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HomeMy Public PortalAbout9417 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION E 875 (11-84) CE MISCELLANEOUS APPLICATION C 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insuie, or a certificate of Workers'Compensation Insurance,or _ _ , 'fl a certified copy thereof(Sec. 3800,Lab.C.). . Policy No. Company FOR APPLICANT TO FILL IN r BUILDING ADDRESS Certified copy is hereby furnished. BUILDING 041 7 LOCALITY ADDRESS 7 ElCertified copy is filed with the county building inspection LOCALITY NEAREST 1,7 department. Templ P Ci ty , CA - 91786 . CROSS ST. Date Applicant NEAREST DISTRICT NO. G UP. TYPE P CESSED BY CROSS ST. _ ^ -CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHw AY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. _ 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 5C o P P Y P ( OWNER �� �! I dl I , y, C � so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o f~.7 Date Applicant ADDRESS 60 L„ NOTICE TO APPLICANT: If, after making this Certificate of -TEL. OCCUPANT LOAD CITY CA91106O- 818-5758496 . Exemption, you should become subject to the Workers' z Compensation provisions'of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions Or this permit shall be TRAILER USEGEOLOGY INSPECTION El revoked. E] E] No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic 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. Nrfw� I' f5V5i E% AIRES Inc PARKING REQ'D PROVIDED SPACES 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 INSP TOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI TURE / iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING /I Lic:or Reg.No. Date / �' HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm'that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING t-` ` `` 1-`: Zi SPACES PROVIDED 0 I, as owner of the property, will do the work and the �• = s structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING DIS- I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above i ation is correct.I agree to comply with all County ISSUANCE FEE ordina es nd State laws relating to building construction, and he eb authorize represent tives of this County to enter TOTAL FEE upon t e Ove-me ironed pro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r 10-1 —94. i nature of Perm itteeDate , WORKERS'COMPENSATION DECLARATION.` 76M444 ; ) lL. A®PLIC4ISCELLANEOU'S TION CE875 (2=80 I hereby'affirm` that I have a' certificate of consent to self + COUNTY OF LOS ANGELES BUILDING, 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 isRhereby furnished: ADDRESS ' V f 90 LOCALITY 0 Certified:copy is flled`wth the county building inspectrio n "' NEAREs.T '00de 'OC ALITYrg Jy ® CROSS ST. partment. PY Date -,Applicant•' +. + NEAREST. _ DIST.RICT'NO. GROUP TYPE PROCESSED.BY - 1 CR OSS ST. ,-: - 'CONST' CERTIFICATE OF EXEMPTION:FROM WORKERS' LEGAL " • = DESCRIPTION LOT NO. - 'BLOCK �MAr - HIGHWAr y - COIVIPENSATION INSURANCE Ho. " ' (clw'c�E) STATE MAJOR SECONDLOCAL d NO,'OF BLDGS +s. USE- 'SPECIA1: CONDITIONS - O (This. section need not:be completed if the work"involved TRACT, NOW or, dor V by.the permit is for one hundred.dollars ($100) or less.) USE of s IZE OF LOT EXISTING BLDG I certify that.in the performance of the work foi which this. ,4; permit is issued,*S shall not employ any person In any.manner- o W NER' �' - 'so a's to become subject to the Workers' Compensation Laws. - OCCUPANCY-GROUP' AIL • 0 _ - DRESS .�� - Date Applicant NOTICE TO APPLICANT:'-If, after making this Certificate of clTv NO. V:'y 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 I _T RAILER USE. - GEOLOGY INSPECTION O Spec O `deemed revoked. ❑ . - OCCUPANCY'INSPECTION - - - - •, No . Knowl LICENSED CONTRACTORS DECLARATION, P81lIC Devices, I hereby'affirm that I am licensed under provisions of Chapter SAFETY PERMIT [� (LIST ITEMS BELOW).,. •.N O. OF EXITS 9 (commencing with Section-7000) of.Drvision 3 of the Busi- ness and Professions`Code, and,my.license is in full force and _• • PARKING effect. SPACES REQ�D O PROVIDED , :e Lhcense Number Lic. Class LIMITED TIME, USE Contractor. Date DATE DATE w FROM: TO:'. - I am exempt from the licensing requirements as I am a, - INSPECTOR'S licensed architect or a'.-registered professional'engineer , SIZE OF No. 0F.._-" -SIGNATURE acting in my professional capacity (Section 7051 1571 Bus. EXISTING B_AcG. ssoR15S iness and Professions Code). ` -• " � ESENT USE OF BUILDING - !