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Home My Public Portal About9110 LAS TUNAS DR_Miscellaneous__ I WORKERS' C,UMMMP,11UN 1JCl:LAKA1.IUIY20-0063DPW:2/90 1r!1.1.:7�:+L::LLf11'1iGV V.'7 t-,I—f LA'�t-�a .av:l'e I hereby affirm that I have..a certificate of consent to self COUNTY OF LOS'ANGELES = BUILDING:.AND SAFETY DIVISION jinsure,or a certificate of;Worlers' Compensation Insurance, or a certified copy thereof (See:3800, Lab. C.) Policy No- Company FOR APPLICANT TO FILL IN BUILDING ' BUILDING ADDRESS ADDRESS ❑ Certified copy.is-hereby furnished. g /�d L/9S 7Ze V4—f :D/L LOCALITY ❑ Certified copy is filed with the county building inspection CITY zIPQ department. 7i f'LE 4c-or Ty !l 79 d NEAREST. CROSS ST. Date '' '° - Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY ( �, - CONST. O CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. V I COMPENSATION INSURANCE MAP HIGH WAY No. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGEPARCEL by the permit is for one hundred dollars ($'.100) or less.) s-3a ®23 O3 USE ZONE SPECIAL CONDITIONS -.T ert� Owner O, i I, certify that in the perform ance.of the work for which'this TEL N R4/3 �f/6 S Lgb b 61 W permit is issued:I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws- ADDRESS OCCUPANCY GROUP n Datel LV dZ Applicant . B mL3tay 6A14 CITY _ ZIP NOTICE TO APPLICANT: If.' after making this Certificate S9��g'`Z/� �— 9/ of Exemption, you should become subject to the Workers' APPLICATION FOR OCCUPANT LOAD Compensation provisions of the i abor Code.you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be -deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. Elrevoked. r�. OCCUPANCY INSPECTION�,S Panic Devices ❑ . LICENSED CONTRACTORS DECLARATION 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 Business NO.OF EXITS and Professions Code,and my license is in.full force and effect.I Name dt B4SMeSS PARKING• REQ'D PROVIDED . License Number Lic. Class PARK!% I I Contractor Date - LIMITED. TIME USE I ❑ 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 NO.OF INSPECTOR'S i EXISTING BLDG. �� r and Professions Code). � STORIES .SIGNATURE. Lic. or.Reg. No. - Date PRESENT USE OF BUILDING j//�� N7- y +� FINAL APPROVAL Poe-7-ciZ :7zs r eee j• 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 9 .SPACES PROVIDED. CI ❑ L, as owner. of the property, will do the work and the structure is not intended or offered for sale(Section 7044,X PROPOSED USE OF BUILDING Gv�6fCc Business and Professions Code). 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. C.).. PROPOSED MAX.OCG Lender's Name APPLICANT(PRINT) TEL NO. /3a 6'2-d Z/ 7-x-72 Lender's Address ADDRESS _ I certify that I have read this application and state that the SAn /�L M 4/ ?J_ above information.is correct. I agree to comply with all Count I P Y Y PERMIT FEE ,. ordinances and State laws relating to building.construction,and "" l '= hereby authorize'representatives.of.this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. . I._.t. .{ ;. I TOTAL FEE X � Z S—O� SEE REVERSE.FOR EXPLANATORY LANGUAGE^ Sign re of Permittee Date I WORKERS' C.UMY1r1VJA11VLV 1JC.1.LH1Ct111V1V 20-0063DPW42/90 IKl-1-DL.1C::LLf�11i1r..VUr� HrfJ...l�l'"ll11J1�1 - I. I hereby.affirrn that I have-a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING:.AND SAFETY DIVISION *insure,or a certificateof,Wbfkers' Compensation Insurance, or { $ certified copy thereof (Sec. 3800, Lab.C.),- ' - - Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING-ADORESS ADDRESS ❑ Certified copy,is.hereby;furnished. g zl j/'d L,¢S o✓d•-S ^.04 LOCALITY ❑ Certified copy is filedwith the county building inspection CITY ZIPp Q y department. 