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HomeMy Public PortalAbout9233-9251 LAS TUNAS DR_Miscellaneous__ Am 1\Or.1:LRs C0\IPE1,iSAIION DCCL CE 97 a5 I1 7 Bal M ISC1.ELLANEG! -A_RFL1CA-TJ I CE 97 I hereby affirmthat I have a certificate of consent to self COUNTY OF LOS .-ANGELES BUILDING AND SAFETY (VISION Insure. or a certificate of Workers'Compensation insurance,or a certified copy thereof(Sec. 3800, Lab C 1 Policy No Company FOR APPLICANT TO FILL IN 9uDDR�ss ILD NG Certified op} is hw erebv furnished p BUILDING Y A AD DR Ess 2 u CL S0, t-� 1-O CA_IT Y i Certified copy is -Jed with the county building Inspection gLOCALITY NEAREST departmentr� L7 _Ross ST Date 1pvlicint NEAREST CROSSDISTR NO GRO P ITYPETCONSCESSED 9Y 'O G ) CERTiFIC ITE OF EXEMPTION FROV 110R(:ER5' LEGAL a COMPEMATION INSI,R k`.CE DESC9IPTION Lor VO BLOCK w,G Mw sv TROP I�IR�L[)NO STATE MAJOR SECOND LOCAL (This ,ection need not he completed If the Work Involved TRACT NOWOF B ON LOT OT S (ISE ZONE SPECIAL CONDITIONS by the permit is for one IlUndred Joll Irs IS100) or less ) USE OF [ .erttf}•tha[ m 'he nrCuT;nano;: .)t 'lie lurc 'o: 'thich 'lis SIZE OF LOT EXISTING BLDG permit is Issued. [ )hall Sit rmvlo am ve2.on n jnv manner OWNER (�7 so as to become :uh)ecr -o the ''�orkers Comvensation Laws ,,AIL OCC1_'P4NCY GROUP ADDRESS - Date _—__--- 1orhLant -- -- x NOTICE TO aPPL1C 1\T If. liter makxs_ his :_:,L1IL1[e ut C17- vo OCCUPaNT LOAD E%emptfon, Tou Aioula become ,ubject -o :he lt'omers APPLICATION FOR E,<I'HARCYVARE Comvensation vro%tsmns )t the Laoor Coae , ou must torch lith Lomnh• %iib v,-t o-mis,ons r ru •e-nit ,nail I)e -RAIL--R J,E — GEOLOGY INSPE_"ON — '_ Jeenled rekoh.d — — to Soec K,SoLvl ZZ LICENSED I O\TR.aCFOIZS JL�L W �Tlt)'. OCCJP 4NC' INSPECTION B Panic Devices I ierebv at`trm :Iia[ t _m licensed under provisions of Chanter - - - I LIST ITEMS 3E LOIYI 9 tLOmmenc[ne '%ith Section /0001 of Dnlsion 3 of -he Bush SAFETY PERMIT ( NO OF EXITS - ness and Professions lode and m� hrensc is :n ill orce and _ etfeL2 PA SPACESREDREO J D PRJVID ED 1 II 'e til.....___... License �unle _ L.L t=las, LIMITED TIME USE ContraLtor DJT_ I tin e,cn1p2 rum hr 'iLensuSe :euuue:ne-i2s :, 1 _,In i I hLensed 1r h1(rl: Or 1 -e_isiered nrotessronal _nc!ne_r ;,zE OF NO OF tNsPEc-oR s ? actin'_ In 'nt Drwe,Sional .:anal:[ seL:;on 'I_ i bus- =XIS- NG 3L:G I JTORIEi SIGNATURE iness and P-otessions Cudel J LIL t)r Rcc 'J., - D.I'L -__ _____ "'REiE'IT '15E OF 3UILD1`!G FINAL APPROVAL I HV1EXISTING OE OIINCR RL DELL aR f `.lONo of 0 BUILDINGS /1 '7N LD- AND 'OSE VV h I hereby affirm :ha[ t tillr.empl :nm :he Cantr.IL2or, �' �i 6 LiLense Ixt for :he L Ilo,%ul'_ -e non -fie. lin "I) I Bu,h ness .Ind ProiessiunsCidei NO PARKING I -010EE 1, as •s ,PA Ccs 'RovIDED ,) nee ut -hr orupern sill du. hr ion and he structure Is .wt intended or oite-ed uT ate Se.aian 044 Bit'It lnd Proiessions C)dei IROPOSED USE OF BUILDING t ONSl Rl CllO\ LC`DI\G ��C�C1 hereb% aiftrm that :here is I Lonstruct[on lending ienc:• for the performance of the work for wlnLln [Ills permit is issued (Sec 309- Cn i 1 Lender'sdame ------_—_-- --------____-- PROPOSED MAX OCC Lender s address 25.00 1 - PERMIT Fee 1 certify that I Ita)e read this application and state 'hat the abo%e Information is correct l agree to comph %%ith all County ISSUANCE FEE urdurances and State lads relating to budd[ne construction. Ind hereb,v authorize rep�r�e�,s�e"ntawes of this Count% to enter TOTAL FEE 25.00 ( I upon the� V it t`/AI Way for InspeLtnun purposes % �'`'" 7�^� /"'`"`l SLE RE%ERSE FOR EXPLaN-kTORY LANGUAGE t I WORKIRS' COMPENSATION DECLARATION 20-0063DPW12/90 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 cen ificate of Workers'Compensation Insurance, or a certified cope thereof (Sec 3800, Lab C), Policy No Company FOR APPLICANT TO FILL IN BUILDING 2 BUILDING ADDRESS ADDRESS ✓� \ `+ ❑ Certified i opy is hereby furnished g 'tj"j 'GIGLR-<> LOCALITY ❑ Certified copy is filed with the county building InspectionNEAREST cl zIP�`Zn department `(� CROSS ST Date _ Applicant SIZE Olt LOT 0 NO OF BLDGS NOW ON LOT DISTRICT Nd GROUP TYPE I PROCESSED BY Q CERTIFICATE OF EXEMPTION FROM WORKERS' C ONST TRACT BLOCK LOT NO. COMPENSATION INSURANCE MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL (This Section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) "—iXrfy er TEL NO a I certify that in the performance of the work for which this �J i014, � I permit is issued I shall not employ any person In any manner �T� La so as to become subject to the Workers' Compensation Laws ADDRESS a OCCUPANCY GROUP Z { Date Applicant CITY ZIP NOTICE TO APPLICANT If, after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE comply with Such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ l revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) r i 9(commencing with Section 7000)of Division 3 of the Business No OF EXITS and Professions Code,and my license is in full force and effect)(Name ot Husimess ^' PARKING REO'D == PROVIDED D � License Number Lic Class �, �� �'v � { SPACES ' ( i Contractor _ Date 1 LIMITED TIME USE ❑ I am exem,t from the licensing requirements as I am aDATE DATE licensed architect or a registered professional engineer mSIZE OF FROM ro C NO OF INSPECTOR'S t , acting in y professional capacity (Section 7051,Business EXISTING BLDG 5� and Professions Code) �� STORIES SIGNATURE. Lic. or Reg No Date PRESENT USE OF BUILDING �(� FINAL APPROVAL 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 70315, Business and l Professions Codc)• 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, PROPOSED USE OF BUILDI G t Business an.i Professions Code). l