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HomeMy Public PortalAbout9123, 9123 1/2, 9125, 9125 1/2 LAS TUNAS DR_Miscellaneous__ WPRKERS'COMPENSATION DECLARATION CE 875(2-80) Intl �SC E L LA N E O U S A P P L I C AT B ON. 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 ceilified copy thereof(Sec:3800,Lab.-C.) Policy No. Company FOR APPLICANT TO FILL`IN BUILDING eri✓ ADDRESS ❑ Certified copy is hereby furnished. BUDREING ss LOCALITY L DCertified•copy is,filed with the county building inspection, rvEaREsr department. If LocwLlrY CROSS ST. Date Applicant NEAREST DISTRICTjGROUP TYPE PROC SED Yeg CROSS ST. �i Y 2 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL U .DESCRIPTION LOT NO. BLOCK MAPS HIGH wwY COMPENSATION-INSURANCE 7 (CIRCLE) STATE MAJOR SECOND LOCAL N O. ' 1 Q. NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOTUSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF [[ma�•cc CJ ' SIZE 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 OWNER Of .buildQ ing 3" 0 so as to become subject to the Workers' Compensation Laws. L ' OCCUPANCY GROUP Qr2� w DDRESS Date Applicant TEL. n NOTICE TO APPLICANT: If, after making this Certificate of CITY Er No. OCCUPANT LOAD Exemption, you should become subject to the Workers' 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 USE❑ GEOLOGY INSPECTION deemed revoked. ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION MK Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and q effect. �t Name _ _ IT V'P SPACES. REQ'D PROVIDED License Number Lic.Class Hoole .Add fess 6533 e- S'— J _ /7 `� LIMITED TIME ..USE Contractor Date �J GE/rs 1 OQ7"d DATE DATE Phone 0713 v FROM: TO: I am exempt from the licensing requirements as 1 am a: licensed, architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIS SIGN TORE E iness and Professions Code). P ESENT USE OF BUILDING FINAL APPROVAL o� Lic.or Reg.No. Date 13 HOME OWNER-BUILDER DECLARATION No. aF EXISTINGUJLDINGS 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- D 3 1 '�,b A ness and Professions Code): NO. PERKING zI, SPACES PROVIDED , ❑ I, as owner of the property, will do the-work and the # o o o o 4 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). P oPosED USE of BUILDING o 0 0 0 a 0.b CONSTRUCTION LENDING AGENCY 1.20.—, 80 I hereby. affirm that there is a construction lending agency — CF 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 lawn relating to building construction, and hereby authorize repre tatives of this County to enter TOTAL,FEE up o t v � r�flspection p rposes- SEE REVERS E FOR EXPLANATORY LANGUAGE nature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 84 541(11-84) MISCELLANEOUS APPLICATION I hezZby'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.). g Policy No. CompanyFOR APPLICANT TO-FI LL IN ADDRESS r�d' Certified copy is hereby furnished. BUILDING ?/ ,/ LOCALITY ADDRESS j 0 Certified copy is filed with the county building inspection LOCALIT NEAREST department. I CROSS ST. Date Applicant NEAREST /\a p-^ - DISTRICT NO G'OUP TYPE CESSED BY CROSS ST. v •7 ��� a CONST., / IW CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL r) V COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER [z;E y so as to become subject to the Workers' Compensation Laws. MAIL l OCCUPANCY GROUP o ADDRESS / u, _6z I— Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CIT �� �� I NO. OCCUPANT LOAD z Y Exemption, you should become subject to the Workers' AP LIGATION FOR / EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ ' GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION / Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3o the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. S PARKING SPACES REQ'D PROVIDED .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 SIGNATURE iness and Professions Code). FINAL APPROVAL / PRESENT USE OF BUILDING (^ ak:�— Lic.or Reg.No. Date y HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's fl License Law.for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED 1, as owner of the property, will do the work and the VI 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 NC /e.S ) for the performance of the work for which this permit is r issued(Sec. 3097,Civ.C.). Q� LJy Lender's Name PROPOSE MAX. OCC. Lender's Address B-0 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 he by authorize representatives of this County to enter TOTAL FEE upon ab ve-mentioned property,for inspection urpos s. j „SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ittee / Daeee WORKERS'.COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I• affirm that I have a certificate of consent to sett' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insuresure,, or a-certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING r �I • ADDRESS Certified copy is hereby furnished. AD.REss ' 9 123 C. L,4S 7UN,4S I)RI M LOCALITY ElCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP ITYPE PROCESSED BY CROSS ST. ' ,y�/ CONST.i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (fa v 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 ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF ���555 SIZE OF LOT EXISTING BLDG. ��� -// 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 OWNERpfy NIN RICCI so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP AMAILDDRESS1_9125 E. .Ca'6 Tunas DIt-i Dle Date Applicant I„ TEL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CIT 7,E('PL,' CI 7 N�-8 9 8-2 8 5-3 2 2 4 N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR E ARDWARE: with comply with such provisions Or this permit shall be TRAILER USE ❑ GEOLOGY INSPECT N ❑ Spec. Knowl. deemed revoked. Pani Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS ELOW) 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 T ��� PARKING effect. 