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HomeMy Public PortalAbout9906-9910 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(,', 84> MISCELLANEOUS APPLICATION I hereby ,affirm cert 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 a certe`ied copy thereof(Sec 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS f Certified copy is hereby Furnished BUILDING / 7 LOCALITY �/► ADDRESS L v/ Certified copy is filed with the county building inspection7 LOCALITYNEAREST department. t' ( r 7 6 CROSS ST. Date Applicant NEAREST DI T IC Nf'� O TYPE P CESSED BY CROSS ST. �- 5 x CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (� 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 SIZE OF LOT EXISTING BLDG. d which this o permit'is issued, I,shall not employ any person in any manner OWNER LL S 0 C / F s' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS O T64A _ v� C3 Date Applicant Lu NOTICE TO APPLICANT: If, after making this Certificate of CITY rTio� Sv/T� OCCUPANT LOAD y 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. Know). deemed revoked. Panic Devices El 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 REQ•D PROVIDED SPACES License Number Lic. Class ` LIMITED TIME USE Contractor Date /S L497 A/ l c DATE DATE ❑ 1 am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineerSIZE OF No of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG' STORIES SIGNATURE mess and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING D _ / Lic.or Reg.No. Date Ari I HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS N10 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 �� — -- ES PROVIDED SPACES 1 �r,C F1 I, as owner of the property, will do the work and the 7402 1 AM 3:25 structure is not intended or offered for sale (Section Y' , 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING y C 1 hereby affirm that there is a construction lending agency �S 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 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 00 p the/above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur f Permittee ate I WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION {� CE 875 LI 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. Bu1LDING G��p .�— LOCALITY DR ADESSI� G DCertified copy is filedwlth the county building inspection LOCALITY NEAREST department. CROSS ST. Data Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. D Q CONST CERTIFICATE OF EXEMPTION-FROM WORKERS' LEGAL a Y COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK MAP HIGHWAY (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. I certify that in the performance of the work for which this o permitas issued, I shall not employ any person in any manner OWNER J so as to become subject to the Workers' Compensation Laws MAILOCCUPANCY GROUP �_a a ADDRES ~ Date Applicant ' LC A NOTICE TO APPLICANT If, after making this Certificate of Cir a NOI. - 818"_ -)_s 4 -1 lO D 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. 0 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 ���. �l �' effect. PARKING REq'D D PROVIDED D SPACES License Number Lic. Class .-1 a LIMITED TIME USE Contractor Date DATE DATE FROM TO a I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INS P TOR'S acting in,my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES s TORE mess and Professions Code). FINAL APPROVAL - PRESENT USE OF BUILDING Lic or Reg.No Date HOME OWNER-BUILDER DECLARATION NO. OF,EXISTING BUILDINGS - // 1 No 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 !s=r'-=jl;�I} - SPACES PROVIDED �_;. i �.�rE --e•I� 1, as owner of the property, will do the work,and the ;_,rp i s structure is not intended or offered for sale (Section 7044,Business and Professions Code). I/+ CONSTRUCTION LENDING AGENCY PROPOSED USE OF.BUILDING I� 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 -- - - 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 rep sentatives of this County to enter TOTAL FEE upon the ab - ent ne property for inspection purposes. L SEE REVERSE FOR EXPLANATORY LANGUAGE 1 r O ermltteeaI3to - - - WORKERS'COMPENSATION DECLARATION CE 875(11-84) 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 cer ified cod y thereof(Sec. 3800,Lab C) Polic�'No, Company FOR APPLICANT TO FILL IN BUILDING ./ ADDRESS Certified copy is hereby furnished ADDRESS m5, unGl L, ! LOCALITY ElCertified copy is filed with the county building inspection LOCALITY NEAREST department- CROSS ST. Date Applicant J NEAREST ` DIS RICT O TYPE CESS BY CROSS ST , CONST CERTIFICATE OF EXEMPTION FROM WORKERSLEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR ECON 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 slzE of LOT EXISTING BLDG o permit is issued, I shall not employ any person in any manner OWNER OF-Pjmk (NP., ` ( - =' so as to become subject to the Workers' Compensation Laws. MAIL u OCCUPANCY GROUP o ADDRESS S� � T U C.3 Date Applicant NOTICE,TO APPLICANT If, after making this Certificate of lCITY No* Z-84^(01) OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLIC TION 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. Know]. 0 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. ��j PARKING REO•D pROVID ED r SPACES License Number Lic Class v-2�5S v` V �� LIMITED TIME USE Contractor Date eY V t c-e- DATE DATE 0 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 CTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS I FEE 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�14 —� � ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 74'34 1 Ali 9:54 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 I hereby affirm that there is a construction lending agency �(� sexaczt 1 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 PERMIT FEE � I certify that I have read this application and state that the above at is c ect.I a ee to comply with all County ISSUANCE FEE ordinanc s nd State la s rely to build gA truction, and he e y utho e e esent ves of this o to enter TOTAL. FEE 5t bo a me do ed rope y for inspec o �ses. 3 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date i WORKERS'COMPENSATION DECLARATION CE 87,5a MISCELLANEOUS APPLICATION CE 87, �-8 4) I hereby affirm that I have a certificate of consent to self `NOUNTY OF LOS'-ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compehsation Insurance,or a certified copy thereof(Sec. 3800,Lab.C). Policy No. Company FOR APPLICANT TO FILL IN BUILDING 990 / �(�7/ ADDRESS {�lrti Certified copy is hereby furnished. BUILDING 0 GS ��A5 D , ADDRESS [� LOCALITY ElCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant ` NEAREST B�, ^-41�' DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. (nR �D ` _� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d 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 �?iI certify that in the performance of the work for SIZE OF LOT EXISTING BLDG. k_which this - permit is issued, I shall not employ any person in any manner OWNER /y� y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP, C:) Date Applicant ADDRESS �pI 000tflLL 8�.1fD w NOTICE TO APPLICANT: If, after making this Certificate of CIT YXAZ62A No. OCCUPANT LOAD N 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 USE GEOLOGY INSPECTION ❑ deemed revoked E] ❑ 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 lV E O� �US�' S effect. PARKING /! SPACES REp•D �'iW80V1 � License Number Lie Class j,p E-5 11J LIMITED TIME USE L Contractor Date DATE TE f J� � , I am exempt from the licensing requirements as I am a FROM TO L3 2 licensed architect or a registered professional engineer SIZE OF No. OF IN SPECTO R•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code). FINAL APPROVAL T �_67_Q� LIC or Reg No. Date PRESENT USE OF BUILDING [ / HOME OWNER-BUILDER DECLARATION -NO.OF EXISTING BUILDINGS �'�• G'` ' ON LOT AND USE ISI I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- ness and Professions Code)• • NO.PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency 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 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 ab -me tioned p inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION E LARATION 76M444 ' CE 875 (11-84) MISCELLANEOUS APPLICATION {� I hereby a c rthat I have a certificate of consent to self COUNTY OF LOS ANGELES .BUILDING AND SAFETY DIVISION LI insure,"or a certificate of Workers'.Compensation Insurance,or a certified copy thereof(Sec. 3800;Lab.C,). PolicyADDRESS LNo. Company FOR APPLICANT TO FILL IN BUILDING D /_Aw 1!O�uAf� n J/ aCertified copy i's hereby furnished BUILDING D u�/ D C. �) LOCALITY �- LE &l / 7� J� ADDRESS N v DCertified copy is filed with the county building inspection LOCALITY NEAREST 6�77W/1v department CROSS ST �'(�1 Date Applicant NEAREST ��J d,/A DISTRICT NO GROUP TYPE P CESSED BY CROSS ST."DAJ,,A1 +I• D CONST, CERTIFICATE OF EXEMPTION FROM WORKERS'. LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY .. ` I _ - 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 ,y I certify'that in the performance of the work for which this SIZE OF Lor E (STING BLDG. Ci a permit is issued, I shall not employ any person in any manner OWNER so as'to become subject to the Workers' Compensation Laws. MAIL f�O / OCCUPANCY GROUP o AD DR ES � /�L F— Date Applicant I I`� NOTICE TO APPLICANT: If, after making this Certificate of CITY ,S' 0,1 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 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 Busr NO OF EXITS ness and Professions Code, and my-hcense is-in full force and effect. J/•��--� PARKING REQ'DPROVIDED S SPACES L��J License Number Lrc. Class L�1VT''f LIMITED TIME USE Contractor Date DATE DATE FROM TO I-am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE OFNO 2 ! OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS EXISTING BLDG ,(U I(f STORIES SIGN TORE mess and Professions Code) �� /� FINAL APPROVAL PRESENT USE OF BUILDING Lrc.