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Home My Public Portal About9116 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444, J MISCELLANEOUS SC LA N rOU APPLICATION L I C I O NCE 75 (11-84) 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.). - BUILDING Policy No: Company FOR APPLICANT TO FILL IN dDDREss ❑ Certified copy is hereby:furnished. BUILDING 9 �� . ADDRESS .� 2 LOCALITY L ci .. . ❑-Certified copy is filed with the county building inspection LOCALITY NEAREST department. TEMPLE CITY CROSS ST., .. Date Applicant - 'NEA RE ST -LOMA DISTRIC 'NO., GE20 ITYPEPROCES5ED BY ' CROSS ST. - ��{/ O CONST-,/ CERTIFICATE OF EXEMPTION FROM WORKERS' 'LEGAi COMPENSATION INSURANCE DESCRIPTION' LOT No. BLo cK tidP HIGHWAY - . - STATE No. ,(CIRCLE) . L MAJOR SE OCA'L - " (THIS section need_ NO. OF BLDGS.not be completed.if the work involved TRACT NOW ON LOT &BE.ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars, ($100) or less.) USE of ` •SIZE OF LOT / - I ceitify that`in the performance of the work for which this ExIST,NG BLDG. ghp o permit is issued, I*shall not employ any-,person in any manner OWNER B 'BENDER =? so as to become subject to the Workers' Compensation Laws. MAIL (� TT•.� m `•\OCCUPANCY GROUP ADDRESS ' 9074 1JQ5 tunas-L.Y' �. `• tai. G, l\ ��x�''� J �.� �y t.� ti`•':. - Date Applicant, clrY NOL,. _ � LtJ, NOTICE TO'APPLICANT: If, after making this Certificate of Temple City 286-3169 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 G OLOGY 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 PERM/,❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi--_ ivo: of EXITS ness and Professions Code, and my license'is in full force and effect. PARKING REq'D D PROVIDED - - SPACES License Number49Y8.478 Lia Class. C-61 LIMITED TIME USE Contractor Hardware Date 9/18./86 - DATE - DATE . - ❑ I am exempt from the licensing requirements as I am-a PROM: TO: licensed architect or'a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS EXISTING BLDG. 20� SCI Ft STORIES One SIGNATURE iness and No.- Code). " PRESENT USE'OF BUILDING Locksmith Shop FINAL APPROVAL Lie.or Re g 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 13 a 4A .. ❑ PROVIDED ' - - •I, as owner of.the property, will do the work and the'-.. SPACES PROV structure is-not intended or offered .for sale:.(Section 7044,Business and Professions Code). 1 Z 2 g 8: CONSTRUCTION LENDING AGENCY y. PROPOSED USE OF BUILDING'Locksmith office - ho to.public) •hereby affirm that there is a construction lending agency ", (Premises will not be open topublic for the performance of the work for which this permit is, - issued(Sec: 3097,Civ.C.). Lender's Name PROPOSED MAX..00C. - Lender's Address p - .'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 �\ n the above-m tion roperty for inspection purposes. "' 4 SEE REVERSE FOR EXPLANATORY'LANGUAGE \ 12/19/88 - Signature of Permittee. Date WORKERS'COMPENSATION DECLARATION CE 875(1.1-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION R 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 1/ ' Certified copy is hereby furnished. BUILDING T ' ADDRESS Las Tunas DY' LOCALITY T- 0 Certified copy is filed with the county building inspection L CALITY NEAREST department. TEMPLE CITY CROSS ST. Date Applicant EAREST LO DISTR�NO. Gir TYPE PRJ.0 SED BY I. CROSS ST. 'J.-OMA � /(J[ CONST.. CERTIFICATE OF EXEMPTION FROM WORKERS.' LEGAL � COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY r No, (CIRCLE) STATE MAJOR DLOCAL 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 SIZE OF LOT EXISTING BLDG. d_ o permit is issued, I"shall not,employ any person in any manner OWNER ti s-� so as to become subject to the Workers' Compensation Laws. M IL B. BENDER . 