'j'��f L 6- el / �7`� v CROSS ST. Date )'' .J='- Applicant SIZE OF LOT / ` A NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY } CERTIFICATE OF EXEMPTION FROM WORKERS,' 6 3 CQNST. O TRACT BLOCK LOT NO. V I . .. .COMPENSATION INSURANCE S3 7. O 2 3 ( No. CIGHWAY RCLEI STATE MAJOR SECOND LOCAL.. (This Section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL the permit is for one hundred dollars ($'.100) Or less.) USE ZONE SPECIAL CONDITIONS by e I p . ,S3 � c�2 3 p a l t� L certify that in the performance,of the work For which this X 16402*ewe Ley er TEL No. F, permit is issued.I shall not employ any person in any manner Rub C+'f0� 191;9r_4 d_46/ iu so as to become subject to the Workers' Compensation Laws. ADDRESS OCCUPANCY GROUP ftZ l Date f�!?3 �- Applicant ,f3d B�' Z-4-1" CITY zIP NOTICE TO APPLICANT: If,' after making this Certificate SAsV A�Q/L- L , 9 �7 �� OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: comply with such provisions or'this permit shalt be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ ' revoked. ❑ OCCUPANCY INSPECTION[ Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that I am.licensed under provisions of Chapter._ SAFETY PERMIT❑ (LIST ITEMS BELOW) I 9(commencing with Section 7000)of Division 3 of the Business ame (j 11$mess NO.OF EXITS and Professions Code.and my license is in.full force and effect. PARKING• �� . i License Number Lic. Class L CaNb A-467 SPACES REQ'D PROVIDED ��JJ I Contractor Date LIMITED TIME USE i ❑ I ama tempt 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 NO.OF INSPECTOR'S 'I and Professions Code). EXISTING BLDG. z STORIES .SIGNATURE, Lic. or.Reg. No. - Date PRESENT USE OF BUILDING l/AC q--;OV T FINAL APPROVAL ? 2 a c7292 u.0 r AVV V—'-_P O 4 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, Business and oe /fig E Professions Code): NO.PARKING .SPACES PROVIDED. ❑ I, as owner. of the property, will do the work and the structure is not intended or offered for sale(Section 7,044,Y PROPOSED USE OF BUILDING Business and Professions Code). I 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 . I (Sec. 3097,Civ.C.)'.. PROPOSED MAX.OCC j Lender's Name APPLICANT(PRINT) EL NO. �b?7 Lender's Address ADDRESS I � I certify that I have read this application and state that the . traivo,�� '¢D• �'V 6Q� ��i09 '77-r above information:is correct. I agree to comply with all County PERMIT FEE - ordinances and State laws relating to building,construction,and r.. hereby authorize Yepresentatives.of.this County to enter upon ISSUANCE FEE ' the above-mentioned property for inspection purposes. . f .t. ..I TOTAL FEE X / Z� OZ SEE REVERSE.FOR EXPLANATORY LANGUAGE Signature Permittee Date WORKERS'COMPENSATION DECLARATION 76M444* CE 875 (11-84) APPLICATION ..• I hereby, affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or . a certified,copy thereof(Sec. 3800,Lab.C.). - Policy No. Company FOR APPLICANT TO FI LL IN BUILDING " ADDRESS Certified copy is hereby furnished. BUILDING // D S J-7-�,,-n us ��, LOCALITY ADDRESS (( El /� Certified copy is filed with the county building inspection LOCALITY /p / NEAREST department. � ek,1 C- C �� CROSS ST. Date Applicant NEAREST -PNO. CT NO. GROUP ITYPE CESSED BY CROSS ST. yl O �J .CONST. .. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK HIGHWAY (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS.(This section• need not be completed if the work involved TRACT NOW ON LOT NE 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 ` A rnnue-Ir so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a o • MAIL 7 V Date Applicant I S ( LLJ NOTICE TO APPLICANT: If, after making this Certificate of clrY ^t'er'1 le }- NOL: �` - G19S OCCUPANT LOAD Exemption, you' should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No,Spec. Knowl, ❑ deemed revoked.. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El 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'D PROVIDED trtcr License Number Lic. Class e LIMITED TIME USE Contractor Date DATE DATE FROM: TO: EJI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF ' IN S acting in my professional capacity (Section 7051, Bus- EXISTING BLD . STORIES SIGNATURE iness and Professions Code ' � PRESENT USE OF BUILDING Q C✓�J - FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS IA 9 s€I + I_�I� ��(�7 f y •j i� ' ON LOT AND USE !1 - - _ /+-'~•�' I hereby affirm that I am exempt from the Contractor's '' r'�>_',:�_, .rl 9; = I License Law for the following reason (Section 7031.5, Busi- �' _ � •�� ness and Professions Code): NO. PARKING F] 1, as owner of the property, will do the work and the sPAces PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I' hereby affirm that there is a construction lending agency 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' j above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to construction, �-7- and hereby authorize representatives this C unty to enter roraL FEE or.�^� upon the above- entioned propert inspe on purposes. 11 SEE REVERSE FOR EXPLANATORY LANGUAGE X ,2-7- Signature of Permittee Date 1 WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) = ° (MISCELLANEOUS APPLICATION I hereby affirm that I have •a certificate of consent to'self COUNTY OF LOS ANGELESBUILDING AND'SAFETY DIVISION insure, or a certificate of,Workers'Compensation Insurance,or a certified copy thereof(Sec. A00, Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING, ADDRESS ❑ Certified copy is hereby;furnished. BUILDING r -0' L g LOCALITY -- ADDRESS ❑ .Certified copy is filed with the county building inspection NEAREST department. ' LocwLlrY ceoss ST:' • _ gJ� BY Date' Applicant RAREST - - 'DIST _N Q� .G OUP TYPE Pft ESSED CROS S;.ST. - GJJJj(�f� _ CONST ', _ CERTIFICATE OF EXEMPTION FROM WORKERS' . LEGAL r _ DESCRIPTION LOT NO - BLOCK :MAP HIGHWAY COMPENSATION INSURANCE No: (CIRCLE) STATE MAJOR'SECOND LOCAL a _ NO. OF.BLDGS. (This section need not be completed if _ the work involved'' TRACT NOW.ON LOT USE'.ZONE SPECIAL CONDITIONS OU -:by, the permit is for one hundred dollars ($100) or,less.) USE OF S ZE OF,LOT EXISTING BLDG • - - - I'certify that in .the' performance 'of-the work for which this 0 permit is issued, I shall not employ any person In any manner OWNER' 1— so as to become i6bject to the Workers' Compensation Laws_. /_ _ / {- OCCUPANCY GROUPLLJ AILADDRESS U - •, J U I�'•(� ..�''lAn.U7 .•�` NOTICE TO APP ICANTntIf, after,making this Certificate of CITY ' S a „� . No� ®y 3� 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 .permitshall be TRAILER USE�, - ,\ GEOLOGY'1 NSPECTION No Spec. Knowl. deemed revoked Panic DeVIC2S EJOCCUPANCY INSPECTION - •LICENSED.CONT RAC TORS DECLARATION El I hereby affirm that I am licensed under provisions of Chapter sd FETv PERMIT q (LIST ITEMS BELOW) N0. 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. - REO'D PROVIDED _ .- / SPACES. •' License Number Lic.Class LIMITED TIME USE COntra Ct Or Date - DATE DATE ❑ FROM' TO: I ani exempt-from the llcensing,requirements as I am a _ , licensed architect or a 'registered professional engineer, SIZE OF '-FN O. OF - - - . INSPECTOR`S acting. in my professional, capacity (Section'70.51., Bus-. EXISTING BLDG. - STORIES SIGNATURE. iness'and Professions Code). FINAL APPROVAL �t PRESENT USE OF,BUILDING .C� - ` OA Lic.or Reg.No." Datevu FEE . HOME OWNER-BUILDER DECLARATION. ON of EXISTING BUILDINGS . - - �- ON LOT AN D;,U.SE .. , I hereby affirm that,'I am-'exempt from the Contractor's O yU ri J. j License Law for the following reason-(Section 7031.5, Busi- NO1 i � . _ - -,ness and Professions Code):' _ PARKINGSP P.0 ES.PROVIDED FTI owner,of the property,'will do the.work and the V structure is.not intended pr offered for sale (Section 7044, Business and Professions Code).. -• PROPOSED USE OF BUILDING CONSTRUCTION LENDING:AGENCY I hereby affirm that there.is a construction lending agency for the performance, of the work for which'this permit is issued(Sec. 3097,'Civ.C.)