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HomeMy Public PortalAbout9117-9119-9121 LAS TUNAS DR_Miscellaneous__ TEMPLE CITY 76M444-DBS 7511.55 MISCELLANEOUS APPLICATION 1 DIVISION. OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO F LL IN NEAREST OWNER L��AI�.s Fc/S FLU CROSS ST. MAIL C, ` ILmss` / U� Dmf DISTRICT N0 l ) GROUP TYPE CONST. ADDRESS L L. L! TEL. CITY /dL �e T_ NO. MAP Gy / STATE TEL, NUMBER �C C� HWY YES NO CONTRACTOR NO. USE ZONE SPECIAL CONDITIONS \ ADDRESS LEGAL v DESCRIPTION I LOT NO.,-414".;14 I BLOCK BUILDING EXIST., NO.OF BLDGS. SETBACK YARDI HWY STREET N E � I WIDTH I - TRACT S © °J I NOW ON LOT FRONT P. L. USE OF SIDE SIZE OF LOT EXISTING BLDG. P L APPLICATION FOR INSPECTION RECORD OCCUPANCY INSPECTION I SAFETY PERMIT TRAILER USE I LIMITED TIME USE ___ � .... i _... ....---:........ _.__... DATE FROM: 4 TO: SE Oir STRIJCTURES OR VICES I I — _ ._........................................._ Cc f __— .......:................1................. .............. f __ _ _ .__... .......:...... �......................._........ INSPECTION FOR OCCUPANCYAS ---- - I-•—_ _._..._.......:........................................_.........I.................-............. APPROVALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS DATE INSPECTOR'S SIGNATURE APPLICATION AND STATE THAT THE ABOVE IS CORRECT _ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES OCCUPANCY APPROVAL AND STATE LAWS REGULATING BUILD NG CONSTRUC- GROUP OCC.LOAD TION. SIGNATUR11 TRAILER USE PQRMITTEE Q SAFETY PERMIT ADDRESS TEMPORARY IVB STRUCTURE APPROVED * TEMPORARY - FEE$ STRUCTURE REMOVED � lY1d i/ �'� � t FINAL APPROVAL JOHN A. LAMBIE, COUNTY ENGINEER VALIDATE CLYDE N. DIRLPA CHIEF BLDG.INSPECTOR CK MO CASH 4... i 4 � t r WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E�� LA N EO U S•A P P L I C AT I O N 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 certificatebf Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy Ne, Company FOR APPLICANT TG'.FILLA BUILDING _ ADDRESS 77 .AL2 Certified copy is hereby furnished. BUILDING ` \G Com- -�a� ADDRESS 1 _1 1i v LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY SS ST. `C/ D f1 -� CONST ` Q O COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGRWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL ' -CERTIFICATE OF EXEMPTION FROM WORKERS" 'LEGALNO. 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. �j •'a - I certify that in the performance of the work for which thiso permit is issued, I shall not employ any person in any manner OWNER ,r �u140/*V' CD so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP �a o ADDRESS x ' Date Applicant TEL UJX' NOTICE TO'APPLICANT: If, after making this Certificate of CITY - No. 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 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�' (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 /e7�S���S effect.; /.J PARKING 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 saE 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 „ F1 NAL APA PROVL. Lic.or Reg.No. Date E C HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSO FEE ON LOT AND USE `_` 1►►(A/{'/ '-"" V O ' I hereby affirm that I. am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi 0000-+ 001 '11/24192 ness and Professions Code): NO. PARKING SPACES.PROVIDED ❑ 1, as owner of the property, will do the work and the 6701 1 PM 5:06 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING S F'P—V C C I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address a , PERMIT FEE - I certify that I hav read this application and state that the above informatio s correct.I agree com ly with all County ISSUANCE FEE• ordinances and tate laws r to bu' ding construction, and hereby a orize rep n ives of t is.County to enter TOTAL FEE upon the a ve- entione spection purposes. It23-pZ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per tt Date l WORKER ,°COMPENSATION.DECLARATION 76M444 CE 875 (11-84) M I SC E L LA N EO U S APPLICATION I hereby affirm that i have certificate of consent to self COUNTY OF LOS ANGELES, BUILDING AND SAFETY DIVISION insure, or d certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company - fl/r/4-IR APP LI CANT TO FILL I • BUILDING ADDRESS •N.C� Certified copy is hereby furnished. BUILDING L LOCAL.rr ❑ ADDRESS. ��GI/// J�� - Certified copy-is filed with the county building inspection LOCALITY NEAREST department. el CROSS ST. Date - Applicant - ' EAREST �`�� � �. DISTRICT N9. G TYPE PROCE rSED BY CROSS ST. Jr OX CONST. 