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Home My Public Portal About9170 LAS TUNAS DR_Miscellaneous__ -WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N I hcraffirmthat I have a certificate of consent to self CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insuree,, or 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 // O ljydA�� Certified copy is hereby furnished. `X BUILDING D / LOCALIT ADDRESS f�. D Certified copy is filed with the county building inspection x LOCALITY NEAREST department CROSS ST Date Applicant NEAREST DISTRICT NO G OUP TYPE / PRO SS BY CROSS ST. f./e• •D �/ CONST. \ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ,v 0 Y COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCKMAP HIGHWAY STATE MAJOR SECOND LOCAL NO OF BLD 65 NO (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 ///J /!a 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 G/, so as to become subject to the Workers' Compensation Laws J MAIL OCCUPANCY GROUP lzil_ oADDRESS �'1 I 3 TE Date ApplicantLL, NOTICE TO APPLICANT• If, after making this Certificate of CIT Y5;, f� NOL �L 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. 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 iii full force and effect. PARKING • . SPACES REQ'D PROVIDED 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 SIG ATURE iness and Professions Code) FINAL APPROVAL 1 /1 ��PRESENT USE OF BUILDING Lie.or Reg.No Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS D ` ON LOT AND USE / �O I hereby affirm that I am exempt from the Contractor's (y/ 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 r-1_ . �;z•1 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 /P $ for the performance of the work for which this permit is ` ti 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 Dull above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and h by authorize representatives of this County to enter TOTAL FEE , upo above me io e rop y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 7 7 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N E O U S APPLICATION CE 875 I hereby-affirmcert 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.C). Policy No. Company FOR APP LI CANT TO FILL IN BUILDING / ADDRESS Certified copy is hereby furnished. n'OR.S �1 7 9 F_ 1-145 T-e�$ )Q LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST , department C47-j ; G9/ CROSS ST Date Applicant NEARESTDISTRICT �Q 141—W TYPE ,�� ESS ED BY CROSS ST. �,Y'� J� CO NST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d CJ COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this C� permit is issued, I shall not employ any person in any manner owNERQ I C4 (x,F,i s' so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP o ADDRESS I-TV 2 ` � Date Applicant L, y TEL OCCUPANT LOAD NOTICE TO APPLICANT If, after making this Certificate of clrY �i; / No _ Exemption, you should become subject to the Workers' Z Compensation provisions of the Labor Code, you must forth- _ APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ❑ ❑ No Spec. Knowl. deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION EJ Panic Devices 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 and �y/� G effect �1/i�V / PARKING SPACES READ D PROVIDED D License Number Lic. Class 4 ,455- d2 LIMITED TIME USE Contractor Date - DATE D ATE I am exempt from the licensing requirements as I am a PROM TO licensed architect or a registered professional engineer SIZE OF No of INSPECTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG TURE mess and Professions Code). FINAL APPFeOVAL PRESENT USE OF BUILDING Lic or Reg.No. Date cpm HOME OWNER-BUILDER DECLARATION No of (STING Bu LDINGS ( �� FE ri ON LOT AND USE _A I hereby affirm that I am exempt from the Contractor's /�(A/►J^' o/V/ License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING _ .__ 3 v, .S. 97 F11, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec 3097,Civ C.) Lender's Name PROPOSED MAX. OCC. Lender's AddressIm PERMIT FEE " I'certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentione property for inspection purposes. ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M44'4 CE875 (2-80) MISCELLANEOUS APPLICATION I 1 �e ' m that I have certificate of consent to serf COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or.'a a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ao ❑ G ` Certified copy is hereby furnished, BUILDING / ?O, LAS TV�J/t}s .aR c d� LOCALITY A DRESS ❑ Certified copy is filed with the county building inspection � o{ _7Q - NEAREST .department CALITYcM PILE CtTY CA CROSS ST Date Applicant A EAR EST -` A DISTRICT GROUP TYPE RO ESSED B SY - CROSS T E1J Ci.L N 3 CONST.' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP _mow}�'jIGM WAV } `CIRCLE) STATE MAJOR SECOND LOCAL d NO OF BLDGS (This section need not be completed if'the wo1k-Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS O 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 Q permit is Issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation LawsMAIL -,QCCUPANCY°GROUP:�•- •70 E_ L�4,S TO i45 \, `,�•.' .•�\ a DDRESS 9/ l Date Applicant _ to NOTICE TO APPLICANT If, after making-this Certificate of CIT,Y,7'EMpt,P_ C(T NOL 8(8• �8w . 1G3 OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR, EXIT HARDWARE Compensation provisions of the Labor Co'de, you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION , , deemed revoked' El ❑ NO Spec. KnOW�. ❑ 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 Exlrs 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 REO'D D PROVIDED D License Number Lie 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- ISTING BLDG. STORIES GNATURE loess and Professions Code) PRESENT USE OF BUILDING O r_)C::� FINAL APPROVAL Lie.or Reg No Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING B ILDINGS 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, SPACES PROVIDED - ❑ I,,as owner of the property, will do the'work and the structure is not intended or offered for sale (Section 7044, Business and'Professions Code). ;2 5 8 4,3 A PROPOSED USE OF BUILDING , # O •,O O 8 8 CONSTRUCTION LENDING AGENCY , • • • O o • • I hereby.affirm that there is a construction lending agency SA,64OS" 5 �O�l E �� / for the performance of the work for which this permit is 01. 13--86 = Issued(Sec. 3097,Civ.C). "•r 1�� Lender's Name PROPOSED MAX 06C Lender's Address • - PERMIT FEE I certify that I have read this pphcation and state that the, above information is correct F gree to c ply with all County ISSUANt E FEE ordinances and State laws.' lating ilding construction, TOTAL FEE and hereby au orize r pr ntati s thl County to enter pon the abo e- nt prop ty or;n pection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Wrnifittee Date WORKERS'COMPENSATION DECLARATION76M444 CE 875(2-80) 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 Workea rs'Compensation Insurance,or , a certified copy thereof(Sec 3800,Lab C Policy No Company, FOR APPLICANT TO FILL IN BUILDING ADDRESS L- � 0 vJ Certified copy is hereby furnished V EUILDING -LOCALITY / 1 ❑ ADDRESS , Certified copy Is filed with the county building inspection L NEAREST department Locwurr�' 1-7 90 CROSS ST Date Applicant' t NEAREST DISTRICT NO GROUP ITYPE PROC SS • CROSS ST -p �• CONST � - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL, 1 �/ COMPENSATION INSURANCE DESCRIPTION LOT No BLAP HIGHWAY OCK ' M ��iI {/// ,. Iwo 11 L)` (CIRCLE) STATE MAJOR SECOND LOCAL t1 NO OF BLDGS (This section need not be completed.if the work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit•is for one hundred dollars'(S 100) or less.) USE OF y` U SIZE OF LOT EXISTING BLDG. t,r 3 - CC 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 so as to,become subject to the Workers' Compensation Laws ASL OCCUPANCY GROUP W ADDRESS /-70S S �(� LL Date Applicant to TEL. NOTICE'TO APPLICANT If, after making this Certificate of CITY LE �7 No. 2/3 S 33fo�{ OCCUPANT LOAD Exemption, ,you should become -subject to the Workers r A PLICATION 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. 0 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions Of Chapter - SAFETY PERMIT q (LIST ITEMS BELOW) NO OF EXITS a 9 (commencing with Section 7000) of Division 3 of the Busi- i •ness and Professions Code, and my license is in full force and PARKING. effect SPACES REq'D O PROVID EO 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 1ne55•and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL 1 Lic.or Reg.No. Date UJ 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 SPACES PROVIDED I, as owner of the property, will do the work and the structure isnot intended or offered for sale (Section 2 3'7 p 7044;Business and Professions Code) PROPOSED USE OF BUILDING" �frSt^i� #'0'® • e 88 CONSTRUCTION LENDING AGENCY , I-hereby affirm that there is a construction lending agency • e • o o e o for the performance of the, work for which,this permit is issued(Sec 3097,Civ C) I 1 8 Lender's Name `PROPOSED MAX OCC Lender.'s Address PERMIT FEE I certify that'l 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, TOTAL FEE ry and hereby authorize representatives of this County to enter Upon the bove-mention d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ,,'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) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished DING �� per, �_e LOCALITY / p� ADDRESS ` J L��G Certified copy is filed with the county building inspection NEAREST department LOCALITY �� /� /! /� CROSS ST Date Applicant NEAREST !