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Home My Public Portal About9223 LEMON AVE_Miscellaneous__ WORKERS7COMPENSATION DECLARATION 76M444 0;1 CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(See. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ^f ADDRESS Jl Certified copy is hereby furnished. we oResG LOCALITY I 'Certified copy is filed with the county building inspection LOCALITY NEAREST department. _ CROSSST Date Applicant NEAREST ! DISTRICT NO. G UP TYPE PROCE bED BY CROSS ST \ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (((�� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY _ No. (CIRCLE) STATE MAJOR SE CON 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.) /Q usE of I I certify that in the performance of the work for which this SIZE of Lo (/ EXISTING BLDG. permit is issued, I shall not employ any person in any manner OWNER =' so as to become subject to the Workers' Compensation Laws. Aur- MAIL J ],,," OCCUPANCY GROUP: �?J o ADDRESS Date Applicant NOTICE TO'APPLICANT If, after making this Certificate of CITY f rTioL OCCUPANT LOAD N Exemption, you should become subject to-the Workers' I z Compensation provisions of the Labor Code, you must forth- APPLI TION FOR EXIT HARDWARE with comply with such provisions or this permit shall'be TRAILER USEGEOLOGY INSPECTION Eldeemed 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 effect. JP11 n 01j0A1 PARKING REQ'D D PROVIDED O SPACES License Number Lrc.'Class LIMITED TIME USE Contractor Date DATE OATH 1 ' I am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OF S NO. OF �, R acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES I RE mess and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS o /7/(J(/ ON LOT AND USE, C H a 5 0 I hereby affirm thaf I am exempt from the Contractor's 2 8,-88 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE ' I certify that I have read this application and state that the I 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 o erty or pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �� \\►l �c.-lam �� . Signature of Permittee Date COUNTY QE LOS ANGELES p � DEPARTMENT OF PUEI.IC WQt88 MICROFILM INFORMATION Record Search Building Address 90� Locality Tract No. Lot No. Lot Size 6ax loo -+Building Permit Issue Date /-3/4 Final Date P�/04e4tZ/) Description of work X,DV2 To Sq. Ft. /S 'X!�' A0 f A1,074- Building OfBuilding Permit Issue Final Date -d(l- Description of work 6L ,9SS €v — 1�J �"4��f7` Sq. jl�Buildi Permit # fl 3�3 Issue Date /O a7 Final Date a_ Description of work 2ze,(,o Ata e , ,,� a l-- Sq. Ft. Building Permit # Issue Date Final Date Description of work Sq. Ft. Building Permit # Issue Date Final Date Description of work S,q. Note: The information given is taken from Building Permit Records. Unless an Occupancy Inspection is requested and the fee for this inspection is paid, no investigation of the property will be made by this Department. Sewer Permit # Issue Date Connected to sewer in street : Inspection Date e forClerk' a 4 COUNTY OF LOSANGELES DEPARTMENT OF PUBLIC WORDS MICROFILM INFORMATION Record. Search Building Address 9�a�3 Locality Tract No. hotNo. Lot' Size 6ax_loo J'-Building Permit Issue Date /-3/--6 Final Date Description of work i¢,dy_) Sq. Ft. - No t Na Building Permit Issue Date Final Date -aV Description of work020- h7' Sq. Ft. 9la-�X_ /.S;_ Building ,Permit # ±/ 3L? Issue Date /© -7Final Date) . Description of work G "f2 Sq. Ft. Building Permit # Issue Date Final Date Description of work d Sq. Ft - =Building Permit #- T Issue Date Final Date Description of work a Sq. Note : The information given is taken from Building Permit Records. Unless an Occupancy Inspection is requested and the fee for this inspection is paid, no *investigation of the property will be made by this Department. Sewer Permit # Issue Date, Connected to sewer in street: Inspection Date Se for Cler