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HomeMy Public PortalAbout9414, 9412 LAS TUNAS DR_Miscellaneous__ WO,•RKERS'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 insjrre, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab:C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS �-• ,. � `� 1 Certified copy is hereby furnished. Aooeess VC LOCALITY 0 Certified copy is filed with the county building inspection COCALITY ! NEAREST 1 department. CROSS ST., Date Applicant NEAREST f DISTRICT O. GFy�O UP 'TYPE IPR,,�CIESED BY CROSS ST: /} •✓ C NST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �. COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY rvo. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF'BLD G S. (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 It of Lor ISTING BLDG. O permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. AIL _ _ /���J /y.�� OCCUPANCY GROUP a ADDRESS .Z .S /jam �`TH I/ ! ~ Date Applicant � r w NOTICE TO APPLICANT: If, after making this Certificate of Y CQ nC 1Tvo� gl� /fS-!� OCCUPANT LOAD CITz 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 E] No Spec. Knowl. deemed revoked. LICENSEDCONTRACTORSDECLARATION OCCUPANCY INSPECTION ElPanic Devices E 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 PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: Ei 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- ISTING BLDG. STORIES 516 AruRE E iness and Professions Code). PRESENT USE OF BUILDING �' C(� ��g"° FINAL APPROVAL Lic.or Reg:NO. Date HOME OWNER-BUILDER DECLARATION No. OF,EXISTING eu1LDlNcs ON LOT ANO 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 Il� DI, as owner of the property, will do the work and the SPACES PROVIDED I structure is not intended or offered for sale (Section 7044,Business and Professions Code). _ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING i/Q 7 G 0CER4CS �8 8 2 0 A # o0 88 I hereby affirm that there is a construction lending agency C(.. V I D 10 d-- 0 L � L for the performance of the work for which this permit is a o ® e e.o o z issued(Sec. 3097,Civ.Q. l(3` � N )/y(; Lender's Name 0 1,22-88 ' 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, D and hereby authorize representatives of this County to enter TOTAL FEE INIf on the above-mentioned property for inspection purposes. ° SEE.REVERSE FOR EXPLANATORY LANGUAGE Signature of geTMittee 7Date WORKERS'COMPENSATION DECLARATION 75(11-84) CE 875 MISCELLANEOUS APPLICATION CE 8 I hereby affirm that I have a certificate of consent to self COUNTY.OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or arcertificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company 'FOR APPLICANT TO FI LL IN BUILDING / ADDRESS Certified copy is hereby furnished. BUILDING �/ ,T'C­ LOCALITY G ADDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. �� cRoss sr. Date Applicant NEAREST „µ.����������,�.����//ppppy� i�P �q� ^Q �1 DIST fCT/( O. GR UP TYPE PROCE D BY PP CROSS ST. P& \lJ V„ Vim„ os�WY r� {�/j ( CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �J COMPENSATION INSURANCE DESCRIPTION I 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. - >67- 1 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 1%.f. `Yl'�`�<_Q_ ��� s' so as to become subject to the W kers' Compensation Laws. MAIL OCCUPANCY GROUP/ o Date o�9 , —Applicant , ADDRESS 9k'�y —_ �± AAA � 77" C� p,�TEL. W NOTICE TO APPLICANT: If, after making t s Certificate o clr( L«O.NO. OCCUPANT LOAD N Exemption, -you should become subject to the Workers'_ FOR EXIT HARDWARE: Z_ �-_Compensation-provisions•of-the-;Labor-Code;you-must fortfi= APPLICATION 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 E� PROVIDED SPACES License Number Lic. Class LIMITED TIME•USE Contractor Date DATE DATE ' FROM: TO: 0 1 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- XISTING BLDG. STORIES SVGNATURE iness and Professions Code). PRESENT USE OF BUILDING . LS FINAL APPROVAL Lic.or Reg.No. Date UezaA U. 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 ,8.5 I, as owner of the property, will do the work and the SPACES PROVIDED ;g# o.o, 1, o.o structure is not intended or offered for sale (Section \ o o to'o o o.o 7044,Business and Professions Code). h\ CONSTRUCTION LENDING AGENCY . , PROPOSED USE OF BUILDING v,l I hereby affirm that there is a construction lending agency '„ \�_ 12 D 6-8 7 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 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 up the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 8754(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 'fl a certified coplrthereof(Sec. 3800,Lab.C.). -31 Policy No. Company FOR APPLICANT TO FILL IN BUILDING p �. _ ADDRESS Certified copy is