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Home My Public Portal About9163, 9163 1/2 LAS TUNAS DR_Miscellaneous__ ` AORI,ERS' CONI PLNS\TION DE( L\R ),1'IO. 76 1444 MISCELLANEOUS APPLICATION CE 875 11 841 ` I herebv affirm that I have a certificate of consent to Self 'VISIONOF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a cernucate of Rockers Conmensdnon Insur,ln,e,or a I,ertified cope thereof (Sec 1800 Lab C ) u Poiicv No _ —t.ninan\ I BJ ILDING C u - FOR APPLICANT TO F LL IN ADDRESS Certified Lopy Is hereb% turntshea BUILDEING LJCAL.-- :DOR SS I I Certified opy Is tiled nith [Ile .oiint, iluudln`_ Inspection LOCALITY Temple Cit AR ST department P Y CR Date \nl,Il'..IIII NEAREST DISTRIg.T NO GR P TV PE CESSED BY CROSS ST CONST CER FICIC\TL Of L\ENIPTIO\ I-RoM '\ORKERS LEGAL 1 I t O\IPL\S MON INSI R\\(!_ OE SCRIPT ON LOT VO SLCCK I rtAP .IIG RW Av •10 STATE MAJOR SECOND LOCAL ` NO OF BLDGS 1Tlits section need not he Lomvleted If the \%ork Invoked -RAC' 'JOt'/ JN LOT USE TONE 3PFCIAL CONDITIONS by the permit is for one hundred dollar, I 100) or less.) USE OF —, SIC`= OF LOT I EXISTING BLDG I erttfe that n1 :he penonnans `,r' '!le 'or. -o Lhlch los L. permit is 'ssued I ,hall lot -mplo% im ne-son n dmmance sy JNER VIA It SO ds to heL,1n1e ,ulnect :o the 1\orke.s I-`•n�en4a I ms OCCUPANIC' 3ROUP I� - ',AIL .ESS �, - I Date AD OR\pphcdrit _ NOTICL rO \PPLIC\`sT I!. u-e n Elm= ':u ' =--:Kale ,t XI CIT '� G 1/71 ��zl) V� L/ OCCUP�IN- L AC E\empno 1 Lou ,notild becople ,uriec: 'o 'ha _ Lompens.`non rro• (,non, ,r :hc Libor - .),le `ou Ti is ro,:ir APDL Ca'IC� _\'- }oRrl„_,�_ } \\illi Colil,'I\ %\Irh u,ll nrmi,,on, rl Ill, crit ,lldil heI -RAIL=R J3E '� :;EOLr. N=P=J- CV — NO Soec K le-I 11 deemed :0` 11,ea 11 — — LIL!-NSLD, O\lit \CTORS DI=( LkRAT10" JCCJPANC'( INSPEC�ION� 311IC Ce,)-r-, I hereby di!Irm -hat I :in licensed undo-rresl,tons,l:(:lduter SAFETY PERMIT (LIST ITE-AS SELO •11 9 Iconiwenuna ,Lith SeLnon -0001 it Dt%i rwn it :he 13usi- - NO OF EXITS ncss dnd I' "Ic„Ilnr ( ,)dr old n\ hL.n,e ” n ml :I`rL,,and - ------- C1!eL, !jF/ PPq RKESGIV REO O -RC`JIDED L..� LILense \umhe,_ L,c (!a„ z.L � LIMITED TIME USE (oniractor 1'die DA— W Z ❑y l dm .sempt •_ons .h-- ILen>mg reaulrcnlent, u I dm 1 a I keens '1 drehueL: or .1 ree_t]tCred p-niesw.)iill mgmeer IZE OF yO 7- INSPECTOR s 2 dlnn_ n ill pri,t-;Zonal .'r -;l• ,_ io i -1041 Iltl`,- XISTIN� SLD� I iT'7P1� -- _ - — --- -SIGNATURE 9 Inl'5,—id i''I II:,,Ir ll,l.Id.l _-- — -' U -- - -- "REENT USE OF BUILDING FINA PV 4L APROQ ,�j LIL ,r Ree V, - ---- D e c- -- - / z I _ HOME (91\\i R-81, ILULR DLCL\!t \DItJ\ NO OF EXISTING BUILDINGS A ON LOT AND USE I -II ii I herebv at:Irn1 that I ani exempt 1,on1 the C-ontra,tor s t�,•1 1 License Lan for the follo,Lln_ redson (SeLnon -'ill ; Busi- ness and P-oiessions Code) NO PARKING l 1, as .inner of the propert}, \\til do he nark Ind the SPACES PROVIDED strucnlre Is not Intended or offered tllr .die ISeLtwn 1 7044 liu,iness and Protesslons Coder L O\SI RL(1IO\ LLNDI\G \(II-\( \ PROPOSED USE OF BUILDING I hereby affirm that there Is a construction IendimgI�encs Le ) 1 Wkt for the performance of the pork for Mii,h this per itl Is issued t Sec 3097.Cn C I Lender ;Ndnlc _ _-- - PROPOSED MAX OCC Lender's address — ( 1 Lernf\ that I have read this application and state that the PERMIT FEE 25.00 above Information Is Lorre--t I agree to conlpl} nrth all Cowry ISSUANCE FEE ordlnanLes and State Ides relating to budLhm_ construLU011, and hereby aurhorize representduses of this County to enter TOTAL FEE 25.00 t upon the aboLc-mentioned property for mspeLtlon purposes SEC REVERSE FOR EXPLANATORY LANGU-\GE I � Swriature of Perinittee Date I WORKERS'COMPENSATION DECLARATION 76M444 .-- I CE 875(11-84) ^ MISCELLANEOUS ,APPLICATION = 1 hereby affirm that I have a certificate of consent to self , insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION` a certified copy thereof(Sec. 3800,Lab.Q. Policy No Company FOR APPLICANT TO FILL IN BUILDINGADDRESS Certified copy is hereby furnished. Bu1LDING S TV"S i9L LOCALITY XX AD DR Egg FICertified copy is filed with the county building inspection Locnurr _ C T NEAREST department. ][y. �[j �� Q l CROSS ST Date Applicant NEAREST DISTRICT NO GROUP TYPE -0CESSED BY CROSS ST �P �j CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o D COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY No. (CIRCLK) STATE MAJOR SECOND LOCAL NO. OF BLD6g. (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.) USEOP SIZE OF LOT EXISTING BLDG. p I certify that in the performance