., Lender's Name' PROPOSED MAX.,OCC. Lender.'sAddress PERMIr.FEE- a� I certify that I -have read.this application and state that the ; above information is correct. I agree to comply'with'all County !ssuANCE FEE ordinances'and` State laws relating to-building construction, •TOTAL"FEE' and hereby authorize representatives of this County to enter upon the above-mentioned "property for inspection purposes.: ,SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 8754(11-84) 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.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS FICertified copy is hereby furnished. BUILDING (� ' I /1 LOCALITY DDRESS / lM- ECertified copy is filed with the county building inspection LOCALITY�A I� NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED'BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY (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 ZE of LOT EXISTING BLDG. o} permit is issued,I shall not employ any person in any manner INNER J v � a s> so as to become subject to the Workers' Compensation Laws. a ;OCCUPANCY GROUP _ o MAIL 1,� �`. I-- ADDRESS ••�,� �„ 4,..1.:�. A : �� U Date Applicant Q� q F r w NOTICE TO APPLICANT: If, after making this Certificate of, CITY NO. r 19W� 15�v OCCUPANT LOAD a Exemption, you should become subject to the Workers' AP LICATION FOR EXIT HARDWARE: '— .Compensation provisions of the Labor Code,you must-forth- with ustforth- with comply with such provisions or this permit shall be TRAILER USEGEO GY INSPECTION ❑ E] ❑ No Spec. Knowl. deemed revoked. El LICENSED CONTRACTORS DECLARATION occuPwncY INsvecTloN 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•D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am,a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: TO: INS NA R'S acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES GNATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTINGBUILDINGS 7, ON LOT AND USE 9 3 3.3 A 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 ness and Professions Code): NO. PARKING SPACES PROVIDED •:O O O;O'010 2 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 0 4.-o 7—8 8 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 � �V I certify that I have read this application and state that the IL above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, tu id hereby authorize representatives of this County to enter TOTAL FEE —nu on abov ned operty for inspection pu oses J SEE REVERSE FOR EXPLANATORY LANGUAGE � o . Signature of Permittee Dat WORKERS'CONSIjENSATION DECLARATION CE 875 (1'I-84) MISCELLANEOUS APPLICATION CE 875 l'hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION li.•sure, 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 FlCertified copy is hereby furnished. V BUILDING n, /� SAS r LOCALITY -� /� ADDRESS Y V /Y /t7121�1,� 1 Certified copy is filed with the county building inspection J LOCALITY NEAREST ' department. CROSS ST. S�yjq ,BL�Y� Date Applicant � "' � NEAREST DISTRICT NO. GR U/P� TYPE IFRO S ED BY CROSS ST. 905gyne &d_ !'v / CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL . v /rte COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SEC)I'- LOCAL NO. OF BLDGS. (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) or less.) USE OF ///1 nj� SIZE OF LOT EXISTING BLDG. 1 '.