/ C/( DISTRICT NO GROUP TYPE RO ESSED BY CROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL _Z—• COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK P Q IG. cW AV E) } STATE MAJOR SECOND LOCAL Q. NO OF BLDGS NO ( (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 ($100) or less.) U USE OF E OF LOT EXISTING BLDG ' LC I-certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner OWNER 0 so as to become subject to the Workers' Compensation Laws IL OCCUPANCY GROUP 3 —� W ADDRESS !76 F G Q, Date .Applicant rn E _ NOTICE TO APPLICANT If, after making this Certificate of CITYA _ TNoL.. OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be deemed revoked TRAILER USE GEOLOGY INSPECTION NO Spec. Knowl. ❑ ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION XXPanic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force andcant's Name d ARKING. effect [PACES REO'D O PROVIDED D License Number Lic Class Ho a ddress — L LIMITED TIME USE Contractor Date ~LMo IV ZE / DATE DATE 0 I am exempt from the licensing requirements as I am a Phone — TO licensed architect or a registered professional engineer SIZE OF NO OF ROM INSPECTORS acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL ESENT USE OF BUILDING e,/r'o/(� y¢ 1^�`'•�✓ '� Lic or Reg No Date HOME OWNER-BUILDER DECLARATION NO,OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- ness and Professions Code). NO PARKING SPACES PROVIDED I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code) ;2 1 9 a$ A OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCYn C # o 0 0 0 4.0 I hereby affirm that there is a construction lending agency C- �� Z for the performance of the work for which this permit is 0 D 010 0 o D issued(Sec 3097,Civ C) Lender's Name - PROPOSED MAX. OCC 0 9. 04 -80 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—V^ ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon above-mentio rop rty f r inspe on pur res SEE REVERSt FOR EX LANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby afYcrm that t have a certificate of consent self COUNTY OF LOS ANGEL' S BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or ^. a certified co rtheereo (Sec. 380,0Lab.C�+— Policy No Jr�x4- FOR APPLICANT TO FILL IN BUILDING ADDRESS O • Certified copy is hereby furnished. ADDRILDESINGS - t LOCALITY Certified copy is filed with the county building inspection ALITY / NEAREST department �° L� CROSS ST Date Applicant NEAREST DISTG OUPTYPE CESSED BY CROSS ST. ` �j j� _� CONS'. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (/o COMPENSATION INSURANCE DESCRIPTION Lor NO BLOCK MAP H.G.-Y(CIRCLE) IGXW AY(CIRCLe) STATE MAJOR SECOND LOCAL , NOOF BLOCS (This section need not be completed if the work involved, TRACT NO.W ON LOT U5E 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 Lor EXISTING BLDG. O permit is issued, I shall not employ any person in any manner OWNER n yl =' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUPl :] a ADDRESS i� Date Applicant ,`-:)�, NOTICE TO APPLICANT If, after making this Certificate of CITY No 3— 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. deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busr SAFETY PERMIT EJ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code,and my license is in full force and r, ` effect. PARKING ►A�/� �� q SPACES REQ'D O PROVIDED License Number Lic ClassnF11-��1� LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM TD INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE ness irReg E No Date dProfessionsCode). Lic.or Reg FINAL APPROVAL PRESENT USE: OF BUILDING Z � � iOFF �I( — HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS V ON LOT AND USE v I hereby affirm that I am exempt from the Contractor's 9 11t_1�1U-10001 c/i�1/97 License Law for the following reason (Section 7031.5, Busi- ness usi Oci�iF � 11�'2; Hess and Professions Code): No. PARKING r , _� ElI, as owner of the property, will do the work and the SPACES PROVIDED _ structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency (� for the performance of the work for which this permit is issued(Sec 3097,Civ.Q. Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE .0 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 SOD upon the ab mtione property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee D Ze ~ WORKERS'C6MPENSATION DECLARATION CE 875(1 1-84) MISCELLANEOUS APPLICATION 'fl I herebr af£erthat 1 have a certificate of consent to sett' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, oor a certtificate of Workers'Compensation Insurance,or a certified copy thereof(See-3800,Lab C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS G ,Certified copy is hereby furnished. BUILDING '71,70 1 A s R. ADDRESS ADDRESS I_hTUqAS 1) LOCALITY El Certified copy is filed with the county building inspection LOCALITY NEAREST department. �� CROSS ST Date Applicant NEAREST DISTRICT NO. 14F3 CROSS ST CONST.TYPE PR CESSED BY C,� a CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO HLO CK MAP NO. CI(CI Rw RCLE) 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. v7 0 permit is issued, I shall not employ any person in any manner OWNER p =' so as to.IIVcojne subject to the Workers' Compensation Laws. L IVU r laoOCCUPANCY GROUP MAIL ADDRESS Date AC-3 Applicant 1L-L- I TE NOTICE TO PPLICANT If, after making this Certificate of CITYS' GL - awa.. OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION F 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 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busy SAFETY PERMIT ❑ (LIST ITEMS BELOW NO OF EXITS ness and Professions Code, and my license is in full force and effect. 