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Home My Public Portal About9215 LAS TUNAS DR_Miscellaneous__ WQRKERS'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 �L � A � FOR APPLICANT TO FILL IN BUILDING / `f DDRESS , Certified copy is hereby furnished. LOCALITY AD E55 I C I Certified copy is filed with the county building inspectionOCALITY �J NEAREST 1 department. T.c�m��.c� li�7 CROSS ST L ITYPE / Date Applicant RAREST c� (/�/a DISTRICT ICO G�SI,P CONST/ PR SSED BY CROSS ST. VVV CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK MAP / MIG MW AV NO (CIRCLE)�s(CIRCLE) STATE MAJOR SE ND LOCAL NOOF SLOGS (This section need not be completed if the work involved TRACT NOW. ON LOT US ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF �/J 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 _ so as to become subject to the Workers' Compensation Laws AIL OCCUPANCY GROUP a Date ADDRESS U Applicant NOTICE TO APPLICANT- If, after making this Certificate of CITY NOLQSl� OCCUPANT LOAD Exemption, you should become subject to the Workers' _ Compensation provisions of the Labor Code, you must forth- O F M EXIT HARDWARE with comply with such provisions or 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 Busr SAFETY PERMIT (LIST ITEMS BELOW) 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 DAT! 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 TOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE mess and Professions Code) FINAL APPROVAL �� Lic.or Reg.No. Date RESENT USE OF BUILDING �ivvwb� V09CR Al 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). 6 3 7.4 A ROPOSED USE OF BUILDING # 0 0 * 0 CONSTRUCTION LENDING AGENCY �Z J 0 lJ 1 hereby affirm that there is a construction lending agency R_e_ r5JYJ-*9 A9ND • • • D • • • for the performance of the work for which this permit is 0 1.21 _$7 issued(Sec 3097,Civ.Q. R t 7FR,09Tj 0A1 S Lender's Name PROPOSED MAX. OCC. Lender's Address ' I certify that I have read this application and state that the PERMIT FEE above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE v� upon he ove-mention erty for inspe ion purposes. 'h�lZ2c� / . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WGRKERS'COMPENSATION DECLARATIn?' 769444 G• ~ APPLICATION {� CE 875 (11-84) M ISC"LLeANEOUa , 1 here'-,y affirm th-wticat 1 have a certificate of consent nc self COUNTY OF LOS ANGELES BLILDING AND SAFETY DIVISION insure'or a certificate of Workers'Compensation Insurance,or LI a certified copy thereof(Sec 3800,Lab.C) Policy No Company FOR APPLICANT TO FILL IN BUILDING 9a/� ADDF ESS 7 ❑ Certified copy is hereby furnished BUILDING /`( T T ;'1I LOCALITY �-X AD DR E35 J Af I Vn0.f ICN'I�� Certified copy is filed with the county building inspection LOCALITY NEAF EST department. -11y, CROSS ST Date Applicant NEAREST ( DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST n�Ih,l 1uS �` l CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V+I (J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY HO (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. — (This section need not be completed if the work involved TRACT NOW ON LOT USE 70NE 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 r 0 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 /ty CICCUPANCY GROUP ADDRESS 1 i4l Date Applicant d 4k w NOTICE TO APPLICANT If, after making this Certificate o' CITY /,f1 �{ol� G�wr� TNoL` D'Sf'S� d l OCCUPANT LOAD Exemption, you should become subject to the Workers = Compensation provisions of the Labor Code, you must forth /lo/ APPLICATION FOR EXIT HARDWARE with comply with Such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices I hereby affirm that I am licensed under provisions ofChaptet 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 ari effect X Name of business PARKAIG REO'D RG r0. V,S PROVIDED 1�� C. 11"-t � SPACES License Number Lic Class LIMITED TIME USE Contractor Date— DATE DATE PRO N. 