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Home My Public Portal About9109 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 r IV1 LLAINE A ICATION, - ; • CE 875-(2-80)" I S C E L.L N O.0 S P P:L : . ific I •hereby ,affirm that..I'have `a cert ataof con . sent.,to self COUNTY OE-LOS ANGELES `BUILDING AND SAFETY DIVISION :Insure ora certificate of Workers.Compensafion'Insurance or. y a:certified copy thereof(Sec-380b;Lab C. Policy Nd. Company FOR:APPLICANT TO;F_ILL IN BUILDING 'ADDRESS .. Certified•copy is:hereby furnished. LocwLiry ' UILDING x Certified copy is-flled;withlthe county building Inspection NEAREST department: - , ,_, OCALITY - .. .. _ , :. } _., n- '.. ,. - ROSS ST. '•Date Applicant '" •5 EARS ST 'DISTRICT.N O.' GROUPS TYPE PROCESSE D.,BY ` - •: CROSS:ST / CONST CERTLFICATE OF EXEMPTION FROIvI:WORKERS Y -LEGAL COMPENSATION 'INSURANCEY oEscRIPTIgiv Loiirvo aL'ocic NOP'- (� RA) cLE STATE MAJOR SECOND.LOCAL �. NO.�-OF BLDG.S . - - (This section need.not be;completed If the,-WOrlc 1nVO1Ved TRACT NOW,ON LOT USE ZONE SPECIA'L'-CONDITIONS Q by. the! Permit, is for one hundred dollars°:($fooyao; less:)' - „ usE:oF r.... ..>. ' r,, SI,ZE.OF LOT, :, EXISTING�,BLDG I 'certify„that in the';performance"of the:work for,which this .a. permit Is issued, I'shall not,employ any person•m any.•maru er:, owrvER' so as to become subject.to the Workers.Compens4fiuh Laws: a�L OCCUPANCY GROUP .: r . .ADDRESS. �) ...d 7 Date A' llcant.' ` .z k: .. xNo.;” " .,, —:; r k NOTICE TO APPLICANT; If, after>making6,11 T- OCCUPANT LOAD. Certificate of Exemption,".,.you should',-become'`subject to- the ',Workers"'` Compensation provisions of'the Labor Cod'6;-y.ou-must;forth `'APPLIC'ATION FOR EXIT HARDWARE", with,comply with such provisions or 'this•p"ermit.shall be' TR AILER'U SE' GEOLOGY INSP,E CTI Ow ❑ ❑ No Spec. Knowe..; ❑ deemed'.revoked ., 1 LICENSED CONTRACTORS;-DECLARATIOoccuPwrvcv irvsPEcriow N Pan cDevices -❑ Ii.hereby affirm Ghat I am licensed under provisions of•Chapter: ;sAFerv-PEerniT (Llsr IrEMs'BE�ow):' - - _ NO: OF EXITS,. , 9 (commencing with Section 7000) of.Division 3 o_the,BU3i n _ Q ,1{ess and Professions_Cod e,.and my'license is in full force.and _ effect.. PAC ES EO'D 'R. RR License Number Llc.Class IMITED TIME USE Y, Contractor - Date ogre. on re . --: •''.. - - - FROM,' El •I arrc,exempt fiom, the licensing requirements as.I am a ° 11Ce❑Sed_'arChlte Ct Or •3'Cegl'stered.•.piOfeSSI071a1 engineer-' SIZE OF _s NO, OF`` _ ' I IV SP EC TOR S _ acting'in' my professio,,naC,capacity'(Sectlon ;7051 Bus— ,,•ExlsriNG BLDG. sroRlEs'. 'SIGNATURE mess and Professions Code) t BUiiDING FINAL APPROVAL P SENT USE.:OF Lic.or Reg,'No. Date �Q+ - . NO:"O.F EXISTING BUILDINGS HOME OWNER BUILDER-.DECLA'RATION.' • . ON,LOT AND USE _ I Hereby affirm' that-'][ am .exempt-from the Contractor's o License Law;for.the=;followingreason;(Section 7031:5, Busi- z 3!51,9,0 A B' fessions Code).:. * No: ew RICING ' - ; ' SPACES PROVIDED ness and,Pr'o _ 1 as owner' of the property, will do'the`work'and the f' I r ''8 sfructure is.•not, intende'd or offered• for sale=.(Section i o a o 7044, Business and Profgsslons.Code). 1 _ P SED USErOF BUILDING , OS L-A8 4 CONSTRUCTION:LENDING AGENCY t ,fhereby affirm that,there is a construction lending==agenc ~ '..'for.the p'erforance of the work for which this,permit.is' in issued.(Sec.3097,:Civ:C) k Lender's Name PROP0SED MAX.,;OCC Lender's Address -. _ ,... - .PERM'IT FEE.' I certify that' I.ha"ve read''this application' and'state•that the "= ISSU ANC,E n - H FEES.. �,- above'information is correct:d`agree to comply with all County, ,> ordinances and State laws relating-.to'building construction, ✓ and hereb .,.. 