of the work for which this J permit is issued, 1 shall not employ any person in any manneXX OWNER of buildin ( SRA@ IQ/-A so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS U Date Applicant 4, NOTICE TO APPLICANT If, after making this Certificate of CITY No`' OCCUPANT LOAD Q, 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 Panic Devices 1 ICENSED CONfRAC I ORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that 1 am licensed under provisions ofChapter SAFETY PERMIT [ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busy- pp NO OF EXITS ness and Professions Code, and my license is in full force anix Name of business M� 1 lit�A' �1 efleLt PARKING REQ�D 1 PROVIDED SPACES J �J License Number Lic Class --- LIMITED TIME USE Contractor Date DATK DATE FJ1 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 SIG TORE iness and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING I_Ic or Reg.No.— — Date._ HOME OWNER-BUILDER DECLARATION No OF EXISTING BUILDINGS I hereby affirm that I am exempt from the Contractor's ON LOT AND USE 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 II structure is not intended or offered for sale (Section 7044,Business and Professions Code). p CONSIRUC FION LENDING AGENCY PROPOSED USK OF BUILDING 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 ,p, Lender's Address __ C, '7� PERMIT FEE 1 certify that 1 have read this application and state that the 25.00 ,= above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to budding construction, and hereby authorize representatives of this County to enter TOTAL FEE 25-00 _ upon the Ib mentioned property foir inspection pu oses I / SEE REVERSE FOR EXPLANATORY LANGUAGE X —L XX ZTy (7 �` J� l WORKERS'COMPENSATION DECLARATION 76M444 /�t L�_A I�t��.J A P P L I C A T I O N M I� k hereby affirm that I have a certificate of consent to self CE 875 (11 84) 1 COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, Jr a certificate of Workers'Compensation Insurance,or ca certified copy thereof(Sec 3800,Lab C) 2 '� Policy No Company FOR APPLICANT TO FILL IN ABUILDING DDRESS Certified copy is hereby furnished. ` BUILDING �� T X ESS P6 �c✓a (IMG✓J Vr. LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department 3tx CROSS ST. Date Applicant NEAREST DIST T NO. GROUP TYPE CE SSED BY CROSS ST I��y 0 CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL LL//O COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MwP HIGHWAY STATE MAJOR SECOND LOCAL NO. NO. OF BLDGS (CIRCLE) (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 C ^ o permit is issued, I shall not employ any person in any manned o R of building0 q�r0g-0 so as to become subject to the Workers' Compensation Laws MAILOCCUPANCY GROUP o Date Applicant ADDRESS NKK vietO 1DRIV6 ZZU NOTICE TO APPLICANT• If, after making this Certificate of CITY �LH/} I�2� TE U-1 -1b-'9 -g63fL 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 oI this permit shall be TRAILER USE E] 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 9 (commencing with Section 7000) of Division 3 of the Busi SAFETY PERMIT (LIST ITEMS BELOW) NO OF EXITS ness and Professions Code, and my license is in full force a effect �X Name of business PARKING }� SPACES REQ'D PROVIDED License Number Lic. Class L� G . D BA 4jodt� -S LIMITED TIME USE Contractor Date DATE DATE 1 am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OF NO OF INSPECT R'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES GNAT RE 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 �A/ G 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 I hereby affirm that there is a construction lending agency (- S7ro for the performance of the work for which this permit isY issued(Sec 3097,Civ.C.). Lender's Name i PROPOSED MAX0OCC. Lender's Address PERMIT FEEi I certify that I have read this application and state that the 25 . 06f 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 -r. upon the above-me troned pr rty for inspection purposes i SEE REVERSE FOR EXPLANATORY LANG,U,AG•E SI atr of Permittee Date ) WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ij)sure, 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 gDDRE55 f Z" ❑ Certified copy is hereby furnished APU DDRESS Q - /t�/l hi LOCALITY F-1 / Certified copy Is filed with the county building Inspection NEAREST department LOCALITY r, _ CROSS sr Date Applicant NEAREST DISTRICT NO GROUP TYPE PROC SSED'BY CROSS ST CONST / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL l v COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK NOP () Y } (CIRCLE) STATE