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HomeMy Public PortalAbout9157, 9157 1/2, 9159 LAS TUNAS DR_Miscellaneous__ 1 76M444-DBS 75 11-55 MISCELLANEOUS APPLICATION DIVISION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS Department of County Engineer County of Los Angeles BUILDING f! JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS .J CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOAPPLI ANT TO FILL IN NEAREST OWNER CROSS ST. MAIL ,7; ® _ DISTRICT NO. I GROUP I TYPE O T. ADDRESS C.. ,�Cb IT— �J TEL. C— CITY O. MAP q+ a SHw; NE YES NO ✓ TEL NUMBER 6Ci/T CONTRACTOR NO. USE ZONE SPECIAL CONDITIONS ADDRESS LEGAL DESCRIPTION I LOT NO. I BLOCK v,� BUILDING SETBACK YARDEXIST. NAI HWY I EET E I WIDTH NO.OF BLDGS. FRONT TRACT NOW ON LOT Iff?'C�I P. L. I EX SI NG BLDG. SIDE I �� /f/ I / SIZE OF LOT P L oYn APPLICATION FOR INSPECTION RECORD OCCUPANCY I INSPECTION V SAFETY PERMIT ' 'I'F2Gv e- AILERUSE LIMITED TIME USE .� n �,�./�- �+L..xi �,,r-1A *,•?/J DATE DATE FROM: TO: USE OF STRUCTURES OR DEVICES � ....._ _ rcptAvvFQa co Pe Vaa-a o 2-'�I- 6,� � ._._....._.. �. ..................... — -�.......... ......... t � f .............�..... - .. ... INSPECTION FOR /�-, �.�,1��L ,P ��J . _ __.._..._..._�......._....................�(.. OCCUPANCY A AP�PROVALS V �/ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS f-�E �jU44-06 ^ 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 BUILDING CONSTRUC- GROUP OCC.LOAD TION. SIGNATURE OF TRAILER USE PERMITTEE ADDRESSIeT44,4Vak- SAFETY PERMIT TEMPORARY STRUCTURE APPROVED TEMPORARY STRUCTURE REMOVED FEE$ FINAL APPROVAL JOHN A. LAMBIE, COUNTY ENGINEER VA ATION CLYDE N. DIRLAM,CHIEF BLDG, INSPECTOR CK MO CASH - �oaQ7g2 0E01522 0 15.00N4 WORKERS'COMPENSATION DECLARATION . CE 875(2-80) 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.) S� BUILDING Z� Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished, ..DING a=Ez==9qZ.— LOCALITY1. _ C� ADDRESS ED Certified copy is filed with the county building inspectionNEAREST department. OC ALITY CROSS ST. Date :Applicant AREST - DISTRICT NCO/ O -TYPE PROC SED-BY• CROSS ST: �® y CONST. (� CERTIFICATE OF',EXEMPTION.FROM WORKERS' LEGwL y a COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAF A HIGHWAY 4K I NO. o�OCf (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be' completed if the work involved NO. OF SLOGS. Y1 P TRACT 5 9 NOW ON LOT - USE ZONE SPECIAL CONDITIONS O by the permit is for one.hundred dollars ($100) or less.) 0 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, L 16WN.- L Q 0 so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP �r V A'D DRESS W Date Applicant N TEL. OCCUPANT LOAD Z NOTICE TO 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 deemed revoked. ❑ NO Spec'. KIIOWl. ❑ 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- ness and Professions Code, and my license is in.full force and effect.. - PARKING . SPACES REq'D O 'PROVIDED O . 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 mess'and Professions Code). FINAL APPROVAL / ESENT USE OF BUILDING, Lic.or Reg.No. Date LJ 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)i NO. PARKING # e s`8 8 - SPACES PROVIDED El I, as owner of the property, will do the work and the r structure is not intended or offered for sale (Section 7044, Business and Professions Code). OSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm, that there is a-construction'lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name - - PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this gree cation 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, rf� and hereby authorize represent Ives of this County to enter TOTAL FEE upon t e above-mentioned pr rty for mspe tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 'gigniiture7 of Permittee Date �f • Al Q� AI,G'r WORKERS'COMPENSATION DECLARATION CE 8754(2-so) . MISCELLANEOUS APPLICATION I hipreby 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. IsuILDING J LOCALITY ADDRESS !/ -Certified copy is filed with the county building inspection A NEAREST. department. LOCALITY 1 �j CROSS sr. r Date Applicant NEAREST DISTRICT N GROUP TYPE PR ESSED BY CROSS ST. Q CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP MIGXWA1 - NO. U (clitc LE) STATE MAJOR SECOND LOCAL } (This section need not be completed if the work`involved NO. OF BLDGs. a TRACT NOW ON LOT - USE NE SPECIAL CONDITIONS -per, by the permit is for one hundred 'dollars ($100) or less.) USE of 0 SIZE OF LOT EXISTING BLDG.. I certify that in the performance of the work for which this Cr permit is issued, I shall not employ any person in any manner O so as to become subject to the Workers' Compensation Laws. MAaER� ' © OCCUPANCY GROUP ADDRESS `„�`, G - 'CL � Date Applicant (A NOTICE TO APPLICANT: If, after making this Certificate of clrY L' OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATIO 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 L J (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING effect. - . SPACES RE q'D O PROVIDED D License Number - Lie.Class