4 PARKING SPACES REQ'D PROVIDED License Number Lie. Class L(Z� � Z— 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 SIGN A7URE mess and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS O ,{ ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 4 License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code). SP PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section Yd1 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY1,,-PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency n rej( y 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 f—a 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, �y and hereby authorize representatives of this County to enter TOTAL, FEE c�(S upo above-mentioned y for inspection pu oses. 3 SEE REVERSE FOR EXPLANATORY LANGUAGE Signat e of Permittee D to WORKERS'COMPENSATION DECLARATION CE 875 11 1-64) MISCELLANEOUS APPLICATION CE 875 I free, o affirm that I have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or ,,• y a certified copy thereof(Sec. 3800,Lab.C.). Policy No CompanADS y FOR APPLICANT TO FILL IN BUILDING ORE Cerltfled copy is hereby furnished. BUILDING �• -'7o S 1 ADDRESS 1 / l LA- TU' GLS LOCALITY FICertified copy is filed with the county building inspectiont LOCALIT q NEAREST L�✓ department. f; '��v� , `� (_ �-� 7 moss sT Date Applicant � � NEAREST DISTR IC NO GROUP TYPE �J P ESSED BY CROSS ST �� f{ CONST CERTIFICA"IE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP RIG Rw AY NO. (CIRCL.) 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 oP /' 1/1 SIZE OF LOT EXISTING BLDG. G(1(1 y' 1 certify, that in the performance of the work for which thi C--i permit is issued, I shall not employ any person in any mannekCX% OWNER of buildin <A- `AN �' v\ 5� . � =' so as to become subject to the Workers' Compen%ation Laws. 7 �.�/1 OCCUPANCY GROUP ,- ADDRMAILESS Date Applicant LI NOTICE TO APPLICANT If, after making this Certificate of CITY NOL OCCUPANT LOAD v-3 Exemption, you should become subject to the Workers' " Compensation provisions of the Labor Code, you must forth APPLICATION FOR EXIT HARDWARE 3 with comply with such provisions or this permit shall be ❑ ❑ No Spec. Knowl. F1 P Y P P TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ Panic Devices I ICENSLD CON I RAC I ORS DECLARATION occurANcr 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 anix effect Name of business PARKING REQ D PROVIDED ,rJ SPAC68 II��= License Number Llc Class t`�)" � '� �'^ _ LIMITED TIME USE Contractor Date �' `��'C- DATZ 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 1 S;GE CTO RR ES acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code) FINAL APP OVAL �1 PRESENT USE OF BUILDING Llc.or Reg.No — — Date 110ME OWNFR-BUILDER DECLARATION NO OF EXISTING BUILDINGS /►�(((//////�� ON LOT AND USE ��J ;�,;.j,n ;-• 4- I hereby affirm that I .uu exempt from the Contractor's (A1 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 ; structure Is not intended or offered for sale (Section '= 7044,Business and Professions Code). CONSTRUCI ION IENDING AGENCY PROPOSED USE OF BUILDING _ 1 hereby affirm that there Is a construction lending agency �"j7L�7L�•TG'G-[� for the performance of the work for which this permit is issued(Sec. 3097,Civ C I Lender's Name — PROPOSED MAX. OCC. Lender's Address— _ _ I certify that 1 have read this application and state that the PERMIT FEE 25.00 above information is correct.1 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 th ove-mentioned propert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX I f WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION i 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) o – Policy No Company FOR APPLICANT TO FILL IN BUILDING Xj�7e R j ADDRESS / Certified copy is hereby furnished. B4o'L'IN / Q 46 IYA' s Y, 154 PL �e�VIS� OCALITY h Certified co is filed with the county building inspection NEAREST PY g P LOCALITY department. cRoss ST Date Applicant NEAREST DISTRICS Nq GROJdP CONST. CESSED BY CROSS ST ✓/1}'�/~JV{y !