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 11111/ /1� p, !Ill1 License Law for the following reason (Section 7031.5, Busr- y_i f Pill 113 57 ness and Professions Code): NO. PARKING 3 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). 7- r PROPOSED USE OF BUILDING s`-7QVlC' CONSTRUCTION LENDING AGENCYL I liereby 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 y 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 autho rep ntatives of-this County to enter TOTAL FEE 5B� ,upop the above do roperty for inspectro purposes. �?� SEE REVERSE FOR EXPLANATORY LANGUAGE /' Signature of Permittee D e WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION J� CE 875 I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certif tate of Workers'Compensation Insurance, e,or a certified copy-thereof(Sec 3800,Lab.C) Policy Noi- Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. (ADDREINGqq SS 1/g r1IJ it Q. LOCALITY C F1Certified copy is filed with the county building inspection LOCALITY ` ^ �j NEAREST department. Pl E l0 0 CROSS ST Daie Applicant NEAREST [NN'O. S RICT NO GROUP TYPE PROCESSED BY CROSS ST. ' CONST. ` / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V - COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK P HIGHWAY (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS.(This section need not be completed if the work involved TRACT NOW ON LOT E 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 slzE of Lor EXISTING BLDG. A 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 ��Q� /� OCCUPANCY GROUP�..�, � �, a AD DR ES LJ IJ u/lt 1 "` i4-l.t ti' � w \ , ° ~ Date Applicant , C-3 NOTICE TO APPLICANT• If, after making this Certificate of clrr TE Lglff OCCUPANT LOAD ° Exemption, you should become subject to the Workers' i A PLICAT ON FOR EXIT HARDWARE Compensation provisioris of the Labor Code,you must forth- with comply with such provisions oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ElE] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION' OCCUPANCY INSPECTION Panic Devices 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 Q PARKING REO'D I pROVID ED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE F1am exempt from the licensing requirements as I am a PROM TD licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE mess and Professions Code), FINAL APPROVAL PRESENT USE OF BUILDING Lic or Reg No. Date HOME OWNER-BUILDER DECLARATION No OF EXISTING BUILDINGS 0_ EE 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- M-0001 5/16l87 7��4 ness and Professions Code) NO.PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 33r- 1 PM12:34 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING S� 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 I certify that I have read this application and state that the PERMIT FEE � p� 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 u n above-mentioned prpperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE _ Signatu a of ermittee Date WORKERS'COMPENSATION DECLARATION 76M444 M I SC E L LA N E O U S APPLICATION CE 875 (11-84) I herg"or 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 certified copy thereof(Sec 3800,Lab.C.) Policy,No Company FOR APPLICANT TO FILL IN BUILDING ♦ .y,//'.A'�{/' ADDRESS Certified copy is hereby furnished. X BUDDR / 7 ILDESS ING D Las �YIA5 �IY� /�L'v LOCAL.ET A Certified copy is filed with the county building inspection LOCALITY NEAREST department 191 7� 7 CROSS ST. Date Applicant NEAREST 7 DISTRICT NO. GROUP TYPE CESSED BY CROSS ST. rI�S va ✓D /} -� CONST I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL / 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 slzE of Lor XIS 'ING BLDG. o permit is issued, Ije not employ any person in any manner �( o ER ;= so as to become subject to the Workers' Compensation Laws. /` MAIL Q OCCUPANCY GROUP a I P ADDRESS � Date Applicant LUL, NOTICE TO APPLICANT: If, after making this Certificate of X CITY OCCUPANT LOAD O_ Exemption, you should become subject to the Workers' APPLICATION FOR `��1`�'/� Compensation provisions of the Labor Code, you must forth- 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 ❑ 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 Y effect. I/YW'// PARKING SPACES REq'D O PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date- DATE DATE ElI 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 SIGNATURE mess and Professions Code) �"Oj1 FINAL APPROVAL Q� a2 PRESENT USE OF BUILDING ` _l Lic or Reg.No. Date Z� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS lll y ESC A FEE ` ON LOT AND USE CI�� 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 -L:�-t 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 v .t for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PRO -SBD 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, m , and hereby authorize representatives of this County to enter TOTAL. FEE lJV upon the above-mentioned prope for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i ture of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 r i I hereby,.affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ,lull insuret•or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BUILDING /// � - ADDRESS , 10 Certified coy is hereby furnished �/ BUILDING j,_ ( /\,0_3 S u-�' &_S P Y /y` 1 c LOCALITY ADDRESS - �1 Certified- rtmecopy is filed with the county building inspection 1 1, LOCALITY ��M CROSS sT. Date Applicant NEAREST I�l� [, I 1_ /) DISTRICT NO GR P CO' PROCESSE B CROSS ST. W r ate/ /�j, CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 17 COMPENSATION INSURANCE. DESCRIPTION LOT NO BLOCK MAP HIGHWAY" NO (CIRCLE) STATE MAJOR SECOND L CAL _ 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. I certify that in the,performance of_the work for which this : o permit is issued, I shall riot employ any person in any manner OWNER C ,�d f" 1/ L ' A ss aw-*fes %> so as to become subject to the Workers' Compensation Laws. MAIL n OCCUPANCY'GROU_P��-Em o i 1 1 ADDRESS lD�� Adm ��I `\1����u., \ `�,J U Date Applicant q pr I„ NOTICE TO APPLICANT• If, after making this Certificate of clrY�l 9&p ryOL eC•OJ - ? �'� OCCUPANT LOAD OL_ 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 USE ❑ 'GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked _ - LICENSED CONTRACTORS DECLARATION occuawrycY wsPEcrlory` Panic Devices El I hereby affirm that I am licensed under,provisions of Chapter SAFETY PER IT (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'O O PROVIDED 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!� SIG ATURE mess and Professions Code). I ` FINAL APPROVAL PRESENT USE OF BUILDING l 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 I, as owner of the property, will do,the work and the sPwces PROVIDED 1 3 3 A structure is not intended or offered for sale (Section 7044,Business and Professions Code). # o o e o 88 CONSTRUCTION,LENDING AGENCY PROPOSED USE of BUILDING e e o o e s o z I hereby affirm that there is a construction lending agency 1 'S 0(Z 1 2'1 5 8 8 for the performance of the work-for which this permit is y issued(Sec 3097,Civ C.) 'To GI ,�� SI( Q` 0 W Q/- Lender's Name PROPOSED MAX. OCC. Lender's Address C+00 PERMIT FEE J 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 o u Ion the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - • - Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 87 5(11-84) MISCELLANEOUS APPLICATION CE 875 I hereby ,cert that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure;�or` certificate of Workers'Compensation Insurance,or a certifie copy,thereof(Sec. 3800,Lab.C.). Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING ll S S C)R LOCALITY ADDRESS Certified copy is-filed with the county building inspection LOCALITYp NEAREST department L� Crl CROSS ST Date Applicant NEAREST ��7�/ c \ DISTRICT NO. GROUP TYPE PROCESSED'BY CROSS ST. L�/O� EJ QW 7 I j�� �� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL !/ I/ 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 SIZE OF LOT EXISTING BLDG. I certify that iii the performance of the work for which this �� o permit is issued, I shall not employ any person in any manner 'OWNER j U ' C' , y so as to become subject to the Workers' Compensation Laws. ^^MA'LJJ /f�j OCCUPANCY GROUP ,�J1 � ADDRESS ,� LT I V I O Date Applicant c TEL. LV NOTICE TO APPLICANT: If, after making this Certificate of CITY (� No. �O OCCUPANT•LOAD N 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 USE'[] GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. ;, • LICENSED CONTRACTORS DECLARATION occuPwNcv INSPECTION ❑ Panlc,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 irfull force and / f!'/ /� effect. ` Icy `7 PARKING REQ'D PROVIDED SPACES LicenseNumber Lic. Class LIMITED TIME USE Contractor Date DATE DATE ` FROM TO El 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 S NA RE iness and Professions Code). - PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date / HCl HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS p €LL 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) usi- nessandProfessionsCode) NO. PARKING `I 'I• -: j„� I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section � '` - t't'; Y�:,., 7044,Business and Professions Code). PROPOSED USE of BUILDING 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. 