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HomeMy Public PortalAbout9217 LAS TUNAS DR_Miscellaneous__ OORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCE'LLA'NEOUS 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 'fl a certified copy thereof(Sec. 3800,Lab C.) 41 Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑, Certified copy is hereby furnished. BUILDING 94p, LOCALITY ADDRESS ❑ Certified copy is filed with the county building Inspection NEAREST department LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT GR UP TYPE PRS} SSED BY CROSS ST - v / CONSTIZ / - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V t AV COMPENSATION INSURANCE DEsc RIPrION LOT NO. BLOCK_ MAP HIGHWAY } , No , (CIRCLE) STATE MAJOR SE NO LOCAL d (This section need not be completed if,the work involved NO OF BLDGS ZONE SP CIAL CONDITIONS O P _ TRACT NOW ON LOTT U- by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. cc I certify that in the performance of the work for'whlch this Q permit is issued, I shall not employ'any person in any manner owNERG. r E- so as to become subject to-the Workers' Compensation Laws MAIL '•OCCUPANCY GROUP- W • ADDRESS s .Y C' Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY Qyr` l� -�. No�'ZI 3 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 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 I -µ SPACES REQ'D PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE ❑ FROM TO 1 am exempt from the licensing requirements as I am a ' licensed architect or a registered professional engineer siz E'oF No OF INSPECTOR'S acting in my professional capacity (Section'7051, Bus- EXISTING BLDG STORIES SIG ATURE iness and Professions Code) FINAL APPROVAL /{ - PRESENT USE OF BUILDING d7 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 ;2'2 8 9.3 A License Law for the following reason (Section 7031 5, Busi- 'NO. PARKING • • • • 88 ness and Professions Code) SPACES PROVIDED ❑ I, as owner of the property, will do the work and the • o • • o • • z structure is not intended or offered for sale (Section 7044, Business and Professions Code). PROPOSED USE OF BUILDING � Y 09. 1 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 tt Lender's Address PERMIT FEE 1.certify that I have read this application and state tfiat the 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 representatives of this County to enter O Lupo the above-men ned roperty for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date y, Wj)RKERS'COMPENSATIONDECLARATION 76M444875 2801 MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insgre, or a certificate of Workers' rs'Compensation Insurance,or " a certified copy thereof(Sec 3800,Lab C.) f Policy No Company FOR APPLICANT TO FILL IN BUILDING /�7 ADDRESS / / 446 /(14 15 ❑ Certified copy Is hereby furnished ILDING 2 LOCALITY LE ADDRESS am Certified copy Is filed with the county building Inspection C4, NEAREST e/ department DcwLITv, ejyj ,e CROSS ST All Date Applicant REST •A,� DIS` CIVO. IEXU� TP YPE PRO SED BY T. ;NI o(/ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP �©/b ' HIGHWAY 1' _ rvo /VJ (CIRCL'E) STATE MAJOR SE�DLOCAL Qom, NO OF BLOCS. O (This section need not be 'completed if the worlt'involved TRACT NOW ON LOT USEZONE SPECIAL CONDITIONS t, by the permit is for one hundred dollars ($100) or less.) 6 USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this O permit is Issued, I shall not employ any person in any manner NER KAI er (~j so as to become subject to the Workers' Compensation Laws. IL Gar OCCUPANCY GROUP. n • / � w Date Applicant DDRESS 92i5 � to NOTICE TO APPLICANT: If, after making this Certificate of TY Temple— &I U-AY - OCCUPANT LOAD Z Exemption;• you should become subject to the, Workers' gppLICATION 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 INSPECTIONClNo Spec. Knowf. ❑ deemed revoked. � Panic DBVIC@S ❑ 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 PARKING. effect - SPACES REQ'D I I PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE � FROM TO ❑' I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR'S acting-in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES - SIGNATURE mess and Professions Code) FINAL APPROVAL SENT USE OF BUILDING LIc or Reg.No Date HOME OWNER-BUILDER DECLARATION NO of Exls rvG 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- 7 S Q A ness and Professions Code) SP PARKING I ' SPACES PROVIDED I, as owner of the property, will do the work and th4 # structure Is not Intended or offered for sale (Section in 7044, Business and Professions Code). e e e e • e e l OPOSED USE OF'BUILDING CONSTRUCTION LENDING AGENCYsy 0 3,2 7"8 5 I hereby affirm that there Is a construction lending-agency aa�z r, r for the performance of the work for which this permit is issued(Sec 3097,Civ.C) Lender's Name PROPOSED MAX OCC. Lender's Add ress 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, TOTAL FEE and hereby authorize representatives of this County to enter upon abo e-m one property for Inspect) purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat re o ermitt a Date �J WORKEI2S'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N E O U S APPLICATION CE 875 L I hereby affirm that i have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I�LJII insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING �/ ADDRESS FICertified copy is hereby furnished. BUILDING %ADDRESS LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY ' NEAREST department I� CROSS ST Date Applicant NEAREST DISTRICT;O. GROUP TYPE P OC SSED BY CROSS ST UD CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP/� MIG RwAV (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDG No (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this - o permit is issued, I shall not employ any person in any manner OWNER c� so as t bee e subject to e k ion Laws. MAIL OCCUPANCY'GROUP.- r� a Dat Applic ADDRESS Y • 1 y NOTI E TO APPLICANT• If, after making this a ate of CITY NEO OCCUPANT LOAD D_ Exemption, you should become subject to the orkers' 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 El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect, PARKING REQ'D O PROVIDED O SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM' TO licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S I G76ATORE mess and Professions Code). FINAL APPROVAL PR ESEN USE OF BUILDING Lic.or Reg No. Date i` HOME OWNER-BUILDER DECLARATION IN..OF EXISTING Bu DINGS -! ON LOT AND USE I hereby affirm that I am exempt from the Contractor's P-'-'T.41 License Law for the following,reason (Section 7031.5, Busl- Nor" rr4= ness and Professions Code): I No. PARKING F1I, 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 UILDING AN —a t''.' I hereby affirm that there is a construction lending agency r f � Y 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 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and here authorizer resentatsves of this County to enter TOTAL FEE u en ne erty for inspects n puypose . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I Hereby affirm that i have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified,copy thereof(Sec. 3800,Lab C.) Policy No Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS E �,,�7� ADDRESS � Certified copy is hereby furnished. BUILDING ! t s ADDRESS /... LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTR TI NO G OUP TYPE PROCESSED BY CROSS ST. - �" O v CONST•/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL \J a V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLDGS 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 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 OWNERD1= I.L� y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP Q� 0= •yy`y3 O Date ADDRESS Applicant w NOTICE TO APPLICANT: If, after making this Certificate of clrY No� '�('q 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 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. l�CU1/xe�rr ✓ �lrN`C, PARKING REQ'D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE F1I am exempt from the licensing requirements as I am a PROM. TO. licensed architect or a registered professional engineer SIZE OF NO. OF NO F oR's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES E mess and Professions Code). FINAL APPROVAL 9 PRESENT USE OF BUILDING Lic.or Reg.No. Date ��` .I- _ - a i.; 1 FIN 4:44 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 12 0 . 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 0 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 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 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 author" esen atives of this County to enter TOTAL FEE upon the ab ntione pr erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignatu f Per Date WORKER$'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N I hereby affirm that I have a certificate of consent tself CE 875(11-84)COUNTY OF LOS ANGELES Y BUILDING AND SAFETY DIVISION insure,•or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab C.)._ i Policy No L�3` � Company�i�Tc F(--tFV"'4 FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING / LOCALITY ADDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST Date Applicant NEAREST DISTRICT NO GRQUP TYPE P ESSED BY CROSS ST. ^� L(� CONST COMPENSATION CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL U C✓1/ �/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS (This section need not be completed if the work involved TRACT NOW ON LOT Use ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this SIZE of LOT EXISTING BLDG. O permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP _ o ADDR ESS�C. ��V i C U Date Applicant L,I NOTICE TO APPLICANT• If, after making this Certificate of CITY 11�L NO. OCCUPANT LOAD oA 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 hcensedunder provisions ofChapter 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 O PROVIDED License Number 7G U '1 Lie. Class C-3 LlL L C V C) L.,4�zL G� LIMITED TIME USE Contractor I —Date– DATE DATE ❑ I am exempt from the licensing requirements as I am a D licensed architect or a registered professional engineer SIZE OF /- NO. OF INSPECTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG ov S r STORIES SIGNATURE mess and Professions Code). G � ) FINAL APPROVAL PRESENT USE OF BUILDING x / /� /�T— Lic.or Reg.No. Date v 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 riess and Professions Code): NO.PARKING – (, I^'J- ? El1, PROVIDED I, as owner of the property, will do the work and the u� 1 i`I, 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.). Q 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 upon-the above-mentioned pro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 M ISCELLANEOUS APPLICATION � ^ L ) I hereby cert that I have a certificate of consent tself CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION lull insure, or a certificate of Workers'Compensation Insurance, e,or u a certified copy thereof(Sec. 3800,Lab.C.) Policv No Company FOR APPLICANT TO FILL IN BUILDING / /�c�U ADDRESS �7.J 15 Certified copy is hereby furnished BUILDING ��� �/�/i s LOCALITY001— CY ADDRESS /✓�7 ! Certified copy is filed with the county building inspection gLOCALlNEAREST e ���� department. GJr ceosS ST. Date Applicant NEAREST / DISTRICT N�OJ GROOUP CONS ITYP ESSED BY CPE ROSS ST Lr 0 y /) T� CERTIFICATE OF EXEMPTION FROM WORKERS' 1. LEGAL (/ COMPENSATION INSi:R-\NCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY Nc. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF 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 (S 100) or less.) usE of I 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 g OWNER 2� [�� so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP = V MAIL A ADDRESS�b ��� I Date applicant = NOTICE TO APPLIC-\NT If, after making flus Certificate of g CITY �l NOL 6 OCCUPANT LOAD - Exemption, you should become subject to the Workers' fAPPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with Such provisions or this -)ermit shall be TRAILER USE i—I GEOLOGY INSPECTION No Spec. Knowl. 71 deemed revoked N Panic Devices LICENSED CONTRACTORS DECLARATION occuPANc� INSPECTION LM 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 Busr- NO of EXITS ness and Professions Code, and my license is in lull force and t� ePARKING effect SPACES REO'D D PROVIDED -J � License Number Lie. Class LIMITED TIME USE Contractor Date DATE OATE y F 40 M `O n I am exempt irom .lie licensing requirements as I am a 7 I licensed architect OI 1 Ie^3SteIed �rote$slOn11 englneeI SIZE OF NO OF INSPECTOR'S _ - SIGNATURE acting in my orptessional caod(.1t' ISection 0�1. Bus_ EXISTING BLDG STORIES a mess and Professions Code) FINAL APPROVAL / C PRESENT USE OF BUILDING �C i U Lie.or Ree No Date ff� •J HOME OW,'NER-BLILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE Q I hereby affirm that i am exempt from the Contractors License Law for the .following reason (SeLtion 7031 5 Busi- ness and Professions Code) NO PARKING SPACES ,ROVIDED ! -t I, as owner of the property, will do the work and the structure is not intended or offered for ;ale ISectlon 7044.Business and Protessions Code) CONSTRICTION LENDING \GENC 1' X PROPOSED USE OF BUILDING / I hereby affirm that there is a construction lending aBencv ! for the performance of the work for which this permit is issued(Sec. 3097,Civ C ) Lender's Name PROPOSED MAX OCC Lender's Address 25.00 I PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply%%ith all County ISSUANCE FEE ordinances and State laKks relating to building construction, and lie y au oriz a se t ives`of is County to enter TOTAL FEE 25.00 ! o e b e io e pection purpose _ M� J SEE REVERSE FOR EXPLANATORY LANGUAGE Signal ir,:of D,,to 1VORiCERS'COMPENSATION DECLARATION CE 875 111-84) MISCELLANEOUS APPLICATION ' CE 875 I I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS AI'vGEL�S BUILDING AND SAFETY DIVISIONInsure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). L Policy No Company FOR APPLICANT TO FILL IN BUILDING. ADDRESS Certified copy is herebyfurnished. BUILDINESSG Z�7 TLiNPrS XX ADDRLOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. XX (;ROSS ST. Date Applicant NEAREST J/ / DISTRI T ��fQ1 G�PUP TYPE Pyyyppp���--E SSED BY CROSS ST �j/V L/( �f I D�/ {'I CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MA- HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLOCS. (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. r I certify that in the performance of the work for which this CD permit is Issued, I shall not employ any person in any manne3CX OWNER of building so as to become subject to tA ers' Co ensatio Laws. L) OCCUPANCY GROUPfi� o MAIL '--- ADDRESS f Ow431 Date J 9SApplican / LO NOTICE TO APPLICANT ma mg this Certificate of CITY e/G ITvoL OCCUPANT LOAD Exemption, you should ecome 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 1 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 P SPACES REQ'D � PROVIDED l�� Sl License Number Lic. Class O -- C C&551 C (A7-S L^U LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a P.O.: TO' f y INSTOR'S licensed architect or a registered professional engineer SIZE of NO. OPEC R 9 ATURE acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIESP iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING , Lic or Reg No. Date HOME OWNER-BUILDER DECLARATION No OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code) NO. PARKING 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 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 25 .00 Upon the Ove-ment' ed property for inspection purposes. p�_ SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX �' Signa re of Permittee Date COUNTY OF LOS ANGELES TEMPLE 's:TT '# O7Co MiSCE_LANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAr TUNAS !;P O:08 0408190001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CI:v CA 9;780 PHONE: ;626) 2C5-'0488 EXT: LEGALNo. F CONST TDI i ING nDIDRESS: TR: 6561 LT: 376 SQ. FT STORfES' TYPE OCCUP GROUP 9217 LAS . INAS DR STRUCTURE: 16 V C TEMP CA 917801908 ASSESSORT ON NUFSBER: _ NEAREST CPOFS STREET: ENCINITA 8587-001-012 'EXIST : US THOMAS PAGE: 596 GRID: J3 LOCALITY. TEMPLE CITY, C EXIST OCC GRP: B USE ZONE: _ TENANT: —1BLDG _ ISSUED ON: PROCESSEXPIRES ON: DAHLQUIST LYNDA �BLDGS. NOW ON LOT: VALVA IOIS- 08/19/04 JK 02/15/05 OWNER: TEL. 0: FJAL TE Vii.'+AL B'f: CGi�E: (TAT, JONATHAN (626) 284-6322- LIS ITEMS: (V�� 229 N. SEGOVIA AVE 1 O (( 1 lSAN GABRIEL CA 91775 DESCRIP1 ION OF STORK ENCLOSED PORCH (EXISTING) OCCUP LOAD EXIST: APPLICANT: TEL. OCCUP LOAD NEW: !SAME AS OWNEP. - ' PARKING SPACES-REaI;.kED- SPECIAL CONDIi,c,p5 PARKING SPACES PROVIDED: iE-,I-1 HARDWARE' _ CONTkACTOR: TEL. NO: I L1%3ITED TINE USE SAME AS OWNER NBR OCEXITS: FROM TO LIC. NO f1 FEES PAID APPROVALS DATE INSPECTOR S;GNATURE !FEE DESCRIPTION: QJAN1IIY: VOM: PMOUNT:I ARCr:IT T OR NGINEER: . un• ( TRr.'_'-ER USE —' ;"A ?ERMIT ISSLpvrr 27:7:, -- — LIC. NO: iOZ SITE INSPECT'ON 3S 280.95 (SAFETY PERMIT j TGTAL FEES ?-.'ti �TIE,IP. STT?;C-T. �UP NO.- SEWER MAP BOOue PAGE: FIRE ZONE: CMP:i HEMP, STRUC I. AE u7v_l :40. OFFALIE . DWEL INC -G UNITS: APT/COND: STA 0LA_SS_:'_l NO I SCHC L WITHIN HAZARDOUS "`— AIR QUALITY: 1000 FEET MATERIALS NO `:O NO -- REQUIRED TOIAL SETBACK FROM EXIST "--' SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508