LIMITED TIME USE Contractor Date DATE DATE / FROM: TO: a1 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 I�GNATURE mess and ProfesslOns Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date 10V HO.OF EXISTING BUILDINGS U .3 3 A HOME OWNER-BUILDER DECLARATION ON LOT AND USE I I hereby affirm that• I am exempt ,from the Contractor's 1#10 0 o,o.8.8 License Law for the following reason (Section 7031.5, Busi-' m ness and Professions Code): rvo. PARKING 0 0 0 0 0 0 o z 1. SPACES PROVIDED I ,, EI; as owner of the property, will do the work-and the S O 9—8 3 structure is not intended or offered for sale (Section 7044, Business and Professions Code). y_ PROPOSEDUSE OF BUILDING. - CONSTRUCTION LENDING AGENCY ' 1 hereby affirm that there'is a construction lending agency " for the.performance of the work for which this permit is issued(Sec,: 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I'certify that I have-read this application and state that,the V 4 1 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 represen tives of this County to enter Upon,ohe above-me0ioW pr erty for pectiI purples. SEE REVERSE FOR EXPLANATORY LANGUAGE k,gignat of Per it ee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I -hereby affirm that I have a certificate of consent to self COUNTY OF LOS 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. ,nDILDIN �s �s LocwLlrY ❑ Certified copy is filed with the county building inspection — NEAREST department. 'LO cALITY' /s �T ceoss ST. Date A licant EAR EST /,�//jI� DISTRICT NO. GROUP. TYPE PROCKSSED BY App4• CROSS ST. NvJ '�•I CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 5 �I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP MIGM WAY NO. (CIRCLE) - STATE MAJOR SECOND LOCAL NO. OF BLDGS. CL (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS C) 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 5 ' ���E permit is issued, I shall not employ any person in any manner 'OWNER 6&16•'EI O��' so as to become subject to the Workers' Compensation Laws. MAIL vG� OCCUPANCY GROUP - ADDRESSLU Date Applicant TEL. NOTICE TO APPLICANT: If, after making-this Certificate of Clry �j NO. ��� OCCUPANT LOAD •Exemption, you. should become subject to" the Workers' Compensation provisions of the Labor Code, you must forth- AP LIGATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. C3No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION occUPwrvcY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ '(LIST ITEMS BELOW) 9 icommencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING REq'D F DED ' SPACES Lioense 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 registeredprofessional engineer SIZE OF NO. OF J INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLD STORIES / SIGNATURE 42 inessand Professions Code). FINAL APPROVAL "+ PRES N S O UILD NG"Z�XlVifwV/r Lic.or Reg.No. Date Lr' (/VVI/ivJ ,l•�J� HOME OWNER-BUILDER DECLARATION, NO.OF EXISTING BUILDINGS ON LOT AND USE - I hereby affirm that, I am exempt from the Contractor's z 2.5.7.1'7'A License Law .for the following reason (Section 7031:5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED- i#.O O-OO 8.8 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section o 0 0 0'o I o o a 7044,Business and Professions Code). PROPOSED USE OF BUILDING 0.'6'0'7-83 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency !(� for the performance of the work for .w.hich this permit is issued(Sec. 3097,Civ.C.). Lender's Name - PROPOSED MAX. O 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' .. %% upona above-me tinned property for inspection,purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i Ignature of Permittee Da WORKERS'COMPENSATION DECLARATION 76M444 CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have 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 L S ADDRESS LOCALITY DCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date 'Applicant NEAREST '� ) V'9 DISTRICT NO. GROUP TYPE RO ESSED BY CROSS ST. ,Jq (+ g CONST, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP .G HIGHWAY NO. F BLD GS. NO. 7��-Z�S (CIRCLE) STATE MAJOR SECOND LOCAL (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 SIZE OF LOT EXISTING BLDG. } I certify that in the performance of the work for which this It permitis issued, I shall not employ any person in any manner Cn OWNER G (/ri:SG, L(�/►�B/�G y so as to become subject to the Workers' Compensation Laws. OCCUPANCY.GROUP. _�, `� /'' ADD. S ZZ I L 1� r ✓ '. .i._.t.0•: '� ` � Date Applicant - E; NOTICE TO APPLICANT: If, after making this Certificate of CITY-M0 ITvo. Q—�� OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be ❑ deemed revoked. TRAILER USE E] GEOLOGY INSPECTION No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION f� 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 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). T PRESENT USE OF BUILDING a /CG FINAL APPROVAL / /_ / Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS `6 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 5 4 4 4 A 7044,Business and Professions Code). # • • •.