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 To rAL FEE upon the above-mentioned property'for inspection purposes I I Zk 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Sii;� uVlfermittee Date WORKERS'COMPENSATION DECLARATION CE875(11-84)M CE M I SC E L LA N E O U S,A P P L I C A T I O N 875 I hereby affirm.that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION in'sure,'oiya certificate of Workers'Compensation Insurance,or - , a certified copy thereof(Sec. 3800,Lab C). Policy No Company FOR APPLICANTTO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. u1LOING / Q-S G�/C<'�S r ADDRESS LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY /n ` NEAREST department. f.� G l © CROSS ST Date ApplicantNEAREST DISTRICT NO GROUP' TYPE P CESSED BY CROSS ST. MAUS r D f/ _ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY Ho NOOF BLDGS (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.) us OF �p SIZE LO TING 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. MAIL OCCUPANCY GROUP Date Applicant ADDRESS S t~Uit NOTICE TO APPLICANT• If, after making this Certificate of clry ` No. OCCUPANT LOAD °- Exemption, you should become subject,to the Workers' APPL CATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth with comply with such provisions or this permit shall be TRAILER US ffDGEOLOGY INSPECTION E) No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ El I hereby affirm that I am licensed under provisions of Chapter ❑ 9 (commencing with Section 70 00 ) 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 SPACES REQ'D O PROVIDED O I r License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF FROM' To' INSPECTOR'S acting in my' professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE mess and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No Date n HOME OWNER-BUILDER DECLARATION NO.OF EXISTING IbUILD1fNGS 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�y 3 0 id .:I- 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 a for the performance of the work for which this permit is t issued(Sec. 3097,Civ.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 property for inspection purposes 44\ SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date WORKERS'COMPENSATION DECLARATION a CE 875(11-84) M I SC E L LA N EO U S APPLICATION • CE 87 ' 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 ADDRESS /BUILDING- 977 Gpo O .,W.1 El Certified-copy is hereby furnished BUILDING 0 Q 16 rr ADDRESS E "A-.I LOCALITY n Jf Certified copy is filed with the county building inspection LOCALITY / ¢ NEAREST department. x �ih /Ci Cr CROSS ST - NEAREST /� DISTRICT NO. GROUP TYPE P OCESSED BY Date Applicant CROSS Sr i,&.., -A � �0 y ` CONSV CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O O` V COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL I - I NO OF BLDGS. - (This section_need not be completed if the work involved TRACT NOW ON LOT JUSE ZONESPECIAL 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. � 0 permit is issued, I shall not employ any person in any mannerx OWNER ,so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a a ADDRESS 1--• Date' Applicant LUS NOTICE TO APPLICANT If, after making this Certificate of CITY Nol. 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 oI this permit shall be TRAILER USE ❑ - GEOLOGY INSPECTION El GEOLOGY Spec. Knowl, a deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY'INSPECTION E] 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 hcense is in full force and J >effect. Y f�lli% PARKING SPACES REp•D PROVIDED /151 ON/ J 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. {p�U �}� STORIES S NATURE mess and Professions Code) / FINAL APPROVAL PRESENT USE OF BUILDING '1 Lic.or Reg.No.' Date r '_a �. HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS •' ON LOT AND USE I hereby affirm that I am exembt from the Contractor's License Law for the following reason (Section 70315, Busi- 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 (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ��p )lC71r,1 r 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 I certify that I have read this application and state•that the above mfor tion is correct I agree to comply with all County ISSUANCE FEE ordinance a State laws relating to building construction, and her y thorize re ntatives of this County to enter TOTAL FEE upon t e ab e-mention roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS 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 N6'-z Company FOR APPLICANT TO FILL IN BUILDING ADDRESS FICertified copy is hereby furnished. BUILDING LO ADDRESS CALITY , _• Certified copy is filed with the county building inspection LOCALITY NEAREST department. q cRoss sr Date Applicant NEAREST DI TRICT NO. I 'OUP TYPE PROC SS BY CROSS ST. . � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP/�I HIGHWAY rvD J 43449 (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWNO OON LOT S. USE ZONE SPE IAL 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. permit is issued, I shall not employ any person in any manner OWNERRillA550eld60h!J � so as to become subject to the Workers' Compensation Laws. MAIL // (� i� // �/p 7�ys / ` OCCUPtANCiY GR,iOU`P•y�`�`8��� �> o ADDRESS i OTI 5 a1 IU- ' ve• T1 2• "�''-••.•��r, l V KJ S '1N ,. Date Applicant TEL , tU NOTICE TO APPLICANT: If, after making this Certificate of CITY No. ��'—�8�— (� OCCUPANT LOAD' Exemption, you should become subject to the Workers' N 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. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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 PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a rROM TO licensed architect or a registered professional engineer SIZE OF No OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S.50qATURE iness and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING v/ Lic.or Reg.No.• Date HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ; N FEE 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- �� Q�l�(]-Mol 7/17/09 ness and Professions Code) NO. PARKING V I, as owner of the property, will do the work and the SPACES PROVIDED ,� / 1 Afii10:G 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 C0M126d61zf for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name Lender's Address � , � PERMIT FEE PROPOSED MAX. OCC. 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 (J ordinances and State laws relating to building construction, anq hereby authorize representatives of this County to enter TOTAL FEE n the abr e- entioned property for inspection purpos _ 7 r ! SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 j CE875(,t_84) MISCELLANEOUS APPLICATION I he>eby affqxri cert that I have a certificate of consent to self COUNTY OF LQS 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 BUILDING FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished BUILDING �p ` �// ADDRESS I ��1�///�J�,�Ip 14 r LO CA LIT Certified copy is filed with the county building inspection LOCALITY //_^� NEAREST department CROSS ST. Date Applicant NEAREST DISTRICT NO. G OUP TYPE PR CESSED BY CROSS ST fJ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Vf COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY AY N0 (CIRCLE) STATE MAJOR SECOND LOCAL NO OF BLDGS (This SCCtIOn need not be completed if the woIk Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS - by the permit Is for one hundred dollars ($100) or less.) USE OF EXISTING BLDG - Y' I certify that in the'performance'of the work for which this SIZE of Lor — o permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. /� / / �J• 1 OCCUPANCY GROUPp7 MAIL ���V/ I'�• { /;i� ADDRESS � Date Applicant W NOTICE TO APPLICANT• If, after making this Certificate of CIT4PZ ()2No OCCUPANT LOAD 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 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 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 �+ e effect. 7 PARKING SPACES REO'D PROVIDED - 6 License Number Lie. Class .rte y RE-E LIMITED TIME USE Contractor Date DATE yATE r ❑ 1 am exempt from the licensing requirements as I am a PRD. TD 1, � 1 _1 1 licensed architect or a registered professional engineer SIZE OF Y NO. OF '"�35 11 SCN R •1r acting in my professional capacity (Section 7051, Bus' EXISTING BLDG / $/' STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING ' _ Lie.or Reg.No. Date L HOME OWNER-BUILDER DECLARATION NO, OF EXISTING BUILDINGS //,�/ l+-Y 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 ❑ 1, 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 vC I hereby affirm that there is a construction lending agency P x 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 F.O.��C. E ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter T gg entioned property for inspection purposes. 1r^ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perm i e Date WORKERS'COMPENSATION DECLARATION CE8754(11-84) 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). BUILDING Policy No. Company FOR APPLICANT TO FILL IN./ ADDRESS Certified copy is hereby furnished. UD,LD ILE3G N. q �y LOCALITY. A5 j� 7a- Certified copy is filed with the county building inspection OCALITY q�7 Sa NEAR EST / department. CROs Sr. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CE SSED BY CROSS ST A� CONST. _ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE, DESCRIPTION LOT No. BLOCK MAP - HIGHWAY ' NO (CIRCLE) STATE MAJOR SECOND LOCAL NO OF BLDG ' (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 slzE of Lor ExIsrlNc BLDG. �'� o permit is issued, I shall not employ any person ui any manner il OWNER OLL 91 N ® y so as to become subject to the Workers' Compensation Laws. MAIL '1 OCCUPANCY GROUP o ADDRESS µ, 900 Date Applicant LU NOTICE TO APPLICANT• If, after making this Certificate of CITY }} 91g6 NOL _ ion OCCUPANT LOAD N Exemption, you should' become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions,of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter w SAFETY PERMIT EJ (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. L1L-t-rq PARKING REQ%D E� PROVIDED SPACES License Number Lie. Class LIMITED TIME USE Contractor Date _ DATE DATE I 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 TURE mess and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS t s EF 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 / ,•l��� `� ecc- 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 agency0_bA16w.-rwa 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 � - 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 upon the above-mentioned p perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P rmittee Date W(lRZy/RS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION I � CE 875 I hereb�,affirm that I have a cbrtificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, br 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 ADDRESS 9908 Las Tunas DR #I-Temple LOCALITY FCertified copy is filed with the county building inspection LOCALITY City, CA 91780 NEAREST department CROSS ST Date Applicant NEAREST Baldwin Ave. DISTRICT NO. GROUP CONST PROCESSED BY CROSS ST. ITYPE CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (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 I certify that in the performance of the work for which thisJADDRES slzE of Lor EXISTING BLDG o permit is issued, I,shall not employ any person in any mannerWNER J r—Min Shi .� J so as to become subject to the Workers' Compensation Laws OCCUPANCYMAIL 'GROUP• Terra ,� \ ~ �`1ODate Applicant NOTICE TO APPLICANT If, after making this Certificate ofITY 1007 No` 818-446-9788 �, OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- wlth 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 Q effect JAHE J PARKING REQ'D PROVIDED CIAC PROFESSIONAL GROUP, I NC, SPACES License Number Lia Class 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 TO INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code) 'Office and FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg No. Date . Retail store- HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS lk ln �EE 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- 0000-0001 8/23/89 ness and Professions Code): NO. PARKING F1I, as owner of the property, will do the work and the SPACES PROVIDED 5264 1 PM 4:37 structure is not intended or offered for sale (Section 7044,Business and Professions Code). PROPOSED usE_oF BUILDING Credit report , CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency real estate appraisal, real estate / 1 for the performance of the work for which this permit is v issued(See. 3097,Civ.C.). mortgage, structural engineering Lender's Name 31 Lender's Address services. PROPOSED MAX. OCG, vj( 9( � 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 representativ S f this County to enter TOTAL FEE vv up tl� bove-m oned prope inspection p rpose / ,y� / SEE REVERSE FOR EXPLANATORY LANGUAGE 4 v Sign ture ermi ec Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that 1 Have a certifnbate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msure,ror a cer7fficate of Workers'Compensation Insurance, e,or - a certified copy thereof(Sec. 3800,Lab C.). Policy No Company FOR APPLICANT TO FILL N r BUILDING ADDRESS Certified copy is hereby furnished BUILDING Og 7U.(/AK ADDRESS O LOCALITY ElCertified'copy is filed with the county building inspection LOCALITY -7NEAR EST department. ?I CROSS ST.' Date Applicant NEARESTI DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. L W / y CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL' COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY _ NO OF BLDG NO. , (CIRCLE) STATE MAJOR SECOND LOCAL _ S. (This section need not be completed if the woik'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 o permit is issued, I shall not employ any person in any manner Y OWNER Of r0 ert : Gr e S-')so as to'become'sublect to the Workers' Compensation Laws. MAIL Date Applicant / �CCUPANCY GROUP o ADDRESS' Z' c 4D,111.11 C~.7 I„ TE OCCUPANT LOAD NOTICE TO APPLICANT: If,-after making this Certificate of clrr - S — y 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`` E] ❑ No Spec. Knowl. deemed revoked. ` 'TRAILER USE GEOLOGY INSPECTION 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-Profes'sions Code, and my license is in full force and 7�7 effect NaIl2 PARKING REQ'D pROVID ED SPACES J . License Number Lie. Class LIMITED TIME USE Contractor- Date 'T -- DATE DATE FROM: TO 1 am exempt from the licensing requirements as I am a licensed- architect or a registered professional' engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGN RE mess and Professions Code). FINAL APPROVAL I ,� " PRESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS a ON LOT AND USE O I hereby-affirm that I am exempt from the Contractor's r�'� P G1i;3 .(;{301 11 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code)- ,No. PARKING \\ F ! Firi IL 1 fi ❑ 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). r 9 CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING - t I hereby affirm that there is a construction lending agency i C 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 25.00 above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, sand hereby authorize representatives of this County to enter TOTAL, FEE 25.00 upon the above-mentioned property for inspection purposes .SEE REVERSE FOR EXPLANATORY LANGUAGE -, - - Signature ol Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby, affifin certert that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a ificate of Workers'Compensation Insurance, e,or . a certified Copy thereof(Sec 3800,Lab C.). BUILDING Policy No. Company FOR APPLICANT TO FI LL IN CJX ADDRESS Certified copy is hereby furnished. ADDRESSJe O� 7Gli17Gi rC9�/C LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST A``,,n DISTRICT NO GROUP TYPE P OCESSED BY CROSS ST. 71"_ -"a,- hQ Aa �D O �- �i CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL A O� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. OF BLDGS NO (CIRCLE) STATE MAJOR SECOND LOCAL _ (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 . " - d 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 S' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o AD OR 688 �� / �- ' ' U Date Applicant U-1 NOTICE TO APPLICANT• If, after making this Certificate of CITY 70V- NO.) OCCUPANT LOAD Z Exemption, you should become subject to, the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions-or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ 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 Busr NO. OF EXITS ness and Professions Code, and my license is in full force and IIJ077W ECBB 0� I3C15/NC effect. 55 PARKING REQ'D PROVID 6D • License Number Lic. Class L—"TZ� O F -ARCAP1 7EHPa 0T)". LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO' licensed architect or a registered professional engineer SIZE OF NO. OF NO P TOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES ` TURE mess and Professions Code). FINAL APPROVAL f�j� PRESENT USE OF BUILDING IL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS // Q 71.,', PM 4:07 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for wluch 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 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 th above-mentio prop ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0 — -z Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION �-1 CE 875 I hereo 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 FILL IN 4ADDR ILDING ESSCertified copy is hereby furnished. UILDING CALITYDRESSCertified copy is filed with the county building inspection LOCALITY r — ARE3T department. . OSS ST OV Date Applicant AEARESTDISTRICT NO. G UP TYPE PROCESSED BY CROSS ST. ,` CONST - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` v COMPENSATION INSURANCE DEscRIPT ION LOT NO. BLOCK MAP MI rwAv NO. (CIRCLE) STATE MAJOR SE ND LOCAL NO. OF BLOGS. (This section need not`be completed if the work involved TRACT NOW ON LOTUS ZONE S_P6 CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE of SIZE OF LOT EXISTING BLDG. ✓ ,` d I certify that in ihe,performance of the work for which this •� �e _ o permit is issued, I shall not employ any person in any manner OWNER t"u/�` �I� , s> so as to become subject'to the Workers' Compensation Laws. AIL A ,} �{r /J�j�) JlL� �J • .10CCUPANCY GROUP o v JADDRESS GTI � � Vim• 1 ��'V [� "10 tw,.`•�l'��.��l.t:�A.�'r`�'. V Date Applicant rEL' OCCUPANT LOAD NOTICE TO APPLICANT If, after making this Certificate ofrY A-L' .y�X No. — _��V`fl un 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 ❑ ❑ El No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM El (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 D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE PROM. 