hereby furnished. BUILDING 941 LAS —�- S b9- LOCALITY l C ADDRESS l� ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST on N department. CROSS ST. Date Applicant NEAREST Com^ DIS _ R TYPE PR E E BY K CROSS ST. OAK CJ 1 • CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) .STATE MAJOR S COND LOCAL NO. OF.BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100)' or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this permit is issued, I,shall not employ an person in any manner �\� .,(� ��I � P P Y Y P OWNER W�,�I L y -so as to become subject to the Workers' Compensation Laws. L OCCUPANCY GROUP � K MAIL p C~7 Date Applicant ADDRESS WAS TEL' OCCUPANT LOAD n NOTICE TO APPLICANT: If, after making this Certificate of crcv r�MPLC NO.K cn Exemption, you •should become subject to the Workers' A - -- = — - — —Compensation°provisions`of`the-Labbr Code,"you'must fortli- PLICATION-FOR _� EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOG'' INSPECTION ❑ No Spec. Knowl. deemed revoked. - - -. ----'OCCUPANCY INSPECTIONJ91 - - Panic Devices -- -- ,LICENSED CONTRACTORS-DECLARATION - v 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 /t/ �rlCi l�yIW effect. �f PARKING REQ'D PROVIDED SPACES License Number Lie. Class GLavosaL f LIMITED TIME USE Contractor Date - DATE DATE DI am exempt from the licensing requirements as I am a FROM: TO: ' licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATU E iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date 1'S T ;,J l LI i g HOMEOWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS @�� E ON LOT AND USE I 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 - 1 i 12/11/89 I, as owner of the property, will do the work and the SPACES PROVIDED 1 AM �.,8:2 !6 structure is not .intended or offered for sale (Section 7044,Business and Professions Code). /� /) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING TA I-/A '/�V DEL/ I hereby affirm that there is a.construction lending agency c)(P for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name 1 PROPOSED MAX. OCC. I 1 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 ate) upon iabove-mentio d o erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE lt�L�t� Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 SC.E L LA N EO U S APPLICATION ' • CE 875,01-84) I hereby affirrp that I 'have a certificate of consent to self F t insure"or a certificate of Workers'Compensation Insurance,or COUNTY Oi• - ANOtLES BUILDING AND SAFETY DIVISION u a certified copy thereof(Sec. 3800,Lab.C.). , Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING �/Ty _ lL� ADDRESS Certified ADDRSS LCALITY ied copy is,hereby furnished. BUILDEING I O_� •^ Certified copy is filed with the county building inspection LocnLlry q/ NEAREST department. rI` - ceoss ST. Date Applicant NEAREST DISTRICT NO. GROUPTYPE p CESSED BY CROSS ST. k D _ �I CONST CERTIFICATE OF EXEMPTION FROM WORKERS' ' LEGAL o o� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLocX MAP HIGHWAY r NO. (CIRCLE) STATE MAJOR SECOND LOCAL IND OF BLDGS.' (This section need not be completed If the work involved TRACT NOW ON LOT USE E S ZONPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) use of SIZE OF LOT EXISTING BLDG. C/1 I certify that in the performance of the work for which this, permit is issued,I shall not employ any person in any manner OWNER � so as to become subject to the Workers' Compensation Laws. � MAIL y OCCUPANCY GROUP ADDRESS DI - I.— Date Applicant TEL: OCCUPANT LOAD _ O-• NOTICE TO APPLICANT:•If, after making this Certificate of �; CITY 7.e -04 NO: Exemption, you should become subject to"the 'Workers' _ —Compensation--provisions=of-the-Labor=Code;you-must-forth-= -�---=---====A ,,LI,CATION:F__OR__ __.---_, --. _.--_.--- EXIT_HARDWARE:- - with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. ___OCCUPANCY INSPECTION - - _ Panic Devices --LICENSED=CONTRAC-TORS-DECL-A-,RATION _ - -= --- - `- El I hereby affirm that 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. - ^ PARKING REq'D PROVIDED SPACES License Number Lie. Class Z 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 iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date 1 c 0/1 HOME OWNER-BUILDER DECLARATION NO. OF EXIS v G BUILDINGS ON LOT AND USE - - PI - I hereby affirm that I am exempt from the Contractor's �� .✓/� License Law for the following reason (Section 7031.5, Busi- ?, ?" i •" ';, 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 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency 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 - - 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-me tioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 9-rd 9'L Signature f Permittee. Date 11'6RI:I:RS'COfi1Pl{NSA"L[ON DECLARATION C CE 875(11-841 MISCELLANEOUS APPLICATION E 875 here.t.y affirm that l have a certificate ofconsent self 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._-. -- -__-Conipany- FOR APPLICANT TO FILL IN BUILDING ADDRESS / ❑ C.ertlficd copy is hereby furnished. XX �BUIL DI NG LOCALITY ADDRESS pL S U &[3 f�/� 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. 