/_ -:.-.� GGGJJJ F�caWWWdri FINAL APPROVAL _ r� Lic:or Reg.No. Date a - NO. OF. EXISTING BUILDINGS' - •` t- HOME OWNER-BUILDER DECLARATION ON LOT, AND-;USE' ' , I hereby affirm that, I 'am.exempt:from the Contracto'r's ^. License-Law for the following'reason (Section 7031.5;; Busi- / n neSSandPi OfeSS10r1SCO de NO: PARKING - .. Z�2 2 2 4._1"i ' SPACES PROVI.DED - Ias, owner of':the property, will do-the work and,the ; # a :0,0 F0`8.8 structure is not 'intended or offered for sale (Section 7044; Business and Professions Code). Y o 0_0`o 0.0 .0 • - P POSED USE OF BUILDING- AfM!2 - '< CONSTRUCTION LENDING'AGENCY - I ,Y O b,2.5 ,8 4 �. I hereby, affirm that there-is a construction lending agency', A^ /> ✓ ,' 6 for-the performance of the.work for which' this permit is- issued(Sec. 3097,Civ.C.). -Lender's Name PROPOSED,ivlwx:`OCC. ' Lender's Address PERMIT FEE I certify that I have read this application and state'that the - above iriformation is correct..bagree to comply with all County, ISSUANCE FEE ordinances- and Statelaws relating' to building construction,_ TOTAL FEE'` ' .,and hereby authorize representatives of this County to.enter up o the above-mentioned property.for inspe tion purpos s. SEE REVERSE FOR.EXPLANATORY LANGUAGE' ature of. rmittee Fate WORKERS'COMPENSATION.D.ECLARATION 76M444 ' w . CE 875.(2-80). '. llrl,ISCi'1'.P _ELLANE®US ' PLIC °i1 ION I hereby affirm that I have a certificate of consent to self :COUNTY;OF LOS ANGELES BUILDING•AND SAFETY DIVISION insure, or axerlificate of Workers•'Compensation Insurance or a certified copy,thereof(Sec:3800;Lab:C;) " Policy No. Company 'FOR.APPLICANTTO FILL I'N Bu1LDiNG e, t' • ,. ADDRESS Certified copy-.is hereby,furnished. BUILDING LOCALITY " - ADDRESS / o .Certified copy-is filed-with the codnty building inspection NEAF2EST.-- . . LOCALITY ,p CROSS ST. department• t✓ ` 'i NEAREST, p DIST R ICT.N O. GROU TY PE - PROCESS ED BV Date Applicant _ , :. - „, - • CROSS ST. - CONST. - CERTIFICATE'OF.EXEMPTION FROM WORKERS', LEGAL' COMPENSATION INSURANCE 0, rvoP �ci c- STATE MAJOR SECOND'LOCAL } ' DESCRIPTION LOT"NO. BLOCK �y (Th15 section need not be completed ff.-the,work involved•.. TRACT nNiow ONLOT S USE_ZO,N E� SPEC IAL CONDITIONS- OF a' O: by the permit,is for, one,.hundred-dollars (S 1,00) or ,less.) , -VUSE OF ; , •_ 'Y SIZE OF LOT EXISTING BLDG. I,certify that in the performance of the work for which this ` p I employ any person in any manner OWNER 40 so.assubject ao".the Workers' Compensation:Laws_ 'OCCUPANCY GROUP r `, O- _ MAIL ' AD DRESS ul Date'. Applicant FJ_. d> Y - .TEL. - - NOTICE.TO APPLICANT:.If„after making"this Certificate of,-,: CITY ,0 No.” -771:47 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 perm It Shall -be'. TRAILER'USE� GEOLOGY INSPECTION❑ No Spec Knowl. E '- �`tpl'`?emed revoked Panic O0VIC8S LICENSED CONTRACTORS DECLARATION OCCUPANCY INsPEcnoN ❑ t 4,hereby affirm that I am licensed Under provisioiis'Uf Chapter SAFETY PERMIT i (LIST ITEMS BELOW) NO:OF EXITS .. 9;_(commencing with Section 7000) of Divisiori 3 of the Busi- ness,and.'Professions Code, and my license is in full'force and PARKING effect.. SPACES. REQ'D E PROVIDED O License Number Lic.Class LIMITED TAME USE Contractor Date:,. ? DATE ' DATE O FROM: ro': I am exempt from the.licensing re uirements as lam a: . licensed architect or a' registered professional^.engineer SIZE OF NO.-OF , .acting in my .professional capacity (Section 7051', BUs- EXISTING BLDG. STORIES ' . INSPECTOR'S SIGNATURE ' iness and Professions Code) PRESENT FINALAPPROVAL': P NT USE.OF BUILDING. - - Lie`.or Reg.No. Date V - HOME OWNER-BUILDER DECLARF:TION IsnN� • NO: OF EX 'BUILDINGS - - -..,ON LOT AN D'.0 USE: I hereby affirm'that, I am exempt. from,the Contractor's ,Z 6 _ 23,7A License Law for the.following reason (Section 7031.5, g: Busi'-' ' Hess and Professions Code): No. PaRicINC # 'oko SPACES'PR G ED , I as owner of the property,; will do the work and the ' In o'o 'a structure Is, not Intended or offered for sale-(Section,, : i'' 0 0 0:-0 0 0 7044,Business and`Professions Code).. " PROPOSED USE OF BUILDING. ` U`A,:1 5`--8.2 CONSTRUCTION'LENDINGAGENCY• I hereby affirm' that there is a construction lending agency for the performance,of the work•for which-.this,-permit- is.. issued(Sec-. 