i 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 ( i (Sec 3097, CIV- C). PROPOSED MAX OCC Lender's Name _ AP A NT(PRINT) /E Lender's Address AD ESS ( 1�3�I certify that I have read this application and state that the above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the a -me tic ned property for inspection purposes TOTAL FEE —O—Z) SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnatu a of Permittee Date WOR1.1_16 ( ON,PINS,ANONDL( IAIt \Il(), ;;;I;I,,'111P,11 110 MISCELLANE=OUS APPLICATION Ihereb% affirm that I ha%c 1I LCIill iL1ite of (ImNent to NLu COON I Y 01- 1 OS iANGI-I FS IWILDING SAND SAFETY DIVISION Ii insure, 111 a LCIIIIIC,IIC of Worker, (011lpcll,,ll11,11 lnNl ami of �� .I certified copy Iheleol (Sec 3800 Lah ( 1 Pohc) N:) ( onlpall\ FOR APPLICANI 10 FILL IN BUILDING BUILDING ADDRESS ADDRESS ElCerllilCd ulp r, belch) Iulnl,hell X 02-37 LAS TUNAS -DR-- -- LOCALITY ❑ (ertllled CopA Iti I Iled with the I"nLllllA hulldIlig In,J), 11011 CITY ZIP department TEMPLE CITY 91780 NEAREI CROSS ST DJIe Appl IcallI SIZE OF LOT NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CONST ( LR-111 K AIL 01' L-XLMI'TION I ROM \\()Rkl R`, 1f�gcr BLOCK Lor No pt (OMPLNSAHON INSUR ANC! MAp HIGHWAY 'f NO �CIRCLEI STATE MAJOR SECOND LOCAL (This SCLIi0II IICCd 1101 bC L011lplC(Cd 11 Isle Vk Olk 111101\Cd ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS b\ the petmil is lol one inlndled doli'lls (1,100) of 1(%%) _— cclllly (hal Ill the perfolm,lnLc of dl( \\nlk Ins \\hl(h IhI, OWNER TEL NO I ' pClnul iti Is,ucd 1 ,h;Il not e11lplo\ .Inti lwl,on nI ,Im 111.111110 -- -- - --- — - — ' ,) the "'OlkCIN (0111\(nN,unnl I,1\l, ADDRESS -- OCCUPANCY GROUP ,o a, to become wbleLl I u Da Ie A1)pIlid111 CITY ZIP NOT IC L W APP1 K AN 1 II Ater 1n,1kiw, thl, ( cltlll(ate OCCUPANT LOAD Of EXen,puoR yOil ,hould heLo111C NuhlCll to the WolfCl, APPLICATION FOR Compensation pimi,Ion,of the Labor Code you nw,t 101tImith t EXIT HARDWARE COIl1Pl) Nllll NLILII pro\I,loll, or lliiN pcllllll ,hill h" LIC('nled lR\ILER UI CLI GEOLOGY INSPECI ION I_I revoked No Spec Knowl ❑ LIC ENSLD CONTRAIL FORS DI ( I AR \11()NOCCUPANCY INSPECTIONK Panic Devices ❑ 1 hereby tiff(rill that I .illi licensed lllldel I)IOVI,lolls oI ( h,IplCl SAFETY PERMIT ❑ ILIST ITEMS BELOW) I 9(commencing With SCction 7000)(if'DI\i ooil 1 of the I3LI,Ille„ NO OF EXITS and hole„lon, (ode ,Ind 1111 Ilceme I, In lull Iol(e and ellc(i r L l:l -.}11 l PARKING LlLenl e Number I IL ( I,I,N SPACES REO'D PROVIDED LES HAIR SA_L_ON___ - ( olill,iLtol D,ue LIMITED TIME USE ' DATE DATE ❑ I all( L•`( im)( Irom the IILCn,Illg ILIILIIICIIICIII, ,1, 1 ,Illi ,IFROM 70 hcen,ed auchllecl of d legl,telcd plofewolm, Cnenuel ' a(Aing Irl ill) plolc,sioiwl Lalmut\ ItiCl lion 70 1 kllNllll„ SIDE OF NO OI INSPECTOR S i I EXIS IINC,BLDG _ ,,I Il RILS _ SIGNATURE and Plolcwon, (ode) — _ - - - ITC UI Reg No 1),II( PRESENT USE OF BUILDING FINAL APPROVAL `�1 A— BEAUTY SALON IIONI OWNI R-6(111 DI R DI ( I AR-UION NO Or I XIS IINC,BUILDINGS ON LOT AND USE hereb) ,Ifs II 111 (hal 1 ,1111 C\Llllpt 1111111 the (01111,1001 N 1 ILLIINC -- -- ---- I dW for the lollovvnlg lea,on 6CL(wn 7011 � llti ImcNN ,Ind ProfewonN (ode) Nle PARKIN(, SP,\C CS PROVIDCD I aN o\\nci of the plopell\ \,111 (IIS Illc ,,,Ill ,111(1 [11, --- ----- -- --- - -- --- -- - -- NlluLtulC IN Dol I11lende(I Or of Cl I II�I N,Ilc (ILLI "ll ins! PROroSCD USE OF BUIL DING Bu,mC„ .IhII PlolewonN ('ode) BEAUTY SALON —� (ONST RU(TION I I NDIN(I A(d N( 1 - hereb\ 111111111 (1111( II1CIC IN J LonNlluLuo11 ICII(hne ,1"010 for the performance of the moi(, lot Mi0i thl, jmilllt IN mired (Sec 3097, (o, ( ) PROPOSED MAX OCC ender, NdI11C X GUANC:IIIYAQ__HUANG TEL N6) 4 S 19.893 lenders Addle„ cerlll} that I have read till, application and ,tmc IhII the I / / GARVEY AVE # 1 ALHAMBRA 91 8 3 above Information Is LOrrect I agree R)cunlply vvuh 1111 (Dunt) PERMIT FEE ordinances and Stale Id\\, iel,lung to building eonq Li I ,Ind _ IICICby dLllhol Ve ICI)ICWIILIII\C, DI IIIIN ( Dunt) to enlLl upon ISSUANCE FEE the above-mentioned propem for nl,pCLllon ptlipoN(N � TOTAL FEE UN-11 01 51 1 RI v L RSI FOR EXP[ANATORI L ANGUAGF I Slgnaune a crnuncc ;),IL( I WORKERS'COMPENSATION DECLARATION 20-0063DPW12/90 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION •Tinsure, or a certificate of Workers'Compensation Insurance,or , a certified copy thereof (Set. 3800, Lab C.) ` Policy No Company FOR APPLICANT TO FILL IN BUILDING l2 ( j �k� BUILDING ADDRESS ADDRESS G i7S ❑ Certified copy is hereby furnished, g C1235 E• Lhs —TkN f}S !-)9 . LOCALITYElCertified copy is filed with the county building Inspection CITY l� �T y ZIP department l�( L�� ` / l t 78 0 NEAREST CROSS ST l Date Applicant SIZE OF LOT NO OF BLOGS.NOW ON LOT DISTRICT NO I GROUP TYPE PROCESSED BY t O V V 5 CONST O CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT No. (.J I COMPENSATION INSURANCE MAP HIGHWAY (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL NO CIRCLET STATE MAJOR SECOND LOCAL i by the permit is for one hundred dollars ($100) or less.) USE ZONE SPECIAL CONDITIONS I certify that in the performance of the work for which this sW�2�rfy er TEL NO I permit is issued. I shall not employ any person In any manner v "T L/'r-t �3 �& '�� W so as to become subject to the Workers' Compensation Laws ADORE 33 aNT �yLfC OCCUPANCY GROUP Z Date Applicant CITY ZIP —. NOTICE TO APPLICANT- If, after making this Certificate OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ revoked No Spec Knowi LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Ej Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) I 9(commencing with Section 7000)of Division 