3Lx ���r,, cwoss ST. Date______—..__.__Applicant NEAREST DISTRICT NO. GROUP TYPE ,,�....���''' P ESSED BY CROSS ST. O 5 Nr jT• le CONST CFRIII ICATE OF EXEMPTION FROM WORKERS' a LEGAL (� COMPFNSAIION INSURANCE' DESCRIPTION LOT NO. BLOCK MAP NIORWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWNO. OF SLOGS.ON LOT USE ZONE SPECIAL CONDITIONS by (he permit is for one hundred dollars (SI00) or less.) I uSE OF SIZE OF LOT EXISTING BLDG. p 1 certify that in the performance of the work for which this D, permit is issued, I shall not employ any person in any manneXx OWNER of building ' m as to become suhiccl to the Workers' Conipens:ltion Laws. 1 / OCCUPANCY GROUPEi:] c) MAIL' Gj� //� ADDRESS / �JL - - - —� V Date--____-_--__-- Applicant- ----. - "I TEL. OCCUPANT LO NOTICE FO APPLICANT: If, after making this Certificate of CITY NO. �!!S-�.�oZ� CCUPAAD v, Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Conlpens:Ition provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE I] GEOLOGY INSPECTION E] No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION ❑ Panic Devices LICENSED CONTRAC DECLARATION _ I hereby affirm that I ;Illi 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 tinct Professions Code, and my license is in full force anix effect. 1 Name of business PARKING ter- SPACES REO'D 1EI �= PROVIDED License Number ______.-_- Lic. Class C0 A LIMITED TIME USE Conlr:Ictor_ _ Date__ __ S """"� DATE DATE FROM: TO: El I ani 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 1�1/ SIGNATURE inessand Professions Code). FINAL APPROVAL 9PRESENT USE OF BUILDING / /CP p Lic.or Reg. No._____-____-_-.____ Date - IiONIF OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE hereby affirm that 1 ani exempt from the Contractor's ;'];i;: ;•• ? `.? License I.aw 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). CONS IRUCI ION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit issued(Sec. 3097,Civ.C.). Lender's Name--__.-----.-_------- PROPOSED MAX.*OCC. Lender's Address ___ 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, and hereby authorize representatives of this County to enter I TOTAL FEE 25-00 upon the above-Illeliticilled +U` rty for inspection p rrposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Cf — -- --- - XX �7� �ipnIl�In•I�f 1'rrnllll('r _ D:11e WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I heriy .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:) �olicy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING ' �' LOCALITY A DRESS _ - Certified copy is filed with the county building inspection r NEAREST. L CAL'ITY ,` C/� " department: is - CROSS ST. Date Applicant NEAREST DIST T'NO. G OUP TYPE ] PR SED BY. CROSS ST: Y9 A �'I C CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' 'LEGAL COMPENSATION INSURANCE DESCRIPTION LOT Nd.^ BLOCK MA•,. - HIGHWAY ' N0. (CIRCLE) STATE MAJOR SECO D LOCAL (This,section need not be completed if the work involved NO. OF LOT, USE ZONE SPECIAL CONDITIONS 0 p TRACT,' NOW ON LOT, by the permit is for one hundred .dollars ($100) or less.) USE OF /n/ 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 so as to become subject to the Workers' Compensation Laws. AIL. `J J {� o/ ' OCCUPANCYGROUP ADDRESS /T L/•/ �/V/' �a_ . (/ d Date • Applicant ' Q &5 � to .NOTICE TO APPLICANT: If, after making this Certificate of CITY ' �j T` 'rTvo� !V� G�t��/ OCCUPANT LOAD z Exemption, you should become subject to the,•Workers' RDWARE: — - Compensation 'provisions of the Labor Code, you must forth- "` AP.PLI'CA ION'FOR _ EXIT HA with comply with such provisions or this permit shall be TRAILER USE Y GEOLOGY INSPECTION❑ deemed revoked. NO Spec..Knowl. ❑ - e - - �' INSPECTION - - T - Panic D vices LICENSED CONTRACTORS DECLARATION , I hereby affirm that I am licensed under provisions of Chapter SAFE ry PERMIT L 1 (LIST ITEMS BELOW) rv0. 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. PARKING REQ'D PROVIDED SPACES License Number Lic.Class LIMITED TIME USE Contractor Date o ATE 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 7651, BUS- EXISTING BLDG. STORIES SIGNATURE inessand Professions Code). RESENT USE OF BUILDING v, t.� FINAL APPROVAL Lic.or Reg'.No. Date HOME OWNER-BUILDER DECLARATION NO.