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 SI NATURE iness and Professions Code) FINAL APPROVAL RESENT USE OF BUILDING Lic.or Reg.No. Date u f d U oe HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDIN S • 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 1, as owner of theproperty, will do the work and the sPAces PROVIDED structure is not intndd or offered for sale (Section 1 3 0,7 A 7044,Business and Professions Code). # o o e e 8 8 CONSTRUCTION LENDING AGENCY ROPOSED USE of BUILDING 0 0 0 o e o o z I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 3 ) 2;1 3,—8 8 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 QQ above information is correct. 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 TOTAL FEE Q upythe above-m oned property for inspection purposes. J9 11_30&SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875(11-84) M ISCELLANEOUS 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 FILL.445 BUILDING � fir_„ ADDRESS Certified copy is hereby furnished BUILDING ADDRESS 1 {D�O �. I' , _! N&)AJ LOCALITY 0 Certified copy is filed with the county building inspection LOCALITNEAR ES .p(,Q T department. 6W1C{'(r, (-7 CROSS ST Date Applicant NEAREST DISTRICT NO. G OUP TYPE P CESSED BY CROSS ST AUr4es S.T. ' n / ��;X CONST NOOF BLDG CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (JD COMPENSATION INSURANCE DESCRIPTION Lor NO, BLOCK MAP HIGHWAY - NO. (CIRCLE) STATE MAJOR SECOND LOCAL' - S ' (This section need not be completed if the work involved TRACT NO.W ON LOT :�ZONEJSPECIAL CONDITIONSby 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 o permit is issued,' I shall not employ'any person in any manner OWNER C)f—' 2!�7� so as to become subject to the Workers' Compensation Laws. MAIL /� f ` OCCUPANCY GROUP �_ o ADDRESS 171 �O `j� y Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY I►.Ib NOL d �6�o OCCUPANT LOAD a Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ E] No Spec Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El 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 �r effect. e O'1!' I.IS PARKING SPACES REQ'D PROVIDED License Number Lie. Class S I ln �K_ /fUN�,{ a LIMITED TIME USE Contractor Date DATE DATE D 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 SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 'f. mess and Professions Code). Lie.or Reg.No Date PRESENT USE OF BUILDING + 6f�'r(,�2Q�L/ FINAL APPROVAL r / 6_ l CP.>TIZKGT'ol� GE �� _ HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS faffirmON LOT AND USE 0030-13001-10030-13001�1 C/�y0(7ti A //��(( /� (/ •I� I hereby am that I am exempt from the Contractor's vvv I �• i ��1�1��� License Law for the following reason (Section 7031.5, Busi- .9355 ness and Professions Code). NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency 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 (J17 ' above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, 1 and hereby author repr entatrves of this County to enter TOTAL. FEE �J upon the above-me roperty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE el Sig t e of P mittee Date WORKbftS'COMPENSATION DECLARATION C CE 875(11-84) MISCELLANEOUS APPLICATION E 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 FOR APPLICANT TO FILL IN BUILDING ADDRESS _1(706 �dJ/9S v� ElCertified copy is hereby furnished BUILDING U ' DRESS LOCALITY Certified copy is filed with the county building inspecfion LOCALITY NEAREST department CROSS ST Date Applicant EAREST DIST ICT NO G TYPE �j' PR ESS D BY CROSS ST CONST.' 1 / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I Girl/' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF 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 I certify that in the performance of the work for which this SIZE OF Lor EXISTING BLDG. CD permit is issued, I shall not employ any person in any manner OWNER CP so as to become subject to the Workers' Compensation Laws AIL OCCUPANCY GROUP Cal o DRESSI~ Date Applicant TL NOTICE TO APPLICANT If, after making this Certificate of CITY NEO. 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 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 1 effect. E PARKING REQ, PROVIDED � SPACES License Number Lie. Class � � I J b� VILLf� LIMITED TIME USE Contractor Date OG-A- VY A / DATE ,DATE I am exempt from the licensing requirements as I am a I I 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 n IGN TUR iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING h ,6„6 Lic.or Reg.No. Date So "Dr HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS N C1 EE' ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the followingreason (Section 7031 5, Busi- (� �1( (' ( {{'I r�{5/jT' NO. PARKING 0000'�Ll'�4.11 1.2 1•.I/'.J Hess and Professions Code): ' 1, as owner of the property, will do the work and the SPACES'PROVIDED 7559 1 AM 10:4 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 l PROPOSED MAX. OCC. � Lender's Address , b0 �1 PERMIT FEE ` I certify that I have read this application and state that the above inforination is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, / bD �rld hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY,LANGUAGE 4� Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 168 - LE 87575(11-84) M I SC E L LA N EO U S APPLICATION `I hereby affirm that 1 have a certificate of coInsur„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 CompanyBUILDING ADDRESr FOR APPLICANT TO FILL IN S Certified copy is hereby furnished. BUILDINGXX ADDRESS 9906 Las Tunas Dr. Temple CityLOCALITY Certified copy is filed with the county building inspection LOCALITY 9906 Las Tunas Dr, Temple City cRoss ST department. T. Date Applicant NEAREST DISTRICT NO GROUP ITYPE:__—_Ve' P CESSED BY CROSS ST. CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 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 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 manneRX OWNER Of buildin Lui Albert a so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUPEK:] a ADDRESS I� Date Applicant w 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 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 aniX effect Name of business PARKING SPACES REO D E� PROVIDED First Step Productions 19-9 Pr License Number Lie. Class LIMITED TIME 000 � 9/95 Contractor Date DATE OAT =40 F] I am exempt from the licensing requirements as I am a FROM' TD: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES S TURFE mess and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg No. Date OHOME OWNER-BUILDER DECLARATION No of EXISTING BUILDINGS � q ON LOT AND USE I hereby affirm that I am exempt from the Contractor's U _.11V License Law for the following reason (Section 7031.5, Busi- ness and Professions Code) NO. PARKING U I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Sectior 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agenc} for the performance of the work for which this permit ii 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 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 authorize representatives of this County to enter TOTAL FEE 25 -00 up the above-mentioned operty for inspection purposes I �""� SEE REVERSE FOR EXPLANATORY LANGUAGE - XX -L yzv, xx 8/28/95 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION . 76M444 MISCELLANE`.J AP,P CE 875 (11-84) 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 (a Certified copy is hereby furnished U IL01f!rG9f 22.!xx BDDRESS CLOCALITY G FCertified copy is filed with the county building inspection LOCALITY �� %i7,'U NEAREST department. 3M CROSS ST Date Applicant NEAREST w�• DISTRICT-NO GR P TYPE OCESSED•BY CROSS ST.-/7¢NFf J'T; D a CO NST 7/ - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a ,COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP -IG-WAY NO. ICIRCLK) STATE MAJOR-SECOND LOCAL No. OF SLOGS. ' (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 �v Dc-i permit Is Issued, I shall not employ any person in any manneXX OWNER of building, OWr_ �. so as to become subject to the Workers' Compensation Laws MAIL �/J�/ A OCCUPANCY GROUP ADDRESS {I I ! 4/IdG�A✓•D //J✓✓✓ U Date Applicant LLJ NOTICE TO APPLICANT If, after making this Certificate of CITY ] T L OCCUPANT LOAD v� Exemption, 'you -should become subject to the Workers' APPLIC ION 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. Know_ I. - deenled revoked. ❑ P8r11C Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 1 hereby affirm that I am licensed under provisions of Chapter sAPErr 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 an X `1 effect Name of business PARKING REQ D SPACES E== PROVIDED 1 _ L LL��J License Number Lic Class �JTHFi2 'G/- YfU/V �/✓J�c,�AivG�- A¢we - _ LIMITED TIME USE Contractor Date DAT¢ "DATE FROM: TO 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF I SIGNATOR, acting in my professional capacity (Section 7051, Bus- EXISTING BLD 6. STORIES iness and Professions Code) FINAL APPROVAL Lic or Reg No Date (PRESENT USE OF BUILDING , HOME OWNER-BUILDER DECLARATION NO. OF EXISTING-BUILDINGS ILiVU 111 ON LOT AND USE I hereby affirm that I am'exempt from the Contractor's "License law for the following reason (Section 7031 5, Busr ness and Professions Code) NO. PARKING ��� • ' 1, 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 !j w✓,-.,;y ,/ �•r . I hereby affirm-that there is a construction lending agency r� l��iT �ordLorQ�G2. for-the performance of the work for which this permit is issued(Sec. 3097,Civ C). mom- �sc�art�rrtL �� O LSO. 