3 of the Business - IF EXITS Z and Professions Code,and my license is in full force and effect It License Number Lie. Class _ _1 SPACES REQ'D LJv PROVIDED I i Contractor Date2 S LAS 7viQ� ©� LIMITED TIME USE I ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer G `� 175 FROM To acting in my professional capacity (Section 7051, Business SIZE OF NOof INSPECTOR'S and Professions Code) EXISTING BLDG I O V STORIES ' SIGNATURE. Lic or Reg No. - Date PRESENT USE OF BUILDING ��q i g SA«S FINAL APPROVAL ✓' 6 �j3 HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS j ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code)- NO PARKING a El I, as owner of the property, will do the work and the SPACES PROVIDED structure is not Intended or offered for sale(Section 7044_1 PROPOSED USE OF BUILDING S�L� g sz�C—(�V1CL Business and Professions Code) 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.). PROPOSED MAX OCG Lender's Name APP ILCANT PR/NT) _FT�N ELN Lender's Address ADDRESS I certify that I have read this application and state that the 6(C9 N . kf--N G A46-- . -T&,kkr .C.- C 7(1, CA `f(7 8 c-' above information is correct. I agree to comply with all County PERMIT FEE I ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE i the abov -went, rope inspection purpo s. I TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE I D to here affirm :!tat i r.a�e 1 r._'clre 1 —once—: eL CCCUNT� OF LOS, Al NGFiFS BUILDING V'4D SAFETY DIVISION m u7e. or a :erzificcte of '1tiortiers �:xnpeasai.o11 1nsaranCJ Jr certi :ea.:oo_v ihereet (Sec -'Soo Lau , ^Ilcy No Compan% CR— 1 = - PPL C, IMT su1�UfMG ° I r— OGRESS �J Cerrifieu copy .s nereny fumishea I9UILOING X11 ��� f �� � �^ �� T � �^ ��—�]�CR ESS— II�V--�Q� 6/` 1 LOCALITY I I I Certified copy is tiled with-he count% ouildlna inspec;lon ILO C:.I L1T'r ) s 1 NEAREST aepartment. Xj� l (�jJ aepartment. Xj� I �/ CROSS ST Date Applicant I C CSS ST ]ISTR' l GRO YPE CCESSEO BY CONST CERTIFICATE OF EXT-N4PTION FROM"0RAKERS �_ COMPENSATION :\SURA\C OESC—PTION No aL3C,e r H1 M%VAY s _ -ATE `AAJOR SE=ONO _OCAL I DG [This section need not be completed 11 the wm Intoked i BRAC- NO"I y.,N=LOT = !U_'E =ONEISPE C•AL CONOIT.ONS by the permit 's for one hundred dollars IS1oU) or leis., i JSE OF I certify that in the performance of -,he ort; for ' mc.l his �SIOE of _o- -r'S- NG SLOG ri permit 1s Issued, 1 ,n111 not emptcy an% person 'n an} 11r.ne ----,` t-i r, a / become suolect to ,he P., X OL '�L_Z_7 so 1s to 1rzers Compensation L-,%q �CC:,P-s iV C'/ �r=Cl,'P Date appiicant NOTICE TO APPLICANT If, user maicLne ,lis Cir iclr'. If O h� Pr �vc(3y3)�'�cQ- 0 OCC„'PAN- _0"[D E emotion. you scot.ld becorne ,abler, ro Cof-pensat:on pro,�:sions of :he Laoor Coce .ou must :c " - ! P -- -:<;� - nDIP•I�R= `V1111 ComoC_v it ita Duca or oer-11- ,n.l'! -_ - JSE — — ~ j eeemea ale LICE\S D CO\T,R 1CTORS DECL-',.', -. O` ccs ...0 ____-,c,i _ .r ., De, 'ces I 1i il. ,S BE-C cess ula P-o�_,s.J _ Cue ...� � ,. , - � 't •-_� 1 -• ' I =Lx ; :Mame of business NG L..cense ` ,.. . _. _._ -- 5 u _ (I_ _ _-- _il'vI1__D h_1''llr Jv�- _ am - 1"Pled •...-L .. lr.�' _ '- .. ''1 C[: = F -- NSPEC-C R'S ac"jm: In ^r iCs .JC ?_\. '- = 5- 'JG 2_.. n _ __ ( SiGNAT RE .nebs.:iia AP'=CV AL_ i' )vIE 1 Ilei p} 1I: m 'llaC .1.i1 /- Llcen e Lc'% o; -'ie :ouo'.%_n_ ness Ind P oiesslec.,CJue' C R 'NG ' i. ,a u«ner JI .l.e D-ore-- ,%.L ;e -I' -� •I --_ I il�a-' �U�IlleS`1Pa °:OCe�SII`I`S I__'uc -O\STZLCT[C`• _R =csEc J;- _ f=fU �_]�!�'lG [ 'nereb} uf'rm :nat :!:ere is _ _en�t -i'---i11 _ = rf � ` I for the oerCornIlm- CC II,e '%Or-,A ;0' Issued(Sec -,09- '^P C Under s'Nine 1 Lender s.-address _ .'�:.t�.. I certify that 1 na,e read this appllcauoP .,I Li s;::c :'1 -n T 2 5 00J auo,,e information Is correct 11v_ee :o come!% ,%itL tl .; t ssvANCE y ordinances and Stare laps relaung to huunu,* co s,:::L ion. It and hereby auihorze representam es of this Count% :o ,It?r 1 TOTAL FEE 25 . 0 0! upon the above menu rea proretv for msoec;ion ou::Dl .e, s� SEL REQ ERSL FOR E\?L 11,ATOR`. LA\G� %GE `!I XX Z- !7/ XX _ '37 t.i• Signature of Permittee ate - ; M'r7R'KERS'COMPENSATION DECLARATION CE 84 5412-80) MISCELLANEOUS APPLICATION Whereby affirm that I have certificate of consent to self insur COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msure,�or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING jJ ❑ ADDRESS (( Certified copy is hereby furnished UILD ING u D r• ❑ A DRESS C LOCALITY Certified copy Is filed with the county building Inspection NEAREST department LOCALITY �p CROSS ST. Date Applicant AREST l DISTRICT NO. GR P TYPE 1PROCES ED BY CROSS ST. CONST' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J v V COMPENSATION INSURANCE DESCRIPTIO NLor No BLOCK MAP //��D HIGHWAY } NO OF BLDGS rv0 (/ (CIRCLE) STATE MAJOR SEGO LOCAL d (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE FIAL CONDITIONS D by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG I certify that in the performance of the work for which this V Q permit Is issued, I shall not employ any person in any manner NERVe t i r �i U so as to become subject to the Workers' Compensation Laws IL OCCUPANCY GROUP LU ADDRESS d Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY Nor .. p — OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked a Devices NOSpec. Knowl. El ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT V (LIST ITEMS BELOW) NO OF EXITS a 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect SPACES REO'D PROVIDED License Number Llc Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIG)4ATUREA. loess and Professions Code). IWIESENT USE of BUILDING 1. FINAL APPROVAL Lic or Reg No Date Ma/f a, Rudok (` HOME OWNER-BUILDER DECLARATION NO. O EXISTING BUILDINGS ON LOT AND USE ;20928A I hereby affirm that 1 am exempt from the Contractor's License-Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO. PARKING ❑ • • • .I, as owner of the property, will do the work and the SPACES PROVIDED • • • structure is not intended or offered for sale (Section 7044, Business and Professions Code). 