-OF EXISTING BUILD IMGs ON LOT AND-USE �45:29A I hereby 'affirm that, I am exempt from the Contractor's License Law for the following reason (Section 7031.5,•Busi- #•o o O O 8 8 'ness and Professions Code):. • NO.PARKING - SPACES PROVIDED - 0 0 0 0 0 0 0 � 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). (/Jh" O�2 4`-8 6. OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 9 , l �T t� 1vN I hereby affirm that there is a construction lending agency... %Vi?0�- for-the performance of the work for which this permit is iss6ed,(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 rep esentatives of this County to.enter up, the (love-mention operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee kf Date i WORKERS'COIPEN'SATION DECL.'.`ial'ION 76M444 rr ` !" n� � l 'APPLICATION r� r CE 875 11184) MIS CLLL/••k1 • L, 1 hereby affirm that I have a certifi Compensation Insurance. to self COUNTY OF LOS .ANGELES XILDING AND SAFETY DIVISION insure. or a certificate of Workers*Compensation(nsurmce.or a certified copy thereof(Sec. 3800.Lab.C.). Policy No. -Company ADRESS FOR APPLICANT TO FILL IN 3 P Certified copy is hereby furnished. BUILDG I DDRESS Lt F-1CertifiedIN ,GVY\� p/J\,� ICALITY ' Certified copy is filed with the countv building inspection LOCALITY NEAREST department. Temple City C'ROSS ST. Date Applicant NEAREST pISTRICT NO. GR P TYPE CESSED BY • CROSS ST. k.J `� 7 CONST. CERTIFICATE OF EXEMPTION FRO>1 aOR?-LRS LEGAL i COMPENSATION INSURANCE DESCRIPTION LOT NO. :BLOCK (MAP IG tIw Av rip. (CIRCL_) STATE `MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed If the work involved TRACT `IOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars 61001 or less.) USE OF I I SIZE OF LOT I EXISTING BLDG. I :certify that in the performance of the .yoTk :cr •.yhich 'his - permit is issued, I shall not employ an}' aerson in am' manner OWNER II(a, -A Permit so as to become suhiect to the \horkers Compensation Laws. �� OCCUPANC`' GROUP Al ADDRESS px I Date Applicant 1 ll - NOTICE TO APPLICANT: If. a--er making :!tis C�rt:ficare of x]c,TY� �� N01 �(�}'S CCCUPA.NT LOAD Exemption, you <hould become subiect -.o the �Fnrkers Compensation provisions of die Labor ti:,1de, you mus[ fort?r APPL!CAT!CN `':)F cX HAF.C!NAR - with comply with ;uch provis;oms or :his permit shall be I �� G - -RAILER :JSE IJ GEOLOGY :NSP=-=ON No Spec. <:-io,, 1. L� ? deemed re%eked. - LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION:RX F8r1iC Devices II hereby affirm -hat I am licensed under previsions of Chapter r 9 (commencing with Section 7000) of Division c of the Busi- SAFETY PERMIT (LIST ITEMS BE LO:'Ji NO. OF EXITS ness and Professions Code. and my license is u1 fuil force and effect. PARKINGREDO �I I SPGCES PR O`J ID ED License Number Lic. Class G LIMITED TIME USE N C'ontract(1T_ Da t — TATE pA'E N W Z ❑ P•JM: �O: I am exempt from the ':icensing requirements as I am .t , M I licensed architect or a registered prnfessional engineer SIZE of No. CF INs ATT;/11 To s r` ,-. 'll� EXISTING BLDG. �TOR1=5 G AT RE Z acting in ;m professional _a..a: n' on 1. Bus- ° iness and Pr ofessicns Code I. FINAL ? .OVAL U PRESENT USE OF BUILDING x11 Lic.or Reg. No. HOME OWNER-BUILDER DECLARATION' NO. OF EXISTING BUILDINGS �y ON LOT AND USE ? tiL1:J•=x I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section7t)31.5. Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED El 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section i 7044.Business and Professions Code). X CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING C\o I hereby affirm that there is a.constructicn lending a--encv _ I for the performance of the �%ork for which this permit is issued ISec. 3097,Civ. C.). Lender's Name PROPOSED MAX. OCC. Lender's address 1 certify that l 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 r ordinances and State lawsrelating to building construction. and herebv authorize representatives of this County to enter TOTAL FEE 25.00 upon the above-mentioned proeerty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r i wnature of Permittee Date i WQRKERS'COMPENSATION DECLARATION CE 875 (11 84) M ISCELLANEOUS'APPLICATION CE 875 hereby affirm that 1 have a certificate of consent self 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 ADDRESS Certified copy is hereby furnished. BUILDING XX ADDRESS LOCALITY F Certified copy is filed with the count building inspection � y. gip LOCALITY NEAREST department. XX / CROSS ST. Date Applicant NEAREST OISTRIS„Y;�ON`O GROUP TYPE PR CESSED BY CROSS ST. / CONsr CERTIFICATE OF EXEMPTION FROM WORKERS' LEGALC COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF 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 1 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 manneXX OWNER of buil din C `' so as to/'y`ecome subject to the W rkers' Comp