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Home My Public Portal About9207 LEMON AVE_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CEM844541�801 ISC E LLA N EO US. APPLICATION, I hereby affirm th I have a certificate of consent to self' COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. ' Company'` FOR APPLICANT TO'.FILL IN BUILDING ❑ ADDRESS , Certified copy Is hereby furnished. BUILDING 1 LOCALITY O -a ADDRESS ,. LEmo7�1 . Certified copy is filed with the county building inspection NEAREST ,department. - 'LOCALITY' C: cr_ CROSS ST. Date Applicant NEAREST fj� J ��\ /J DISTRICT NO. G UP TYPE' PRO E ED BY CROSS ST. 1 bJU�lt..�L• CONST. ' J . CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL " COMPENSATION-INSURANCE DESCRIPTION LOT No. �. ' BLOCK -MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECON LOCAL tL (This section 'need not be com leted if the ,work involved' No. of BLDas: p P TRACT NOW ON LOT OtJ(E USE ZON SPECIAL CONDITIONS U by- the, permit is for one ($100) or less.) n � USE OF 1 '�L��I�•„GF ' e SIZE OF-LOT 5-T X �'oo EXISTING,BLDG'. R' _ I certify that in the,performance of the work-for which this 0' permit is issued, I shall not e'niploy''any person in any manner OWNER r "• � �L�>J e H so as to become subject to the Workers' Compensation Laws., MAIL l OCCUPANCY GROUP'' W .. - ADDRESS �,•) 'r�' Date Applicant �-, NOTICE TO,APPLICANT: If,iafter,making this-Certificate of' CITY �,�N� �(L-l�=L.No�.�j%�� h-ag13 OCCUPANT LOAD Z Exemption, you,:should ,become' subject to the Workers' APPLICATION FOR 'EXIT HARDWARE: Compensation. provisions of-the Labor Code, yod-must forth- . with comply with such •provisions Or this -permit shall be TRAILER USE GEOLGY INSPECTION - - ' deemed-revoked. ❑ O ❑ No Spec.-KnoJvl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic DBVICBS El I hereby affirm that I am licensed Under pro V1S10ns Of Chapter gA FETY•PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section and 7000) of Division 3 of the Busi- ❑ ness and Professions Code, 'my license is in full force"and \N�� `'1`4 �� I 1 PARKING e ffe Ct: - ,REO'D PROVIDED .- - jt:1I C-0 {.I P' �C+/\l� ' f .. SPACES '- License Number Lia Class LIMITED' TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am ai licensed architect or a.registered professional-engineer SIZE OF U NO. OF PROM' TO INSPECTOR'•S acting in my .professional capacity.(Section 7051, Bus- EXISTING'BLDG. 1�• STORIES I, SIGNATURE iness and Professions Code).' FINAL APPROVAL PRESENT USE OF BUILDING. _ Lie.or Reg.No. Date y LAS HOME OWNER-BUILDER•DECLARATION NO. OF EXISTING BUILDINGS, ON LOT AND USE I he affirm that: I am exempt from the-Contractor's ' 4"5 5-8 A License Law for the,following reason (Section 7031.5, Busi- ness and"Professions Code):- No. PwRPING fJ - # 3'0 SPACES PROVIDED T . ❑ 1, as owner of the property,.will do the work and the _ 18 Q Jr 0 structure is not intended or offered for sale (Section „ , 7044;Business and Professions Code). • _ - PROPOSED•USE SOF BUILDING ''C '0 C 80,50-0 - d�i STI-/V• CONSTRUCTION LENDING AGENCY ►, 4"3' -$b 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 Adaress 4 PERMIT FEE 70"00 }SCS-Z r✓""Z� 'I,c6riify�that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE i S70' --C LA-1-- l-k ordinances and State laws- relating to building."construction, TOTAL FEE aniby authorize representatives of this County to enter OW up t e bo a-m nti d pro y for inspection•p reoses. SEE REVERSE FO EXPLANATORY LANGUAGE Signature of PermitteA Dalre - i 3)a,;RTrZNT OF OOUNT7 L;GINM Building 4 Safety Division Los Angeles; California _ ' 10 r = Records Search . Informatiob . Buildi=g ?nt. 26 Issued (D,te) & ?inal inspection 10/7 Description of work • Sq. Ft. 3" tu_lc: g R.