�J I certify that in the performance of the work for which this \/ C:) permit is issued, I shallnot employ any person in any manner-4 OWNER y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP v o ADDRESS11 _ F- Date O A Applicant V TEL w NOTICE TO APPLICANT: If;after making this Certificate of CITY NO. OCCUPANT LOAD � Exemption, you should become subject to the Workers' z APPL CATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ , ❑ E] 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 EJ (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'D D PROVIDED D 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING'BUILDINGS ON LOT AND USE 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 (�0 ' I, as owner of the property, will do the work and the SPACES PROVIDED �D structure is not intended or offered for sale (Section C 7044,Business and Professions Code).; CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 26710 A I hereby affirm that there is a construction lending agency . . SV i for the performance of the work for which this permit is #,e o e o $.8 issued(Sec. 3097,Civ.C.). o o. o 0 0.640 z Lender's Name . _ PROPOSED MAX. OCC. Lender's Address 0326.—.87 PERMIT FEE .oQJ I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE - ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 'atj 06 upo he above ntioned prope ty fo spection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE . Signature of Permittee Date ` T� WORKERS'-COMPENSATION=DECLARATION', 76M444 CE 875MISC-ELLANEOU� A>PPLIC.ATION f.con en' t self+ , :I hreby affirm,-that I have a certificate o s t ,o_ COUNTY OF L0 ANGELES ',,'BUILDING AND SAFETY DIVISION insure; or a:cettificateot Workers';Compensation'Insuiance Or,. ' a•certified copy thereof(Sec''3800;.Lab C) ; ' Policy` No. Company =' FOR APPLICANT TO FILL IN ' - . .. >' BUILDING ,ADDRESS :.: _,a 'Certified copy i's hereby furnished; eulLliirvG' � L'oCALITY • Ll AO D RESS+ C E]_,:Certified copy is,filed with the county•buildmg Inspection: � rvEaREsr '4 epartment. , y ,LO C ALITY Date Applicant... 'a EAREST - IC=,N TYPE., -s - CROSS.ST _ CONSTq/ DISTR G, UP ]PROCE 'B CERTIFICATE'OF.EXEMPTIONFROM`WORKERS LEGAL, LOT NO !, BLOCK ryAp' MIGRWAY COMPENSATION INSURANCE DEscRIPTION - ,k. ;.'.. a ` _ N O O•F.,B L D G.S (This sectiotr need:'not lie,,co .'tf• hC WOIk;lI1VO1Ved- USE ZONE .SPECIAL'CONDITIONS TA t _ 'TRACT �' •,:-NOW 6N L•O.T -._. ' TE•M.AJOR SECON OCAL b" he a e.}iundred dollats" 100 or less.) Y t p rmlt is,for--on � ($ ) )., , O . - 'EXISTING-, USE OF Y,• .` SI'ZE O-F LOT`:- EXISTING BLDG - I certify hat in the performance,of the work for which this eimit is'issued;I shall not-em to an erson.msany manner�' owrveR. '•r '• t.., so::as to°;become subject to::the Workers 'Compensation Laws.`.' aii' . OCCUPANCY GROUPJoA' W AD. ESS. Date Applicant '.. z /7" -TEL " NOTICE-TO,APPLICANT: If; after niakiilg-this Certificate of e't'r_Y G�'p�t 'C �,T rvo" �t � j — �t)" OCCUPANT LOAD Exemption,'you should become subject to.the Workers' -, AP Compensation provisions,of"the Labor Code;`'you must"'forth- .;._ � ` PLICATION FOR EXIT HARDWARE With Comply Wltll; SUCK prOV1Sl OI1S' or, this,'perm lt,shall.%663, TRAILER;USE GEOLOGY INSPECTION NOS ec..Kri6Wi.. E :, deemed revoked '! }•'.. _ LICENSED CONTRACTORS DECLARATION: occuPwrvcY.wsPEcrtoN Panic,DevicesEJ -I hereby affirm that,-I am licensed under'provisions of Chapter: ' SAFErY PERMIT (LIST,irEMS BELOW) 9 (comm_encing,witti,Section-7000)of Division'3 of;the Busi rvo:o'F Ex ITS Hess and;Irofessions Code;`arid my license is in full force and effect. SPACESPARKING RE PROVIDED License Number Lia Class ` LIMITED•TIME.USE Contract Oi'-.' -'':'I;; ..Date. .. - - .', '. - :o AT:E ,x ..DATE:-.:,., _ - - .. F ROM Lam exempt:from the licensing requirements as I am a;'. �. - R S '>licensed,.-architect or..a registered professional''eriglneer slzE bF ruo of h s acting;in-my.professional-'capacity (Section:70'51 Bus i ,.. UR ,.I N EXISTING BLDG: SPECTO mess and Professions Code): FINAL:APPROUHL STORIE ESENT,.USE OF BUILDING - , Lic,_or Reg.No Date _� • •' NO,-OF EXISTING'BUILDINGS HOME OWNER BUILDER DECLARATION OT AND USEe ' ON L I 'hereby-'.affirm ;that' I am exempt'.from 'the Contractor's License Law for theJollowing reason:(Section 7031:5, Busi-, NO. PARKING„'.'