3 RE 'D PROVIDED License Number Lie. Class SPACES LIMITS TIME USE Contractor Date DATEDATE FROM: TO: El I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF O. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. TORIES SIGNATURE inessand Professions Code). FINAL APPRO AL PRESENT USE OF BUILDING Lie.or Reg.No. Date 4 � F – �-- HOME OWNER-BUILDER DECLARATION NO.OF EXISTING UILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's ( E„!ji l–i ii'I 42 1 121,/"4 S License Law for the following reason (Section 7031.5; Busi- ness and Professions Code): NO. kqRKING I, as owner of the property, will do the work and the SPAC PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY [PROPOSED U OF BUILD( E L (� PROT. I hereby affirm that there is a construction lending agency OFTICE. for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name ROPOSED MAX. OCC. ,0 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 t abo -mention roperty for inspection purposes. �� IZ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittf ate WORKERS'COMPENSATION DECLARATION 76M444 zt;—2 2,Z-2A I 10 ,Quo CE 875(11-84) MISCELLANEOUS APPLICATION {� I hereby affirm that 1. have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LI insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL INR BUILDING-NR UILDING ADDRESS Certified copy is hereby furnished. AD G 1 Ss y A—. LOCALITY 0 Certified copy is filed with the county building inspection LOCALIT NEAREST department. ---ss sr. Date Applicant NEAREST -���� DISTRICT NO. G OUP TYPE PJjR,9n E'S SSED BY y CROSS ST. ', _� CONST. C• './1,t�o 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 I certify that in the performance of the work for which this slzE of Lor Exls INC BLDG. !�[/ o permit is issued, I shall not employ any person in any manner OWNER 10J4= 131//;,/pllyd =' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ss � � a Date Applicant TEL I„ NOTICE TO APPLICANT: If, after making this Certificate of CITY 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- such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ID No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑7 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 and effect. C/S�/7 !/ C PARKING SPACES REO'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date 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 INs 'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES Tu iness and Professions Code). PRESENT USE OF BUILDING x � � INAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE � I•..4� + I hereby affirm that I am exempt from the Contractor's Z!003 ,3013 ws t ¢.!' i1_f; v, Li 1 License Law for the following reason (Section 7031.5, Busi- ness usi `' 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 I hereby affirm that there is a construction lending agency — a- 2 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). s+ tf`�J 1 Lender's Name PROPOSED MAX. OCC. Lender's Address n�a© PERMIT FEE oc I I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon t above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Cl Signature of Permittee Date •WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) M ISCELL4�4KIEOUS APPLICATION I htreb}*�ffum that I have'a Ca tlficate of consent•to self r,r- / insure, gr a certificate of Workers'Compensation Insurance,or• COUNTY OF LOS ANGELES �i BUILDING AND SAFETY DIVISION �f a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN UILo1NG DRESS ,��5 H/✓ Certified copy is hereby furnished. 'BUILPPDR ESSSS OCALITY DRJ DCertified copy is filed with the county building inspection OCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. G OUP TYPE PRO SSSED BY CROSS ST. �"' O CONST. RO \J CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NO. F BLOGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPEJIAL OND TION C4 a by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. \ V permit is issued, I shall not employ any person in any manner OWNER CD so as to become subject to the Workers' Compensation Laws. MAIL r)qC,C / OCCUPANCY GROUP 1 DDRESS U Date- Applicant +,, Cl�l ' D NOTI TO APPLICANT: If, after making this Certificate of CITY �� := Cl rEOCCUPANT LOAD NEC:). � 1 Exemption, you should become subject to the Workers' APPL ATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth- with comply with Such pIOvr$ion$ or this permit shall be TRAILER USE GEO GY INSPECTION ❑ No Spec. Knowl. deemed revoked. 