'TOTwu•FEE' . y'auth ize.,represeiltatives of this.County to enter .-. ;upon,th bove nfioned,pro erty for-inspecti n urpo SEE REVERSELF REXPLANATORY LANGUAGE, Lire of+mitt e Wa e i W0,01; RS', 0)IPENSATION DECLARATION CE 875 (11 84) M ISCELLANEOUS APPLICATION CE 875 19hereby 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 1� ,1 a certified copy thereof(Sec.3800,Lab.C.). Policy No. ` Company FOR APPLICANT TO FILL IN, 13 UILDG ADDR SS Certified copy is hereby furnished. pp BUiLb UNG ` / A ADDRESS D /�/ ' LOCALITY i 0 Certified copy is filed with the county building inspection g LOCALITY /�q1 NEAREST department. /P4 PLE l.�1 , CROSS ST. Date Applicant - NEAREST /(�f]��jQ� � DISTRICT NO. GR UP TYPE P, CESSED BY CROSS ST. t4Vj/'7 Al �D �i CONST: I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ,, COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (clRCLe) STATE MAJOR SECOND LOCAL ' NO. OF BLDGS. _ _ (This section need not be completed If the Work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) use of i - - SIZE OF LOT EXISTI BJ_DG. - I certify that in the performance of the work,for which this. — permit is issued, I shall no[ employ any person in any manner X ow R so as to become subject to the Workers' Compensation Laws. X OCCUPANC GROUP = `RAIL - I Date 3 y3 Apolicant % ~ _ NOTICE TO APPLICANT: If, afteDRESS r akin; this Certificate of CITv �/� vo�.Gw/ OCCUPANT LOAD - Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code. you must forth } xvith comply with such provisions or :Itis Permit ,hall be TRAILER USE 1 11 GEOLOGY INSPECTIONNO Spec. Knowl. deemed revoked. Panic Devices N LICENSED CONTRACTORS DECL.aRATION 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. PARKING REO,D O PROVIDED �. SPACES _ License Number Lic. Class LIMITED TIME USE n Contractor Date DATE DATE, A F47M: �O: am exempt from to licensing equirements as I ami IN SPE CTO RjS n ! licensed "architect or are^_istered professional encineer =rlsuG BL G. I .40 STORIES / SIGNAT E ? acting in my professional cavacit 1,SeCtion -051. (sus s inessand-Professions Codel. - FINAL APPROVAL - _ � ,/� ` r' PRESENT USE.OF 3UILDING - - U / -� Lic.of Reg. No. __ Date _._ — HOME OWNER-BUILDER DECLARALION NO. OF EXISTING BUILDINGS t ON LOT AND USE U J� I hereby affirm that i am exempt from the Contractor's I License Lawfor the follo im_ reason i Sec:tun -031.5. Busi- "'nh ness and Professions Code): NO. PARKING 1, as owner of'tie property. will do the work and :he SPACES PROVIDED structure is not intended or offered for ;ale 1 Section j 7044.Business and Professions Code). CONSTRUCTION I-ENDINGkGL.\C-Y PROPOSED USE OF BUILDING I hereby affirm that there is a construction lendine tgency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.I. Lender's Name : _ - PROPOSED MAX. OCC. - Lender's Address 25.00 I certify that I have read this application and state that the PERMIT FEE above information is correct. I agree to Comply kith all County ISSUANCE FEE ordinances and State laws relating; to-building construction, q anC d hereby authorize representatives of this County to enter TOTAL FEE 25.00 i upon the above-mentioned property for inspection purposes. % % 3 SEE REVERSE FOR EXPLANATORY LANGUAGE SI4rt..tt17of n,r^.ti?',!. Date WORKERS'COMPENSATION DECLARATION 76M444,: eE875I2-80, MISCELLANEOUS APPLICATION I h,erebv affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES' BUILDING AND SAFETY DIVISION insure-,'Fir a certificate of Workers'Compensation Insu7ance,'or a certified'copy thereof(Sec.3800;Lab.C.) -Nolic NO, Com an -. - BuiLDING y p y FOR APPLICANT TO FILL IN' Y . ADDRESS-- i E] .Certified copy is hereby furnished. BUILDING `� - LOCALITY 'O - 4.' 