nsation Laws. �f OCCUPANCY GROUP rr MAIL '^ I ADDRESS U CX)_ DateNApplicant uJ NOTICE TO APPLICANT: If, a er making this Certificate of cit �� _�, NOL 'y Sd5 Lam/ OCCUPANT LOAD C, Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPL ATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY 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 a effect. X Name of business PARKING SPACES REp'D D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE .1 ROM: TO: El 1 am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR' acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATU iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg. No. Date �{ F HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS //Nql.0 / •� 0� ON LOT AND USE ����L" �T i✓ 1 hereby affirm that I am exempt from the Contractor's C 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 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 PROPOSED MAX. OCC. _ '•l 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 building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25 - 00 upon the a ove-mentioned property for inspection purp ses. XX XX S9EE REVERSE FOR EXPLANATORY LANGUAGE S enature of ennittee Date Z 1 WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby a cert that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insurec , or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). . 'fl BUILDING Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. ILDING LOCALITY ADDRESS w Dr Certified copy is filed with the county building inspection LOCALITY // , NEAREST department. (/j CROSS ST. Date - Applicant NEAREST DISTRI T NF' 6 OUP TYPE P CESSED BY CROSS ST. _ �Jj J/ IY-� CONST. 'CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (✓a �f/�-) COMPENSATION INSURANCE DEscRlarloN LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL _ (This section need not be completed if the work involved TRACT NOWOON 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 permit is issued, I shall not employ any person in any manner OWN-or ` y so as to become subject to the Workers' Compensation Laws. MAIL ADDRESS r, OCCUPANCY GROUP -� o Date Applicant I„ TEL NOTICE TO APPLICANT`. If,after making this Certificate of CITY -PrVH No. — OCCUPANT LOAD C/3 . 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. 0� I PARKING REQ�D pROV1D E SPACES 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGN URE iness and Professions Code). FINAL APPROVAL / _ 7 PRESENT USE OF BUILDING G' Lie.or Reg.No. Date NO FE 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 J.-;; fi:-•; ness and Professions Code): NO. PARKING El I, as owner of the property, will do the work and the SPACES PROVIDED i{iW+= i 1 rE) 1 =i 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.Q. Lender's Name PROPOSED MAX. OCC. _ Lender's Address PERMIT FEE I certify that I have read this application and state that the ,Q 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-me 'oned propertypfor inspection purposes. 0 C -Z SEE REVERSE FOR EXPLANATORY LANGUAGE Signatuk of Permittee Date 1 WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E SLA N EO U S APPLICATION CE 875 I hereby affirm,that I have a certificate of consent nc self COUNTY OF LOS ANGELEcr BUILDING AND SAFETY DIVISION insure, or a certificata,of,Workers'Compensation Insurance,or � v' • a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING t0 - ADDRESS FlCertified copy is hereby furnished. BUILDING LOCALITY D DR ESS F1 Certified copy is filed with the county building inspection LOCAL NEAREST department. CROSS ST. Date - Applicant NEAREST DISTRICT NO GROUP TYPE �/ P SSED BY CROSS ST.' (�L/y/� ,�� CONST. i// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION.INSURANCE DESCRIPTION LOT NO. BLOCK 41461� 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 SIZE OF LOT O EXISTING BLDG.` � permit is issued,.I shall not employ any person'in any manner O W N ER O•� - w �/i • 0 !:; so as to become subject to the Workers' Compensation Laws. MAIL // OCCUPANCY GROUP ADDRESS '6�, /, / �� f Date• Applicant _ zz w NOTICE TO APPLICANT: If, after making this Certificate of ,CITY f� TN.L j� j» j��J OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- AP L CATION FOR EXIT HARDWARE: ..with--comply--With..such provisions Or this permit. shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. - - - _ - ❑ No Spec. Knowl. Y - - - - - Panic-Devices - - LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONx Ej 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 N Q m O� effect. Busi ness '• PARKING REO'D 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 516 ATURE �—. iness and Professions Code). FI-NAL APPROVAL Lic.or Reg.No. Date 2-93PRESENT USE OF BUILDING (� / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS p _ - 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 usi ness and Professions Code): NO. PAR NG 0 I, as owner of the property, will do the work and the SPACES PROVIDED I , •± ! �I I7 structure is not intended or offered for sale (Section77 7044,Business and Professions Code). Z" CONSTRUCTION LENbING AGENCY PROPOSED USE OF BUI DING I Hereby affirm that there is a construction lending agency iz { 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 a State laws relat'ng to building construction, and her uthorize re a Ives of this C to enter _ TOTAL FEE a5 �Ip up a ve do pop ty fI or i tion urpo s. SEE REVERSE FOR EXPLANATORY LANGUAGE i a u Date y4R12KERS'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.C.). Policy 1`!n. CompanyFOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. AD ORess 414 IhJ INIY9.� AA �' LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY NEAREST 671 department. azeuAau 9CROSSST. Date Applicant AREST 'w• �J�/y /� L DISTRICT NO. G OUP PE TYED BY CROSS ST. �AV /(�// Q�/� �/L �/ CONST. P CES5 CERTIFICATE OFEXEMPTIONFROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO.. BLOCK MAP HIGHWAY No. -(CIRCLE) STATE MAJOR R 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 this SIZE of 4T EXISTING BLDG. O permit is issued, I shall not employ any person in any manner W VoCf PR910 ,Sk so as to become subject.to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP DDR 94'I'4•� LAS ?lAN/}S d/p Date Applicant L�LI NOTICE TO APPLICANT: If, after making this Certificate of "CITY�i /�L/C e4To. 29S=G�2 1 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 sllall-be TRAILER USE ❑ GEOLOGY INSPECTION No Spec. Knowl. deemed revoked: - - -- -, -- -- • - Panic Devices - LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ - ET I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. OF EXITS ness and Professions Code,and my license is-in full force and effect. PARKING SPACES REQ'D PROVIDED ce 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 OFNO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessand Professions Code). FINAL APPROVAL S 3 7 J-FfRESENT USE OF BUILDING Lic.or Reg.No. Date � rr 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 usi ness and Professions Code): NO. PARKING '= %- ❑ SPACES PROVIDED 7' ".1N - I, as owner of the property, will do the work and the t y structure is not intended or offered for,sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ROPosED usE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is r v issued(Sec. 3097,Civ.C.). Lender's Name V PROPOSED MAX. OCC. Lender's Address PERMIT FEE - I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL, FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875.('2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self. COUNTY OF LOS ANGELES BUILDING AND SAFETY,DIVISION insure, or a certificate-of Workers'Compensation Insurance,or a-certified copy thereof(Sec. 3800,Lab. C.) Polic No. Com any BUILDING Y P FOR APPLICANT TO FILL IN ADDRESS. v Certified copy is hereby furnished. 006UILDING ' � LOCALITY ADDRESS El Certified copy is filed with the county building inspection NEAREST department. CROSS CROSS ST. Date Applicant - EAREST 'DISTRICT T��PE PROC /SED BY CROSS ST: ' NST. CERTIFICATE OF,EXEMPTION FROM WORKERS' iecaL` L COM PEN SAT ION"INSURANCE DESCRIPTION LOT NO. BLOCK MAP/�///( MIGMWAV _} -.. .-/-J(/�?/ (CIRCLE) - STATE M A J OR,S ECO D LOCAL a /' NO. OF BLDGS. (This section need not be completed if'the WOLIc InVOIVed . TRACT NOW ON LOT USE ZONE 'SPECIAL CONDITIONS O by the permit is for one hundred'dollars'.($100) or less.) U USE O N +, SIZE OF LOT EXISTING-BLDG-. /v Ir 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 o as to become subject to the.Workers' Compensation Laws. MAIL ^f �^ �/� OCCUPANCY_GROUP _ EKE- W .7I. - ADDRESS'- i fJ CSO S '`��.YY� G. Date Applicant (n 'NOTICE TO APPLICANT: If, after making this Certificate of\,) )� 1`/1QFy��� rvo� 8.1�' a -tJja; OCCUPANT LOAD z Exemption, you should become' subject to the Workers' - 'ompensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEO GY INSPECTION O deemed revoked �No Spec. Knowl. O LICENSED CON TRACTORS'DECLARATION OCCUPANCY iNSPECTIO anlc.'DeviceS I hereby affirm that I am licensed under provisions of ChapterSAFETY 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 SE -CoLicense Number Lic.Class 'LIMITED TIME USE. - Contractor ntractor 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 IlvsPecroR's acting in my professional capacity (Section:7051, Bus-, XISTING BLDG. - STORIES SIGNATURE iness and Professions Code). I FINAL APPROVAL - PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION. No. O EXISTING BUILDINGS ON LOT AND USE G O � O.9 (t .