19—$/� POSED USE OF BUILDING MOV 10, CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency Q 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 1 have Wrees application and state that the above information Is cgree to comply with all County ISSUANCE FEE ordinances and Stateting to building construction, TOTAL FEE and here authorize atives of this County to enteruponperty pection p rpo s SEE REVERSE FOR EXPLANATORY LANGUAGE ?bature of P mitt D to WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCE LLAN E O U S APPLICATION I hereby affirm that 1 have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msufe, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800, Lab C) Policy No BUI Company FOR APPLICANT TO FILL IN ADDRELDING ❑ Certified copy is hereby furnished V BUILDING LOCALITY ❑ ADDRESS Certified copy is filed with the county building Inspection 11 1 NEAREST department LOCALITY CROSS ST Date Applicant EAREST DISTRIC�[�,I O G OUP TYPE PRO SED BY I CROSS ST `,Y ,? CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (�o V COMPENSATION INSURANCE DESCRIPTION LOT NO 11 BLOCK MAP /Sv, NO (CIRCLE) STATE MAJOR SEC/ EC NO LOCAL d NO. OF SLOGS (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE of /•)� SE OF LOT EXISTING BLDG 1 ���!' 0 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 U so as to become subject to the Workers' Compensation LawsAIL OCCUPANCY GROUP — lU ADDRESS 0- I Date Applicant NOTICE TO APPLICANT If, after making this Certificate of Lo CITY No� OCCUPANT LOAD z Exemption, you should become subject to the Workers' LIGATION 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. ❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING effect SPACES REO'D == PROVIDED O License Number LIc Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No OF FROM INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL B Lic or Reg No Date 14n� J 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 SPACES PROVIDED 2 4 2 9 6 A ❑ I, as owner of the property, will do the work and the # 8 8 structure Is not intended or offered for sale (Section t� 7044, Business and Professions Code) V - 0 0 0 0 0 0 0 a2 J,41ROPOSED USE OF BUILDING v CONSTRUCTION LENDING AGENCY II�� 0 31 2 6,=8 6 1 hereby affirm that there Is a construction lending agency fes' (1�•�J\ for the performance of the work for which this permit is issued (Sec. 3097,Civ C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above Information Is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon t above-ment ne ejqq ty for i s ection r ses SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PermiAttee Da e WORKERS'COMPENSATION DECLARATION CEM875 (2-80) MISCELLANEOUS APPLICATION I hereby., affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Insure', or a certificate of Workers'Compensation Insurance,or a—mortified copy thereof(Sec 3800, Lab C) }– / . Policy No BUILDING Company FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is hereby furnished BUILDING t ,y j/ LOCALITY ADDRESS G V/VDR. ❑ Certified copy is filed with the county building Inspection ///��� ` /rte NEAREST department LOCALITY —f/ ��7 /� V�1) CROSS ST Date Applicant NEAREST /'I Y� (J DISTRICT(NO GROUP TYPE PROCE SED BY CROSS ST C .^I V� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o V COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK AP/ ;n G/ HIGHWAY } NO J .r`fa (CIRCLE) STATE MAJOR S OND LOCAL O NO OF BLDGS (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) USE OF � i SIZE OF LOT EXISTING BLDG cc I certify that in the performance of the work for which this 0 permit is issued, I,shall not employ any person in any manner OWNER AIJV / /I U so as to become subject to the Workers' Compensation Laws MAIL e�� '/n OCCUPANCY GROUP W ADDRESS QgD � OAQ r'C`A N Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY ? NO.7— 3 OCCUPANT LOAD z O 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 GEOL Y INSPECTION deemed revoked ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT L J (LIST ITEMS BELOW) ❑ NO OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness usrness and Professions Code, and my license is in full force and PARKING. effect SPACES REQ'D D PROVIDED D License Number Lie 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 IN CrOR's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lie or Reg No Date er HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's �G 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 structure is not Intended or offered for sale (Section [`x 4 2 9 5 A 7044, Business and Professions Code). PROPOSED USE OF BUILDING C # 0 0 8 8 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency Ro C A e 1 Q2�- for the performance of the work for which this permit is j 2 b 8 6 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 ISSUANCE FEE above information is correct I agree to comply with all County ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE IJ-S1. 