�]/�1� �TYPE CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ( COMPENSATION INSURANCE or LOT No BLOCK MAP HIGHWAY No (CIRCLE) STATE MAJOR SECOND LOCAL �NO BLDG . (This section need not be completed if the work Involved TRACT NO OF OON LOT S 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 m the performance of the work for which this — permit is issued, I shall not employ any person in any manner ; PWNER i bi I/� so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL -co AILy�/ r I ADDRESS / Z •l-� �� = Date Applicant //� TEL. // OCCUPANT LOAD NOTICE TO APPLICANT If, after making this Certificate of C:TYy i I" No. 2(QO Exemption, you should become subject to the Workers' APPLICATION FOR =-X IT HARDWARE Compensation provisions of the Labor Code. you must forth- i with comply with such provisions oI 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 hcensed under provisions of Chapter SAFETY PERMIT L._ (LIST ITEMS BELOW) l 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 ME 5(4 � n,vSPAC NG REO'D effect PROVIDED n SPACES License Number Lic Class 1' LIMITED TIME USE LL Contractor Date N GATE ❑ATE W I am exempt from the licensing requirements as I am a TO F�tOM f licenseo architect or a registered professional engineer SIZE OF No of NSPE CTO R'S 9 acting in my professional capacity ISe tlOn /05L Bus- X15TING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Ree No. Date 1 HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS /1 � L ON LCT AND USE I hereby affirm that i am exempt from the Contractor s l License Law for the following reason (Section 7031 5, Basi ness and Professions Code) NO PARKING I, as owner of the property will do :he worx 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 1 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 7, 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 upon th bove-mentioned property for inspection purposes. J" i / SEE REVERSE FOR EXPLANATORY LANGUAGE ' AJ SpIature er ittee Date : ( \VORI:ERS'COMPENSATION DECLARATION a CE 875 (11-84) MISCELLANEOUS, Ari'P L I C A T I O N ' CE 87 I hareby-affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES _ _ -°UILDING AIVD SAFETY DIVISION �IL�Ii insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) iADDRESS olicyNo. Company FOR APPLICANT TO FILL IN DDR9 AESS / 1 7�0 Certified copy is hereby furnished BUILDING ` ADDRESS ESSTZ7LO,.:A LITY ! DCertified copy is filed with the county building inspectionLOCALITY City department. Temple CROSS ST Date A Leant NEAREST DISTRICT NO G P ITYPE P CESSED BY PP ->LtiJG( l I CROSS ST ,O� CON I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAI' NIGMWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USC ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) usE of SIZE OF LOT EXISTING SLOG I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner x OWNER L, ��,g tA-A f so as to become subject to the Workers' Compensation LawsMAIL OCCUPANCY GROUP — ' � ADDRESS I Date apphcant OZ CD TEL J NOTICE TO APPLICANT- If, after making this Certificate of X CITY -rte No _2 61 OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICA T IONFOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth �— I with comply with such provisions or rnrs permit shall be TRAILEP :ISE — GEOLOGY INSPEZTION No Spec Knowl I�� deemed re%oked — LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$$ rank Devices I hereb} affirm that I am licensed under provisions of Chapter sAFEr PERMIT _ LIS' ITEMS SE,-OW) 9 (commencing with Sec-Lion 1000) of Dnision ' of the Bus[- — No IF EXITS ness and Professions Code. and m% license is in full force anc ' r eIleCt PARKING REG O I pR OVID ED n SPACES LTJ f z License `umber Lic Class LIMITED TIME USE Contractor Date PATE OA TE L L - FgGM TC I am e,empt :Tom the ucensme -equirements as 1 am g ( licensed architect or are_=isterza proiessional zn,inee: SIZE of I NG 0= NSPE CTO R'S ll EXISTING BLDG STORIES SiE acting in m} professional capacm �Sz,_ion -0__. Bus- _ mess and Professions lode(- FINAL APPROVALr/ EIR PRESENT USE OF HUIa_DING Lic or Ree No Date 1 HOME OWNER-BLILDER DELL ARA:10\ NO OF EXISTING BUILDINGS U I hereby affirm that l am z\empt from the Contractor, ON LOT AND USE i License Law ror the folloltmg reason (Section 7031 S, Busi- ness and Professions Code) NO PARKING SPACES PROVIDED I as owner of the property %,�[ll do :he t,,ork and the ' structure is not mtenaed or offered for sale (Section 7044,Business and Professions Code( CONSTRLCTION LENDING AGENCl PROPOSED USE OF BUILDING LCC9/l� S�FV�C 1 hereby affirm that there is a construction lendinii azencv t I for the performance of the work for xthich this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX OCC Lender's Address ' ' I I certify that I have read this application and state that the PERMIT FEE 25.00 above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby a orizepi tatrves of this County to enter TOTAL FEE 25.00 t i upon the a -me ed� pert} for inspectio purp ses SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermittee Da e