'Lender's Name _ PROPOSED MAX. OCC. Lender's Address I certify that 1 have read this application FEE on and state that the 00 , 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 th bove-mentio ed property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE xx xx Clgnature of Per 1111ee Date 4 f� \10R1:1 RS'('OM1IP1 NSA IION DECLARATION 76M.444 �� ISCE,LLANEOU., APPLICATION CE 87575111 841 I hereby affirm that I have a certificate of consent to self �- Insure• or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES 13UILDING AND SAFETY DIVISION a(ertified copy thereof(Set, 3800, Lab C) Policy No __(onipany _ FOR APPLICANT TO FILL IN noowess `J%D� Certified copy Is hereby furnished BUILDING ALITY X}: ADDRE549906 Las Tunas Dr. Temple Cit LOC Certified copy is filed with the county building inspection LOCALITY NEAREST department ][y, 9906 Las Tunas Dr. Temple City CROSS ST, Applicant -___�_ NEAREST DISTRICT NO. I GRO P TYPE PR ESSED BY � ` ('1'R'III ICA FE OF EXEM11PIlON FROM WORKERS' CROSS ST �S CONST L(Q LEGAL /� CONIPFNSA TION INSURANCE DESCRIPTION LOT NO. BLOCK ..P Hlc Hw wv NO. OF (CIRCLE) STATE MAJOR SECOND LOCAL (I'h IS section need not be completed if the work involved TRACT NOW ONBI LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF SIZE OF LOT EXIST BLDG. certify that in the performance of the work for which this D_0 permit is issued, I shall not employ any person in any manne XOWNER of building ui Albert Wai Yu so as Io bet onte suhleif it) the Workers' Compensation laws MAIL OCCUPANCY GROUP C; ADOR ESS Date----__—_-- Applicant _ — w TEL NO ICI: 10 APPLI('AN7 If, after making this Certificate of clTv NoOCCUPANT LOAD. - vRJ I \emption, jou should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth With comply %Vilh Su(h provisions or this permit shall be TRAILER USE 1] GEOLOGY INSPECTION ❑ No Spec. Knowl deemed rooked I [CI NSI D(ON I RAC 1 ORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby af_'lirin dhit I aril licensed under provisions of Chap ter SAFETY PERMIT LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS nes, and Professions Code, and my license is in full force an!kx effect Name of business PA ttKING REq'D � PROVIDED License Number —�__ I Ic Class Captured Commotion , Inc. SPACES 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.OP •RO nt. TO IN SPE CTO R'3 acting In my professional capacity (Section 7051, Rus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING Llc or Reg No _ Date IIONII OWNFR-BUILDER DECLARATION NO OF EXISTING BUILDINGS ab�j(p �' �-g ^• ON LOT AND USE /r 1 hereby affirm that I .un exempt from the Contractor's License I aw for the following reason (Se(tion 7031 5, Busi- f non—oof i ='I_I•' '. ness and Pro tessions Code) NO. PARKING I, as owner of theproperty, SPACES PROVIDED jT7tj i Ilii =i will do the work and the structure is not Intended or offered for ,ale (Section 7044,Itu4meSs and Professions Code). (ONSI RU( IION 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. I endcr•s Address___--- --____--—_-- -- I certify that I have re.id this application and state that the PERMIT FEE 25 .00 " above Inform.Itton is corret,f I agree to comply with all County ISSUANCE FEE ordinances ' Ind State laws relating to building construction, and hereby a o vere Ives of tlii% County to enter TOTAL FEE 25.00 upon the ab -1 el iied proper , for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE XX X 4Lllrn InI . I',•i mIt - --- D Ire .I "— WORKLRS COMPENSATION DLCLAKATIO\ G-0063DPVJt[Jy0 MISCELLANLC7tJ� APPL>f M 1UN I-hereoy affirm that I have a certificate of consent t„ self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION bS insure, or a certificate of Workers'Compensation insurance or a certified copy thereof (Sec 3800 Lab C) Policy No Company FORAPPLICANT TO FILL IN BUILDING G � BU D G ADDRESS ,f ADDRESS D , ❑ Certified copN is'hereby furnished Lits/ S 141 ar. ,i/ffe LDCA LITY EJ Certified copy is filed urth the county building insp.,,-tion ury ztP department cit 9 9 70 NEAREST cU� CROSS ST Dare Applicant SIZE OF LOT NO OF BLDGS NOW ON LOT DISTRICT NO GR UP TYPE CESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS 'v COMPENSATION iNSURANCE ` TRACT I BLOCK LOT NO ,r Moo HIGHWAY STATE MAJOR SECOND LOCAL (This section need not be completed if the NNork n»')lNed ASSESSOR MAP BOOK PAGE PARCEL UEE ZONE SPECIAL CONDITIONS' by' the permit is for one hundred dollars IS 100) or Ites� 1 + ! Certify ilial In tn2 ,� OWNER ' TEL No 'I pe�formance of the \\ork for \\hitt, this Property yd 6 yg/l Hermit is issued ] snail not the W ke personorn e am m I tiler so as to Gecome subject to the Workers CompensJtion Lava , ADDRESS P N, S OCCUPANCY GROUP 9�749I Date _ .Applicant CITY /J\ NOTICE TO APPLICA\T If after mal.ing thi; Cer icaie ` n 92 I ` / 7 7 OCCUPANT LOAD of Evempuon' \ou should oecome subject to the Wo, rs APPLIC4TIDN FOR _ EXIT HARD`,VARE Compensation oroN,sions cf the LaDOr Coat ,oi, must forte\\,th _ — Compil N\lth such rroviI ions .), tnis pertlia shai, be Ue,.mC-u TRAILER USE GEOLOGN INSPECTION—I NO Spec Knowl ❑ OCCUoANC1 INSPECTION LICE\SED CO\TRACTOF.S DELL-,R-TIO\ Pa lc C_"Ices I herb afl Irm that I am Ilcen;ec unoer iov,vons o, C Stir_ —, , p SAFETI SER h'IT_ _IST ITEa+S 9EL0\h ` I j o (cr,mme,i,:m- v Ith Section 7000)of Lin Kion ',of h: BIM"'r.;< ND OF EXITS ' ano Pro,`esslons Code .Ind m\ ll<:h•c .c-ir full ford ,ind : _ct I PROVIDED License \'unme; Lx C I « Cooiracio Dai; LIMITED TiME USE 1 DATE DATE I 1 am e\,Inpt from the hcenslne r.gotremcnl. ,I� I 'n', a Fit__W TO licensed arch,tect or I rg";cered profz,slonaj to^_"icer SIZE O' NO OF, nsPECTOR s - 3Cllil^_ intil\ prC\l^SCIC�ItJI C.1 p.IC iI_, (S.'Ctl(\]7 rV�l B1I�, 1_S� I SIG TURE EXISTING BLDG STORIES ano Yro�e.slons Code) -- PRESENT USE O-BUILDING O FIIJ4L 4 POROV4L rd� Llc or Ree No DJte. ,L t HO'v1E O\','\'ER-BUILDER DECLAP.ATIOIn ' No OF EXISTING BUILDINGS - ^ ON LOT AND USE V` I herebN affirm that 1 am e\entpt from the Contractor s Llc.`me p LaA for the following reason (Section 7031 ; `Business'and e�1 �G C#- Q1 790 �6 Fmfessions Code) f NO PARKI _ ` 6 , SPACES PROVIDED �'` [I' - 1 as owner of the property wwork ill do thworkand.a the structure is not intended or offered-for`sale (Section 7,,)44X PROPOSED USE O�BUILDING Business and Professions Code) I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending aecnc�;fo,- 'the performance of the wort, for which this permit is iso ed (Sec 3097 CIN C) I PROPOSED MAX OCC Lenders Name __ APPLICANT,PRINT) TEL NO t Lender's Address -- ADDRESS i 1 certify that 1 have read this application and state that the above information is correct I agree to comply +lith ail Co rt; PERMIT FEE ordinances and State laws relating to,building construction tnd -hereby authorize representatives of this County to enter upon ISSUANCE FEE 1 the above-rne:t:c-_;, p:�pertt�•r_or�nspc fan purposes , TOTAL FEE ; CD o %y, SEE RE\FRSE FOR EXPLANATORY LANGUAGE L1 ^ neture of Pernim DJte L f , a.lnn.n � ,i111i1'tl . I hereby affirm that I have a certificate of 11MISCELLANEOUS APPLICATION of consent to ,ell Insure. or a certificate of Workers'Comoensatnon Insurance.or COUNTY OF LOS .ANGELES BUILDING AND SAFETY DIVISION ��I a certified copy thereof(Sec. 3800,Lab C) u Pollcv No Company FOR APPLICANT TO FILL IN ButLDJNG AOOR SS Certified ops Is hereby furnished x UpOD,q �MAg L_ _ ADDRESSSS l-1 b LOCA LITY ADOR t/ 1 FICertified iopv Is:fled ,Lith the counts huddme Inspection R LOCALITNEAREST department Ie U CROSS ST Date \policant NEAREST DISTRICT NO GROUP TYPE CESSED 9Y CRO55 ST �e 6 CONS CERIIFIC iTE OF E'CE}1PTION FROV \1ORKERS LEGAL 0 L()11PF`,S \LION 1`.Sl R\-`.l E JCSCRIPTION LOT VO BLOCK P ,JO ICIw CLe) STATE MAJOR SECOND LOCAL I NO OF BLOCS IThls ,ection need not he �_ompleted If the '�(1r1. II1�nIYed TRAC- NOW ON LOT 115E SONE SPECIAL CONOIT IONS hs the Penult IS ter me hundred hdllrs ISI001 or less I AA^ usE of ,I:E OF LOi V � C -�, EXISTING BLDG 1 ernfv 'flat In 'he ^rrrr,nanLc )t '!Ie •IOr� ,): ,bleb -nus VVV ' •� so as Is Issued. I ,hall ,tut the lot'Ao Jen ne-•On n Jtry manner X' ,wNER 1 b�( {— o l{ so as ro become .uhtee,• o the ''1or{.ers i omcensatnon Lass X. ,,AIL _ /- CCC::P4NCY GROUP AD OR ES S�� G-e^kj C ` Dail' \Cr'lllar[ _ _ _ I _ `'OTICE ir) 1PPLIL \`T If titer makrc his ;er.uiLate .)t xI cl-,q G (�� "E` OCCUP4NT LOAD E,empteon, Lou ,houla become ,ubject -o :he \1urxers -G APPLICATION FOR "<I' HARCwaRE (:o mnensat)on ormismns )t the Laoor COae • ou must torth rth Lomnh. Ittl` n.•i ^ rntvlvls r r,S e^nr ,nail he F "R:.IL.R JiE �cO LJ GY INSPE.-•ON 1 , !ecnn_d rc,'1kJ 1 — — to Spec KnOYvI IJ tt - LICENSED 0`.1R\C FORS JL�L 1R \Th:', 1 �cc JP 4VC' INSPECTION Panic Devices 1 Ilerebs ai'irm •liar I am licensed!under provisiens of Cltaorcr SAFETY PERMIT 9 11.Ornmen Cine •slth Section 7000) of Dnision J Ot -lie BUST- � (LIST ITE-AS 3E LO lY! NO OF EXITS ness and Prnlessians Code and mL I1LenSe :S :n 'Jill orce ind e:fl'L: PARKING REO'! PROVIDED I I SPACES J _ License Numl e _ LL C!a�s LIMITED TIME USE Cont,i,-tor _ La'e - DATE pa rE ❑ I in Ile ILen Sines 'eUll Lre Me-ll, , i aPt 1 v, •, - hLen,ed Jra'ti:eL: u' I e^lste:ea ^rnreSstun ll enc+n.e' ;Izs OF VO F INSPEC-OR s ? actin`_ in 'nL oruie,slunal ..aOJ'-:t Set .on - I JIi S- ( -XIS-'•,G 3LJG I 'TORIEJ SIGNATURE mess and P"otessions( Jde1 J{ IIL u Ill '1, 171� 7�^'",F 'r I_ or 3tJILOI-,n FINAL APPROVAL — i�i� II011C O\\NF_R RLILDCR DECLIR ,171(,1% �VO OF EXISTING 9UILDINGS (G 7N LO- aNO 'JSE I 'ierebv Jf'trnt that t lm z`emo+ rim :he CantuL:or, LILenSe L's ;o, :he -ilo-Im-, -eiIon 'Se, ion I):I : Bu,r Q ness ind Proie,sions(-,)der INN D PARKIG ❑ I JPACcS -ROVIDEO I, as ;'suer Jit ht nn+p•_rn LI[) du hr ti ind' Ire { structure Is .lot untended Or uttered '0' .tie Sel:11011 j 104-4 Bu,uie,s Ind PrOleSS1011S C)del ( ONSI IZL(-IION I-LNDING \GE\11 't -ROPOSED 'JSE OF BUILDING hLmhL itftrm that :here Is t LnnStrlICtlon I.I �e '(_91 -6?