6,C YD/ a1 Hkhrk) V, Signature of Viamittee Date ,} WgRKERS'COMPENSATION DECLARATION CE 876 (11-84) MISCELLANEOUS APPLICATION CE 875 i jeby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION in. e, 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 furnishedBUDDRILDIES NG 2 E I T D LOCALITY Certified copy is filed with the county building inspection LOCALITY Las Tunas Plaza NEAR EST department. cRoss ST Date Applicant NEAREST DISTRICT NO. I GROUP TYPE PROCESSED BY CROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 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 ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF BLDG.OF d I certify that in the performance of the work for which this I..-OF LOT permit is issued, I shall not employ any person in any manner OWNER y so as to become subject to the Workers' Compensation Laws. V liant I OCCUPANCY GROUP �v AIL CD DDRV Date ESS Applicant TEL NOTICE TO APPLICANT If, after making this Certificate of CITY ND..2� 3-7 23 7 5 5 5 OCCUPANT LOAD C11.1Exemption, 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 ❑ ❑ 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 ' e 1 effect. V L PARKING SPACES REQ'D PROVIDED A �/1� License Number Lic. Class w� L/T.S ITLAAS c R . Contractor Date / 1 /7old DATLIMITED TIME USE DATE ` I am exempt from the licensing requirements as I am a ©— oAJ FROM TO: licensed architect or a registered professional engineersl E of NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- (STING BLDG. STORIES SIgIft4ATURE mess and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- ;E 9 8 S 8 A ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED # • • •,• 88 structure is not intended or offered for sale (Section 1 0 0 ! 0 u� 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING Office 0 61,1 0.=8 8 1 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 0fl Y PROPOSED MAX OCC Lender's Address �1 PERMIT FEE \ 1 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, anhereby authorize represent ativ s of this County to enter TOTAL FEE I, on thea ert for inspection purposes ?^SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WOTKERS'COMPENSATION DECLARATION ( 76M444�(�� �enc�d r CE 875 (2-80) MISCELLANEOUS APPLICATION {� I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �J 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 Tc4� LOCALITY ADDRESS S ❑ Certified copy is filed with the county building Inspection NEAREST department LOCALITY Ci t CROSS ST Date Applicant NEAREST DISTRICT NOG ROUP TYPE PROCE D BY CROSS ST IDU CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ✓� 0 COMPENSATION INSURANCE DESCRIPTION LOT No BLocK AlmrI IG Al >_NO (CIRCLE) STATE MAJOR SECON LOCAL d (This section need not be completed if the work involved NO of BLOGs USE ZONE SPECIAL CONDITIONS O l P TRACT NOW ON LOT U by the permit is for one hundred dollars ($100) or less.) USE OF cc SIZE OF LOT EXISTING BLDG. I certify that m 0 the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNERHe so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP W MAIL 0 j a ADDRESS N .Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY NO � Z � 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 deemed revoked ❑ ❑ No Spec. Knowl. El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PgRKING. effect SPACES REO'D D PROVIDED D License Number Lie 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. OFINSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE IneSS and PI'OfeSSlOi1S Code). PRESENT USE OF BUILDING `, FINAL APPROVAL Lie.or Reg No Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON Q 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 SPACES PROVIDED F-1 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performanceof the work for which this permit is Issued (Sec 3097,Civ.C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon t e above-menti ed proper for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE —Z Sig atur f Permittee Date WORKERS'COMPENSATION DECLARATION 8 CE (2-80) MISCELLANEOUS APPLICATION CE 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.) ,', J Policy No. Company FOR APPLICANT TO FILL IN BUILDRESSING. k4a ���C/ ADD Certified copy is hereby furnished. i0oBUILDING u LOCALITY ADDRESS ❑ Certified copy Is filed with the county building inspection NEAREST department IOCALITY CROSS ST Date Applicant EAREST DISTRICT NO G UP TYPE / JP�XSED BY CROSS ST �Z!'v CON$T,/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v D V COMPENSATION INSURANCE - DESCRIPTION Lor No BLOCK MAP HIGHWAY >_ NO OF BLDGS NO (CIRCLE) STATE MAJOR SE OND LOCAL CL (This section need not be completed if the Work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. cc I certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner JoOWNER V ` ZAA' (� so as to become subject to the Workers' Compensation Laws AIL V OCCUPANCY GROUP W AD RESSO CL Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY Nos� OCCUPANT LOAD z Exemption, you should become subject to the Workers' pPLICATION 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. El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is In full force and PARKING. effect SPACES REQ'D PROVIDED License Number Lie Class LIMITED TIME USE - Contractor Date DATE DATE FROM T 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 A URE mess and Professions Code). FINAL APPROVAL # • • • ESENT USE OF BUILDING Lie or Reg No Date HOME OWNER-BUILDER DECLARATION No OF EXIS UNG BUILDINGS ON LOT AND USE I heieby 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 ❑ 1, as owner of the property, will do the work and the structure Is not intended or offered for sale (Section 7044, Business and Professions Code). OPOSED 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 11 Lender's Address PERMIT FEE I certify that I have read this application and state that the f above Information is correct I agree to comply with all County ISSUANCE FEE {ordinances and State laws relating to building