3097;:Civ.C.). Lender's Name - - - ' ,PROPOSED MAX. OCC. Lender's Address - .. PERMIT.FEE - I certify that I have.readthis application and state that the above information is correct, I agree to•comply with all County IssuANCE:FEE ordinances and State Paws 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 r - Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that 1 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 certif160'copy thereof(See. 3800,Lab.C.). A Poli No." Company FOR APPLICANT TO FILL IN BUILDING DDRESS Certified copy.is hereby furnished. - }( AopREss J s / LOCALITY - Certified copy is filed with the county building inspection x LOCALITY NEAREST department-. " yIn CROSS ST. Date - Applicant - ..NEAREST /p'1 DISTRICT NO. GROUP TYPE '.PSSED BYCROSS ST. V y, (y -� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Ua I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP —G—Al _ - No. (CIRCLE) STATE MAJOR SECOND LOCM.. NO. OF BLDGS. (This "section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPE CtAL CONDITIONS by the permit is for,one hundred dollars ($100) or less.) USE of ==l 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 X OWNER so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o r- x [2;�].�� Date Applicant (� J CLo -3 NOTICE TO APPLICANT: If, after making this Certificate of k CITY /NY ToI` OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLIC OR 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. j ��ui �/ effect. PARKING REQ*D PROVIDED License Number Lie. Class SPACES 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 SIGNATURE iness and Professions'Code). FINAL APPROVAL PRESENTU . SE OF BUILDING (� Lie.or Reg.No. Date z3�Z HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS h� ON LOT AND USE I hereby affirm that I am exempt from the Contractor's fifi License Law for the following-reason (Section 7031.5, Busi U � 0000-130131 ;/x.4%9 ' ness and Professions Code): No. PARKING I, as owner of the property, will do,the work and the SPACES PROVIDED 5Io�� structure is not intended or offered, for sale (Section 7044,Business'and Professions Code). CONSTRUCTION LENDING AGENCY X "PROPOSED USE OF BUILDING I hereby affirm that there, is a construction lending agency _ I�jC �j for the performance 'of the work for which this permit is ALE 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, I and hereby aut rize representatives of this County to enter Tor-l_ FEE DD upon the abo I - enti e roperty for inspectio pulp ses. ` Y ct .1 / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate !� WO'IZKERS'COMPENSATION DECLARATION76M444 CE 875(2-80) MISCELLANEOUS APPLICATION [ htleby'.affirm that [ have a certificate'of'consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,`or a certificate of Workers'Compensation In-surance,or a certified copy thereof(Sec. 3800;Lab C) .:. . . Policy No: Company FOR APPLICANT TO FILL IN BUILDING ^ v - - ADDRESS ❑ Certified copy is hereby•furnisfied. BUILDINGIli y LOCALITY ADDRESS 9 7 Las Tunas Dri'we ❑ Certified copy is,filed with the county building inspectionNEAREST department. LOCALITY 'Temple. Ci ty CROSS ST. Date Applicant EAREST DISTRICT NO GR UP TYPE PROC D Y 7 110 CROSS ST.,. Oak Avenue. / ./ CONST CERTIFICATE OF EXEMPTION FROM WORKERS', Le�a� V'✓ v ` DESCRIPTION LOT NO. BLOCK `h.I q'.P - HIGHWAY - - COMPENSATION INSURANCE• I. STATE MAJOR SECON LOCAL d . NO. _ (CIRCLE) (This section need :not be-completed if the work involved NO. of BL T. p p TRACT NOW ON LOT - USE ZONE SPECIAL CONDITIONS'' U 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 WNE Richard & Marilyn Dootson ~' so as to become subject to the Workers'•Compensation,Laws. OCCUPANCY'GROUP r2 W ' ADAILDRESS 2670 S., Myrtle , ,: :FT a '.Date Applicant' N TEL. z .NOTICE,TO APPLICANT: If, after making this Certificate of 40 CITYMQn .i No. 44 -2400 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. C] No SpeC..Knowl. .❑ LICENSED CONTRACTORS DECLARATION. OCCUPANCY INSPECTION Panic DeVICeS ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST,!.TEMS 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 D . 