• I hereby, affirm that, I am exempt from the Contractor's L O Q 1 It License Law for the following reason (Section 7031.5, Busi- #:0 0 0 0 88 ' ness and Professions Code): NO. PARKING SPACES PROVIDED - 0:0.0 0 0 0 0 I, as'owner of'the'property, will do 'the work and the - structure is not intended or offered for sale (SectionQ 2(� 8 7 7044, Business and Professions Code). PROPOSED USE oF,BuiLDIrvG Att _ CONSTRUCTION LENDING AGENCY / I hereby affirm that there is a construction lending agency N for the performance of the work for wJhich.this permit is issued (Sec. 3097,Civ.C.). tender's-Name ♦ ` PROPOSED MAX. OCC. Lender's Address PERMIT FEEb. I certify that 1,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 u Athebove-mentioned rty for inspection purposes. SEE REVERSE FOR EXPL'ANA-TORY'LANGUAGE o ermittee WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION �1 CE 875( r I I h(ilCE 875 11-84)eby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION , ,lull 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 y is hereby furnished. ADDRESS LOCALITY Law �• DCertified copy!is filed with the county building inspection LOCALITY T NEAREST department. - - , / • C � CROSS ST. Date Applicant NEAREST A V_ DISTRICT�J�O. GR P TYPE / PROC D Y CROSS ST. ,i;L/I] CONST. V CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V (�Q COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY - NO. (CIRCLE) STATE MAJOR SE CON LOCAL NO. OF BLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ® o ADDRESS Date Applicant u, NOTICE TO APPLICANT: If, after making this Certificate of CITY ' � TEL. 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 OI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know]. deetned revoked. _ _ LICENSED CONTRACTORS DECLARATION occuawrlcY INSPECTION Panic=Devices= ❑ = - I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED License Number Lie. 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES .I NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING �J Lie.or Reg.No. Date 6/ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING UILDINGS Q -- - /440 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). 2 5 2 7.0 A CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING # 0'00088 I hereby affirm that there is a construction lending agency �syG^ 3,��G �¢ t� CI—e for the performance of the work for which this permit is .�� o 0 0 o m:o o z issued(Sec. 3097,Civ.Q. Lender's Name Q $ $=86 PROPOSED MAX. OCC. Lender's Address , I certify that I have read this application and state that the PERMIT FEE above information is co . agree to mply with all County ISSUANCE FEE ordinances and St,W laws re o building construction, and hereby aut rite sentatives of this County to enter TOTAL FEE upon the abov ' ion propert for inspection purposes. - — -6sEE REVERSE FOR EXPLANATORY LANGUAGE ture of PVmittee Date WORKERS'COMPENSATION•DECLARATION 76M444 CE 875 (2-80) M-ISC.ELLANEOIJS APPLICATION L hereby.affirmthat I .have a certificate of consent to selfCOUNTY 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. CompanyFOR APPLICANT'TO FILL IN ADDRDESS Certified copy is hereby furnished. ILDINGd r' .I LOCn,uTv I F71 _ A DRESS l Z L/TS,.: IU/Y �J//� '. Certified copy is filed with the county buildinginspection . NEAREST department. o'c ALlry / E LE t+!? C / �J CROSS ST., nafj�� Date Applicant NEAREST DISTRICT TGROUP TYPE - PRO E USED B CROSS ST. S'G I t� CONST.;/ CERT.IFICATE'OF EXEMPTION FROM WORKERS' "LEGAL DESCRIPTION LOT NO. ^ BLOCK MAPHIGHWAY COMPENSATION INSURANCE S n7 STATE MAJOR SECOND`LOCA. tl, - NO. (CIRCLE) (This section, not be completed if the woik involved NO::of e1.Das. p . p TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit:is for. one,hundred dollar's ($100) pi iess.)' USE1= V SIZE OF LOT- � EXISTING BLDG. I certify that in the performance of the work for which this /�7 / q� O permit is issued, I shall not employ any person in any manner WNER WlLL�RM U` /r�CCRSE' MES MA ��E 9 (~j so as to become subject to the Workers' Compensation Laws. AIL O� OCCUPANCY GROUP LU L) , DRESS '. Date Applicant N NOTICE TO APPLICANT: If, after,malting.this Certificate of CITY EM L'F _ �jrvoTE � OCCUPANT LOAD Z Exemption, -you',should ,become--subject- to he Workers' Compensation provisions of the Labor Code, you must forth- N6. KATION FOR EXIT HARDWARE:• with comply.-with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION'❑ - El deemed revoked E NO.Spec. Knowl. _ Pa •c''Devic . LICENSED.CONTRACTORS DECLARATION occuaAiucv wsPECTIory I hereby affirm that I am licensed,under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) a 9 (commencing with-Section 7000) of Division 3 of;the'Busi- ness and Professions'Code, and my license is in full force and effect. - - PARKING SPACES REO'DF.