construction, TOTAL FEE hand hereby authorize representatives of this County to enter �upn t above-mentioned roperty for msp tion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE t n� I ature 45X mittee Date i I d0 4P 67— WORKERS'COMPENSATION DECLARATION 76CE 84 54( (11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec 3800,Lab.C.). BUILDING �• n", Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. LDING 9�4 5 E. Las Tunas Di• T e i LOCALITY DDRESS 0 Certified copy is filed with the county building inspection OCALITY LAS Tunas P�d2d NEAREST department. �I� / ��J CROSS ST Date Applicant AR EST A esS1 YD fTVG DISTRICT NO, GRO/p�P TYPE PROC S BY CROSS ST. 1 J( ONST� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �f COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP/5-0 HIGHWAY rv0 (CIRCLE) STATE MAJOR SECON -CAL NO OF BLD GS (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. ff O I certify that in the performance of the work for which this VVV permit is issued, I shall not employ any person in any manner OWNER i L y so as to become subject to the Workers' Compensation Laws. IL OCCUPANCY GROUP o ADDRESS Date Applicant P, 0. LSI NOTICE TO APPLICANT If, after making this Certificate of CITY A4 N-L*(J i3) S'S� 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 OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING REq•D PROVIDED SPACES JJ License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE Elam exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code) f r l ESENT USE OF BUILDING V f r C FINAL APPROVAL 1)— Lic.or Reg.No Date g (J i 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 El I, as owner of the property, will do the work and the SPACES PROVIDED A51 4 9 A structure is not intended or offered for sale (Section 7044,Business and Professions Code). JPOSED USE OF BUILDING # • ' • • 8 8 �y CONSTRUCTION LENDING AGENCY I •"• • • • • • 2 I hereby affirm that there is a construction lending agency 0729-'786 for the performance of the work for which this permit is issued(Sec 3097,Civ C.). Lender's Name Lender's Address PROPOSED MAX OCC. .^ I certify that I have read this application and state that the PERMIT FEE ` above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL. FEE upon the mentione property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Permittee Date WORKERS,COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 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.Q. Policy No Company FOR APPLICANT TO FILL IN BU AUILDING DDRESS Certified copy is hereby furnished BUILDING S ; LOCALITY ADDRESSLl N1 A 0 Certified copy is filed with the county building inspection✓ LOCALITY —FE= NEAREST department. E 1 ,0 CROSS ST. avjw�� Date Applicant NEAREST DISTRICT NO. I G OUP TYPE PROCEASIE. BY CROSS ST (\LCSS CA ii CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J` COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SE NO OF BLDGS. C D LOCAL (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 not employ any person in any manner OWNERs� so as to become subject to the Workers' Compensation Laws. MAIL ��L 1 ` OCCUPANCY GROUP FF_�7� o ADDRESS e.o� oX333 Ho E El Y Date Applicant g C� rEL.�yi`��� �JSS OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. J r�i, 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 Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect PARKING REQ'D D PROVID 6D 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 1 PECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES IGNATU E mess and Professions Code). PRESENT USE OF BUILDING 1� 1 FINAL APPROVAL / --L-ic or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE �� f/,.7 ` 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 '��✓� 4 8&6 A ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section `G �7� # • • • • 8 8 7044,Business and Professions Code). En CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING e� GQ�, `I . . . • . . . I hereby affirm that there is a construction lending agency \rV p 6,2 5-8 6 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 ve entioned property for inspection purposes. � ✓ � �3 g� SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date 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 certified copy thereof(Sec 3800,Lab C). Policy No Company FOR APPLICANT TO FILL IN BUILDING , ADDRESS Certified copy is hereby furnished. L.0 BUILDING kZ: ��5 kN C LOCALITY ADDRESS S ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department algh a. CRoss ST Date ApplicantAREST < ) DISTRINNN///DDD G UP TYPE PROCESSED BY CR03S ST �� JA"/V �D�( CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK MAP rI.—AY 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. O permit is issued, I shall not employ any person in any manner OWNER VA L I A� I-A so as to become subject to the Workers' Compensation Laws IL OCCUPANCY GROUP a ADDRESS @@ 1--3 Date Applicant P 3 Ex��] TEL. LaJ NOTICE TO APPLICANT If, after making this Certificate of ITY �I o4-rakAfK No. �Z�j -r OCCUPANT LOAD ° Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKINGSPACES REq'D D PROVIDED 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 engineerslzE of No of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING Pi-A-zA HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS I hereby affirm that I am exempt from the Contractor's ON LOT AND USE License Law for the following reason (Section 7031 5, Busi- ness and Professions Code)- NO PARKING t� I, as owner of the property, will do the work and the SPACES PROVIDED pf/�/S��/ structure is not intended or offered for sale (Section p� f 7044,Business and Professions Code). /r/ c' :2471.8A l CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING � # • • • • $8 I hereby affirm that there is a construction lending agency co 5l Z� � • • • • • • • 2 , for the performance of the work for which this permit is issued(Sec 3097,Civ.C.). 0528-86 Lender's Name PROPOSED MAX. OCC Lender's Address I certify that I have read this application and state that the I 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 upoi the above mentioned operty for inspects n purposes. ;C Al/ SEE REVERSE FOR EXPLANATORY LANGUAGE — C S bj Signature of Permittee, Date WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION {� CE 875 L J 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 furnishedUD DiNG 7 LOCALITY ADDRESSpp Certified Copy is filed with the county building inspection LOCALITY � ��� 1 TY NEAREST department CROSS ST Date Applicant RAREST C jr DISTRICT NO GR UP TYPE �&SED BY CROSS ST LESS ND U� ;� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP /J 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 SIPECIAL CONDITIONS 0 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 0 permit is issued, I shall not employ any person in any manner A<WN IL VALIANT _OCCUPANCY GROUP I— so as to become subject to the Workers' Compensation Laws wi W ADDRESS UJ Date Applicant NOTICE TO APPLICANT if, after making this Certificate of CITY N0. 7� 3"7,7TEL 55 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 E] GEOLOGY INSPECTIONCl 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 Q (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. r ksect SPACES REO'D PROVIDED License Number Lic Class 11��JJ LIMITED TIME USE Contractor Date DATE DATE ' am exempt from the licensing requirements as I am a PROM TO licensed architect or a registered professional engineer SIZE OF No OF INSPECTOR'S acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ESFINAL APPROVAL ENT USE OF BUILDING 77 Lic.or Reg No Date Vill- VACMT If 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 SPACES PROVIDED ❑ I, as owner of the property, will do the work and the # e e • • 88 structure is not intended or offered for sale (Section I 7044, Business and Professions Code) OPOSED USE OF BUILDING e O O D O O • CONSTRUCTION LENDING AGENCYt 1 0 8 2 0—8 4 i hereby affirm that there is a construction lending agency 1 L� for the performance of the work for which this permit is issued (Sec 3097,Civ C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE 0 and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION �$ CE 875 u I hereby affirm that I have 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 �/ ❑ Certified copy is hereby furnished BADDRESS UILDING ADDRESS LOCALITY ❑ s/ • S ,t,(w�aS Certified copy is filed with the county building inspection j00 e /� NEAREST department LOCALITY TE'k4 PLe C; ry CROSS ST Date Applicant EARESTnn DISTRICT NO. GROUP PE R CESSED BY CROSS ST AI'�'sS�, �/�O CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT No BLOCK MAP /y RIGMWAV NO F No v (CIRCLE) STATE MAJOR SECOND LOCAL >_(This section need not be completed if the work involved TRACT NOW ONLOTS USE ZONE SPEC AL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) U USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG p V � permit is issued, I shall not employ any person in any manner NER Q� �� 1S'8/ 5. / so as to become subject to the Workers' Compensation LawsAIL p p PANCY GROUP /� V LO ADDRES r v -� W Date Applicant A TEL nn NOTICE TO APPLICANT If, after making this Certificate of carr No. OCCUPANT LOAD Exemption, you should become subject to the Workers' gppLl ATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION deemed revoked El No Spec. Knowl. ❑ ❑LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect SPACES REQ'D O PROVIDED D `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 SIGNATURE iness and Professions Code) r r FINAL APPROVAL '� P SENT USE OF BUILDING �r.. 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 , s258.3A License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO. PARKING SPACES PROVIDED I , ❑ I, as owner of the property, will do the work and the o e o • • •,• , structure is not intended or offered for sale (Section 1. ' ' I 7044, Business and Professions Code) 0,Wr607-83 ROPOSED USE OF BUILDING , CONSTRUCTION LENDING AGENCY I hereby affirm that 'there is a construction lending agency 5GL0TLL17." &4I! for the performance of the work for which this permit is issued (Sec. 3097,Civ C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of th County to enter 1 0 6 upont abov do d pr rty for pection purposes SEE REVERSE FOR EXPLANATORGUAGE Z�xvvv Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76 44 (2-$0) -MISCELLANEOUS APPLICATION CE 875I hereby afcert that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Insure, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec 3800, Lab C) .a Policy NoCompany FOR APPLICANT TO FILL IN BUILDING 7 ADDRESS Certified copy is hereby furnished Bu DRESIG DNS 9249 Las Tunas Dr. LOCALITY Certified copy is filed with the county building Inspection " NEAREST department LOCALITY Tem le City CROSS ST Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROC SES BY CROSS ST. Alessandro B_� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAPHIGHWAY } rvo 06- 7 (CIRCLE) STATE MAJOR SECOND LOCAL IZ (This SOCtIOn need not be completed if the work involved NO OF BLDGS USE ZONE ECTAL CONDITIONS Q P TRACT NOW ON LOT U by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG 0 �� I certify that in the performance of the work for which this ] permit is issued, I shall not employ any person In any manner NER A r. O so as to become subject to