•A nCSS and.PiOessions`COde):'.- - SPACES PRO V.ID ED., V-.. "I, has owner of the'pr'operty,-will do .the work and the" '- ,_r ��✓`-o~ o i' i'nteiided or offered for sale (Section 70441 Business and Pro es ibM Code) : ' OPOSED USE,O F.'BUILDING, t''.CONSTRUCTION LENDING AGENCY. 'I hereby affirm that'there"is a construction lending agency' for.-.the-performance"of the,work for which this permif'is 'issued (Sea 3097;Cie.C). .- :. ' • -r Lender s Name „ •. -PROPOSED MAX. OCC.-I, `.Lenders Address w ' ', •_ ,:.. PERMIT FEE.. << _ s-',� to I certify. that I have read this applic ------------- ation 'and state that the )' --, ISSUANCE.FEE ab"ove information is:correct. I agree to comply with all County, t `t x ordinances;and State,law's relating to'building;construction, /apZh by aut'Z�rle., preserifative"s:'of this.County to enter AL FEe'ab pr y• orinsp ctio purposesSEE REVERSE FOR'EXPLANATORY L^ANGUAGE Sign re-of Permittee Date ;.z I� WORKIIRS'CONIPE.NSATION DECLARATION ,7610444 M ISCELLANEOUS APPLICATION ` I hereby affirm that I have a certificate of consent to self CE 875(11-84)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 ADOR ESS 5;P1,1 e Certified copy is hereby furnished. BILDENSS LOCALIIG 8 �/ Q XX UDR ADTY Certified copy is filed with the county building inspection LOCALITY NEAREST y, department. y °-" `gl'Z�D CROSS ST. yy Date__—_.___.__.__Appllcalllt____.--___ NEAREST DISTR CO.. OUP CONITYPE S CESSED BY o. CROSS ST. O��J` CERTIFICATE OF EXEMPTION FROM WORK F,RS' LEGALAJ ('ON IPE•.NSA LION INSURANCE. DESCRIPTION LOT NO. BLOCK NOP (CIRCLE) STATE MAJOR SECOND LOCAL _ NO. OF OLD S. (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. p certify that in the performance of the work for which this n permit is issued, I shall not employ any person in any manne3[X OWNER of building IW ® c: So as to heC0111e Subject Io the Workers' Compensation laws. OCCUPANCY GROUP ADDR .C.� MAIL j�{/ �" U_ ESS d G - r Date_____._.______—. Applicant_-- _-- -- Lal NOTICE TO APPLICANT: If, after making this Certificate of CITY , CI- T 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 lir this permit shall be TRAILER USE E] GEOLOGY INSPECTION j] No Spec. Knowl. deemed revoked. LIULNSE:D CON'TRACTORS DECLARATION OCCUPANCY INSPECTION I] Panic Devices I hereby afflrin that I am licensed under provisions of Chapter SAFETY PERMIT [] 'LIST ITEMS BELOW' F 9 (commencing with Section 7000) of Division 3 of the Busi- No. of Exlrs ness and Professions Code, and my license is in full force anix effect. Name Of. buSlrieSS PARKING Sa'A CES LL��J REQ'D � PROVIDED I�J License Number .._—.___—__ Lic. Class- LIMITED TIME USE Contractor---_--.-------.._._..-- ._--- Date_ ---- — DATE DATE FitOM: TO: I am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE of NO. OF INSP CATUTRe O R'S sl acting in my professional capacity (Section 7051,Bus- EXISTING BLDG. STORIES inessand Professions Code)• a _. PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg. No.___--_—_ - _ Date IIONIF OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (alp Yy 2��p�t i ON LOT AND USE �-11 ✓ hereby affirm that I ani exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING -- I, as-owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCHON 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 ISec. 3097,Civ.C.). Lender's Name•-------..------.—.:--- ' PROPOSED MAIC*OCC. Lenders Address.---_--.---._----------.--------- --- PERMIT FEE 25 . 00 1 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 lays relating to building construction, and hereby authorize representatives of this County to enter . TOTAL FEE 25 .00 upon the above-mentioned property for inspection purposes. SEF REVERSE FOR EXPLANATORY LANGUAGE XX XX Ci,-11011w .,f Prrmiltrr 11:IIe