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 SATURE acting in my professional capacity.(Section 7051, Bus EXISTING BLDG STORIES mess and Professions Code) FINALAPPROVAL Lic or Reg No Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ''Q /, ON LOT AND USE 6 1 hereby affirm that I am e%empt from the Contractor's License Law for the following reason (Section 7031 5, Busi- g yCi FEE ness and Professions Code) NO. PARKING El1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale Sectior r;^ 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING ~i ' =t•' 1; I hereby affirm that there is a construction lending agency for the performance of the work for which this permit i, issued(Sec. 3097.Civ.C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE 25 . 00 1 certify that 1 have read this application and state that the above information Is correct I agree to comply with all County ISSUANCE FEE �It ordinances and State laws relating to building construction reby authorize representatives of this County to enter TOTAL FEE 25 , 00 rnd,he pt e-rb ve- nt' ned property for mspechon p uposesX XXg�W� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perinittec Date WORKERS'COMPENSATIONDECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby a cert 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 certifiedco the e/If--(Sec 3800 Lab. .) PohcyNo d ��Coriipany vt' FOR APPLICANTTO FILL IN ABUILDING DDRESS / U Zei_S Certified copy is hereby furnished \ BUILDING � e // ADDRESS LOCALITY r l_ Certified copy is filed with the county building inspectionLOCALITY l.'L L n / NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NOG TYPE PROCE 5E Y CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. NOOF BLDGS BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL . (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. 1 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 OCCUPANCY GROUP MAIL ADDRESS U % NOTICE TO APPLICANT Date Applicant w TEL. OCCUPANT LOAD D- If, after making this Certificate of clrY No. C/3 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 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 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 ��G 410 �� LIMITED TIME USE Contractor Date DATE DATE Elam 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 IGNAT RE iness and Professions Code). PRESENT USE OF BUILDING 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 � � c •L:.- 5 License Law for the following reason (Section 7031.5, Busi- I � I 12Y 15/S ness and Professions Code) NO. PARKING ;o F11, as owner of the property, will do the work and the SPACES PROVIDED 7561 1 AM10%47 structure is not intended or offered for sale (Section 7044,Business and Professions Code) _ CONSTRUCTION LENDING AGENCY PROPOSED USE DF BUILDING I hereby affirm that there is a construction lending agency Qw for the performance of the work for which this permit is 1 issued(Sec. 3097,Civ C.). Lender's Name PROPOSED MAX. OCC. Lender's Address v b PERMIT FEE \� I certify that I have read this application and state that the above infgrmation is correct.I agree to comply with all County ISSUANCE FEE Pordmayces and State laws relating to building construction, av and hereby authorize representatives of this County to enter TOTAL FEE The above-mentioned property for inspec�tiop Puqposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee I Dale WORKERS COMPENSATION DECLARATION 6M-144 MISCELLANEOUS APPLICATION 20-0063DPW12/90 I hereby affirm that I have a certificate of consent 'n sell COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I� msz�re, or a-certificate of Workers' Compensation Insurance or a certified copy thereof (Sec 3800 Lab C) t Policy No Company_ FOR APPLICANT TO FILL IN BUILDING r �� BUI DIN RE r)DsS ADDSS bI/C ❑ Certified copy is hereby furnished ' fy9// C _ Lim S LOCALITY ❑ Certified