+0 - lot the pertormanLC OI the Isork fur Mudd this pernut is — Issued (Sec 300- (-I, C I Lender ,N Ilnc -- PROPOSED MAX OCC Lender, \ddress— 25.00 I l ,:e;tily that I Inac read this apollcanon -Ind ,tate hot :he PE R.MIT FEE ebose miormatirn IS correct I aitree to Lomph %%ILII all County ISSUANCE FEE ordinances and State lass relaxin-- to buddme construction. ind herehv authorize representaines of this County to enter TOTAL FEE 25.00 I I anon the lbuve-mennnnrd Pr rr,n Inr insl`eLnun Pu:pO,es -C/ — g SEE RE FRSE FOR E\PLaVaTORi' LANGUAGE • / n WORKERS'COMPENSATION DECLARATION CE 8754(h 84) MISCELLANEOUS APPLICATION I h;reby affirm that I have a certificate of consent 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 FICertified copy is hereby furnished BUILDING XX ADDRESS 9908 Las Tunas pr, H LOCALITY 0 Certified copy is filed with the county building inspections LOCALITY Grand Plaza NEAREST department 3t3: CROSS ST Date Applicant NEAREST DIST ICCCyyyTTT NO GROUP TYPE CESSED BY CROSS ST. ID� CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MA' HIGHWAY ND. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF 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 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 a manne}rX OWNER of building so as to become subject to the Work s' Compen n aws MAIL OCCUPANCY GROUP Date ADDRESS 1 201 W. Foothill Date 3 1 1 5 9 54pplica IyJ NOTICE TO APPLICANT f, aft akmg this ertificate CITY Azusa N 81 8-81 0-6409 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 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 aiiX effect Name of business PARKING SPACES REp'D O PROVIDED License Number Lie Class Beeper Happy Electronics & Auto LIMITED TIME USE Contractor Date Accessories , DATE DATE Q El 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. 644 S Ft. STORIES 1 SI ATU RE iness and Professions Code). l' PRESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg No. Date 77 G HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS P _"/� � �,'� ui hereby affirm that I am exempt from the Contractor's ON LOT AND USE 8 L— �� License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO. PARKING SPACES PROVIDED . .. '. ElI, as owner of the property, will do the work and the _ �,_ structure is not intended or offered for sale (Section 1__ ! h_ir' 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 I certify that I have read this application and state that the 25 , 00 above information is correct i agree to comply with all County ISSUANCE FEE ordinances and State laws relating to ildmg construction, • and Hereby uthorize re esentatives o its County to enter TOTAL FEE 25- 00 upon tl a ention property f spechon purposes E REVERSE FOR EXPLANATORY LANGUAGE IXX XX 3'-C?y` Signature P putteeDate t�CiXtiil.S' :,J:t .-EN lig),, DLt_L ii ? ae-eLv atrtrr.7 th,,r t ,lay: 'I _er:•tiutl� o* '_o�az„' :�, ,et, _. . _inure „r a cert itc,,:z t�t',,.:er C unp 1 II:u: 'nsu...ar_ (moi- = !,T ' '� E:IL 3'' 1_DiNG ND SAF=TY DIV1SION No P, R Certtflc'l _opJ is .,crc�y ,,,..:I^-..r 3•J,L N ��U LCL - S TUhf/Ag' +r >s v X-1 • DGRE J q r11-O JCerttite•i Cap ' Is filed ttL :hc &in p E depar':Ilerit k?� i /;�ci , Gl9/7SO cPess �,• I t-- —�C-�--�, } T Date-- \rpl'cunt--. ___ lEA. T ����_ 1 STR,Ci " O GROUP TY�E iP _S3EDS f -_ IcONST Ci=RTITICA-iL OF E_—DIPTiC'•: FR!;,I `VORKER; G L J— I � I C-OMPF-4s iTi(7f,: 1 NSL R-t N,.L BLOCK i ,c�•,.av T� STATE' ;.IAJ07Z SECOND LOCAL 1This g,!tvjn aced not he :repleted II the work ln%niv;?i ,•2A CT rlJ:' •N LOT IJ;E ­)NElyP—I CC,AL COAD•;ION3 by the perm:t n for one hLiidreu collars '•SI00) or k'sr'I ' E O �Ji �c� I ��� 1.✓I '::S f,P,G I Certify rha: is the perinrm,.nc. of .he .voIZ� 9LOG :k for utuclt t'i;s -- -- - - i erne; s Issue'.. 1 "Idil apt t-nplot Inv ?erson to ami m,:inc.. building '� ' heel ., _ iVerizrs' Compem *lost Lar. X c, NeR of rt- Ct4 1 P ` ;a as :u ,nye su;reet toCU La mw As. - OftCE TO --\PPL1( -1 NT atter making tilts Ceri,ftc;.re c,T _ & -40 �o'�ir- Q�7' �/W ! r,CCl:P4NT I_Ghz.0 L ,etr.ption, you ;iii ull-, :'ecorte suplect ro tke '.lo .'=;, n Oul'-T ^N FOR c,: T 4 �DVeQnc Cuu:pensation or(',si^ns cr t1,. Laeor Cone you must to:_: «uh oomph •:ail olo:Imons ­lr ,'IIs )erinit 'i:all SE i_ GEow sP T:ora ueemed rz.ol ,i I - — NIIC Spec Kno•vi S . )`' ii- -TGg`, ULIi R.�T1O\ „__,_P ,•.' Ns"E- := - - j Psrl;C �ev es L I I nere"v ,_rl' -Pa; i ,'t. !.._Isec :err:provlelon,or C"t,a '• - — _ -- 3AF•_-f �_=rte'- r�15- Ebis n-_O1Y 9 (co nm°�., _ t� .1 �_ -, ';,t0• Ot l?r-tsum 3 ,. -I;c Bt ,'- -- —-- r necs and 'ro::_, .m'ti io.ie P'a leer'. ., a: au1 :n,c: j — — -- Name or L.us it e s s -R� r4G 1—_A)_/—'k_ ��, __--11. I� RSO D _EO _Ice,•ce \unl'J_ - -- -- L: ,i.. ti ------- 13 ryWt7Y> 1L� liJ—ln-pftU,p- L- -- ; LIMITED TWE E USF C. J n 17Ce1lSed ar�Ii,LeCt OC 1 re Jt��:rd CIOieiSl011..1 :n'_I,"cc; 1 F •,O O� ,rlSPE CTOR s al'ring ul nr, prl)i-_,Nloital (Se'T10r 0- _ i _ S_1•:C- 9L.0 13_Ori�E': _-- SIGNA-URE ,ne)s and?Tot es,iont I-oje -� 1 _ S.ImI-IL 0, ELI r'NA7_ aPPRG'/4L LIC O` i.Co Vo — ---------- ?'tie--------- '— ' H 0%I L" 0LR-L'l iLJI_h DFhL\RATIr)X. 1 NO DF F•. STING 3UI�DINGS tt,at l t:l 7 me C 'ta- L,cer�e L.IN t0r tele 7:,31 _ ness and Profe'.s:om C od., j^_s =aR ,Nc ---- d ; _4 qr - - ; P�_E_R_vt_� - - - r' 1 'S ,t�*7er ni -I,c r,o_•,;- ; , '7t the ' cr' aa•� �'': � •^-• - -, ,- stl"UMI e is r.:* nt-'a e.7 :re ea tur sale I_`,C't, ,'t ' I' 70d4,BL7SM,?,S„Pu C - C;,N�i ?uCCiO\ LEND, .G \G \C� 71'FCPOiED USE O 3UILDIC,G 1 herein at`1;rt th.,, there ,s ­oP,"r:,c'1oP lencuns Lerrl, ` " _ -� + or the perlwmar,e e, Ti", `.ur Guth this pert t lssaed Sec 3097 Ca C; OkheS I Under ,Name _ s { L— PROPOSED MAX OCC i Lender's.aadress RM PEI i T FEE I ce:ttfy that I ,lave read rh,s :'pnhc.,uon gnu State .hat t; 25 0011 above Information is correct I agree io compIN ith,ll C:u'tn; 1 Issuarve2 FEE oralnances ana State I,w„ .elauny to building const 25 . ano hereby authorize repre;entaL,ves of thu Count to er.t;: TOTaL FEE upon the above-mentioned proper; for lmpectlon purposes ' SEE REVERSE FOR E\PL a`:.\TOR`' LA2:GUAGE xx .�~ XX 7- Signature of Permittee Date R M 1 WORKERS (OMPLNSAIION DL( L�RAi!ON 20-0 ,jDPW12'90 MISCELLANEOUS APPLICATION I ' hereby arflrni chat' I hdVC a cclullLatc III U)n,Clll W sell COUNT-Y OF LOS ANGFI CS BUILDING AND SAFETY DIVISION !1 Insure,or a cerin Icate of Workers' (ompu)sation InslUam, of a certified copy thereof (Sec 3800 I ah C) Policy No Company I FOR APPLICANT TO FILL IN BUILDING ADDRESS yyOg �• �q s TUN95 �� BUILDING ADDRESS ^T ^ Certified Lopy is hereby IIIIIIIShed ygp� LF- [.q C' 740V4 P,<• -� ✓ LOCALITY 74-M GE C/`7 , CA 4/7J'0 Certified copy Is tiled with the county bullding 111,1)%:Qon CITY zip J �� department 7b' 7ACROSS ST Date _ Appl cant SIZE OF LOT NO OF BLDGS NOW ON LOT DISTRICT NO I GROUP TYPE PROCESSED BY CONST I CLRIII ICAIL 01 EXEM131ION FROM WOKKI RS l �� C ('OM.)1'.NSAI ION INSURAN(L TRACT MAF- BLOCK LOT NO HIGHWAY ' N0 ICIRCLE) STATE MAJOR SECOND LOCAL (This section need not be Completed if Ilii' work III%011Cd ASSES OR MAP BOOK Z 001 PAGE PARCEL �1SE ZONE SPECIAL CONDITIONS t by the permit is for one hundred dollar% (SI00) of less.) ! am" Q/e S-v 1 1 Lertlly',hal In file perfolnlancc al the walk IDI which Phil oWN`E .41467 TEL NO �j2G•- permit Is Issued, I shall not em Io in e)son III n malncl t ) zz so as to become subject to the Walken' Compensation L,lwADDRESS, ( OCCUPANCY GROUP rr cJ�O�,' 4. LAS j L�jrq S D•P. •� J i Date --- -- Applicant - CITYZIP NOTICE TO APPLICANT If, alicl ni,iking this (erlilit•t _e EN t=/ (- 4 C?-/ 7Y10 OCCUPANT LOAD of Exemption, you should become subject to the Work.rs' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you niust forilmith t comply with such provisions or this permit shall-be Lleel',Ied TRAILER USE❑ GEOLOGY INSPECTION❑ ❑ revoked No Spec Knowl �y ❑ LICENSED CONTRAIL FORS DL( I-ARAII()N OCCUPANCY INSPECTIONPanic Devices hereby affirm that I am licensed Linder plovislonh of (hapter SAFETY PERMIT❑ (LIST ITEMS BELOW) Y I 9(commencing with Section 7000)of Division 3 of the Business I NO OF EXITS ? and Professions Code,and my IICCIISe rs U7 lull loice and eftLc! �7 - Gt' PARKING II� License Number Llc Class / SPACES REQ'D E= PROVIDED Contlactol Dale iws Gvkc Inc- LIMITED TIME USE E= DATE DATE ❑ I am exempt from the licensing re(i LUIe111011S as I all) a 'FROM TO licensed architect or a registered plofetislonal englnl•cr r jSIZE OF NO OF INSPECTOR'S acting m my plofetislonal capacity (tiLLlwn 7(151. Iin,In'_ss 1 EXIS FIND BLDG STORIrS� - — SIGNATURE D ^- and Prole„lon, (odcl ' Llc or Re Na Date PRESENT USE OF BUILDING Reg FINAL APPROVAL S 5-Lc�q - - -- - - i 0 771'64- _ -• I IIOML OWNER-Villi DLR DI ( l ARAI[ON NO OF L XISTING BUILDINGS I )N LOT AND USE hereby alf nm that 1 an) evempl lion) the('UnuactoI's l 11,6isc Law for the following reason (Sc(,Llon 70315 Busutes, and + Professions Code) NO PARKING ; ' SPACES PROVIDED - ❑ 1 as owner of the plopem 11111 do the \Valk mill'i- — stILlciuic Is not intended LII 011CIed 101 sale (tiCLIIan Illl-1, PROPOSED USE OF BUILDING i Business and Professions Code) 1 CONSTRUCTION LENDING AGEN(1 1 hereby alflrm that there is .I conslluctlon Icodine agetiLl !ol the performance of the vloik lot which this pclmlt I, issued l (Sec 3097,Civ ( ) PROPOSED MAX OCC �) Lender's Name -_-- _ _ __ -_ -, - _ _ APPLICANT(PRINT) T L O Lender's Address _ - ) AD RESSn t certify that I have read this appIlLatlon and state that ,the 2 ` Q above Information Is cerre Lt I agree to comply with all(otiyty PERMIT FEE I ordinances and State laws relating to building construction,:,lid hereby authorize representatives of this County to enter ul',)n ISSUANCE FEE the above-mentioned 1 operty for Inspection purpose, �l I TOTAL FEE W ' o X SEE REVERSE FOR EXPLANATORY LANGUAGE ILI Signature of rm ee Date t WORKERS'COMPENSATION DECLARATION �6(11-84) MISCELLANE�OI,�' APPLICATION - 1 hereby affirm tlat I have a certificateCE6 icate of consent to self .