3J CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL u ✓l COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATEMAJOR SECON LOCAL NO. OF BLD GS, (This section need not be'completed if the work involved TRACT NOW ON LOT USE ZONESPE C IALCONDITIONS by the permit is forone hundred dollars ($100) or less.) USE OF ' IZE 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 �E-,r� _D6C'rp[' so as to become subject to the Workers' Compensation Laws. no _ ,J' }} J�//A µA µms/", OCCUPANCY GROUP o JADDRESS ,/..'IS//'w�// Al � '� - I. Date Applicant c C-3 rEL' OCCUPANT LOAD N NOTICE TO APPLICANT: If, after making this Certificate oflrY �'C No. f Y Z l 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 I hereby affirm that I am licensed under provisions o£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 17 I,.am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: To: INSPECTOR'S acting in my professional capacity (Section 7051, Bus XISTING BLDG._ STORIES SI NATURE inessand'ProfessionsCode). _ 1'A�C� FINAL APPROVAL ' PRESENT USE OF BUILDING �C , L'ic.or Reg.No. Date r`inf�rK N HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE e e • a s o o z I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi I ( ' $7 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING r' I hereby affirm that there is a construction lending agency x C� 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 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 u n the above-mentioned pro erty for inspection p rposes. Z � SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Dade YORKERS'COMPENSATION DECLARATION 76M444 16" CE 875(11-84) - M ISCELLANEOUS APPLICATION I hereby affirm that'I have a certificate of'consent`'to self insure, or a certificate of Worker s'.Compensation Insurance,or COUNTY OF LOS ANGELES_: BUILDING AND SAFETY DIVISION u a certified copy thereof(Sec. 3800,Lab.C.). BUILDI. Policy No. ` Company FOR APPLICANT TO FILL IN . . .G ADDRESS. .Certified copy is hereby, V BUILDING \ LOCALITY ADDRESS v a Certified copy is filed with the county building ihspection� LOCALITY `� CROSS sT. department. Date Applicant NEAREST DISTRICT NO. GROUP YPE' OC -SSED BY " � LL ` Fj`��7 e - V CROSS ST. � 7 �: `Y '. CON r CERTIFICATE OF EXEMPTION FROM'WORKERS_ LEGAL COMPENSATION INSURANCE' DESCRIPTION LOT No, BLOCK MAP ) [GHCWAY - - ,., NO.���•�aCIRCLEI- STATE SECOND , T TE MAJOR E ND LOCAL NO. OF BLDGS. (This section need n'ot 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 BL - /..- "!— - - I certify that in`the. 6rf6rmance',6f the work for which this ' 1. of permit is issued,I shat not employ any person in any manner,-j `OWNER. 'r y, so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP . . . . \� MAIL �p� �� Q .d .Date Applicant ADDRESS TEL' OCCUPANT LOAD LLI NOTICE TO APPLICANT: If;after making this Certificate o cITYl No. C Exemption, .you should' become subject to the WorkersAPPLICA ION FOR , EXIT HARDWARE: z 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: 0 ❑ No Spec. Knowl. El 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 Bus!- NO. OF EXITS 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: I am exempt from the licensing requirements•as,I am a licensed architect or a registered professional engineer' SIZE OF. NO. OF INSPECTOR'S SIGNAT acting in m professional capacity (Section 7051, Bus EXISTING BL.D G. STORIES u mess and Professions.Code).. RE - v PRESENT,USE BUILDING - FI NAL APPROVAL AL' +t SAI I Lic.or Reg:No. Date �e r \ 7 2A O ' HOME OWNER-BUILDER DECLARATION No. OF EXISTIN UILDINGS # •+•`�,� $$. ON LOT AND USE ' �U)'.- I hereby,affirm,that I am exempt from the.Contractor's - License Law for the following'reason (Section 7031.5, Busi cJ.;;87 ness•and Professions Code): No. PARKING _ 0;�"� SPACES PROVIDED, I, 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). CONSTRUCTION LENDING AGENCY V. PROPOSED USE: OF.BUILDING OJ'.`` d0 YYf, y�P I hereby .affirm that there is a construction lending 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, and hereby authorize representatives of this County to enter TOTAL FEE- a1' •00 upo above-mention roperty fu r inspection pu: oses. - SEE REVERSE FOR EXPLANATORY LANGUAGE _ Signature of Permittee date, WORKERS'.COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION , CE 875 I he:ebor certificate that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, of a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.).. Policy No. CompanyFOR_APPLICANT TO FILL IN BUILDING ADDRESS BILDING Certified copy is hereby furnished. ✓ t I AUDDRESS LOCALITY Certified 'copy is filed with the county building inspection LOCALITY V /� I NEAR EST department. �— S io1 CROSS ST. Date Applicant NEAREST , DISTRICT NO. GROUP TYPE P O ES5ED BY CROSS ST. V!(/('f11- CONST.,I/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a �/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL . (This SCCtIOn need not be completed if the work involved TRACT NOOF BLDGS.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. — A d 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 �01j1� �f Sf,( o so as to become subject to the Workers' Compensation Laws. / MAIL OCCUPANCY GROUP 4 � /,( r/ V/ ADDRESS Date Applicant l/ Z-45 /II/�/FT TEL. n NOTICE TO APPLICANT: If, after making this Certificate of ✓ CITY 1 NO. ZLd 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] El 'I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 Of the BUSY SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED .� ' License Number Lia Class Z \, l as 7 /&7n 6t 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). FINAL APPROVAL Llc.or Reg.No. Date PRESENT USE OF BUILDING , HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS- / G � wg €� - �y'" ON LOT AND USE - 0 ° '• "'"' I hereby affirm that I 'am exempt from the Contractors License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING =1 € - "±_'3 ` '}',•'. " ' I, as owner of the property, will do the work and theSPACES PROVIDED - • ! h�!�9 ',,r�s 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 L 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 reprepentatives of this County to enter TOTAL FEE upon the above-mention roperty for inspection urposes. SEE REVERSE FOREXPLANATORYLANGUAGE ✓ �f O Sign of er'mitt ee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). 4 Policy No. Company FOR APPLICANT TO FILL IN eu"DING ADDRESS Certified copy is hereby furnished. BUILDINGS J ADDRESS LO CA LIT Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DIST T'N G OUP TYPE P CeS5ED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o� �-WA COMPENSATION INSURANCE DESCRIPTION Lor NO, BLOCK MAP HIGHWAY ' - NO. (CIRCLE) STATE'MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the Work or less.) TRACT NQW ON LOT USE ZONE SPECIAL CONDITIONS by. the permit is for one hundred dollars ($100) or less.) • �'� STI BLDG. - I certify that in the performance of the work for which this 5 . .o I „ _ .'. — o permit is issued, I shall not employ any person in any manner ef-, so as to become subject to the Workers' Compensation Laws. y � Mt I P MAIL _�, �s - �' OCCUPANCY GROUP o ADDRESS`_ _ I y Date Applicant - TEL sIJJ o_. NOTICE TO APPLICANT: If, after making this Certificate of CITY OCCUPANT LOAD G NO. _ a2I' Exemption, you should become subject to the Workers' APPLIC ION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth With comply with such provisions or. this permit shall be TRAILER USE _GEO OGY 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 ❑ (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 2 � ny f effect. T. V PARKING SPACES REQ'D PROVIDED License Number Lic. Class _ LIMITED TIME USE r Contractor Date - t - - ---� -t+-S DATE DATE I am exempt from the licensing requirements as I am a ' FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). Lic.or Reg.No. Date PRESENT USE OF BUILDING r FINAL.APPROVAL ,Q HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS D ON LOT AND USE G §-"@ € FEE 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. PARicING is;_i;yi= i',)_;� ^�:�.