00CUPANCY GR UP._. DREss 9094 Las Tunas DR '•;.;:,,_ :, .;,:,4� `t,,;-, i•+ o Date Applicant r Te le Cit TEL 286-3169 OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of clrY mp y No. 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 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 REQ'D .PROVIDED License Number 498478 " Lic. Class C-61 SPACES Hardware 9-18-86 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. 490 S' Ft STORIES One SIG ATURE iness and Professions Code). PRESENT USE OF BUILDINGVacant FINAL APPROVAL Lic.or Reg.No. Date HOME.OffNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ' ON LOT AND USE One . 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 El I, as owner of the property, will do the work and the SPACES PROVIDED Off Street Parkin lot at 221 structure is .not intended or offered for sale (Section 3 8 5 A 7044,Business and Professions Code). rear of building: Capacity: 8 vehicles # , D'e . $$ PROPOSED USE OF BUILDING Locksmith Shop ' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency • o 0 0 • e • z for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. - ( 2_21 8 8 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 \,I� ordinances and State laws relating to building construction, `d an hereby authorize representatives of this County to enter TOTAL'FEE u on the abov en' ned property"for inspection purposes. V 12/16/88 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date RKLRS'COMPENSATION DECLARATION '76M444 > -CE 875(11-84) MISCELLANEOUS APPLICATION t lieqo y affirm that I have a certificate ofconsent 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 ADDRESS, 9 C LOCALITY 41 Certified copy is•filed with the county building inspection LOCALITY Te le City , NEAREST department. mp CROSS ST. Date Applicant - NEAREST DISTRICT N OUP TYPE PROCESS D BY CROSS ST. ( �� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS Ll LEGAL CG "p C I v COMPENSATION'INSURANCE, DESCRIPTION LOT NO. & J./ 'BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND OCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE,ZONE SPECIAL CONDITION by the permit is for one hundred dollars ($100)'6r less.) USE of SIZE OF LOT ' EXISTING BLDG. C/ LWU � 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 B. Bendery so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROU0P1PR � ADDRESS 994 Las Tunas Dr . Date Applicant w L. NOTICE TO APPLICANT: If, after making this Certificate of CITY Temple City NO. (818) 286-3169 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 USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ FanicDevices E I hereby affirm that I am licensed under provisions of ChaptersAFErY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and AFTER THE FACT open atio cover PARKING effect. SPACES REQ'D D PROVIDED at rear of;bldg: 12' X' 29' License Number Lia Class LIMITED TIME USE Contractor Date 2. Interior Partition 97"Y " GATE 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 705 1, Bus- iness and Professions Code). _ locksmith 'shopFINAL APPROVAL PRESENT USE OF BUILDINGIU Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE one — lock shop I hereby affirm that I am exempt from the Contractor's License Law for the following,reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1, as owner of the property, will do the .work and the SPACES PROVIDED- structure is not intended or offered for sale (Section 7044,Business and Professions Code). , PATIOCOVEM , 7_ L 01 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ..shelter from element I hereby affirm that there is a construction lending agency ,� - 8i 5r for the performance of the work for which this permit is Room lvl er. � )tI IT E � �'_I>_i issued(Sec. 3097,Civ.C.). Lender's Name .TOTAL - - 50 PROPOSED MAX. OCC. _ Lender's Address _'HE'_K ,cl i 1 certify that I have read this application and state that the PERMIT FEE i above information is correct.I agree to comply with all County ISSUANCE FEE - CHANGE ordinances and State laws relating to building construction, _i �� and hereby authorize representatives of this County to enter TOTAL FEE .� upon the above-me ioned property for inspection purposes. a tai l0ii—I010ri i 1;f f29 SEE REVERSE FOR EXPLANATORY LANGUAGE . _ v�.'I�r 1 �il�il�efty Signature of Permittee f WORKERS:COMPENSATION DECLARATION • ' CE 875 (11-84) M I SC E L LAffEC U S APPLICATION PPLICAIION hereby affirm that I have certificate of consent to self ertificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION nsure, or a c certified copy thereof(Sec: 3800,Lab.Q. G'olicy No. Company FOR APPLICANT TO FILL IN BUILDING r/ _ pD DR ESS Certified copy is hereby furnished. BUILDING (•�� i,� ,,_ ADDRESS Y 1,�. LOCALITY PCertified copy is filed with the county building inspection LOCALITY �n NEAREST department. Cl j CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE CES5ED BY CROSS ST. CONST .CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION "NO, BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL - _ NO. OF BLDGS• ' This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. G�✓J` I certify that in the performance of the work for which this ((// permit is issued, I shall not employ any person in any manner OWNER Y� o so as to become subject to the Workers' Compensation Laws' MAIL 1 OCCUPANCY GROUP Dat C } :Applicant" wDOREss �/t(/)4 NOTICE TO APPLICANT: If, after making this Certifi e of CITY NO.t �U I OCCUPANT LOAD ° Exemption, you should become subject to the rkers' Compensation provisions of the Labor Code,you must forth- I APPLICA ION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed_revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS Ell ness and Professions Code, and my license is in full force and effect. PARKING REQ1D PROVIDED .SPACES 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: INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING �//� FINAL APPROVAL // l` a�- Lic.or Reg.No. Date p" HOME OWNER-BUILDER DECLARATION NO..OF EXISTING BUILDINGS N �'15� }—I F I-•1 t 'r f S7 ON LOT AND USE - �I I 12 y,j92' I hereby affirm that I am exempt from the Contractor's �#*� �II License Law for the following reason (Section 7031.5, Busi- 1 ness and Professions Code): No. PARKING EJI, 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 r� I I hereby affirm that there is a construction lending agency 1 Iuia V for the performance of the, work for which 'this permit is issued(Sec. 3097,Civ.C.). Q ( Ca✓ Lender's Name IAV 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 hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE GlS Si ture of Permittee Date WORKERS'^COMPENSATION DECLARATION CE 8754(2-80) M ISC E LLA N EOU•S A PP:LICAT 10-N. I:hereby affirm. that I have a certificate of consent to self COUNTY.OF LOS ANGELES ` BUILDING AND.SAFETY DIVISION - Insure, or a cer,tificate'of Workers.'.Compensation.Insurance,or , a certified copy,thereof(Sec. 3800,Lab.C.); Policy No. 'Company FOR APPLICANT TO FILL iN BUILDING ADDRESS E1'-Certified"copylis hereby furnlshed> Urcp ING 9116 Las Turia5 Dr1Ve LOCFALITY r: i. .' ADDRESS Certified copy is flied with the county building inspection NEAREST }•-� � department' LocALIT.Y same'. . CROs ST. Cri�trt'✓ ._Date AppIlCaRt EAREST . - DISTRICT.NO. 'GROUP,' .TYPE•' PROC SE D�BY CROSS ST. Temple'•'Cty Blvd Q CONST .CERTIFICATE OF EXEMPTION TROM WORKERS' LEGDESC RIPTrON LOT NO. jp"Sr, BLoaKy- MAP RIGRWAv COMPENSATION INSURANCE. t? STATE MAJOR SECOND LOCAL f _ N O. ` �f NO. OF BLDGS. � —`� � (CIRCLE) '- � (This section. need riot:be Cotnpleted'if the .work involved TRACT n l NOW ON LOT USE ZONE SPECIAL'CONDITIONS O by ;the permit is for one 'hundred`dollars ($100) or less.) w U SIZE"OF LOT EXIST USE O NG BLDG." 1 I certify.that in the performance of.,the work for which this permit is issued, I shall not employ any person in any manner WNER Mr Bruo.e"'Bend6r so as to subject.to'-the Workers' Compensation Laws. AIL (}7 OCCUPANCY GROUP U, .. AD.DRESS:-9094 'Las Tunas Drive - LU !