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 INSP C4RSacting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SI NA inessand•ProfessionsCode). FINAL APPROVAL - ESENT USE OF BUILDING•, Business Of f,I ce Lic,or Reg:No. - Date_' �1-2V Property Management 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- 1714 5 2 8 A ness and Professions Code NO. PARKING )' SPACES PROVIDED H {j Oro O O 8 8 - I, as owner of the property, will do,the work and the structure',is not.,intended„ or offered for sale Section o o-0 0 0 0 0 7044;Business and Professions Code). ( r ROPOSED USE OF BUILDING. BUS (ness, _Of ice 1 • . i•I ,04,24 86 CONSTRUCTION LENDING-AGENCY I hereby affirm..-that there is.a construction lending agency Pro Bert Mana ement for the-performance of the work for wJhich 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'b/hunty construction, TOTAL FEE ereb au oriz representatives of to enter or ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I// i na re oT Permittee Date k' WORKERS'COMPENSATION DECLARATION CE 8754(2-80) - . . MISCELLANEOUS A PP L.ICAT_IO N . I hereby affirm that I have a certificate of.consent to self ` COUNTY OF LOS ANGELES. BUILDING AND SAFETY DIVISION i4ture, or a certificate of Workers'Compensation Insurance,or- a certified copy thereof(Sec. x800,Lab. C.) Policy No. - CompanyFOR APPLICANT TO FILL IN BUILDING ❑ .. i .... .. ADDRESS Certified copy is.hereby furnished. uILDING 1 A y LOCALIr Y. (n• ADDRESS 1 :L,1'� U/��� TEmLE ❑ Certified copy is filed•with the county building inspection NEAREST department. L CALITY' �C� l o ( /f� cixoss ST. OkK Date' _ Applicant. - NEAREST - DIS RI TN O:` 11ROUP TYPE 'PROC D BV CROSS ST CONST.CERTIFICATE OF EXEMPTION FROM WORKERS'_ LEGAL L/ V COMPENSATION.INSURANCE DESCRIPTION dor yo. BLOCK ` .MA'P HIGHWAY NO. (CIRCLE) STATE MAJOR,SECOND,L CAL NO. OF BLDGS. - ,'0, (This section need,'not be completed if the WOr1C 1nVO1Ved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by',tlie permit is for one hundred dollars ($100)"or-.less.)' . USE OF i� _ - ' - SIZE OF LOT EXISTING BLDG. - (((v//// I certify that in the performance of the work for which this 0- OWNER is issued; I shalhnot employ any person in any manner OWNER I - E—. Amb' S t.v ,b MCa� v U . so as to become subject to the Workers Compensation Laws. MAIL OCCUPANCY GROUP ���r�j/ \/-fes// �� W L11 Date Applicant TE . t' Z ..NOTICE TO:APPLICANT: If, after making this Certificate of CITY No. q'754,N�• 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. C] No Spec. Kf10WI. 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 ' PARKING effect. - . ' - SPACES REQ'D E= PROVIDED. D License Number Lic`Class LIMITED TIME USE Contractor Date: DATE. DATE FROM: TO: I am exempt from the licensing requirements as lam a licensed 'architect or a registered professional engineer SIZE OF r= NO.'OF2 iNSPEcroR's acting In my professional capacity (Section 7051, BUS- E STING BLDG. s Jd /� STORIES GNATURE iness and Professions Code). t FINAL APPROVAL PRESENT USE OF BUILDING ,`'v,.r J,c G LJ' C ✓� Lic-or Reg.No. Date 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 L {,6/�•� ;II ❑ I, as owner of the property, will do the work and.the V U 11 structure is not intended or offered for sale (Section #•o.o o • $8 7044, Business and Professions Code). F•ROPOSED USE OF BUILDING - •• CONSTRUCTION LENDING AGENCY # o o•o 0 8,8 I hereby affirm that there is a construction lending agency /�N�s/p - I /fit le' o a a 0 a a o z for the performance of the work for which this permit is ;J issued(Sec. 3097,Civ.C.). 0.Y0,2.-_8 7 Lender's Name PROPOSED MAX. 0­ Lender's Address PERM[ - 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 eove- en 'reby authorize representative •bf his ounty to enter TOTAL FEE' O '�0 upo a abrop ,y s ection purposes. SEE REVERSE FOR EXPLANATORY,LANGUAGE . ignature of Permittee Date WA KERS'COM PEN SATION:DECLARATION " 76M444"' /� �1 1 'C /� p p /� T • CE 875 (2-80) M SCEL.L.ANE®US '/`�rf-•�'c/"�' 1 1®N'_. I he-eby, affirm.,th'at-.I have.a certificate of`consent.to sett 'insure, or,a,certificate of Workers'Compensation Insurance,or, COUNTY:OF;-LOS ANGELES BULLDING',, ND'SAFETY.DIVISION. a certified copy thereof(Sec. 3800,Lab.G) �BU,ILDING / n Policy No. Company F.OR APPLICANT TO FILL IN woD,REss tAlf •❑ „Certified copy is.hereby'furnished. BUILDING y blltldln m - ADDRESS -••uN .l iO LOCALITY Certified,cop,y.is filed with the count g'' spection rvEwREST t a department_ oe ITx cROSS'ST Date Applicant DISTRICT AREST DI NO: G OU TYPE- / PRO S ED BY -. CROSS�ST. CONST' .CERTIFICATE OF EXEMPTION FROM WORKERS'- LEGAL COMPENSATION INSURANCE DESC Rler,lori LOT No MAF H��rwwv STATE'MAJOR j F.. M01 (This section need not be com leted if the work involved ' No. of BLDGs C1 c`N) P TRACT ' N'OW ON`L OT: permit - O ` .. USE ZONE � CIAL• O DITIONS by ,the permit•is for one hundred dollars ($100) or less.) SECON LOCAL - _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 wNER ` .CjC _jf14A,0AC,QTS 0/✓ so as to become,'subject to the Workers' Compensation Laws. � OCCUPANCY GROUP W . D, i• - - - JADDRESS 3 s. - d Date (o7Q S ./l,YRj'Lr .� Applicant,.. TEL. z NOTICE'T.O APPLICANT. If; after making this Certificate of CITY _:N 9. )'sd 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 -Orthls permit SIIaII be, TRAILER:USE Q ' GEOLOGY INSPECTION deemed revoked ❑ Spec ❑. .. No . Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION, Panic DBV1C@S ❑ (commencing - ) prOVIS10 nS of Chapter r SAFETY PERMIT ❑ (LIST ITEMS BELOW) EXITS,' _ I hereby affirm that I am licensed under No of 9with Section 700Q of Division 3 of the Busi- ❑' ness and Professions Code, and my license is in full Torce and effect: PARKING SPACES REQ`D �.. 'PROVIDED License Number Lic. Class LIMITED TIME, USE Contractor Date DATE DATE FROM: ❑�-I am'exempt from the licensing requirements-as I am a - - I PECTOR`S licensed ,architect or a• registergd',pro fessional engineer S12E`OF. rao. OF -acting,in my •professional capacity .(Section 7051, Bus_. Ex( rlrvG.BLDG. sToeiEs iness and Professions Code).. DING FINAL APPROVAL _ • RESENT USE OF BUILDING IGNATURE. Lic.or Reg.No. Date.• / ' • ,HOME OWNER-BUILDER'DECLARATION 1 N NO.`OF EXISTING BU LD1 GS ON LOT-AND USE - I hereby affirm that I am:.exempt from' the -Contractor's X2812-A Licei se Law for the following`,reason'(Section 7031.5,;Busi- . - NO. PARKING .: ness and Professions Code): 88 ,' - - SPACES PROVIDED` - FJ-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). „• OPOSED USE OF,BUILDING •OF/�.IC CONSTRUCTION LENDING fAGENCY I hereby`affirm that, there'is a:.construction,lending agency ' for.the.performance of the work for which this permit is issued(Sec. 3097,Cid.C.); Lender's Name .PROPOSED MAX: OCC:.' . Lender s"Address' - - 'PERMIT-FEE - - abovelinformatlonaiecorrecthIsagree to ctomply that Y PP County .ISSUANCE FEE';' + v. ordinances and State, lawsrelating to building Construction, �TOTAL,FEE'and hereb y, authorize representatives of this County to enter /on"the above-menttii�oned..,property for in pe tion purposes. SEE REVERSE"FOR EXPLANATORY LANGUAGE Signature of Permittee. Date' WORKERS'COMPENSATION DECLARATION, 76M444 p g � CE 875 (280). MJSC.ELLAN'EQUS, APPLICATION �ON 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 1 :ADDRESS'. .. Certified copy,is:hereby:furnished. L000 BuILDIN� ` ' ADDRESS !jL V�.J J LOCALITY . Certified copy is.flled with the°county building inspection.•"' NEAResr ,department LOCALITY C! ... CROSS ST le Date' "Applicant " EAREST ' DISTRICT NO. '.GROUP TYPE. ' PROCESSED BY_ , CROSS ST. JLC ONST. CERTIFICATE OF EXEMPTION:FROM WORKERS LEGAL .. : .. .BLOCK .MAP HIGXWAY. "COMPENSATION INSURANCE: DESCRIPTION LOT.NO. (This section need,not .lie_completed if the worki invdlved TRACT rNO. (CIRCL N,ow ON Lor s usE ZONE IAC CONDITIONS TA TE MAJOR SECOND LOCAL by the permit •is`foi 'one hundred dollars ($100) or less.)'' USE of _ SI - OF LOT: EXISTING BLDG. ✓�I "•' U I certify,that'in the performance,of the work for which this O. permit is issued,T`.shall not employ any person in ar}y-manner OWNER so'as to become subject to,the.Woikers!-.Co'mpensation.Laws. � OCCUPANCY GROUP W,. r OO � _ - AIL'.. - .. .ADDRESS - Date Applicant S E, P P �' • '. , V r1 NOTICE TO APPLICANT:.If, after making this.Cerfificate of CITY V No� 5 O OCCUPANT LOAD z Exemption; you should become subject ',to, the-.Workers' Compensation:'provisions' of the-Labor Code, you'must forth- with: orth I APPLICATION FOR, EXIT HARDWARE: with: comply with SUCK pr,OV1510Us or this`.permit shall be TRAILE RUSE GEOLOGY INSPECTION a deemed revoked. No Spec.;Knowl. ❑ LICENSED CONTRACTORS DECLARATION ' occuawrvcv IrvsPecTIoly Panic DevicesEl I hereby'affirm that I,am licensed urider provisions of Chapter : SAFETY PERMIT[� (LIST ITEMS BELOW) NO. OFEXIr.S ' 9 (commencing with,Section 7000) of Division 3 of the Busi ness and Professions Code, and my license is in full force and"' PARKING. - E _ - .• SPACES' .. License Number' Lic.Class LIMITED' TIME USE' FTontractor- `. Date .. - - 'DATE .,'. DATE, ' - FROM: TO: .. am exempt from the licensing requirements as I am a, -licensed architect 'or a registered professional engineer SIZE OF No. OF INSPECTOR'e acting,in my professional capacity, (Section 7051, Bus EXISTING BLDG. sro131Es• sIGNATuRE, inessand`Professions Code).. E of DING �r FINAL APPROVAL �P R SENT USE BUIL • `�'/� -fir ��' V Lic.or Reg.No. Date 12 2 r. HOME OWNER-BUILDER DECLARATION rio:,oF E (STING BUILDINGS _ ON LOT:ANO USE l hereby•:affirm that I `am exempt from the Contractor's ia•� License Law for the following reason (Sect io❑ 7031_.5; Busi , D'8 07 .ness and Professions Code): rvo. PARKING '. :, S F _ l SPACES PROVIDED ! - - �.�.'0:Q'O O'� .n '_. .y .'. I; as, owner of.the property, will do'the work and the' structure is not intended or offered :for sale`(Section .o o G.o 01 O o ' , 7044, Business and Professions Code) oPosED usE of BUILDING O ! . - ,0 1 •0 9 CONSTRUCTION LENDING AGENCY " I I hereby affirm that there is a construction lending agency'. 6 C T 1 y at' f i for the performance of.the, work for which this permit is 99 issued(Sec:3097,Civ.C.) ° . ci —. 1 u, Lender's Name r oPosEp,Mw Lender's Address I, - ERM1T'FEE p, I certify that I have read this application and state that the, " above information is correct.:Lagree to comply with all County IssuwNce FEE ' ordinances and State laws relating,to building,construction, .- ' =. Ir FEE y,and hereby authorize representatives of this County to enter T6TAL UP .the•above-mentioned property for inspection urposes. SEE REVERSE FOR_.EXPLANATORY LANGUAGE nature o ern ittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that cL:f Wo certificate of consent to Self COUNTY OF LOS ANGELES WILDING AND SAFETY.DIVISION insure, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec.,3800,Lab.C.) ov _ Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS sielZ Certified.copy is hereby furnished. BUILDING LOCALITY 01 ADDRESS 9417 E. Las .Tunas -Dr-. A-D O -Certified copy is filed with the county building inspection NEAREST department.' LOOALITY' Temple Cit CA 91780 CROSS ST. Date Applicant' - EAREST .DISTRICT NO. GR OU P' TYPE PROCESSED BY CROSS ST. Oak .Ave .. � -r I CONST, - - CERTIFICATE OF EXEMPTION FROM-WORKERS' LEGAL , G!/> COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP - N,�HwAY NO. `% (ciRCLE)' STATE MAJOR SECOND LOCAL .'• NO. OF�BLDGS. a" (This section need not be'completed if the, work involved TRACT Now ON LOT USE Z NE SPECIAL CONDITIONS by the permit is-for one hundred dollars ($1'00)'or'less:) U _ USE OF _ IZE,OF,LOT EXISTING BLDG. -le I`certify that in the performance of the work for which this cc Permit is issued,-I shall not employ any person in any manner OWNER Dootson InvestmentsH so as to'become'subject to the Workers' Compensation Laws.. aiL OCCUPANCY GROUP U ADDRESS 2670 S, Myrtle .AVe - � - W Date Applicant d TEL rn .NOTICE'TO APPLICANT: If; after.making'this Certificate of CITY '" Monrovia- NO. 445-24.00OCCUPANT LOAD Exemption,. you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation, provisions of the Labor Code; you must'forth- ., with comply with such. provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ . ❑ -No Spec. Knowl. ❑ deemed revoked. . � �. - � Panic.Devices 0. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 D PROVIDED O License Number Lic.Class t'7 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 SIGNATURE inessand Professions Code). FINAL APPROVAL. PRESENT USE OF BUILDING, Lic.:or Reg.No. Date Of Stora e shod HOME OWNER-BUILDER DECLARATION No.of EXISTING BuiLDiriGs- - - ON LOT AND USE p - I hereby affirm that., I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- - z 3,4 6.2 A ness and Professions Code):. NO. PARKING SPACES PROVIDED - O I, as owner of the property, will do the work and the o m o .o structure, is not intended. or 'offered for'sale.(Section LI ' 8 8 7044,-Businessand Professions'Code). . PROPOSED USE OF BUILDING Offices, .storage O O O'O O o o z :' CONSTRUCTION LENDING AGENCY 0'70 7=8 3 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:)i Lender's Name-'---- PROPOSED MAX. OCC. - Lender's Address - .r. 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 ppon'the above-mentioned operty for ins p ction,,pur Vises. SEE REVERSE-FOR EXPLANATORY LANGUAGE 18?Signature of Pe ittee D to WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS A P P L IC.AT.10 N I hereby affirm that I tiave 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. DRESS L uILDING ' i /� Q '^/ LOCALITY � 'J. J V � 1.02 - - El Certified copy is.filed with the county building inspection ] EAREST " . department. LOCALITY � ./QC e► CROSS ST. Date Applicant NEAREST .DISTRICT NO. G UP TYPE PRO ESSED BY CROSS ST: CONST: CERTIFICATE OF'EXEMPTION FROM WORKERS' LEGAL " DESCRIPTION LOT NO. BLOCK MAP (CIRCLE) IG E)IRcwAY STATE MAJORSECONDLOCAL � NO. OF BLDGS. ' COMPENSATION INSURANCE . c � } ro (This section need not be completed if the work involved TRACT NOW ON LOT USE Z NE SPECIAL CONDITIONS 0 by the permit is.for one hundred dollars ($100) or less.) U USE OF ;XZ.OF LOT EXISTING BLDG. I certify that in the performance of the work'for which thiJA Q permit is issued, I shall not employ any person in any manneN R p0Q a y v� ( IL'I'fd" so as to become subject to the Workers' Compensation LawsoL Ess"< ! ® � M �'� OCCUPANCY GROUPWDate Applicant .'NOTICE TO APPLICANT: If; after'making this Certificateo M iv�Q'V `' rvo. �— 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. ❑ " N0 Spec. Knowl. 0 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT 1 (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. PARKINGSPACES— REO D E== PROVIDED .� Licenfe Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: To: ❑`fM 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 iness and Professions Code). �/A e FINAL APPROVAL Z7� ESENT USE OF BUILDING VV _ Lic.or Reg.No. Date.' HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE x38&3A I. hereby -affirm that, I am.exempt from the Contractor's `# o,o 0­ 88 License Law for the following, reason (Section 7031.5, Busi- . - ness and.Professions Code): NO. PARKING. SPACES PROVIDED 0 a 0 0`O 0.!0 z ❑ I, as owner of the property'-will do the work and the structure' is not intended or offered for sale (Section 8 3 7044,Business and Professions Code). //�}!!'• OPOSED USE OF BUILDING 0' 'G L. �• /I/, - CONSTRUCTION'LENDING AGENCY I herebyaffirm that there is a•construction lending agency for the- performance of the work for which this permit is issued,(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. ' Lender's Address PERMIT FEE I certify'that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE - ordinances and State laws relating to building construction, and l ereby authorize representatives of this County to,enter TOTALFEE u on the above-men ioned r insp ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu er ittee Date `WORKERS'COMPENSATION DECLARATION 76M444' , CE 875 (2-80) IVIISGE.LeL:AI�I'E®lJS :APP:L'I:GATI®N certificate .of consent to self• insur e, or a a certified co eytthereof 7Seo r3800 Compensation Insurance,or COUNTY OF LOS ANGELES BUILDIIVG:AND SAFETY.DIVISION I he; oy affhm that- I' have a P ;Lab,C.) Policy No. Company, ° 4 ' ''BUILDING FOR APPLICANT TO FILL IN ADOREss Certified copy is hereby«furnished. Uir_DING•, ,.•.'. �', ADDRESS LOCAL TY ' Certified'.copy is filed with the count buildm ms eciion P Y g P '" 'LO C'ALITY- //�� .NEAREST ..department �i 1 CSI• cRoss sr. sr., Date 'Applicant DISTRICT�NO. G AP TYPE - ]PROC�S ED BY EAREST () _ 'CROSS ST. ' CONST'. '/ '. Y _ LEGAL. _ .'CERTIFICATE OF_EXEMPTION FROM'WORKERS DESCRIPTION LOT.tvo.r: BLocK p / COMPENSATION INSURANCE m:P "IGMWA }' ey; ... NO. NO. i.iC IRC+LE). ^ST (This section need not be completed if,the.work involved TRACT NOW ONL OT 3 USE ZONE SPECIAL CONDITIONS' AT O ' r aiy the permit is for one hundred dollars' ($100),or less) USE of I U E MAJOR SEC ND.LOCAL p; I SIZE OF LOT - �EXISTING`81-13G. - '• � I certify that%n the performance:=of the'work'for'which this " - r permit is issued; I shall not employ any,person in any manner NEF2 (�' �: 17��'t a F so as to become,subject to the Workers Compensation;Laws. AIL, OCCUPANCY GROUP. ' W ADDRESS - ~� 7 � / . C / / / y • Date - Applicant:, -. � C/3.TEL. NOTICE TO.APPLICANT•: If; after,making this Certificate of CITY, � No: OCCUPANT LOAD Z Exemption, ,you should become sublecf= to."the Workers';' APPLICATION FOR EXIT HARDWARE: Compensation,provisions of the.I:abo'r Code,you'must forth- with comply with such .provisions. or this permit 'shall be.r TRAILER.USE GEOLOGY INSPECTION deemed revoked ❑ No Spec. Knowl. Q OCCUPANCY.INSPECT16NPanic Devices - LICENSED CONTRACTORS DECLARATION- r I hereby affirm that I am•licensed-under provisions of Chapter SAFETY,PERMIT q` 1LIST 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. PREQ'D PROVIDED_ ARKING;- �. License Number Lic.Class SPACES " LIMITED .TIME USE. Contractor Date- o n T E DATE - - _ FROM: - 'TO: [ am exempt from the°licensing requirements as I ani a, licensed architect or a registered'professional engineer. SIZE-OF rvo. of iNsP;E'crbR s acting in my professional.capacity (Section 7051,.'Bus- "' EXISTING'B LD G. - _ STORIES - SI NATURE- messand,YrofessionsCode). y� /` FINAL APPROVAL ESENT USE OF BUILDING•`•', r rf7no � / /', _ v�n Y Llc.or.Re'g.:No, Date- - �/ /V/ HOME OWNER-BUILDER DECLARATION' NO.