--;._Z4 I as owner of the property, will do the work and the SPACES PROVIDED i? -- �_. , structure is not intended or offered for sale (Section 52164 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.Q. Lender's Name PROPOSED MAX. OCC. - Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE Fee ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL. FEE �s upon the bove-mentio9rd p pert for mspe tion,purposes. /Q SEE REVERSE FOR EXPLANATORY LANGUAGE � ' s Signature of Permittee Date ^•WORKERS'COMPENSATION'DEC LARATION CE 875(2-80) M, I SC E'L LA I eA E®'V S. APPLICATION . I.hereby affirm that L have a certificate of consent to self COUNTY,OF LOS ANGELES' WILDING AND SAFETY DIVISION- ;I:nsure,'or a certificate of Workers"Compensation Insurance,'or a'certified copy the'reof.(Sec. 3800,Lab C.) Policy No..neW Company State• Fund' FOR APPLICANT TO FILL INr3.uiLDRESSirvG. ADD _ O Cerfified-copy is hereby furnished.- W.LNG: LOCALITY. 55 - - 1 l E L s..Tiin s D Certified copy.I:q.filed`with the county building inspection NEAREST - �•; LOCALITY - CROSS ST. 1 '- : department, Date Applicant NEAREST P DISTRICT NO. GR UP TYPE PROC SI-D`bY J - CROSS ST �- _ .O.F. �J CONST�- CERTIFICATE`OF EXEMPTION FROM WORKERS' LEGAL OY v` DESCRIPTION LOT.No. LOCK M'AP HIGHWAY ,STATE MAJOR SECOND LOC AL COMPENSATION•:INSURANCE Q •.a ` ,. - - '..[NOW ON LOT NO. (CIRCLE) _ NO. OF.BLDGS _ (3. (This section need.not be`completed:If the work InVO1Ved TRACT- t� USE ZONE SPECIAL CONDITIONS by-;the permit.is. for'one hundred dollais ($100) or less:)'' USE OF { - ' - - SIZE OF LOT EXISTING.BLDG.,.. I certify that In 'the performance of the work for which this cc I permit to[ I shall not employ any person in any manner wNER tv�.�-1 �� Charles ,Doeppel so as fo become`:subject'to the Workers' Compensation Laws Mart C O e rlgera On OCCUPANCY GROUP =,0 DDRESS LU Date Applicant TEL NOTICE TO APPLICANT: If, after making'this'Certificate of.. ciTYTemple -C-ity, NO.'. - OCCUPANT LOAD Z Exemption, you should. become• subject' to the 'Workers' APPLICATION FOR '' EXIT HARDWARE: Compensation provisions of the Labor Code',.you must forth- with- comply with SUCK prOV1S1005 Or this'permit Shall be- -TRAILER USE�' GEOLOGY INSPECTION a - No Spec. KnoWL Q deemed revoked. PBniC Devices- ❑.' OCCUPANCY INSPECTION - -LICENSED,CONTRACTORS DECLARATION ❑ . -I hereby affirm ihat.I am.,licensed under provisions of Chapter SAFETY PERMIT.Q (.LIST ITEMS BELow). 9 (commencing with Section 7000)of Division 3 of the•Busi- rvo..o,F EXITS El ness and Professions'Code, and my license is in full force and PARKING effect." i.. REO'D PROVIDED SPACES -� License Number:- Lic.Class I LIMITED TIME USE COntiaCtOr .,Date - DATE - DATE, , a. FROM T O: 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: 7051, Bus-' EXISTING BLDG STORIES SIGNATURE AnesS'and Professions Code). r PRESENT USE OF BUILDING - - - - FINAL APPROVAL. Lie:,orReg::rro. Date Mail Order Crafts.. HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 3 7 7,[I A ON LOT AND USE- y,affirm',.that..I am'. exempt,from the Contractor's License Law for the following reason.(Section 70&1.5,'Busi- ; . .. -> NO. PARKING r0'.O'.010 O 0 2 ness and Professions•Code): � SPACES PROVIDED 0, 0 I, as owner of the'property,:will'do the work and'the' E structure is not-intended or offered for sale (Sectio Q 7044, Business and'Professions:Code). 