�' Date Applicant - , TEL. 0 NOTICE TO APPLICANT: If, after making this Certificate of clrY T�emplt City..,' No; 286., 3169` OCCUPANT'LOAD 2' Exemption, you should become subject to .the Workers' -.Compensation he provisions'of tLabor-Code, you must forth- ..with. comply with. such provisions or this.permit Shall beTRAILER•USE GEOLOGY INSPECTION No Spec d"eemed revoked 13 :-Knowl. F] OCCUPANCY INSPECTION. 1 ' LICENSED CONTRACTORS,DECLARATION D PBnIC Devices ❑'; I hereby affirm that I amlicensed.und'er provisions of Chaptersw FE rY PERMIT ❑ (LIST ITEMS BELOW)`' 9NoOF Exlrs . (commencing with.Section 7000) of Division 3 of the, . Busi- ness and Professions Code, and my license is in full force and effect. • - - - PARKING REQ'D 'PROVIDED SPACES License-Number Lic:.Class _ LIMITED. TIME .USE Contractor Date •. _.. _ DATE DATe .. FROM _ TO: ❑. , I amexempt,from the'licensing requirements'as I am a licensed architect'or' a' registered professional,a nginee'r SIZE OF, - NO. OF - _ ,INSPECTOR'S acting, my--professional capacity (Section 7051, BUS EXISTINGBLDG. STORIES SIGNATURE, mess and Professions Code). RE SE NT_,U SE OFBl11LDiNG •2'1.oIIe - FINAL APPROVAL , - .-e-�- Lic.or Reg.No. Date" em empty,... y: 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- : NO. PARKING _ - '} ness and Professions Code 9. f )' = SPACES PROVIDED �I O O 1, as owner of the property, will do the work and the # oTo'•o o' 8 . structure is not-intended or offered: fur sale (Section i 7044, Business and Professions Code). Bo 'oto 0 0 0 o W ' ' -POSED USE OF UILDING - _ CONSTRUCTION LENDING AGENCY UphOlSery, 'T QUph01$teTy 0;5.24,782 l hereby affirm that.there is a construction'lend.i ,.. g agency for the performance of,the work for which this permit is Shop.`Or }ussiness issued(Sec. 3097,Civ.C.). Lender's.Name veoPoseo•Mwx. bcc. Lender's Address PERi�tIT FEE I.certify, that:t have read this application and state that the above informatlon'is correct.I agree to comply with all County ISSUANCE FEE ordinances_'and State;laws relating.to building construction; .�Q, TOTAL FEE - and hereby authorize representatives of this County to,enter,. I �. on the abo -mentioned ro ert for' ins ec ion purposes. p P , D y p p p SEE REVERSE FOR EXPLANATORY LANGUAGE' gnatur ermittee" Date -' WORKERS'COMPENSATION DECLARATION 76M444 -MISCELLANEOUS APPLICATION CE 875 (1184) f� 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.). �J Policy.No. Company FOR APPLICANT TO FILL IN puILD�NG �j AD OR SS ❑ Certified copy is hereby furnished. g BUILDING LOCALITY ADDRESS $ ~ („ D t i F Certified copy is filed with the county building inspection X LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST OISTRICT NO, I GR� ITYPE / ESSED BY CROSS ST. D� CONST.(///// i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE OESCRIPTION Lor 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 IS100) or less.) UsE OF SIZE OF LOT EXISTING.BLDG. I certify that in the performance of the work for which -his ; permit is issued, I shall not employ any person in any manner X OWNER so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP �� = MAIL DORESS ` �. I " . Date applicant X - = TEL..- NOTIGL TO APPLIC.�NT: If, after making this Cenificate of CITY i-2T ?.3 OCCUPANT LOAD -- Exemption, you should become subject to the Workers` APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code. you must forth 1 with Comply -with such provisions )r :his permit shall be TRAILER USE !!