4 ADDRESS' ,1 Certified copy is filed with the county building inspection //JJ"JJ' NEAREST p, - LOCALITY CIIC�G� L-tT ' . department. CROSS ST. ' Date Applicant. AREST /�n ` DISTRICT NO. G UP TYPE PRO ED BV CROSS ST. /7Q (�I►.• /Ut CONST. CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL ' �• ' 'DESCRIPTION" -LOT NO BLOCK - MAP - HIGHWAY "- - 'a - COMPENSATION INSURANCE STATE MAJOR sEco D LOCAL (CIRCLE),� .. NO. OF BLDGS. 0 ' (This section_-need not. be completed if the work involved TRACT NOW ON LOT, USE ZONE SP ECTAL CONDITIONS: by the permit is for one hundred,dollars ($1'00) or less.) SIZE''OF LOT •' EXISTING BLDG. � 1`.�/ ' cc I certify ttiat in the performance of the work for which this 0 permit is issued, I shall not employ any'person in any manner NER c C`L� U so as to become subject to the Workers' Compensation-Laws. IL //qq OCCUPANCY GROUP LU D R ESS (V Date Applicant NOTICE TO APPLICANT: If, after making'this Certificate of CITY �OL6 �// NO. b!b' Z�t OCCUPANT LOAD z Exemption, 'you, should become subject 'to. the Workers' APPLICATION FOR EXITHARDW'ARE: Compensation provisions of.the Lalior 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 •occiJvalvcr i1vsPEcrloN� =.� Panlc..Devices, I hereby affirm that I am licensed.under'provisions,of Chapter y. SAFETY PERMIT L I (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 PwekuvG. effect.' - _ REQ'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 INSP CTOR S acting in, my.professional capacity.(Section 7051, Bus- iness Us- EXISTING BLDG. STORIES SI NATURE riiessand Professions Code): : - SENT U DING �C FINAL APPROVAL E SE''OF BUIL Lia or Reg.No. Date HOME OWNER-BUILDER DECLARATION` NO.of EX ISTING`BUILDINGS' �;2 Q 9a.A, ON LOT AND USE I hereby affirm that h•am`•exempt from.the Contractor's,.. _ #x •'• • 88 License Law.for the'following reason (Section 7031.5, Busi- ness'and Professions Code): NO. PARKING `. • • o'•'.• • o •SPACES PROVIDED - D I, as owner of the property, will do-the work and_the 0 7 8_8.Jr' structure is not intended•or.offered. for sale (Section , 7044, Business and Professions Code). P_ SE USEOF BUILDING CONSTRUCTION.LENDING-AGENCY " I hereby affirm that there- is a construction lending'agency 'l _ v��`�/� �`�`/''/��• for''the performance of the work for which this permit.'is issued (Sec..3097,Civ.'C.). ` Lender's Name PRovosEp Max. occ. Lender's Address PERMIT FEE I certify that 1•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 her b•y'authorize representatives of this County to enter upon e:abov' en" ed ropert r inspect, purposes. SEE REVERSE FOR,EXPLANATORY LANGUAGE n v —Vg natu of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION - . 75 - I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a rrertificate`of Workers'Compensation Insurance,or , . a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN SS E DRAD7 6�e ADDRESS Certified copy is hereby furnished. uILDING Q �( LOCALITY C ADDRESS Certified copy is filed with the county building inspection LOCALITY• NEAREST department. - CROSS ST. Date Applicant NEAREST ? DISTRICT NO. G OUP TYPE CESSED BY CROSS ST. 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-OF IZE 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 owNee C&Io TA so as to become subject to the Workers' Compensation Laws. a�� ` OCCUPANCY GROUP o ' ADDRESS Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY No� pp y OCCUPANT LOAD- Exemption, you should become subjectto the Workers' �/� O��~` _ 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. Knout' 1. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby 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 effect. PARKING REQ`D D PROVtD ED �� SPACES License Number Lic. Class LIMITED TIME USE Contractor -Date DATE DATE DI am exempt from the licensing.requirements as I am a PROM. TO: licensed architect or a registered professional engineer SIZE OF //�� NO. OF INSPE R S acting in my professional capacity (Section 7051,-Bus- EXISTING BLDG. VOO STORIES SI uRE iness and Professions Code). FINAL APPROVAL _/ou PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USEIE„II„l 1 ;r •''%.� �• I hereby affirm that I am exempt from the Contractor's • o License Law for the following,reason (Section 7031.5, Busi- Q ness and Professions Code): No. PARKING I, as owner of the property, will do the work and the sPAces PROVIDED n 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. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permitte Date WORKERS'.COMPENSATION DECLARATION 76M444 875 (2-so) 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,ceriWicate of Workers'Compensation Insurance,or.- a certified copythereof(Sec.3800,'Lab.C:) Bu)LDrriG Policy No: _ Company FOR APPLICANT TO FILL IN ' . _ADDRE SS Q _ -0 ' Certified copy is hereby furnished. fruIUDINGLOCALITv, Certified,copy-is]filed with.the county building inspection p 'pL TY ,, y � NEAREST LOCALITY dC�GS/ Tit �!° Ci CROSS ST. Date Applicant T L TYPE SS ED/ DISTRICTy/N(�O. GROUP' PROCES ED BY - . CROSS ST. l<<�4:f �OV �' 'CONS- - COMPENSATION EXEMPTION;FROM WORKERS'. LEGAL • CE&TIFICAT MPENSP TION•INSURP:NCE Y oEscRlvrloN LOT No,, a 7 BLocK MAP HIGHwAV > No��'�/S/-•2/�S''(c IRCLEf STATE MAJOR SECOND LOCAL d, �j NO. OF BLDG_S `(This section need.not be completed if the -work involved TRACT O } NOW ON LOT USE ZONE SPECIAL'CONDITIONS O' ' -'by the' permit-is-,-for-one--fitindred'dollars-($100)-or less.)— ---- - — -- --- -- — - ___ _ _ _ _ ... . .. .SIZE OF,LOT-G �13 0i' EXIES TO NG'BLDG T- I certify that in•the performance of the work-for'which,this .permit is issued,.1-shall not employ any person.in any manner NER Lc i �r c �` so,as to become'subject-to the Workers' Compensation Laws. :OCCUPANCY GROUP_,AIL E:V3:_9 :.•. , AD .LU Date " Applicants rn TEL. '� - - Z -•. NOTICE TO APPLICANT: If, after"making this Certificate of -tel-TY j�i,+r �+.G/ NO. ��•('- OCCUPANT'LOAD Exemption, you should become subject to the Workers'. Compensation provisions of the Labor Code,-you must.forth-" APPLICATION FOR EXIT HARDWARE:. with comply with such 'provisions or this permit shall be TRAILER USE' GEO LOGY•IN SPECTION Q NO Spec. KIIOWI. El deemed revoked 4J LICENSED.CONTR ACTORS DECLARATION. ;� OCCUPANCY INSPECTION Pa1]IC'DeVICeS' O - I hereby affirm-that I am licensed under.provisions of.Chapter 'SAFETY PERMIT q (LI$T,ITE Ms BELOW) - NO: O FEXITS .� 9'(comm`encing with Section 7000)of Division 3-of the'Busi- ness and,Professions Code, and my license is in full force and PARKING • effect.. RED'D PROVIDED , - - :. SPACES License Number Lic,Class LIMITED TIME USE Contractor - Date F.. E DATE DATE FROM: TO:I am-exempt;from thelicensing.requirements as'I am alicensed architect or 5-registered professional engineer. , NO. of INSPECTOR'.S. acting'in my professional capacity (Section 7051, Bus- G,BLDG. STORIES S GNATUREiness'and Professions Code): FINAL APPROVAL T USE OF BUILDING .. Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION' rio. of ExISTiNG.eutl DlNos '. ON LOT:.AND'USE, I' hereby, affirm that, I am exempt; from the Contractor's License Law for the following reason (Section 7031•.5, Busi- ,ness and Professions Code):, NO. PARKING SPACES PRov1IiE'o. I, as''owner of the property,,will do life work sand the X535 '7q structure is'not intended or offered for sale (Section # •r e • 88 7044, Business and.Professions Code). - POSED USE OF BUILDINGIn - - - CONSTRUCTION:LEND ING AGENC 'agency �.