~� ms'are, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES ItUILDING AND SAFETY DIVISION u a certified copy thereof(Sec 3800,Lab.C) Policy No Company FOR APPLICANT TO FILL IN BUILDING n AC DRESS l/ Certified copy is hereby furnishedBUILDING4 D /�y^/f S D �// X21. ADDRESS / Z I LO CA LIT Certified copy is filed with the county building inspection i LOCALITY NEAREST department xx caoss ST Date Applicant NEAREST D STRICT NO. GR UP TYPE CESSED BY CROSS ST ,D� CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY _ NO' (ClRcLe) STATE MAJOR SECOND LOCAL NO. OF 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 (5100) or less.) USE OF G I certify that in the performance of the work for which this SIZE: of Lor p�X]STING BLDG. � L p permit is issued, I shall not employ any person in any manneXX OWNER of building / ��/� )C99 U I so as to become subject to the Workers Compensation Laws A q / ( OCCUPANCY GROUPMAIL �- ADDRESS / L'JS �'r/ rJ Date Applicant TEL o/ L'I NOTICE'TO APPLICANT If, after making this Certificate of CITY NO �7 b/ fOCCUPANT LOAD v3 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) F 9 (commencing with Section 7000) of Division 3 of the Busr I i NO. OF EXITS ness and Professions Code, and my license is in full force anJX effect. Name of business PARKING _ ,t, SPACES REWD PROVIDED � License Number Lic Class N GLV�� SA�� T6 A-1 IR FR� LIMITED TIME USE Contractor Date J M. TO DATE DATE FJ I 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZEOF / gyp NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXITING BLDG. 4 �/ STORIES slcN TURE r iness and Professions Code) FINAL APPROVAL LIC or Reg NO Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO, OF EXISTING BUILDINGS ON LOT AND USE 1 hereby affirm that I .Int exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) No PARKING y) U 1, 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 CONSTRUCTION LENDING AGENCY PROPOSED USE Or BUILDING I hereby affirm that there is a construction lending agency ALC of s RTELGi'/E 7� A& A1A11q for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Ll- Lender's LA/T ^�.Z/VS ALS Lender's Name - PROPOSED MAX. OCC. � Lender's Address I certify FEE Cy that 1 have read this application and state that the 00 -- -''' above information is correct 1 agree to comply with all County ISSUANCE FEE , ordinances and State laws relating to building construction, and hereby an s ounty to enter TOTAL FEE 25,QQ upo ove- �presentatjves ection purposes T SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX Signature of Permitlec Date „'URI:EKS�CUMYLM)AIIUN llLLLVR.attUN CE 87MISCELLANEOUS APPLICATION hereby-affm irthat I have a certificate of Comenl to wlt COUNTY OF LOS ANGELES R111,FING SNI) S NI,C(Y I)INASION (sure, or a certificate of Workers'Compensation Insurance,or certified cop} thereof(Sec 3800,Lab C) olicy No Company FOR APPLICANT TO FILL IN AUILoINGt AD OR ESSr Certified copy is hereby furnished BUILDING ADDRESS D - C LOCALITYi, �L Certified copy is filed with the count} budding inspection LOCALITY (�� n (�f NEAREST' department1 Itn CROSS ST - tate Applicant NEAREST DIS�'NO GRAUP TYPE � P ESSED BY CROSS ST O G //� CONST // CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL o /s (/ COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK MAP N1...Al NO (CIRCLE) STATE MAIOR SECOr�D I OCAL - - - - NO OF BLDGS - • This section need not be completed if the \cork Involved TRACT NOW ON LOT USE ZONE S-ECTAL CONDITIONS y the permit is for one hundred dollars (5100) or less) USE OF SIZE OF LOT EXISTING BLDG certify that in the performance of the work for which this -- ermrt is issued, I shall not employ any person in any mannerOWNER as to become subject to the Workers' Compensation Laws �MAIL � _ _ OCCUPANCY GROUP A D D R E S f1 Aa ,E�j}.i(//W/�- C, AVE - ate Applicant -G� 9 40TICE TO APPLICANT If, after makme this Certificate of CITY NOL Z — -�7� OCCUPANT LOAD kemption, you should become subject to the Workers' :APPLICATION FOR EXIT HARDWARE ompensatibn provisions of the Labor Code, }ou must forth- - ith_ comply with such provtstons or this permit,tihall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec Knowl. seemed revoked Panic Devices LICENSED CONTRACTORS DELL-%RATION OCCUPANCY INSPECTION hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW) i 1 (commencing unh Section 7000),of Dnision 3 of the Bust- No of EXITS Tess and Professions Code, and m} license is in full force and ffect PARKING, �� SPACES REO'D O PROVIDED icense Number Lic Class LIMITED TIME USE ontractor Date DATE DATE FROM TO I am e,,empt from the licensing requirements as ] am a licensed architect or a registered professional en�Zineer SIZE OF NO OF IN TOR•S acting in my professional Capacii\ (Section 7051 Bus- EXISTING BLDG STORIES - SIGNATURE inessand Professions Codr) FINAL APPROVAL PP ESE hT USE OF BUILDING , .ic or Reg No Date HOME OWNLR-BL ILDER DELL%R,T10n \ h0 OF EXISTING,BUILDINGS ON LOT AND USE �J T hereb} affirm that I ant e,,empt from the Contractors •�2 (cense Late for the follovt ing reason t SeLtion 1031 5, BuNi111 less and Professions Codes - NO PARKING VVV 1, as owner of the propert} \till do the ie oil. and the SPACES I PROVIDED structure is not intended or offered for bale, (Sctuoii 7044•Business and Professions Code) CONSTRUCTION LLNDIhG ,(;LACI ' PROPOSED USE OF BUILDING here[)} dffinu thdi there n d LOWMIttton Iendine aLCnt1 n, t r� or the performance of the se ork for ee hick this permit is - - �-- J i slued(Sec 3097 Civ C 1 ✓ -ender's Name PROPOSED MAX OCC , .ender's Address , certify that 1 have read this application FEE oUcation and stere that the I _ , Ibove information is correct I agree to comply with all Count} ISSUANCE FEE Irdinances and State lams relating to building construction. Ind hareby authorize representatives of this County to enter TOTAL FEE �e Ct ikon the-above mentioned pro rt} for inspection purposes SEE REVERSE FOR EXPLAIN%TORI' LANGUAGE Signature of Permittee Date „'O1t1;LRS CONIPENSAT,ON DECLARATION 76M444 SCE 875 (11 841 M ISCELLANEOUS APPLICATION �! I hereby affirm ica[ t have a certificate of consent tself COUNTY OF LOS ANGELES IBUILDING 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 F!LL IN eu1LDING D� �i AD OR E93 0 �L Certdied copy is hereby furnished BUILDING 99 LOCALITY XX ADDRESS 0 Certified copy is fled with the county building inspection NEAREST department X71 LOCALITY UNIT K, 9908 LAS TUNAS 7PS5 ST Date_ __ %ppheant NEAREST DISTRICT NO I GROUP ITYPF �� ESSED BY CROSS ST AG �O G f� CONST ( I R 1 It iCATE Of EXEVPTION FROM WORKERS' LEGAL COMPENS•kTION INSURANCE DESCRIPTION LOT NO BLOCK nwP c wwr NO. (Ciq�l•) STATE MAJOR SECOND LOCAL NO OF SLOGS (lhlS �eLtion need not be completed if the '.%ork Involved TRACT NO. ON LOT USE ZONE,SPECIAL CONDITIONS ny the permit is fur one hundred dollars (5100) or less.) I1 USE OF SIZE OF LOT EXISTING BLDG >O I �2-tifs that In the pertormance of the Work for wnich this permit is Issued, I shall not employ any person In any manner OWNER OL buildin oR VCE V REALTY so Is iu hetonre �nhicti •u the 'Norkers Compentiauon Laws MAIL OCC'JP4NCl/ GROUPI� I C ADDRESS 9119 LAS TUNASTEL e NOTICE fO aPPLI( ANT if atter making this Certificate of CITY TEMPLE CITY No 818 28778100OCCUPANT LOAD I %enivuon, you should beLome subject to the Workers' _ (,uripensauon provisions of the Lauor Code, you must forth- APPLICATION =0R EXIT HARDWARE 111ti1 conink 11tH Cudi provisiuns or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec Knowl decille•d reok,.d I I( L NSI D(ON 1 RA( I ORS DEC L XR\TION OCCUPANCY INSPECTION ❑ Panic Devices I hcrchy atfirni that 1 dm hLensedunder provisions ofChaoter 0 7 SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS Icununenun2 with Section 000) of Division 3 of the Bust- , tress ,Ind Profes,aons (ode and m% license is In full force a n ! e.,,L•Lt �{ Name of business PARKING -,PACES REO O PROMO ED I 1 ! ­l,c '-unme _ -- -- _ _ I IL ( lass SIMSEN USA INC - LIMITED TIME USE hate_ DAT! DA re rgofin -o I ani ese•npt irum the IiLensin2 requirements as I am a hLensed architect or a registered professional engineer SIZE OF No of NSPECTOR s aLtin2 m my prolessnonal capacity (Section 1051, Bus- EXISTING SLOG STORIES SIGNATURE � inessand ProtessionsCode) FINAL APPROVAL PR ESE VT USE Or BUILDING I IL or Re2 No _ _ ___— _ Date 110%il OWNER-RI'ILDER DECI.-\R4TION NO OP EXISTING BUILDINGS I� I hcrl:hy ,I0um nt that I ,un exempt from the Contractor's ON LOT AND USE J{, I ILense I AW for ;he tollox%mR re.lsoo (Secuon 7031 5, Bust- ness and Professions Lode! NO PARKING I, as owner of the property, Lull do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code) (ONS I RU( I ION I LADING kGENCY PROPOSED USE or BUILDING I hereby affirm that there Is a Lonstructton lending agency r_j i`-tea tor the pertonndnce of the work for which this permit is issued (Sec 3097,Civ C) I ender s Name.—_----- _ ---- _ PROPOSED MAX. OCC. I ender s %ddress PERMIT FEE02 I I leruly th SAUdithis ap1111LdUon and state that the above tnton +y] f� comply with all County ISSUANCE FEEordunnces �l lR io building construction, J. and hereby autho ize r p a �4•of this County to enter TOTAL FEE 25 . 00 Upon thefove-I nuoned opert% for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE