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HomeMy Public PortalAbout9218-9224-9226 LAS TUNAS DR_Miscellaneous__ WORAERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION JJJ��� • CE 875 Irheieby 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 G FICertified copy is hereby furnished. UILDING 'I LOCALITY e TADDRESS Certified copy is filed with the county building inspection 4 o,15cALITY / NEAREST department CROSS ST Date Applicant AREST DISTRICT,�I� G OUP TYPE PR ESSED BY CROSS ST. �- CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP TRIG HW AV No Isd_9 (CIRCLE) STATE MAJOR 4C-ND 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. ll�� �� o permit is issued, I shall not employ any person in any manner WNER _� so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP AIL io D ,� ADDRESS ~ Date ApplicantC�I w NOTICE TO APPLICANT If, after making this Certificate of cl ��}/NOL* 100/_e 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 beEl deemed revoked. TRAILER USE ❑ GEOLOGY INSPECTION ❑ 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) 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. PARKINGSPACES REQ D D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE El I am exempt from the licensing requirements as I am a FROM licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S GNATURE mess and Professions Code). ESENT USE OF BUILDING FINAL APPROVAL �l Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION No. of EXISTING BUILDINGS 6 3 7,73 AwlA ON LOT AND USE I hereby affirm that I am exempt from the Contractor's # • o e 0 ,30 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code). NO. PARKING • o • • o e • z El I, as owner of theproperty, will do the work and the SPACES PROVIDED 0 1,2 1 x'87 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ROP SED USE of BUILDING I hereby affirm that there is a construction lending agency `i�j for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name I V \I`I PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that ' ha v this ap i tion and state that the �o above informati is c ect I a ee o comply with all County ISSUANCE FEE ordinances e s re i to building construction, \rV and here or prese a v s of this County to erVer TOTAL FEE upo ab ve- ro for inspec n p rpos . I SEE REVERSE FOR EXPLANATORY LANGUAGE Signat o Per/tee ! Da WWORKERS'COMPENSATIONDECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION , m that I have a certificate of consent tc selfCOUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ertificate of Workers'Compensation Insurance,orpy thereof .Sc. 3800,Lab.C) CompBUILDIN any FOR APPLICANT TO FILL IN, ADDRESS. ADDRSS Certified copy is hereby furnished. BUILDING DDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST Date Applicant NEAREST t (STRICT NO GROUP TYPE PROCESSED BY CROSS ST � '� Q , CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY ND. (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 SIZE OF LOT EXISTING BLDG. d 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. MAIL OCCUPANCY GROUP �� p Date Applicant ADDRESS �/�� I— U NOTICE TO APPLICANT- If, after mak !e '� TE L. p ��3 $3 OCCUPANT LOAD W making this Certificate of CITY / rvo. J—� cn Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APP ICATION 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 PERM( ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS El ness and Professions Code,and my license is in full force and effect. PARKING REQ'D PROVIDED License Number Lic. Class SPACES SLIMITED TIME USE Contractor Date py D� DATE DATE El I am exempt from the licensing requirements as I am a FROM TO INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO. OF sl TORE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES mess and Professions Code). FINAL APPROVAL Lie.or Reg.No Date PRESENT USE OF BUILDING s NO E HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 0000-1'1001 9/15/39 I hereby affirm that I am exempt from the Contractor's IJ UV111 /7 License Law for the following reason (Section 7031.5, Busi- 17338 j PM 2*-04 ness and Professions Code) NO PARKING D1, 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). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agenc 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 , 0b 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, andeIeby authorize representatives of this County to enter TOTAL FEE 0(� u o. *he above-mentio pr tty for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE I i Permittee Date I Ii I WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION ' CE 875 I heret 'affirrrl that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C.) Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished ABU'DDRELD1 N SS 645 7VAIAS k�e LOCALITY �G r 0 Certified copy is filed with the county building inspection LOCALITYNEAREST department. P66 r^/T CROSS ST. Date Applicant NEAREST p J T/� DISTRICT N GFW ty TYPE PROC SED BY CROSS ST. 4/V C(A/G A �`// /�i..// CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v Y �/ COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MA P�r-/� , / IG„WAV N0 J/V(- C/IJV (CIRCLE) STATE MAJOR SE CO D 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 Lor 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 E3 OCCUPANCY GROUP o Date ADDRESS Applicant WJ NOTICE TO APPLICANT- If, after making this Certificate of CITY I TN 0. 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 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 D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE ❑ 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 SI NATURE mess and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date Z w/aT - HOME OWNER-BUILDER DECLARATION NO. OF EXIS ING BUILDINGS ON LOT AND USE :2 8 2 9 8 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- # 9 - 688 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). 1 1,0 5 x 8 7 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 ` 1 Lender's Address 1` 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE rgnature of ermittee Date r 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 BUILDINGND 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 ' -1 ADDRESS ❑ Certified copy is hereby furnished BUILDING ?oTuA�p,� aS `j�� LOCALITY ADDRESS �/ ✓ k.!! ❑ Certified copy Is filed with the county building InspectionI NEAREST department -LOCALITY Te Y►'1 `-+ CROSS ST Date Applicant AREST - J/� DISTRICT NO GR P TYPE P O SSED BY CROSS ST / // a- CONST CERTIFICATE OF EXEMPTION-FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK rvoP �d (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT rNOW oN Lor s USE 210NE sP CIAL CONDITIONS a0 by the permit is for one hundred dollars ($100) or less.) U USE OF SIZE OF LOT EXISTING BLDG /i i2 I certify that in the performance of the work for which this } C/ VVV O permit is Issued, I shall not employ any person In any manner WNER V t so as to become subject to the Workers' Compensation Laws AIL a f /� OCCUPANCY GROUP / U ADORESS�Q « W Date Applicant � TEL. Cl) NOTICE TO APPLICANT If, after making this Certificate of CITY NO 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 USEGEOLOGY 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 ❑ VI (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is In full force and y e - PARKING effect SPACES REQ'D PROVIDED Y - +Llcense Number Lic Class LIMITED TIME USE Contractor Date DATE DATE FROM TO ❑ I am exempt from the licensing requirements as I am aINSPECTOR'S - licensed architect or a registered professional engineer SIZE OF No OF acting In my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SI NATURE mess and Professions Code) E SE NT USE OF BUILDING FINAL APPROVAL ✓ C/ �1 ��� Llc.or Reg.No Date G � HOME OWNER-BUILDER DECLARATION NO of EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's 2,9,3,2,3 A License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO, PARKING # • o • • 8 8 SPACES PROVIDED 1 . ❑ I, as owner of the property, will do the work and the e e•o e o • •.� structure Is not intended or offered for sale (Section + 7044, Business and Professions Code) n(� . OPOSED USE OF BUILDING ,Y ��O,1 -8 4 CONSTRUCTION LENDING AGENCY � ( _1, u�� I hereby affirm that there is a construction lending agency Oh Tt 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, TOTAL FEE �© and hereby authorize representatives of this County to enter upo t above- entioned r perty�for Inspects n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � G SI ature of Permittee Date C/ 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 BUILRDESSING ADD ❑ Certified copy is hereby furnished BUILDING � LOCALITY i+ r� IDADDRESS �[�•(P Certified copy is filed with the county building Inspection G NEAREST department LOCALITY �70 CROSS ST Date Applicant NEAREST �J DISTRICT NO. GROUP TV PE PROCESSED BY CROSS ST -'� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK NOP O (DIRC E) STATE MAJOR SECOND LOCAL d NO. OF BLDGS (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE 5 CIAL CONDITIONS 04 by the permit is for one hundred dollars ($100)4 or less.) USE OF i SIZE OF LOT EXISTING LOG. •� CC 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 OWNE U so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUPE:= W ADDRESS / jVeJ fL Date ApplicantU) TEL.q� NOTICE TO APPLICANT If, after making this Certificate of CITY 6ze�/ dv3 No f 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 I 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 q (LIST ITEMS BELOW) NO OF EXITS 44)(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 O PROVIDED Lbcense Number Lic Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM To INSPECTOR'S licensed architect or a registered professional engineer SIZE•OF NO OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL - PRESENT USE OF BUILDING 12 Lic.or Reg.No Date �•/ HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS CO 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- �,8 8 1,11 A ness and Professions Code) No, PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the #'• • • • 8:8 structure Is not intended or offered for sale (Section f i 7044, Business and Professions Code). 0 0 0 o e • •' PROPOSED USE OF BUILDING I I • 1 • CONSTRUCTION LENDING AGENCY ,0 2 0 8—'8 4 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 upon the above-mentioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORIfFP,S'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C AT I O N {� LI I hereby,affirm that I have a certificate of consent to self CE 875 (11-84)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 BADUDRESSILDING � A ,�/I_ l/f �/L Certified copy is hereby furnished. �( BUILDING _ o` j �L '\ ADDRESS ���� �-} (//V DR LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY ) NEAREST department X L - c, CROSS ST Date Applicant NEAREST ) ,/ DISTRICT NO. G OUP ITYPE P ESSED BY CROSS ST. L S NPR 0 �`�yl� - `) CONST.'/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C/ /_ `/ COMPENSATION INSURANCE DESCRIPTION I LOT NO. 8c BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO. F SLOGS. (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 LOTEXISTING BLDG. I certify that in the performance of the work for which this 1 CD permit is issued, I shall not employ any person in any manner OWNER �� so as to become subject to the Workers' Compensation Laws. L(�G VJ�N Ir J P MAILl ../ 11 ^ OCCUPANCY GROUP ADDRESS `p(�0 GLA5 lo*45 PA , O Date Applicant LE3LI NOTICE TO APPLICANT If, after making this Certificate of CITY t,& G( TNoL OCCUPANT LOAD Exemption, you should become subject to the Workers' IAPPLICATION 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. OCCUPANCY INSPECTION El Panic Devices LICENSED CONTRACTORS DECLARATION 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 X { � W✓�/ ` PARKING II�I effect REQ�D D PROVIDED 1�� J� Aff SPACES License Number Lie. Class ci R L �` � 0 LIMITED TIME USE Contractor Date DATE DATE F] I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No of FROM' INSPECTORS SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES mess and Professions Code). FINAL APPROVAL X PRESENT USE OF BUILDING /7 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'sLicenJ 1 nese se Law for the Code):Wing reason (Section 7031.5, Busi No. PARKING �!1�pq -1=1- J 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 O4 W44 L w for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). p Lender's Name Lender's Address PROPOSED MAX. OCC. 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 repr tatives oft s County to enter TOTAL FEE upon th m tlo& pr perty for In cti rposeS. SE HEVEFRSE FOR EXPLANATORY LANGUAGE Signature of Perm ee ate � `' WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION {� `. CE 875 u I hereb_ affirmSthat 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 BUILDING ��]��` 7 a$ T�.raB D=.� LOCALITY ADDRESS L. 4 i./ 1=i/ ❑ Certified copy Is filed with the county budding inspection NEAREST department LOCALITY e CROSS ST lei lee Date Applicant NEAREST ��rV/// DISTRICT NO,-JGROUP T PE IPROCESSED BY CROSS ST. CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NOP (CIRCLE) STATE MAJOR SECOND LOCAL d _ 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 ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG cc 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 Harry J.Quinn U so as to become subject to the Workers' Compensation Laws MAILp {/� p OCCUPANCY GROUPLLJ ADDRESS 510 S,Burnside#,#llH 'Z CL Date Applicant in NOTICE TO APPLICANT If, after making this Certificate of CITY lips Angeles NO. OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HAR jWARE 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 usrness and Professions Code, and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED � License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE FROM TO ❑ 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 iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic or Re No Date fr [� Reg. V8Ca1'l't HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE 39, 6A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busr olo e • 8 8 ness and Professions Code) NO. PARKING SPACES PROVIDED O O O O O e 0 � I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 12 Q 6—83 7044, Business and Professions Code) PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY Sales Office I hereby affirm that there Is a construction lending agency for the performance of the wok 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, TOTAL FEE and hereby authorize representatives of this County to enter upo t above-me property for Inspect n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit; Date