the Workers' Compensation Laws MAIL NCY GROUP LU ADDRESS C.. Date Applicant Box 333 , Monte NOTICE TO APPLICANT If, after making this Certificate of cirY Ca. 1 4 NOL 685-4NT 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 E] GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 91 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000) of Division 3-of the Busi- ness and Professions Code, and my license is in full force and effect Oster I Cclnt i 5 Name - Nlilbre OstPARKING. SPACES REO'D O PROVIDED O License Number Lic Class Home Address - 481 W. Palm, Arcadia LIMITED TIME USE Contractor Date 91006 DATE DATE ❑ I am exempt from the licensing requirements as I am'a Plione - 446-7815 FROM TO INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO OF acting In my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE iness and Professions Code) RFINAL APPROVALESENT USE OF BUILDING Lic.or Reg No Date Maneme t training HOME OWNER-BUILDER DECLARATION NO 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 SPACES PROVIDED I, as owner of the property, will do the work and the 22 61.6 A structure is not Intended or offered for sale (Section 7044, Business and Professions Code) # • • • • 40 ROPOSED USE OF BUILDING , CONSTRUCTION LENDING AGENCY • • • • • • • 2 I hereby affirm that there is a construction lending agency no change - for the performance of the work for which this permit is Q�1 5-80 issued(Sec 3097,Civ C) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above Information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upo the above-epentioned pro for pec urposes SEE REVERSE FOR EXPLANATORY LANGUAGE SignatLre of Permittee Date WORKERS'COMPENSATION DECLARATION 8 CE (2-SO) MISCELLANEOUS APPLICATION CE 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) i PolicyNo Company BUILDING P FOR APPLICANT TO FILL IN ADDRESS d' Certified copy is hereby furnished L UILDING LOCALITY ADDRESS 7 ❑ Certified copy is filed with the county building Inspection NEAREST department LOCALITY CROSS ST. Date Applicant AREST DISTRIC NO GROUPPE IPROC SED BY CROSS ST. a [CTONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL _ COMPENSATION INSURANCE DESCRIPTION LOT No BLocK Mpp L y O_ (CIRCLE) ND Q lRl-E) STATE MAJOR SECOND LOCAL a NO OF BLDGS O (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE 5FFECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE TI f O SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person In any manner OWNER U so as to become subject to the Workers' Compensation Laws AIL OCCUPANCY GROUP LL ADDRESS Q Date Applicant N TEL. NOTICE TO APPLICANT if, after making this Certificate of CITY �e NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTIONEl 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) NO. OF EXITS 9 ('ommencmg with Section 7000) of Division 3 of the Busl-_ ness and Professions Code, and my license is in full force and effect PARKING SPACES REQ'D PROVIDED � LIc,Yise Number LIc.Class LIMITED TIME USE Contractor Date DATE DATE FROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES �* SIGNATURE mess and Professions Code). CIn / RFINAL APPROVAL USE OF BUILDING LIc.or Reg No. Date CCCOOG F a_ V HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's - 2382A 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 # o,-.0 0 88 structure Is not Intended or offered for sale (Section 0 0'0 o 0 0 o z 7044, Business and Professions Code). PosED ..E of BUILDING '29—8 4 CONSTRUCTION LENDING AGENCY ¢ ` '� l I hereby affirm that there is a construction lending agency C .(LCSLt2) 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 tate laws relating to building construction, TOTAL FEE and �ahesentatives of this County to enter uponpro ty for Inspectio purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 6— Sig a ure of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION {� CE 875 L J I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ;nsure, 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 BUILDINGel2 V/ C LOCALITY I ADDRESS 1,�{( .�I� L��I(.L `yJ J ❑ Certified copy is filed with the county building inspection NEAREST department Lo ALITY �m� `. cRoss ST. Date Applicant NEAREST DIST_ICT 40 G UP TYPE PRBC ESSED BY pp CROSS ST /;t/ !v/I I CONST �� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP /� (HCIGIRHCWLEAY) R SECO STATE MAJOLOCAL a} �J � NO OF BLDGS. � (This section need not be completed if the Work involved TRACT NOW ON LOT USE ZONE SP CIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE of /r`J ^/// SIZE OF LOT V r✓ EXISTING BLDG ��I CCI 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 IL OCCUPANCY GROUP W ADDSS Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY wok-) (� G` NoLV-7 13OCCUPANT 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 shal! be TRAILER USEGEOLOGY INSPECTION ❑ C1No 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) NO OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect SPACES REQ'D PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE FROM TO ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES S GNATURE iness and Professions Code). L Cl^ FINAL APPROVAL �/ SENT USE OF BUILDING 1 Lic or Reg.No Date HOME OWNER-BUILDER DECLARATION O of EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's ww,� i�4 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code) NO PARKING T, 1G8 SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency i t1 , IL for the performance of the work for which this permit is 114 Issued (Sec 3097,Civ C ) Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter up�a�entw���iv for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee /�j Date