• 8 8 PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 0.0 • • • • • z I hereby affirm that there is a construction lending agency t for the performance of the work for which this permit is �� 09.1 6-86 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 inform�atlprize is correct.I agree t comply with all County ISSUANCE FEE ordinances : tate laws relating to uilding construction, and hereby represefitativ s this County to enter TOTAL FEE upon he ab n igne prop t r ins ction purposes. CJ SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of ermAW Date _'4QRKERS'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 FI LL IN BUILDING S ADDRESS Certified copy is hereby furnished. ILDING 5 /L G ADDRESS LOCALITY Certified copy is filed with the county building inspection OCALITY NEAREST department. I CROSS ST.' Date Applicant AR EST �/Jr `, /^) DISTRICT�O. GROUP TYPE OCESS D B� CROSS S. s�{�-'/ C. 13 t �/ , O - CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL L COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NOP —�(�� HIGHWAY (CIRCe) 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 SIZE OF LOT EXISTING BLDG. i2— o permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. OCCUPANCYI,G.ROU_P. C3 111XDDRESS MAIL /^� Date Applicant 22 �/r (/ _ " \ u�J NOTICE TO APPLICANT: If, after making this Certificate of CITY �Q/(/ C No� �� 2�D— � ��, OCCUPANT LOAD y, Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- A PLICATION 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 0 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: 0 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 SIGNATURE inessand Professions Code). Er FINAL APPROVAL 1 SENT USE OF BUILDING v� ��c �� 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). (� C CONSTRUCTION LENDING AGENCY iwROPOSED USE OF BUILDING f/ �5 44.3 A 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. �� #.• •.• 8 8 Lender's Name PROPOSED MAX. OCC. e,I\ Lender's Address V I certify that I have read this application and state that the PERMIT FEE 9. 16,-8 6 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and Sta laws relating to building construction, and hereby author' a representatives his County to enter TOTAL FEE ' upon the abo m nt' ed property f spectio urposes. c� ��, _,/)_ SEE REVERSE FOR PLANATORY LANGUAGE Signature of P mi ee V bate +ORKERS'COMPENSATION DECLARATION CE 877610444(2-80) N9 I SC E L LA N E O U S 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 Lertified copy thereof(Sec. 3800,Lab.C.) Policy No. Company, FOR APPLICANT TO FILL IN BUDDING' / / ADDRESS ❑ Certified copy is hereby furnished. VUILDING 4. LOCALITY (ARD....9J&:7 t f" / - ❑ Certified copy is filed;with the county building inspection NEAREST department. LOCALITY cRoss sr. \ Date Applicant NEAREST h '/ DISTRICT NO. UP TYPE / PROCES ED BY CROSS ST. ONSTc / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL " 1/ COM PENSAT ION.INSU RANCE' NO.DESCRIPTION - LOT NO.' BLOCK MMAI (�©D (CIRCLE)ICNw^Y STATE MAJOR SECOND LOCAL "'S NO. OF BLOGS. (This section, need not be completed if the work involved TRACT . NOW ON LOT USE ZONE SPECIAL CONDITIONS ; O by the permit is for one hundred dollars.($100) or less.) USE OF IZE OF LOT - EXISTING BLDG. �� 0 I certify that in the performance of the work for which this ' permit is issued, I shall not employ any person in any manner WNER SO as to become subject to the Workers' Compensation Laws. MAIC OCCUPANCY GROUP LL DDR ES �2CL Date Applicant Z rEL _ OCCUPANT-LOAD z NOTICE TO APPLICANT: If, after making this Certificate of.. cITY (.� rvo.'2 '7 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.INSPECT.ION Q No Spec. Knowl. E1deemed revoked. LICENSED CONTRACTORS DECLARATION occuawNCY wsPEcrlo Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 'N O. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the B'usi-- ness and Professions Code, and my license is in full force and PARKING effect. : - SPACES REQ'D E= 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': acting in my professional capacity (Section 7051, BUS- EJ�[STING BLDG. STORIES SIGNATURE iness and Professions Code). OF BUILDING Q l FINAL APPROVAL ,a �?j / ESENT USE Fes•-�.�f v Lic.or Reg.No. Date TI HAND HOME OWNER-BUILDER DECLARATION No.of AUNG BUILDINGS ON LOT AND USE I hereby affirm. that, I am exempt from the Contractor's 5.2'0,7 A License Law for the following reason (Section 7031.5, Busi- - O nes5 and Professions COde): - NO. PARKING .#.0 ® e 4 0- SPACES PROVIDED . ❑, I, as owner of the property, will do the work and the 0 0 0 0-A 0'0 structureis not intended or offered for sale (Sectio 7044,Business and Professions Code). L O 5 1.1 —81 PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm, that there is a construction lending agency for the performance of the work for which this permit is L 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 grpon the above-men ioned p operty for inspection purposes. SEE REVERSE,FOR EXPLANATORY LANGUAGE ` �6-- / _ I Signature o ermittee Date' `'