,, p / Q Q to NOTICE TO APPLICANT If, after making this Certificate of Ci Y SA 4"N&/� 1,,G,L Nol �'��/ S"'�� 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 INSPECTIONNo Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is In full force and PARKING effect SPACES REQ'D D PROVIDED " License Number Lic Class LIMITED TIME USE A,.Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM TO INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE RESENT USE OF BUILDING mess and Professions Code) �� V� ( �� FINAL APPROVAL �. ' 7 _ � Q� `� Lic.or Reg.No Date HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE �837,5A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- # 0 0 0 0 8 8 NO. PARKING { ne55 and PIOfeSS10D5 Code) SPACES PROVIDED � r ' O O o O Z F-11, as owner of the property, will do the work and the O0O structure is not Intended or offered for sale (Section 7044, Business and Professions Code). 12, 1 6-82 PROPOSED USE OF BUILDING STA CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction-lending agency for the performance of the work for which this permit is Issued(Sec 3097,Civ C) Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above Information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and representatives of this County to enter KnM&j2tioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SignatLre of Permittee Date WORKF,RS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICAT0ON 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.certifi6Ae of Workers'Compensation Insurance,or a certified copy thereof(SEc. 3800,Lab.C) Policy No. Company FOR APPLICANT TO FI LL IN BUILDING r ADDRESS C Certified copy is hereby furnished. AU ILDINDDRESS O s LOCALITY Certified copy is filed with the county building inspection L CALITv r M I NEAR EST department L h CRoss sr Date Applicant NEAREST DISTRICT NO GROUP CONST.TYPEP SED BY CROSS ST. L6 A D F^ 1� .. 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 ($100) or less.) us E OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER OMN /(i so as to become subject to the Workers' Compensation Laws. AI OCCUPANCY GROUP *- o Date Applicant A RES$ ' Z V, NOTICE TO APPLICANT: If, after making this Certificate of CITY �A+ C L n.L if/,Z$S 9 qrl 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 REQ'D D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM' TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF I SIGNATURE acting m my professional capacity (Section 7051, Bus- Ex, TING BLDG ST mess and Professions Code) FINAL APPROVAL Lic.or Reg.No. Date RESENT USE OF BUILDING l A. J& UO 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] I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 5 5 5 4 A 7044,Business and Professions Code). PROPOSED USE OF BUILDING # 0 0 0 0 $8 CONSTRUCTION LENDING AGENCY 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. � / 0 1.03=86 Lender's Name PROPOSED MAX. OCC. 11J Lender's Address I certify that I have read this application and state that the PERMIT FEE above mformation is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and he reb authorize representatives of this County to enter TOTAL FEE up e ove-mentioned property for inspect n purpose In /th B I � SEE REVERSE FOR EXPLANATORY LANGUAGE ig ure of Permittee rJ Date b 'WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA I tl E®U S IXP P L I V AMI tl I hereby a that If 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 BUILDING017 ADDRESS Certified copy is hereby furnished. Au1LDDRESS !ING ) G) �/ ' LOCALITY D Certified copy is filed with the county building inspection LOCALITYI � �! /d NEAREST department. �- / C CROSS ST Date Applicant AREST DISTRICT I�9 G OUP TYPE, / R CESSED BY ROSS ST. I �I (/ I CONST) 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 SIZE OF LOT EXISTING BLDG. d OF , 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 Ow p f J y so as to become subject to the Workers' Compensation Laws. IL OCCUPANCY GROUP o .DRESS t/ ' U Date Applicant /� Iyl NOTICE TO APPLICANT. If, after making this Certificate of ITY �L' ��% $) 7 OCCUPANT LOAD N 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ❑ El 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 SPACES REQ PROVIDED License Number Lic. Classk, D 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 a INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S/rp A u R E iness and Professions Code). O RESENT USE OF BUILDING �L� � �� FINAL APPROVAL f _GJ Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ✓✓✓JJ! f ON LOT AND USE .,..,.�_...._ i. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi 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 O Q 7044,Business and Professions Code). ' b n^\ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 I hereby affirm that there is a construction lending agency �� z� }O I' 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 S ate laws relating to building construction, and hereby auth riz re esentatives of this County to enter TOTAL FEE upon t}� b e- e o property for inspection�iurposes ��iq ✓���/r c / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermitteee.1,1 �ti ate WORKERS' COMPENSATION DECLARATION CE 875 (11-84) M Q SC E L LA N E®U S APPLICATION CE 875 I hereby a that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insiife, 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 0 Certified copy is hereby furnished. BUILDESSING ADDRUrJR-S �. LOCALITY Certified copy is filed with the county building inspectio LOCALITY ! /1np ��r- G� NEAREST department. CROSS ST Date Applicant X NEAREST DISTRICT NO GROUP TYPE PROCESSED BY CROSS ST CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY ND (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 this C:) permit is issued, I shall not employ any person in any manner OWNER F fY114--r y so as to become subject to the Workers' Compensation Laws. MAIL / OCCUPANCY GROUP ac, / � oz-A � 1�- U Date Applicant L„ E`' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of clrY (71p No. �� N 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 deemed revoked TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. LICENSED'CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices Thereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT E] (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 r L ` effect G O PARKING SPACES REQ'D PROVIDED I�-J JJ License Number Lie. Class ' LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE of ND OF INSPECTORS acting in my professional capacity (Section 7051, BAs- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code). �L lr� FINAL APPROVAL Lic.or Reg No Date PRESENT USE OF BUILDING710 1,YIIP 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 I, as owner of the property, will do the work and the SPACES PROVIDED 1}897 1 AM11:513 structure is not intended or offered for sale (Section 7044,Business and Professions Code). ' CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agent 4__rCX}6 ^ for the performance of the work for which this permit is �, (`/\ issued(Sec. 3097,Civ C.). Lender's Name J PROPOSED MAX. OCC. Lender's Address 1 PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL, FEE �6, 00 u on he above- e ne md property or inspection purpos _ 6 EE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D e WORKERS'COMPENSATION DECLARATION 76M444 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 FI LL IN BUILDING ADDRESS ❑ Certified Copy is hereby furnished. ADDRESS •/ I I� n LOCALITY -� l I i Certified copy is filed with the county building inspection LOCALITY /V nye }� NEAREST ✓I' o✓ department. CROSS ST. ' Date Applicant NEAREST DISTRICT NO 7P CONST. ESSED BY ! CROSS ST. �G ` CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a ! COMPENSATION INSURANCE DESCRIPTION LOT NO NO BLOCK MAPHIGHWAY) STATE MAJOR SECOND LOCAL OF BLDGS (CIRCLE) CI NC. (CIRC LHE) (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 (SI00) or less.) usE OF �� } SIZE OF LOT EXISTING BLDG I certify that in the performance of the work for wluch this permit is issued, I shall not employ any person in any manner oIVNER 66= 15L//LZ>//YL11 so as to become subject to the Workers' Compensation Laws. �+ A r OCCUPANCY GROUP E�:] Date Applicant ADDRESS s �� J 490VG TEL. OCCUPANT LOAD -- NOTICE TO APPLICANT If, after making this Certificate of CITY No. Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code. you must forth- ❑ I with comply with such provisions oI this permit shall be TRAILER USE 1 1 GEOLOGY INSPECTION No Spec Knowl. deemed revoked. C OCCUPANCY INSPECTION LICENSED CONTRACTORS DECLARATION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) oI Division 3 of the Bust- NO. OF EXITS ness and Professions Code.and my license is in full force and effect PARKING REO�O PROVIDED SPACES LL��11 J o License Number Lic. Class ` op 'eon LIMITED TIME USE Contractor Date N DATE DA Tfi J P 40'A TO Z INSPECTORS y I I am exempt from the licensing requirements as I am a SI NATURE 9 ) Licensed architect or a registered professional engineer SIZE OF NN OF Z I acting in my professional capaciv, (Section /051. Bus- EXISTING BLDG - STORIES mess and Professions Code) FINAL APPROVAL _ O PRESENT USE OF BUILDING U Lic.or Reg.No Date Cr ' b HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE q I hereby affirm that I am exempt from the Contractor's � 1 License Law for the following reason (Section 7031 5. Busi- ness and Professions Code) NO. PARKING • :-��II+)I"�-I I, as owner of the property will do the work and the SPACES PROVIDED J_ - 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 I for the performance of the work for which this permit is issued(Sec 3097,Civ C.) Lender's Name PROPOSED MAX OCC. I Lender's Address ' PERMIT FEE I certify that I have read this application and state that the above Information is correct I agree to comply with all Countv ISSUANCE FEE ordinances and State laws relating to building construction, I and hereby authprize representatives of this County to enter TOTAL FEE c5, dd 1 upon the above entio ed operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE • I attire of ermittee /Date/