MAJOR SECOND LOCAL � (This section need not be Cum leted if the work Involved //��I r NO OF LOT USE ZONE SPECIAL CONDITIONS P TRACT �• 0LJ NOW ON LOT Q by the permit Is for one hundred dollars ($100) or less.) USE OF nay V SIZE OF LOT EXISTING BLDG (j I certify that in the performance of the work for which this 0 permit is Issued, I shall not employ any person in any manner, OWNER P/`7 0/ so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUPZ W Date Applicant ADDR ES. 131Y vn.y Vpe NOTICE TO APPLICANT If, after making this Certificate of CITY t1-/� �� (+ NTE OL 2 _ 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 deemed revoked NO Spec. Knowl. ❑ � Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (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 !cant's N Name - �, r JJ AJx KING. effect SPACES REq'D O PROVIDED O �+ /� License Number Lie Class - 6 V 6 P t/ g LIMITED TIME USE Contractor Date r� ^/ TO - DATE DATE F-1 am exempt from the licensing requirements as I am- — FROM I aoaon 2 /C licensed architect or a registered professional engineer SIZE o No of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE loess and Professions Code). ESENT USE FINAL APPROVAL OF BUILDING 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 7.031 5, Busi- ness and Professions Code) SP PARKING SPACES PROVIDED —4 � ��, Ell, as owner of the property, will do the work and the structure is not Intended or offe�d for sale (Section # 0 0 0 0 [G O 7044, Bus mess and Professions Code p pPOSED USE OF BUILDING S c r t-r CONSTRUCTION LENDING AGENCY V 0.0 0 o e 0 0 1 hereby affirm,that there is a construction lending agency / for the performance of the work for which this permit is 0 a '1,2,-, 80 issued(Sec .3097,Civ C.), Lender's Name PROPOSED MAX OCC ::::j 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 ordirtuiiees and State laws relating to building construction, TOTAL FEE and,hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signa�&e of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) KISCELLANEOUS APPLICATION I hereby'affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, ora ertificate of Workers'Compensation Insurance,or a ceftified copy thereof(Sec 3800, Lab C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING O ADDRESS Ln - Certified copy is hereby furnishedBUILDING G uN�S LOCALITY A DRESS [/ Certified copy is filed with the county building inspection or I NEAREST department Lo ALITY CROSS sT. Date Applicant EAREST DISTRICT N_O/ GR UP TYPE PROCE 81 CROSS ST. ��•I�V CON S7 / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (!0 `/ COMPENSATION INSURANCE DESCRIPTION LOT No BLocK MAP HIGHWAY >_ NO OF BLDGS NO (CIRCLE) STATE MAJOR SECO LOCAL CL (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U . by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG cc - I certify that m the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner , so as to become subject to the Workers' Compensation Laws IL AuT�a OCCUPANCY GROUP w Date Applicant - ADDRESS � to NOTICE TO APPLICANT If„after making this Certificate of ciry l.r(, NOL3� OCCUPANT LOAD z Exemption, you should become subject to .the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of-the Busi- ness and Professions Code, and my license is In full force and PARKING. effect REO'D PROVIDED - SPACES License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE i FROM TO ElI am exempt from the licensing requirements as I am a licensed architect or a registered'professional engineer SIZE,OF NO OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. - STORIES SIGNATURE iness and Professions Code). RESENT USE OF BUILDING em FINAL APPROVAL Lic or Reg No Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt, from the Contractor's (j' /1 License Law for the following reason (Section 7031 5, BUSi- ,lei r ness and Professions Code) NO PARKING b SPACES PROVIDED -� 1, as owner of the property, will-do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code) # 0:o'e,e8$ ROPOSED USE OF-BUILDING CONSTRUCTION LENDING AGENCY � �f ��Y+C le e O O'e O e'2 I hereby affirm. that there is a construction lending agency Q b -8 b for the performance of the work for which this permit Is issued(Sec 3097,Civ C). Lender's Name PROPOSED MAX OCC.- Lender'sAddress 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 ordinance nd State laws relating to building construction, TOTAL FEE and ie y authorize representatives of this Co my to enter do up he ove- ened pro/elty for inspe ion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o ermittee 7 Date '