� PROVIDED License Number 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 N0.'0F. IIv SIGNATURE R's I in my professional capacity (Section 7051, Bus_ EXISTING BLDG. STORIES SIGNATURE mess and PrOfesslons Code). . - ESENT USE OF BUILDING - FINAL APPROVAL Lic:or.Reg.No. Date Li Ll — - - HOME OWNER-BUILDER DECLARATION No:OF'EXISTIN�'-G' dS — — - 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 z,5,3 4,3J A .. )''' - SPACES PROVIDED I, as owner of the,property; will do the work and the ;# o:o'o o 4'0 structure is. not intended or offered for sale (Section ' 7044, Business and Professions Code). o'o^e o 0 0 0 / 'ROPOSED�USE OF BUILDING.. CONSTRUCTION LENDING AGENCY - 0 5 2.0-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 vRoeoseo 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 Issuwnlee FEE ordinances and State laws relating to building construction,` TOTAL FEE k d hereby' authorize representatives of this County to enter on the' bovementione perty' for ins ection �o es. SEE-REVERSE R EXPLANATORY LANGUAGE [/l/ Si to e o tte Date WORKERS'c6MPENSATION DECLARATION. 76M444 p� c- APPLICATION /� /� T N CE 875 (2-80). M.1�:L,I, �- S /1'� "�A 1 I'o 1�! 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 BUILDING AND SAFETY DIVISION a certified.copy thereof(Sec:•3800;:Lab,..-C.) ksPolicy No. 'Company ""FOR-APPLICANT•TO FILL IN w�oeEss Certified copy is hereby'"furnish ed: BUILDING' LOCALITY Q,1 4 � w,.' T p�tp/� '� ❑ ADDRESS ,11 '1.- L.Y�/� � • .I-Ci'G� \f I 0 :Certified copy,Is filed with the county building inspection _ NEAREST department. G 'Local rr CROSS ST. /T L Date Applicant '�- NEAREST - DISTRICT�V O:. Gg10UP_: TYPE PRO E ED B�' -, -CR OSS'ST: U\ //(✓71 C;ONST� _. .V V_1� S�t�..- CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL —.,- •i— - •- _ - ;D ESCRIPTI,ON LOT_.;'NO .BLOCK ,M Ac MIGRw Av - COMPENSP TION INSUR'A'NCE' ' a `'' ,".STATE'MAJOR SEC ND LOCAL .. : NO'OF BLDG rvo (c CIRCLE This'section,need not'be'completed if, the work involved S (• - p ._ TRACT ,• - NOW ON.LOT - "o- USE ZONE SPECIAL CONDITIONS by-the' pe mit-is foi'one,,hundred;d'ollii s (�100).or-less.)`' USE of SIZE.OF LOT , EXISTING BLDG - ' -' , - -.:, V - . I'cerfify''that in the 'performance of the work.for`_which this " - OW-NER - permit is issued Lshall not employ any person-m any manner Y m O so as to become subject to!the-Workers'"CompensaUonLaws; Q /� ' - w- OCCUPANC GROUP {n(— a MAIL' \-T -�/✓ - .. ADDRESS TNN�Agi'- ,. 1 .• , Date Applicant' NOTICE TO APPLICANT If, after snaking this Certificate of e-CITY OCCUPANT LOAD ' ''tn Exemption you should, become subject to the' Workers' APPLI ATION'FOR EXIT HARDWARE: Compensation provisions-,of the Labor Code,you must forth with comply with such provisions of this permit shall be TRAILER USE GEOLOGY Spec INSPECTION'❑, - ..deemed-,..deemed-,revokeddeemedevoked hlo KrlOw —_ - e OCCUPANCY INSPECTION}}qq�� C., " Panic"D`evics ❑ ___ ' l LICENSED.CONTRACTORS DECLAR'A'TION h I hereby,affirm that,I am licensed under provisions,df-Chapter. swFETv PERMIT 1 (LIST ITEMS BELOW) 9 (com'mencing.with Section 7000) of Division.3 of the Busi = ness and Professions.Code; and my license is.in full;foree and PwRKING. N O. OF EXITS - effect. - - - :-R ECI'D'•� ":PROVIDED - - SPACES': LL��..JJ License Number' Lic..Class " LIMITED TIME USE, Contractor - Date .GATE GATE OY .,. FROM: TO: I am exempt from the licensing, requirements.as I am a licensed architect or a registered professional engineer' SIZE of No; of # •'d NgP� ��z s acting in tmy professional capacity (Section 7051; Bus- EXISTING BLDG STORIES SIG wriYeE . me.sand P' fessi6ns'CO. ).'.. - �.pRESENT USE.OF'BUILDING v v..� Y`/" FLN'AL APPRO AL ® 8 8 Lic.or Reg.No. Date NO.'.OF EXISTING"BUILDINGS•.s - 021 8-'rLIlJ R HOME OWNER,-BUILDER DECLARATION ON LOT,AND'USE Ihereby'aff".Yhaf I am-exempt' from the;.Contractor's License Law for the following reason.(Section 7031.5,;Buss nes§and,Professions`Code): No:PwRKirlc SPACES PROVIDED 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).:, ' ,F.sROPOSEDU SE OF BUILDING , - CONSTRUCTION LENDING'AGENCY L 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.) PC a V. _ l , ' Lender's Name V �' ..PROPOSED M AX. OCC- 14 -Lerldei'S Addre SSLA+ _ PERMIT-FEE. - - Icertify that I.have"read„this application and state that the above information is-correct.I•agree to comply with all County IssuwNCE FEE ordinances and State laws,.relating,,to building construction, and hereby.authorize'representatives,of this.County'to enter;' TOTAL-.FEE upon'the'above rationed property for inspection purposes: SEE REVERSE'FOR EXPLANATORY-LANGUAGE Signature of Permit a Dat '