copy is f tied with the county building Inspection Cir ZIP �p department C • �� 7 CROSS ST Date Applicant SIZE OF LOT NO OF BLDGS NOW ON LOT DIETTq GP TYPE ESSED BY coNsr CERTIFICATE OF EXEMPTION FROM WORKERS' <V TRACT BLOCK LOT NO COMPENSATION INSURANCE MAP MIG„WAY I,3 NO ICIR CLEI STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less.) usE ZONE SPECIAL CONDITIONS ) 1 certify that in the performance of the work for which this OWN R TEL NO i b SGC e�X— o,.fD 1--0 B o p permit n Issued, f shall not employ any person In any manner so as to become Subject to the Workers' Compensation Laws ADDRESS ��Y� _L� OCCUPANCY GROUPE�] Date _ Applicant _ _ __ CITY (ri'� `�zip NOTICE TO APPLICANT If, aftei making this Certificate OCCUPANT LOAD of Exemption, you should become Subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code,you must for thwrth comply with Such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ I revoked OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of C'haptei SAFETY PERMIT❑ (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business No OF EXITS and Professions Code,and my license is in full force and effect ` PAR TING REQ'D D PROVIDED License Number _ LIc Class �GTr/3 oS77— Js S SPACES I Contractor Date LIMITED TIME USE I f"`�GLS DATE DATE ❑ 1 am exempt from the licensing requirements as I am a cJ2N� � FROM TO licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Business SIZE OF No of INSPECTOR 5 GN ATURE EXISTING BLDG STORIES and Professions Code) LIc or Reg No Date PRESENT USE OF BUILDING FINAL APPROVAL l HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE O hereby affirm that I . n mm uexept frothe C'ontractor's License nn A Law for the following reason (Section 70315, Business 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, PROPOSED USE OF BUILDING ovffa(tjS'ACtZ / —rAr� Business and Professions Code) 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 I (Sec 3097,CIV C) PROPOSED MAX OCC h Lender's Name _ APPLICANT(PRINT) TEL NO ` Lender's Address ADDRESS + I certify that I have read this application and state that the t � above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and ? I hereby authorize representatives of this County to enter upon ISSUANCE f FEE the above-mentioned property for Inspection purposes i TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE s� i azure of Permittee Date , ( ) WORKIRS' COMPENSATION DECLARATION 2000 3DPW12/90 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 copal thereof (Sec. 3800, Lab C.), Policy'No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified ropy is hereby,furnished X 9215 E. LAS TUNAS DR LOCALITY ❑ Certified copy is filed with the county building Inspection CITY ZIP departmen L. NEAREST ST Date _ Applicant SIZE OF L T NO.OF BLDGS.NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY C CONST. CERTIFIC,%TE OF EXEMPTION FROM WORKERS' TRACT 420- BLOCK LOT NO. C COMPENSATION INSURANCE HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) El er TEL NO !- I I certify that ui the performance of the work for which this �. I permit is issued I shall not employ any person in any manner Jonathan Tat 26-318-1912 LL so as to become subject to the Workers' Compensation Laws. AODgEs -('! a 30U W. Valley Blvd. OCCUPANCY GROUP v ( Datey� 3Applicant CITY ZIP ? NOTICE TO APPLICANT If. affer making this Certificate Alhambra 91803 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code you must forthwith EXIT HARDWARE i comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Know[ ❑ ' revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[$ I Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a 9(commencing with Section 7000)of Division 3 of the Business 8IDe O us ess NO OF EXITS and Professions Code,and my license is in full force and effete PARKING REO'D PROVIDED License Numbei Lic. ClassHITS HWAiaii • D SPACES t I i Contractor — Date LIMITED TIME USE ❑ I am exem n from the licensing requirements as I am aDATE DATE licensed aichitect or a registered professional engineer FROM To acting in my professional capacity(Section 7051, Business SIZE OF No OF INSPECTOR'S t and Professions Code) EXISTING BLDG 42.nSTORIES SIGNATURE, Lic. or Reg No_ - Date PRESENT USE OF BUILDING FINAL APPROVAL Travel & Tours related HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS~ ✓y ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 70315, Business and ( Professions Codc)• NO PARKING El 1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING Business ani Professions Code) CONSTRUCCION LENDING AGENCY Travel & Tours related I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued t I (Sec 3097, Civ- C). PROPOSED MAX OCC Lender's Name _ APPLICANT(PRINT) TEL NO Lender's Address ADDRESS t I certify that I have read this application and state that the 9215 E Las Tunas Dr. Tem le C ty,CA k780 above information is correct I agree to comply with all County PERMIT FEE I ordinances and Slate laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes TOTAL FEE X V SEE REVERSE FOR EXPLANATORY LANGUAGE Slenatu a of Permittee Date i WORI:ERS'COMPENSATION DECLARATION CE 375 (,�-oat M I SC E L LA N E O�J S APPLICATION r aye , I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure.sure, or a certificate of Workers'Compensation Insurance or ' �— a certified copy dtereot (Sec 3800.Lab C) Z:? Policy No Companv FOR APPLICANT TO FILL IN !nOR I SS NI�/� 15 ADDRESS //t /N'LLL/ Certified copy is hereby furnished BUILDING1 n �uN�� V ADDRESS 21s L/7s LOCALITY } Certified cop} is filed with the county building Inspection LOCALITY NEAREST j department Temple City CROSS ST Date Appucant NEAREST )[STRICT NO GR UP TYPE �,/ P ESSED BY CROSS ST CONST T/ I CERTIFICATE OF EXEMPTION FROM`�OR[:ERS' LEGAL I �� _ COMPENSATION INSURANCE i DCSCRIPTION LOT NO (BLOCK HIGHWAY 1 no [CIRCLE[ STATE MAJOR SECOND LOCAL NO OF BLDGS (This section need not be completed if the work involved TRACT NOW ON LOT USE :ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S1(10) or less.) USE OF 7 I ; SIZE O� LOT EXISTING BLDG 1 I certify that in the performance of the NNork for .vhich Zhis AA�^ a — permit is Issued I snall not employ am person m an} ma-Mier , OWNER (�Rv /v'VUZ-A, 1 so as to become suntect to the Workers Compensation La%Ns OCCUP4NCY GROUP I = , MADRIL ESS P AD .O. 1 Date Applicant �i /� NOTICE TO APPLICANT If, after making -.his Certificate of CITY 1 �u /A,�jJfJ/ TEL },�� tp ( OCCUPANT LOAD - Exemption you should become sub}ect to the Workers =: Compensation pro%isions of the Labor Code you must forth- APPLICATION FOR =X!T HARDWARE i with comply with suen pro-visions or this permit Snail be -RAILER USE 1 GEOLOGY INSPECT'ON 1-1 } No Spec Knowl I I deemed revoked. — LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic DevicesEll I hereby atfirm that I am licensed under pro%isionsof Chapter SAFETY PERMIT L (LIST ITE,MZ BELOW) I 9 (commencing with Section 7000) of DI<Ision 3 of the Busi- NO OF EXITS ness and Professions Code, and my license Is to full force inti effect FARKING _ SP4CES REO'D PROVIDED Cr License Number Lie Class LL�� LIMITED TIME USE N Contractor Date DATE DATE N W I am exempt from the licensing requirements as I am a m I licensed arcnitect or a registered professional engineer SIZE OF NO 0- NSPE roR's Z acting m in\" i7r G.:SS10naI Capac1tN (Section 1051 Bus- EXISTING BLDG (STORIES SIG TUR. m iness and Professions Code) a PRESENT USE OF BUILDING FINAL APPROVAL v Lie or Reg No Date !2 HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE I herebaffirm that I am exempt from the Contractors I o of F t j i ,;; I � License-Law for the fol-lowing reason tSecuon 7031 S Busl- b I ness and Professions Code) NO PARKING ElI, as owner of the property will do the work and the SPACES PROVIDED structure is