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 Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and / C effect, PARKING r` SPACES REq•D PROVIDEp O License Number Lic. Class 1 LIMITED TIME USE Contractor Date G' V� S DATE DATE FROM: TO: 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF F INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING B . (7�/ IES SIGNATURE iness and Professions Code). Lic.or Reg.No. Date UU FINAL APPROVAL PRES U F UILDIN HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUIL61 Gs / 30 ON LOT AND USE 1 hereby affirm that I am exempt from the Contractor's ACCT.A License Law for the following reason (Section 7031.5, Busi- 3307 80 o:+c0 ness and Professions Code): No. PARKING v ❑ I, as owner of they, will do the work-and the SPACES PROVIDED propert , P j 1 ITEMS structure is not intended or offered for sale (Section `J TOTAL 112110 Q 50 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE: OF BUILDING \ a� CHEC{�i 80.50 I hereby affirm that there is a construction lending agency v CAANGE .00 for the performance of the work for which this permit is issued(Sec. 3097,Civ-C.). Lender's Name 0000_0001 5/12/89 PROPOSED MAX. O C. Lender's Address PERMIT FEE 7D J 3238 1 AM 3:22 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 y V ordinances and State laws relating to building construction, \ and hereby authorize representatives of this County to enter TOTAL FEE upon the above entioned property for inspection purposes. , D��Co , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 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.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING �, y �� ADDRESS Certified copy is hereby furnished. BUILDING J ADDRESS 1_.=�a (' LOCALITY L Certified copy is filed with the county building inspection LOCALITY NEAREST department. TTAM&2LYCROSS ST. Date Applicant NEAREST D_I ST l I TYPE PRO SS CROSS ST. �y� (/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C•-•��] VA COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY O. F BLDGS. NO. (CIRCLE) STATE MAJOR 5 COND OCAL N (This section need not be completed if the work involved TRACT NOWOON 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. permit is issued,I shall not employ any person in any manner OWNER o so as to become subject to the Workers' Compensation Laws. �� c� MAIL OCCUPANCY GROUP ADDRESS r KI 1P Date Applicant yCl �, TEL. ''Iv1 NOTICE TO APPLICANT: If, after making this Certificate of CITY E _ G• . NO. OCCUPANT LOAD LO Exempiion, 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. 'F� deemed revoked. � Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. OF EXITS ness and Professions Code,and my license is in full force and + �,�J effect.- Uin PARKING REQ'D PROVIDED SPACES License Number Lie. Class S 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 IGNATU iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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 �}(1 SPACES PROVIDED ��1�•310-i"-'- 6/40. 9 I, as owner of the property, will.do the work and the structure is not intended or offered for sale (Section .sag. SII �' If 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINO- I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is r' issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address _ a • I certify that I have read this application and state that the PERMIT FEE above influmation 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 upork4ke above-mentioned property for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 10atJ WORKERS'COMPENSATION DECLARATION 76M444 CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that 1 have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 1 insure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDINGADDRESS'L 91H LOCALITY Certified copy is filed with the county building inspection LOCALITY ` ftS ' NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP wtrw" Y r No. (CIRCLE) STATE MAJOR SE",GO Nb 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 O� SIZE OF LOT EXISTING BLDG. - � 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL �: o OCCUPANCY GROUP ADD �- ADDRESS Date Applicant -r Q NOTICE TO APPLICANT: If, after making this Certificate of CITY No�, OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, must forth- LI ATI ON FO EXIT HARDWARE: W with comply with such provisions or this permit shall be TRAILER USEGEOLOGY 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 effect. PARKING REO'D D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: To: licensed architect or a registered professional engineer SIZE OF NO. OF INSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL Lic.ur Reg.No. Date PRESENT USE OF BUILDING J 'I HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness;and Professions Code): NO.PARKING I, as owner of the property, will do the work and the SPACES PROVIDED �^ structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING..GENERAL g PROZI- 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 a K; 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 fir above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKE D -i0?VIPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION jY CE 875 I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES UIL G AND SAFETY DIVISION insure, or a certificate of Workers',Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN ADDRESS DDR ADDRESSSS M Certified copy is hereby furnished. BUILDING NQS ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY ,� NEAREST department. �m, CROSS ST. Q��-- Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. LO 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 (5100) 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 mannerOWNER �, / so as to become subject to the Workers' Compensation Laws. LQ-1MAIL 0CCUPANCY-GROUP AD° Y/1? 