-t .� 720Issued(Date)b.2 OF:nal Inspection 'F /Ws Desc:ipt:on of work L Sq.Ft. z,e1 L- 3uildi:g t .Y• ' Issued(Date)_L Final Inspec "ionl�_ Dezc.i.ption of work B•,iilz=Lg ?�-t .# Issued(Date)�final Inspection Description of work Building -?-t ` Issued(Date) Final Inspection Description o'' work = Sq.Ft. - 3uildr.ngt.#.' Issued .(Date) Final Inspection Descripti oz of work_ - - Sr. Clerk- COUNTY OF -LOS ANGEItb •• DEPARTMENT OF COUNTY ENGINEER -BUILDING L SAFETY DIVISION , • 6908 N. KouHmon Avenue . • r Teme'le C"V, Cnlifo-rMe i DIr:��TrZNT OF COUNTY EqGINM Building' & Safety Division Los Angeles , California 10 r Records Search A Information - - Ade-cess ?26y___ 4,14 _ . --.Buildi=g Wit. �� .� Iss.ued`(D�te) 8 1.3 /-{ Final iaspec_t,ian. Description. of work • Sq. ?t. c3� Bu - Ptt.� 37?U� Issued(Date-),,.z Or' :tion 21�S'Bu Desc=iption of work Q Sq.Fte zxl tet- 3uilzing Pnt.Y• Issued(Date) inal Inspectio . , Description of work Sq. Ft.— Bu,ildizg ?tet.# Issued(Date) Final Inspection_! Besc:lpticn of work _ Sq Building ?rt ' Issued(Date) Final Inspection Description of work Building -tet.#{ _,_..Issued (Date)_ Final Inspection Description of work_ • Sr. Clerk COUNTY OF LOS ANGEUb DEPARTMENT OF COUNT_ Y 'ENGINEE1 DUIIDING i SAFETY DIVISION " .' 8906 N.-KouRman Avenue f Temuls Cov, Call CWWW DEPARTMENT OF COUNTY EiGINEER Building & Safety Division—- Los -Angeles , ivision.Los Angeles , California - Records Search Information Address 'Building Pmt.# �� Issued(D,teFinal Inspection �e 7 j Description 'of work S q. Ft. Building Pmt.## 3"1';' 0 Issued(Date)�°��'� r.=_n'_ Tprpeemen-74 --r � Description of work �� t--1 Sq.Ft. . Building Pmt. . Issued(Date) Final Inspection Description of work Sq. Ft ._, Building Pmt.,#' Issued(Date) Final Inspection Description of work Sq.Ft. Building PmtsIssued(Date) Final Inspection Description of work Building Pmt.# _Issued (Date) Final Inspection Description of work _ - Sq.Ft.�. Sr. Clerk COUNTY OF LOS ANGELLb _ _ =DEPARTMENT OF COUNTY ENGINEER BUILDING .& SAFETY DIVISION - 5906 N. Kouffmon Avenue Temple City, Californ�c :h ,.1>,. - i -- .'t•Y..y.lY•. Tt^_ _ `'1 (' 1 • - •G.. -rS:^so'•• r�;�!el - A a1~i • .'E . - ,. . .1 . t 1 e• 'Syy`'�:ra!'�'` •i.'.'t1 4/-_ .S !v-Yr• ' DZF;.RTFIEN T OF G OUh TY E1G?N..r':.R 4 Building & Safety Division Los Angeles, California -- Records alifornia -Records Search - Information - Ad'•,e s s 2d? -ER$T �Ern dxl 00JUE Buildi=g Pnt•n adz Zssued(D�te) 8 / ?inal Iaspection io Description of Work OW • Sq. . 2t. 3� .cu_lz�g PW-.# OVI)f Issued(Date)x��/S Or mai Inspection � /54-Y jescziption of work Q . Sq.Ft. �,�� •: 'a : ; i • Building P=6 Issued(Date) Final Inspec -ion Description of work Sq. Ft Buiidir.g Issued(Date) e final Lspection Description of work C Building 'tr Issued(Date) Final Inspection • Sq.Ft._,v, . Buildiz. g =tet.# Issued (Date) Final Inspection Descripti or of work. Sr. er -' COUNTY OF LOS ANGELtb DEPARTMENT OF COUNTY ENGINEEi .. 1RUIIDING & SAFETY. OIVWON _ _.. :.1 : : - . ,�•:. �':'' _ x ;: . • We N. Kauffman Avenue: -• - - - - ':-- ..- . ' �- Temple C*4 ' Calihxh*mw