=1 GEOLOGY INSPECTION L.J deemed revoked. _ — No Spec. Knowl. LICENSED CONTRACTORS DECLARATION oCcuPANc r INSPECTION !g Panic Devices N _ M I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT 1L1 TEMS BELOW – ' 9 (commencine with Section 7000)of Division 3 of the Busi- No. of exlTs ness and Professions Code, and my license is in bill force and effect. PARKING SPACES RE.'..D PROVIDED I I n lJ License Number Lic. Class .LIMITED TIM _i .n COntract0r • Dale OATE DATE N FVOM: 'O: 0 1 ani exempt :'rom 'he licensingrequirements .is l ain a: 9 1 licensed architect or a rec_istered professional �niinee-. 31ZE OF -10. OF -INSPECTORS ? actino in Inv .professional capacity I.Sec 11011 0 I. Bus- EXIST:.IG SLOG. -� STORIES SIGNATURE inessand ProfessionsCode). — F!NALAPPROVAL PRESENT USE OF 3UILDING u Lic.or Ree. No. _ Date _ HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS ON LOT AND 'JSE 1 hereby affirm that i am exempt Crom the Contractor's License. Law for the Pollok ing reason ISecttun 7031:'�. Busi- ! `7 ness and Professions Code l: NO. PARKING f SPACES PROVIDED 1, as owner of ,he property. ,vill do the work .ind :he structure is not intended or offered for ;ale Section 1 7044.Business and Professions Code). CONSTRUCTION I-ENDING AGENCY � PROPOSED USE OF BUILDING I liereb_y affirm that there is a construction lendins aoencv 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 25.UU I certify that I have read this application and state that the PERMIT FE_G 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 1 upon thboyo-mention�drtyforinspection purposes.` c SEE REVERSE FOR EXPLANATORY LANGUAGE St^nart:rr of '16 WORKERS'COMPENSATION DECLARATION CE 875(11-841 a CE MISCELLANEOUS APPLICATION 87 ' 1 hereby affirm that o have' certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' rs'Compensation Insurance,or. a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyBUILDING q FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. BUILDING XX ADDRESS -( LOCALITY CQItifled Copy 1S filed with the county budding Inspection' �,LOCALIrr NEAREST - department. ][y.-: /� ��Z7 CROSS ST. Date Applicant ,NEAREST / - DISTRICT NO. GROUP ITYPE _77P,R�ESSED BY CROSS ST. �Q/y +/�� Q CONST ' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Cy ` /cam /ZA�GG� COMPENSATION INSURANCE " ' DESCRIPTION LOT NO BLOCK MAP HIGHWAY NO. (CIRCLE). STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This Section need not be completed if the Work Involved TRAC7 NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) s USE OF SIZE OF LOT - EXISTING BLDG. I certify that in the performance of the work for which this j. permit is issued, I shall not employ any person in any mann OWNER o �xx� of building -n/� =� so as to become subject to the Workers' Compensation Laws. ; MAIL OCCUPANCY GROUP C3 Date A licit J AoD"REss .ypt�Q LQ'S TUi9QS Pp s . TEL. NOTICE T APPLICANT: If, er mg this ertifrcate of ,!.CITr No. �a/�lb`" OCCUPANT LOAD V3 Exemption, you should become subject to the Workers' } Compensation provisions of the Labor Code,you must forth- i; APPLICATION FOR EXIT HARDWARE: with comply With such provisions or this permit shall be. TRAILER USE C]' GEOLOGY INSPECTION'❑ - .NO Spec. KnOWI. ❑ deemed revoked. - Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ 11 hereby affirm that I am licensed under provisions of Chapter j' SAFETY PERMIT ❑ (LIST ITEMS-BELOW) a 9 (commencing with Section 7000) of Division 3 of the Busi- t: NO. OF EXITS ness and Professions Code,'and my license is in full force alk h effect Name of business PARKING REQ'D PROVIDED 1 I .1' SPACES License Number Lic. Class i LIMITED TIME �E :z, Contractor Date DATE DATE FROM: TO: El I am exempt from the licensing requirements'as 1 am a licensed architect or a registered professional engineer SIZE OF No. F INSPECTOR s acting in my professional capacityG BLDG. STOI (Section 7051, Bus- EXISTING RES r7p i SLGNA URE•• iness and Professions Code). , FINAL APPROVAL . I PRESENT USE OR BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS y� 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 o" 1, as owner of thero err SPACES PROVIDED p p y,.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..affinn 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 - ' [ certify that I have read this application and state that the PERMIT FEE above information is correct. I agree tocomply 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. QQ I. "th7abb vementioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY•LANGUAGE XX XX (j b Sign ire of Penifittee Date ,vORl:fa(s'COMPL:IVSATION DECLARATION. CE 875 MISCELLANEOUS APPLICATION- CE 875 (1 1�84) 1 herebor a m that 1 have a. certificate of consent nc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or I certified copy thereof ISec. 3800,Lab.C.). Policy No, __.--.-_—_Con7pallyBUILDING FOR APPLICANT TO FILL IN ADDRESS a Certified copy is hereby furnished. BUILDINGq) )/ LOCALITY XX DR ESS__ll - - ❑ Certified copy is filed with-the County building inspection LOCALITY'/� - NE ARE ST' departlllellt. xy _ CROSS ST. Date Applicant'—___ --_. NEAREST 'DISTRICT NO. GROUP TYPE- CESSED BY -' CROSS ST. ;' 1-,.t�lY1 B�" S7 - 0� CONST. CERTIFICATE E QE EXEMPTION FROM WORKERS' . LEGAL J C ONIPI:NSATION'INSURANCE � DESCRIPTION LOT NO. BLOCK- MAP - - _ NO. (CIRCLE) -STATE MAJOR SECOND LOCAL NO. OF BLDGS: (17his_ section need not be completed if tile. work Involved TRACT - NOW ON LOT- - _ USE ZONE SPECIAL CONDITIONS by the permit is for one. hundred dollars (SI00) or less.) USEOF SIZE OF LOT - EXISTING BLDG. certify that in the-performance of the.work for which this c� permit is issued, I shall.not employ any person in any mannexX R of buildin 13eW& -1_ln d e So as to 11eL'0111e slihfe(•t to the Workers' C'onipensation,Laws• MAIL _ OCCUPANCY GROUP c � ADOR ESS fo �1 LAS IVtf. 141 � '. U Date--------_—_. Applicant_--- — p f�Q L Gj ul _r�/!r I e CI.r TEL• I d—�96— �v l OCCUPANT LOAD NOTICE TO APPLICANT. If, after makingthis Certificate of CITY NO:. N 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-E] GEOLOGY INSPECTION ❑ NO Spec. Knowl. deemed revoked. LI('I::NSI:U('(1N'I RACI ORS DECLARATION OCCUPANCY INSPECTIONE] _ Panic Devices - -. I hereby affirin that I ;lin 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 anX r t effect. e of business PARKING V REO�D 1 1 -PROIDED SPACES l .J E::= License Number-----.--- I,ic. Class-- L7S 60 D,( / 7°Y LIMITED TIME USE Contractor.____---------__---- Date_ DATE DATE FROM: TO: El I ani exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE OF NO.-OF I S CTOR S acting in my professional capacity`(Section 7051, Bus- EXISTING BLDG. STORIES- SI ATURE iness and Professions Code). - PRESENT USE OF BUILDING FINAL APPROVAL >QAJ: Lic:or Reg. No. -- -- ..----- — — Date !` ,_.._..:... IIONI{ OWNER-BUILDER DIiCLARA_"KION NO. OF EXISTING BUILDINGS // �/ _ ON LOT AND USE - � I�� _ i` `•_ _ I hereby affirm that I- ;un exempt, from the Contractor's a� License law for the following reason (Section 7031.5, Busi ,rnit : : hi i; (less 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). CONSIRUCfION LENDING AGENCY PROPOSED USE OF BUILDING hereby affirm that there is a construction.lending agency for the, performance of the"work for which this permit is issued ISec. 3097,('iv.C.1. Lender's Nance —_. r PROPOSED MAX*OCC. Lender's Address.— _ . /I certity that 1 have read ihis application and state that the PERMIT FEE '4 above information is correct.'I agree to comply with all County i 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-mentioned property for inspection purposes.// XX 11 X ,-10� l o SEE REVERSE FOti PL EXANATO )LANGUAGE