4Date Applicant . s TEL. OCCUPANT LOAD d NOTICE TO APPLICANT: If, after making.this Certificate of CITY ��y `� NO. Exemption, you should become subject to the Workers' M.S— 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 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ (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 SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM. TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG, STORIES SI NATURE iness and Professions Code). . PRESENT USE OF BUILDING o�iFINALAPPROVAL Lie.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 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or.offered for sale (Section =L 7044,Business and Professions Code). ACCII AT, CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING WW N43 FEE 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.). I 0 1 1/'27/89 Lender's Name PROPOSED MAX. OCC. 081 f 1, PM I:415 Lender's Address t11 ( I "F PERMIT FEE '�Q I certify that I have read this application and state that the 1 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 ou u on the ab ve-mentioned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate 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-,,hereof(Sec. 3800,Lab.C.). Policy go. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING /2-3 LS i U MAS W- LOCALITY ADDRESS 0 Certified copy is filed with the county building inspection LOCALITYNEAR EST department. I; M.'rLX / I f If 011 9 CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL .1 i COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (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 SIZE 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 U OWNER 16 LDrj J 0 H N K i CC I so as to become subject to the Workers' Compensation Laws. MAILry (I fl-/ (�I / OCCUPANCY GROUP � AD DR ES 'Z-3 Z_e,-( (fj IN� {// 4 G O Date Applicant c.3 LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY'�7h Pl k C i 7 NL I > OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 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. UME Of PARKING REQ'D PROVIDED SPACES License Number Lic. Class L UX m a C c 6-101( Lr5 9 N,C. , d ji,aL 9// 1�'y I LIMITED TIME USE Contractor Date I'••'hIN VQ—C✓/✓LL`�A 5 u-al ew,^-ect- 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 I SIGNATURE iness and Professions Code). U PR ESE NT SE OF BUILDING FINAL APPROVAL Lic:or Reg.No. Date ! p HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �e 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 - Q I, as owner of the property, will do the work and the SPACES PROVIDED i AM11°51 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 Z Q s. for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. p 3.Q , Lender's Name PROPOSED MAX. OCC. Lender's Address /� PERMIT FEE V I.certify that I have read this application and state that the tl/ elf' V above information is correct.I agree to comply with all County ISSUANCE FEE \� ordinances and State laws relating to building construction, i and hereby authorize representatives of this County to enter TOTAL FEE , u on the ab v -mentioned property for inspection purposes. 10,{ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate WORKERS'COMPENSATION DECLARATION CE 875(11-84) I MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION :..,insure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec. 3800,Lab.Q. BUILDING I'y Policy No. Company FOR APPLICANT TO FILL IN ADDRESS ti Certified copy is hereby furnished. BUILDING ADDRESS LOCALITY r ,� I NEAREST Certified copy is filed with the county building inspection LOCALITY J department.. CROSS ST. ,l Date Applicant NEAREST DISTRICT NO. `GROUPTYPE PROCESSED BY CROSS ST. CONS CERTIFICATE OF EXEMPTION FROM WORKERS' i ' COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY LEGAL NOOF BLDGS. R0. (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 SIZE OF LOT EXISTING BLDG. f.. 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 C� _J so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP i� Date ADDRESS Applicant Q TEL' NOTICE TO APPLICANT: If, after making this Certificate of CITY NOOCCUPANT LOAD, p Exemption, you should become subject to the Workers' o_ r. Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: ❑ with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION 11-7 deemed revoked. ❑ ❑ No Spec. Knowl. I� LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) r 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS j ness and Professions Code,and my license is in full force and effect. PARKING REO'D � PROVIDED r SPACES JJ License Number Lic. Class US PE LIMITED TIME U:JE Co nttactor Date DATE O ATE DI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessand Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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 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). =' CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING t `� , 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 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 telating 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 Signature of Permittee Date WOR viERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION • CE 875 (11-84)875 1-11CE I hereby afcert 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.). it Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING ADDRSS E S TU AS DR .TEMPLE ELOCALITY ElCertified copy is filed with the county building inspection LOCALITY CIT NEAREST department. CROSS ST. Date Applicant NEAREST A rN T NO. GROUP TYPE CESSED BY CROSS ST. CONST•��- CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL r COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK //� '..WAY _ 2(pcIwCLE) STATE MAJOR SECOND AL NO. OF BLDGS.