16=8 - PROPOSEDUSEOF BUILDING ., CONSTRUCTION LENDING AGENCY' " I hereby affirm that..'there is a construction lending agency Mail Order 'Crafts, for.the performance'of the work for which this .permit ist. , .issued(Sec. 3097,Civ.C.). Lender's Name' PRoaoseD mwx:occ._ , Lender's Address PERMIT Fee I:•certify`that I have read this application and state that the A , 'above information is correct.:I agree to:comply with:all,County : ISSUANCE FEe ordinances and; State laws relating to building construction, TOTAL FEE. and hereby authorize:representatives of this County to enter P*ignature ove-me tioned property for insp cti n ptirposes. ;SEE REVERSE OR•EXPLANATORY.LANGUAGE of Permittee late HOURS 9 to 2 Mon ithru -Friday ••WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P PL I C AT-ION CE 875(11-84) ' - I 9iereby 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. BUILDING Q �� u �rLOCALITY ADDRESS Certified copy is filed with the county building inspection LOCALITY, NEAREST department. ( CROSS.ST. -Date Applicant - NEAREST DISTRI T NO. G OUP TYPE - CESSED BY • CROSS ST. ' v �� 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 perinit 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 �f o permit is issued, I shall not employ any person in any manner OWNER �- �N : y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRES V' '� I— Date Applicant TEL, w NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. (g(� pQ OCCUPANT LOAD D_ Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLIGUTION FOR 'EXIT HARDWARE: with comply With SUCK prOV1S10II5 OI this permit shall beTRAILER USE E] GEOLOGY INSPECTION ❑ No Spec. Knovvl. 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. !l1� 'S PARKING REp'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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S 15,9;,T U R E iness and Professions Code). FINAL APPROVAL JPRESENT USE OF BUILDING .-7 Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION 'NO.OF EXISTING BUILDINGS ON LOT AND USE `23/9 I hereby'affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi c., r�; ness and Professions Code): NO.PARKING .'.�,-..- ! l aI, 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 5- 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 00 upon the above-mentioned'pr erty for inspection'purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE qt� Sign ure of Permittee !0 Date WORKERS'COMPENSATION DECLARATION '16M444- f 875(11-84) I MISCELLANEOUS APPLICATION insure, affirm that I have a certificate of consent to c 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 CCs Certified copy is hereby furnished. BUILDING / ',.-_,I XX ADDRESS � ' V(tv 7V w"U � C• LOCALITY Certified copy is filed with the county.building inspection LOCALITY NEAR EST department. yy, CROss ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P ESSED BY CROSS ST. fj v CO NSTi. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C/e COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF Or I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. C3 permit is issued, I shall not employ any person in any mannerXX OWNER of building C4q1kN(J ;_3 so as to become subject to the Workers' Compensation Laws: MAIL 1 OCCUPANCY GROUP ® o ADDRESS y, MP / V Date Applicant LLJ NOTICE TO APPLICANT: If, after makingthis Certificate of CITY NOL Z OCCUPANT LOAD /W � �u Exemption, you should become subject to the Workers' APPLICAT ON FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices 1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force an X effect. Name of business PARKING '� SPACES REQ'D � PROVIDED -rA License Number Lic. Class � C `d 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- F INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL GS PRESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 0�A 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 F1I, 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 OR 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.). ,5 int Lender's Name ., PROPOSED MAX. OCC. Lender's Address - I certify that I have read this application and state that the I PERMIT FEE 25 . 00 r s above information is correct. I agree to comply with all County ISSUANCE FEE M ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 upon the ove mentioned propert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX Signature of Permittee / Date'. -