� - I.hereb affirm that there is a construction'lending a enc <! GJ ( y g g y OQ93v.86 for the performance of-the work for which-this•permit. is �ll i issued.(Sec. 3097;Civ.C.). Lender's Name A . - _ - -PROPOSED MAX. OCC. - Lender's Address PERMIT FEE - - I-certify••that I have read this application and•state that the, " above information is correct,. I agree to'comply with'all County ISSUANCE Fee. ordinances and State laws relating to building construction,' and h reby authorize representatives of this County to enter TOTAL`FEE upo thea ov Toned r inspec n purposes; ;,:SEE REVERSE FOR EXPLANATORY LANGUAGE M nature.of Permittee Date A}'ORISI.RS'COMPF:NSAIION DECLARATION 87576M444 11 1-84) MISCELLANEOUS 875 APPLICATION r CE I'lieiehaffirm that 1 have a certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'insuore, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy,No.--__--- _.—Company _ - APPLICANT TO FILL IN wDOR� BUILDING fD Ess Certified copy is hereby furnished. BUILDING• ^ --7W4' , XX ADDRESS FOR LOCALITY JJU ElCertified copy is filed%vilh the county building inspection LOCALITY NEAREST OF ty, department. SCROSS ST. Date_-_.____—_.._._-_..Applicant.— — - NEAREST C �� DISTRICT NO. GRQQQUP TYPE P CESSED BY CROSS ST. 2 L. J \ q !D D CON M CERTII ICATE OF EXEMPTION FROM WORKERS' LEGAL COPENSATION INSURANCE DESCRIPTION LOT NO. In BLOCK {� MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work.'IIIYOIved � TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) uSE dF }(( SrU�fC SIZE OF LOT ,1 EXISTING BLDGS,J^N� G>�� O I certify that in the performance of the work for which this. permit is issued, I shall not employ any person in any mannek owNER_pf building ul as to heronre subject to the Workers' Compensation Laws. MAIL rr b OCCUPANCY GROUP ® ci Date_-----____-- Applicant_— --. — AOOaEss t C— NOTICE -10 APPLICANT: If, after making this Certificate of CITY v �\ No. '' ��pQ OCCUPANT LOAD C� Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Conrpensrtion provisions of the Labor Code, you must forth with comply xvith such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. ❑ LI('I:NSF.0 CON I RAC FORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed tinder 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 mylicenseis in full force an*X effect. N e of business PAPKING REO�D 1 I PROVIDED 1 1 F, SPACES E= LL „JJ License Nunrher .---_- Lic. Class ,tp LIMITED TIME USE Contra Chlr-.--'.-._--..-.—_..-._- Date-__---- DATE DATE ElI am exempt from the licensing requirements as I am a FRUM: TO: licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTORS acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. l � •, STORIES SIG TORE iness and professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg. No.___ _—_ _ Date— — HOME O\1'NIAl-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (�Q ON LOT AND USE hereby affirm that I ant exempt .from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions('ode): NO. PARKING - I�.J� s-#��!•• 0 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). CONS'I'Rl1CHON 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,('iv.CA. Lender's Nanre----------_-__— -- PROPOSED MAJt*OCC. Lender's Address----- ---_.---.__ ,_—, -- 251- 00 I certify that 1 have read this application and state that the PERMIT FEE above information is Correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relali t wilding construction, ` and hereby authorize leprose a v s this County to enter TOTAL FEE 25,QQ upon the above-ment'oned pr rt} f r nspection purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE XX x XX �- - - �Ipn'i1111hi1 I'wnii frr