(This section need not be completed if the work involved TRACT-1 NOW ON LOT 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 C� so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o Date Applicant ADDRESS W TEL' NOTICE TO APPLICANT: If, after making this Certificate of CITY OCCUPANT LOAD �- No. Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth APPLICA I N FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No S . 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 effect. PARKING REQ'D D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE El 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 SIG ATURE inessand Professions Code). FINAL APPROVAL �� PRESENT USE OF BUILDIN Lic.or Reg.No. Date I- I /A HOME OWNER-BUILDER DECLARATION NO. OF EXISTING B IL INGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 9 5 5(1 2 A 7044,Business and Professions Code). (\• # e D D • 88 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING \\ V o 0.0 0 o m o z I hereby affirm that there is a construction lending agency � for the performance of the work for which this permit is 0 9 2 5_8 6 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 uthorize, presentatives of this County to enter TOTAL FEE upon the a e-mens i e roperty for inspection prp s. I 2� SEE REVERSE FOR EXPLANATORY LANGUAGE Sigrre o Pe mittee to WORKERS'COMPENSATION DECLARATION CE 875 (11-84) r CE 875 MISCELLANEOUS APPLICATION I hereby'affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,.or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING /a3 ADDRESS Certified copy is hereby furnished. —J BUILDINGO[� A S g ADDRESS �_ LOCALITY Certified copy is filed with the county building inspection V LOCALITY (/� NEAR EST department. L/l, CROSS ST. Date Applicant NEAREST /� DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. (J�- moi.. O io Z CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL i✓�, Uv COMPENSATION INSURANCE DESCRIPTION LOT NO.91 BLOCK MAP HIGHWAY • NO. NO. (CIRCLE) STATE MAJOR SECOND LOCAL OF BLDGS, (This section need not be completed if the work involved .TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this lL o permit is issued, I shall not employ any person in any manner V OWNER �� ��• — I c> so as to become subject to the Workers' Compensation Laws. - _MAIL OCCUPANCY GROUP o ADDRESS S Date Applicant l w NOTICE TO APPLICANT: If, after making this Certificate of%4 CITY TNF.. OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APP CATION 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 ness and Professions Code,and my license is in full force and effect. PARKING SPACES REO'D D PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor 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 #,O.CINSPIE&rgR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 'SIGNATURE iness and Professions Code): ;``� Y FINAL APPROVAL PRESENT USE OF BUILDING w Lic.or Reg.No. Date �� Yl h HOME OWNER-BUILDER DECLARATION NO. OF EXISTIN BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING F] I, as owner of the property, will do the work and the SPACES PROVIDED ' J structure is not.intended or offered for sale (Section C/V 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 ��v•oQ above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and Stat laws ting o b ilding construction, and hereby authorize epr sen tive of his County to enter TOTAL FEE u o tea ve men ' edgrope ty in pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 cMISCELLANEOUS APPLICATION �I 1 hereby a rrin that I have a certificate of consent to self CE 875(11-84) insuze, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.C.). Policy No.-Company FOR APPLICANT TO FILL IN BUILDING �+ ADDRESS /s Certified copy is hereby furnished. BUILDING ADDRESS 2S" LOCALITY Certified copy is filed with the county building inspectionLOCALITYI NEAREST department. CROSS Sr. Date Applicant NEAREST DISTRICT NO. GROUP TYPE ESSED BY CROSS ST. `O /3 CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL vJ-1 IVf COMPENSATION INSURANCE DESCRIPTION LOT NO. "� BLOCK MAP L HIGHWAY(CIRCLE) STATE MAJOR SECOND LOCAL ^ q NO. OF LDGS. (This section need not be completed if the work involved TRACT �G V NOW ONBLOT USE ZONESPECIAL 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. .