not Intended or offered for sale (SeLtion I 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY X PROPOSED USE OF BUILDING I hereby affirm that there is 1 construction lending yency }AEAb OFFIC& PF-Li 4lou5 i } 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 I certify that I have read this application and state that the PERMIT FEE 25.00 above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State lau s relating to building construction, and hereby authorize representatives of this County to enter I TOTAL FEE 25.00 r upon the above-meikttoned property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SI tature of Permittee Date r i• \1'ORICI RS'('ODIPI NSA IION DECLARATION ,76M444 MISCELLANEOUS APPLICATION in �-7 he: o (' affirm that I have a certificate of consent self CE 875 (1 1 841 COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION U sure, or a certificate of Workers' ompensaUon Insurance, e,or .1 certified copy thereof(SeL 3800, Lab C) ` I'ohLy No _____ __—Company_— a FOR APPLICANT /.}TCO FILL IN tl Jn aooeess ❑ XX ADDRESS �l S �• I/'✓ / V t> V �/� / Certified copy is hereby furnished LocAurr El Certified copy is filed with the county building inspection LocwuTY''^ C NE. /REST department icy, ! (�� T y eA CRCISS ST Dale__---___Applica lit NEAREST t DISTRICT NO. GR UP TYPE ROCESSED BY CROSS ST _1 0 A �(,� '�� CONS f (TR 111 ICAfE.OE EXEMPTION FROM WORKERS' LEGAL (OAIPENSA LION INSURANCE DESCRIPTION LOT NO. BLOCK MAP NO. F BLDGS. Hlc tiw wv No (CIRCLE) STATE MAJOR SECOND LOCAL (('his 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 /jJ SIZE OF LOT EXISTING BLDG. �/' - I certify that m the performance of the work for which this ,q VVV`/ permit is issued, I shat( to (lie Wo any person many mI 1ws X OWNER of buildin — U)�.� 6f, SI, as to hcaouar suhµ•It to the Workers' Compensation I aws * Q q L4y3 OCCUPANCY GROUP MAIL ESS U UADDR0, atc_-------_-- Applicant— -- — LLI NOIICI: lU APPLI('ANl If, after making this Certificate of clry �``�� `L � NO � �50oC? OCCUPANT LOAD V3 I xemplron, jou should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth ❑ ,va rth comply lth SIILh provisions lir this permit shall be TRAILER USE GEOLOGY INSPECTION No Spec Knowl. deemed rooked. I Panic Devices I ICI NSI D(()N I RA( 1 ORS DECLARATION OCCUPANCY INSPECTION El Ihereby altirnt that I :un licensed under provisions of Chapter 9 (conintenLing with Section 7000) of Division 3 of the Bush SAFETY PERMIT (LIST ITEMS BELOW) NO OF EXITS ness and Professions Code, and my license is in full force aniX CffcLt Name of business KING SPACES REO'D 1 1 PROVIDED II?? // ,,..�� SPALJ E:::=I (Cense Number --___-- I Ic Class rfC I,.-n�5 W? LIMITED TIME USE (onlr.a(tor_ _ _ Date— __ DATE DATE I ant 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 Illy professional capacity (Section 7051, Bus E%(STING BLDG, STORIES I "NATURE inessand Professions Code) FINAL APPROVAL Lic or Reg. No -- PRESENT USE OF BUILDING "Zxa/"r Date— U h IIUMI OWN[ R BUILDER DECLARATION 1 NO OF EXISTING BUILDINGS L°' /YJ•� ON LOT AND USE Q I hereby aftunt that 1 ,ant exempt from the Contractor's License Law for the lollowing reason (SeLtion 7031.5, Busi- ness and Professions Code) t NO. PARKING ElI, as owner of (lie property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code) CONS IRUCIION LENDING AGENCY PROPOSED USE OP BUILDING I hereby affirm that there is a construction lending agency VrAeL, ISTt?Pt for the performance of the work for which this permit is lan issued(Sec 3097,('iv (') � I ender's Name----_-------- } " ,^ I PROPOSED MAX.-OCC. ! I ender's Address-___—_- ______——__ _ T, 1 certify that 1 have readPERMIT FEE this application and state that the .-• 00 above utfonn.itrnn IS LJIrreLt 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 a TOTAL FEE 25.00 upon the above-mentioned property for inspection purposes l— SEF REVERSE FOR EXPLANATORY LANGUAGE s