��i, a permit is issued, I shall not employ any person in any manner OWNER CD so as to become subject to the Workers' Compensation Laws. MAIL _ �'~ OCCUPANCY GROUP o Date Applicant ADDRESS q EE9 � pp EL0 L' p OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of -I T (. TE 6 Zg'S 3-22 Exemption, you should become subject to the Workers' _ Compensation provisions of the Labor Code, you must forth- U Al2JLICATION 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 occuawNCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PER MIT 9 (commencing with Section 7000) of Division 3 of the Busi- ❑ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING REQ'D O PROVIDED SPACES J License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: D I am exempt from the licensing requirements as I am a licensed architect or a registered ,professional engineer SIZE OF NO. OF INS ECTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES �9 S NATURE inessand Professions Code). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING (�` C/ 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 ❑ 1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section ;255Q-1 A 7044,Business and Professions Code). ® # o o e e 88 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency 4\ for the performance of the work for which this permit is NO, n/ 9,2 5' 8 6 Lender's Name issued(Sec. 3097,Civ.C.). ,d PROPOS MAX. OCC. Lender's Address PPERMIT-?W 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 Cou ty to enter TOTAL. FEE upon the above-mentioned property for inspectio purp ses. / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PermitZV Date WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION CE 875 (11-84) I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sea 3800,Lab.C.). t' Policy No. —__Company_ FOR APPLICANT TO FILL IN ` BUILDING ADDRESS Certified copy is hereby furnished. BUILDING XX ADDRESS 9123- LOCALITYr 0 Certified Copy Is filed with-the county building Inspection' LOCALITNEAREST department. XY Y Temple City, CA 91.780 CROSS ST. Date __Applicant NEARESTDISTRICT NO. G UP T,Y PE CESSED BY •CROSS ST. Sultana ���� p CO NST. CERTIFICATEOF EXEMPTION FROM WORKERS' ^ LEGAL o COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (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 0 1 certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. permit is issued, I shall not employ any person in any mannexX OWNER of building Kinn Lam c so as to become suhject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ® c� Date—_--- Applicant — AD --�- %� TEL. O_"f0 APPLICANT: If, after making this Certificate of CITY - - ' No, y d(p yo OCCUPANT LOAD U Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- ❑ With C0111pIV with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION EI No Spec. Knowl. deemed revoked. I_ICI:•:NSI:D CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices ❑ I hereby affirm that I am licensed under provisionsof Chapter 9 (commencing with Section 7000) of Division. 3 of the Busr- SAFETY PERMIT E] ,LIST ITEMS BELOW) NO. OF EXITS mess and PT0fCSSi0Ii9 Code, and my license is in full force a effect. n�� XX Name of buginess PARKING REQ'D PROVIDED SPACES Sylvia & Co. Dance Studio License Number _ l.ic. 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 actino In Illy professional Capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FIN L APPROVAL1-341-giPRESENT USE OF BUILDING Lie.or Reg. No.—___ Date — ((�) Or HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS V L ON LOT AND USE p ,� I hereby affirm that 1 am exempt from the Contractor's /n ��• License Law for the following reason (Section 7031.5, Busi- ness and Profession-,Code): NO. PARKING El 1, as owner of theSPACES PROVIDED O property, 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 affirm that there is a construction lending agency," for the performance of the work for which this permit"is `ri issued(Sec. 3097,Civ.C.). F_, ,•=, '•.,,E rW.. Lendcr'sNamc— 1 PROPOSED MAJC.'OC C, Lender's Address_.-_—_ _ _ is PERMIT FEE I certif'v that I have read this application and state that the 25 . 00iT above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and41licrebyuthorize representatives of this County to enter TOTAL FEE 25 ,UQ upe-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX XXri�iin•��t 1'r r...01 NtiORKERS'CO(•1PENSATION DECLARATION C CE 875 (11-84) MISCELLANEOUS APPLICATION ' E 875 1 liaffirm that 1 have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,re, o or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS ' Certified copy is hereby furnished. BUILDING LOCALITY ✓ , Gr-T� XX ADDRESS �. `, (,ec%fJ•S � . ECertified copy is filed with the county building inspection LOCALITY NEAREST department. ][y, cl2oss ST. Z/ Date---Applicant NEAREST DISTRICT NO. G OUP TYPE CESSED BY _ T. jd� / ` O CON CERTIFICATE OI'EXEMPTION FROM IVORKERS LCROSS SEGAL ,o COMPENSATION INSURANCE DESCRIPTION I LOT O. BLOCK MAP Ntc AWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL _ NO. OF BLDGS. (Phis section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manne}�X OWNER of building so as to become subject to the Workers Compensation Laws. MAIL OCCUPANCY GROUP C. ADDRESSxoe Applicant_ TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY .`� No. � + v 7 U ExenlptIon, 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. ❑ I_ICI::NSI{D CONTRACTORS DECLARATION OCCUPANCY INSPECTION ami Panic Devices I hereby affirm (hat 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 ne_ nX ss and Professions Code, and my license is in full force a effect. Name of business PARKING REq•D pROV1D ED I _ SPACES II__--JJ License Number Lic. Class ' 2eGv LIMITED TIME USE Contractor--_ __ Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional Capacity (Section 7051, Bus- EXISTING BLDG, STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic. or Reg. No. _ Date J (J Ju HONIF OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS Ql I� ON LOT AND USE l/ e 1 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 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 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.). ;:•.I:�€.= Lender's Name PROPOSED MAx'OCC. Lender's Address------_--_-- - P`e PERMIT FEE _•,, i+ 1 certif"v that I have read this application and stale that the 25 . 00 <<i 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 uponth above-mentions mperty for inspection purposes. SEE REVERSE POR EXPLANATORY LANGUAGE XX I XX ti.lnlilinC WORI:ERS'CODIPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 675 1 hereby affirm that I have a certificate of consent to self COUNTY OF.LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No._— Company FOR APPLICANT TO FILL IN Certified copy is hereby furnished. BUILDING LOCALITY XXADDRESS - zv (1 �S • EJCertified copy is filed with the county building inspection LOCALITY NEAREST department. yy, CROSS ST. Lp,u,g 1,-,�T Date____Appllcarlt __ NEAREST `O � DRIDC NO. _O� TYPE CESSED By CROSS ST. L i CON CERTIFICATE OF EXEMPTION FROM WORKERS' n LEGAL 1 44 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK Mo.P MIG.WAY N0. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (Tills 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. Or I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mannelCX OWNER of buildingistlEj �� so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP D= MAIL C7 ADDRESS - C.7 Applicant _— u I g TEL 7- OCCUPANT OCCUPANT LOAD NO"flCli 1'O APPLICANT: If, after making this Certificate of CITY No. Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth ❑ with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICE NSEU CON"I RACEORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices ❑ I hereby affirm that I alll licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS nes, and Professions Code, and my license is in full force anJX effect. Name of business PARKING REO'D PROVIDED SPACES License Number Lic. Class Lj Q �� 4 LIMITED TIME USE C.ontractor-__—_ Date DATE DATE El I FROM: and exempt from the licensing requirements as I am a TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting m my professional capacity (Section 7051, BBs- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). __ PRESENT USE OF BUILDING FINAL APPROVAL LIC.or Reg. No. Date r —l! I,q .__ _.-..... HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS O ON LOT AND USE - I hereby affirm that 1 and exempt from the Contractor's f{fistn--fi_io.. i ; License"Law for the following reason (Section 7031.5, Buri \\�\ Q r 4.{a Ile S, itll(l Professions( O(ICI. NO. PARKING 9v/ FJ1, as owner of the property, will do the work and the SPACES PROVIDED (�y� structure is not intended or offered for sale (Section '1 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—._—___—_—. _ 25 - 00 1 certify that 1 have read this application and state that the PERMIT FEE e above information is correct. I agree to comply with all County ISSUANCE FEE r- - ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25 . 00 upon the abovTuentione I roperty for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE XX Z— — XX i�•n�inrr��I I'(•rmitlt� Il;ilt• WORKLIRS' CON111ENSAIION MISCELLANEOUS APPLICATION I berebN MTIrffl that I ll:I\C a cCIlII*iCiIIC 111 1"11111'111 I" I'll. ( O11N1Y 01 I.OS ANGI-11S 131.111 DING AND SAFETY DIVISION insure,or a ceitiI*icaic'oI`Woik,.js' Couipciimion of II I certified cop), thereof (Sec. 3800, Lah. (..) Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUIL NG ADDRESS❑ ADDRESS Ccrtified cop) is licie1w lumislic(l. LOCALITY [j Certified copy is filed Will) IIIC COLIIII\ hLlildIII12' C Z1 department. NEAREST ep, CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. 1 I-RIll ICNII OF EXEMI'llON I RONI WOR KLRII ----jBLOCK TRACT LOT NO. CONIPILNSKNON INSURANCE AP HIGHWAY NO. IC (This seclion need 1101 be compleied if the %%ork inNohed ASSESSOR MAP BOOK PAGE USE ZONE SPECIALIRCLE) STATE MAJOR SECOND LOCAL IONS by the permit -i% for one hundred undd dollars ot less.) CONDIT I OWNER I ccitily thm in the pCilololmicc of III,: \\ojk hi whi,lh dii1 permit is issued. I shall not employ anVerson Ill flay' iiiiInwi. so as to become SUbjeCt 10 the Workers' (,ollipell'al loll Laws. ADDRESS OCCUPANCY GROUP Date NOTICE Applicant CITY CE TO APPLICANT: 11', aficr IllilkiII2 IIIIS ( eitil LLJ[e OCCUPANT LOAD of Exemption. you should become sLlbjeCl to the Workers' APPLICATION FOR Compensation provisions isions of the Labor Code.yout1l(Ist I'l)[11mitil EXIT HARDWARE: corllpl) with such provisions or this permit silaill hC dt't'llj,�d TRAILER UE El GEOLOGY INSPECTION No Spec.Knowl. ❑0 revoked. OCCUPANCY iNSPECTIONI�J Panic Devices LICENSED CONTRACIORS DI.( LARAW)IN ❑ I hereby affirm that I anit licensed UndCr 1110VISloill Of (11:ipwr SAFETY PERMITO LIST ITEMS BELOW) 9(coin meal Cl III, with Section 7000)of Di\ision lol'the BLISilleSS NO.OF EXITS and Prolessions Code.and my license is III I'Lill force and cl'l'cct. F PARKING REQ'D PROVIDED License Number Lic. Class SPACES Contractor Dmc LIMITED TIME USE DATE DATE ❑ I am exempt from the licensirw requirements its 1 :1111 it Ei licensed architect or it registered professional en�inecr FROM; TO: aCtilig ill jjj� plofessiollid C�jjjj,jj) (IsCk-ji,11 ItIlmlics" 117L OF NO.OF INSPECTOR'S EXIST INc,HI I SIGNATURE ; - S I I)RIL __j and Proicssions odc 1. FA01 PRESENT USE:OF BUILDING Lic. or Reg. No. Date FINAL APPROVAL 110NIF OW N 1:R-lit I I I DI.R DI I I.A R \I[()N NII 0I I X111 INIL.Boll IIINGS I)N 1.01 AND UL I hereby alTinn that I and exempt I'loill Ilic Colmactol's I I"ClIsc Law for the following reason (Section 7031.x. litisilless illid Professions Code): NO.PARKING SPAC ES PROVIDED I. as owner of_ Ilic properly. \%ill k, Thi 1\,Iik ;Intl IIIc silliclurc is 11,11 III(elldcd or 1i lICI,:kI lot sale (Sc011I11 U.I L PROP-1-11 USE OF t3HILDIN, Business and Professions Cole). CONSTRUCTION LENDING A61 N( Y I hereby all'il-111 that 111cle is a collsiluclion Icildilli! the peilormaticc of the \\-oik for \\hich This licin'lit is !!sMled (Sec. 3097, Civ. C.J. PROPOSED MAX.OCC. Lender's Name APPLICANT �1 Hl'j7) TEL NO. Lender's Address ' -I ADDRESS I certify that I have lead [[']is dpIlliCalitill and Slil[C 111;11 t1le above information is correct. I agree to comply with all(ounty PERMIT FEE ordinances and State laws relating to building Cor1S[rLIC[io,I.and hereby authorize representatives of this C01111ty it) CFIC`r Upon ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE D V X SEE RLERSE FOR EXPLANATORY LANGUAGE . Wk)K N ILK.) 1111W I'(NNA I IUN I)I_( I-A K A I I()N M15(.,LLLANEOU5 APPLICATION I lilrcby affirm (lial I liaNc it cciii1icille III tIilt',.III jo ,c I I COUN'F)' 01 IOS ANGFIJ_S 1311ILDING AND SAFFTY DIVISION 111SUre,or it cellilicille of W01kcrs, Compensation IlIMlI;IIICC. III certified cop) iliereoi (Sec. 3110(1. Lab. u.) J Policy No. Company FOR APPLICANT TO FILL IN BUILDING 'm AS BLIIIQING ADDRESS _DRESS 12,& Es ❑ Certified copy is hcichl, IIII-IlislIC& y - "/ -6- LOCALITY ❑ Certified copy is filed Will) the count) hnildilliZ W!,I)CCli011 CITY ZIP department. NEAREST 6 CROSS ST. Date Applicant SIZE OF L116 T NO.OF BLDGS-NOW ON LOT -DISTRICT NO. GROUP]TYPE PROCESSED BY CIAMFICAll OF I:XEIvIPlION FROM \VORKI RS CONST. ( M NSAI-ION INSURAN(E No. MAN HIGHWAY'O_ I'L - _ TRACT_ BLOCK _F01T NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This seclion need not he completed if the "ork imol%c(l ASSESSOR MAP BOOK PAGE ARCELIUSE ZONE SPECIAL CONDITIONS I))' Ibc penuil is fol- one Inindred dollars (s. 1001 411- Im.) SP OWNER TEL NO. tit I ccitily that in the pcilollilmicc III Ilic \�I-ik I.q M11,11 1111" permit is issued. I shall not cmpltly dll) 11"Isoll ill 111\ IlIttillicl so as to become subject 10 the Workers' ( onipell,,I[Iol) I_j\vs. ADDRESS OCCUPANCY GROUP Date Applicant CITY ZIP NOTICE TO APPLICANI: 11. ifler making this Cel-(Iflk�lje OCCUPANT LOAD 01' EXeMptiOn, you should become subjectto [fie W(likers' APPLICATION FOR Compensation provisions(it'(fie Labor Code.you must fortimitli EXIT HARDWARE: compl) with such pro\isions or tbis perrijil SlIdIl be 1.11-011,21.1 TRAILER USE L, GEOLOGY INSPECTION revoked. No Spec.Knowl. ❑ LICENSED CONTRACR)IRS DIJ LARAW)N OCCUPANCY INSPECTION!' Panic Devices ❑ I hy a erebffm irthat I :flit til ensed Undr I)I_0 eVof ( hapter iSi0IIN ' SAFETY PF_RMfT_0 LIST ITEMS BELOW, 9(commencing Willi Section 7000)of Di\ision 3 of'(lie Business NO.OF EXITS El and Professions Code,and my license is in full force and elTect. Q' License Number ic. (11,s SPACESPARKING RED PROVIDED • Contractor Date LIMITED TIME USE DATE- El I am exempt from the licensinL requireinent,, is DATE 1 11111 it FROM: TO: licensed architect or ;I registered piofession;il enVineer acting in llly prolicssional capaciIN (Scciion 701. flusiijes,., ""Or NO INSPECTOR'S I LXIhIINC.Ell LIC­ S I`C)R.,-L TURE and Prole'ssiolls (odc). 'TA PRESENT USE OF BUILDING Lie. or Reg. No. Date FINAL APPROVAL II0NII_ ()"'NI.R-til 111 DIIR DI I ARAIR)N 1`41).Of I XI&I IN&m Bou OINGS ON LOf AND UbL I hereby alTirin that I am exempt I'loIll the('On(NICIM'S IALCIINC Law for the following reason (Section 70.111. Business :Ind xf Professions Code): NO.PARKING SPAC E.,PROVIDED 00 1. as owlic" if' the plopcili. \\ill Jo III,- i—ilk :Will \11 licillic is not 111(cildcd of ollcicd 1111 sale (s",Ilon 71t-11. PROP011-11 USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING Md.N( I perch) all'irm IIIJI IIICIC is a C011siltIC11011 ICIlLilliv ,ueni\ GTI the perl,'willance of file \%olk Iol \%hich )his licill Ii( is Issuedcc. 3097 ( . ('iv. C'.). S PROPOSED MAX,OCC. Lender's Narrie .- - . APPLIC;,N (PHI'/ 1 __. T Lender's Address ADDRESS C I certify that I have lead this applic;Ilioll jIIjLI sl;,(c 111�11 III ation is correct. I agree it)comply With al olln,) P Mr, above inform, PERMIT FEE ordinances and State laws relating 10 building consirLIC11011.;old hereby authorize represemati\cs of Ibis Count)' to enter 011111) ISSUANCE FEE the above-ment lolled property for inspection purposes. TOTAL FEE S1.1- Rl:\'LRSL FOR EXPLANATORY LANGUAGE Sigi ture of f"criumee