`o F'EXISTiNG BUILDINGS V ON LOT AND USE. - I`hereby affirm that, I am exempt -from the Contractor's " 3 3 4,7 5 a License Law'for•the_ following reason'(Section 7031.5, Busi- ness and:Professions Code):. NO. PARKING SPAC ES',PROVIDED 1,,.-as owner.- the property,:will'do the and rhe # ®',0 0 0 88 - structure.is not intended- or'offered' for sale (Section ot 7044',Business and Professions Code).. r Poseo USE OF eulLDlrvc , :h. CONSTRUCTION LENDING AGENCY - f I hereby affirm that,there is.a.construction lending agency for the performance of.the work for which this, permif,,is, issued(Sec.`3097,Civ.C.).: L'ender's Name PROPOSED MAX. OCC. Lender's Address PERMIT 1 certify that I have read this application and,state that the',n \!1 - ' above information is correct.l.agree to cornply'with all County ISSUANCE FEE ordinances and State,laws relating;to.building construction, rorpL FEE` oD �J \ and hereby, authorize representatives of this County,to"enter + up above me boned petty for inspection purposes.. SEE REVERSE,FOR- LANGUAGE Sig f e of Per ee". Date,.,, ; .WORKERS'COMPENSATION,DECLARATION CE 876(2-80) MISCELLANEOUS, APPLICATION I hereb " affirm that I have a certificate of consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION in re, or a certificate of Workers'Compensation Insurance,or ,- aified copy thereof(Sec..3800,Lab.C.) . Po)ric} Nd Company /�/f� t FOR APPLICANT TO FILL IN BUILDING +r3��l7tM ADDRESS Certified copy is hereby furnished. UILo1NG LOCALITY ADDRESS ❑ Certified,copy is filed withth ounty building.inspecfion- NEAREST ' department.' - - LOCALITY _ CROSS.,ST. , Date Applicant AREST - DISTRICT NO. GROUP TYPE' PROCES ER BY RO55-ST, t4 C�j' ��. COPISY. CERTIFICATE OF EXEMPTION FROM WORKERSLEGAL - • a DESCRIPTION LOT•NO. BLOCK MAP _ y HIGHWAY COMPENSATION INSURANCE No, iX��l7 (cleccE) _ sTwTE MAJOR SECOND LOCAL a NO. OF BLDGS. O (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.) U USE OF SIZE OF LOT EXISTING BLDG. cc I certify that.in:the performance of the work for which this': Q permit is issued, I shall.not employ any person in any manner wNEe F- l�it^ IJ rho' 'so as to become subject to*the Workers'.Compensation Laws.' MAic �7H �r OCCUPANCY GROUP ,Z W Date Applicant ADDREss /�/L LSC �. z . NOTICE.TO"APPLICANT: If, after making this Certificate of CITY No� OCCUPANT LOAD _ Exemption, you should become 'subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must.forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec: Knowl. ❑ LICENSED CONTRACTORS,DECLARATION. occuvwNcv wsPEcnoN Panic DeVIC@S ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY'PERMIT q (LIST ITEMS BELOW) NO. OF EXITS' .9 (commencing with Section 70.00) of'Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. , - - SPACES REO'D E= 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 SIGNATURE. iness and Professions Code). r r FINAL APPROVAL RESENT:USE OF BUILDING. - Lic.or Reg.No." Date HOME OWNER-BUILDER DECLARATION• No-.oF.ExIS Bu1LDINGs ON LOT AND UUSESE- I hereby affirm that I "am exempt from the Contractor's License-Law for the following reason'(Section 7031.5, Busi= :2 4 5 V5 A NO. PARKING ' ness and Professions Code): SPACES PROVIDED F] I, as owner of the property, will do'the work and the ' # o 0 0 0 8,8 structureis .not intended or offered for sale Section 7044, Business.and Professions Code). ( o 0 0 0 010 o z.. - OPOSED USE OF.B UILDING CONSTRUCTION LENDING AGENCY f/ 0-42 3.I-8 2 1 hereby affirm that there is,a construction lending agency �/ 0 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 25.00' _ I certify that I have read this application 'and state that the - above information is correct.I agree to comply with all County IssuArvce,FeE ordinances'and State laws relating. to building construction, TOTAL Fee and hereby authorize.representatives of-this County to enter 25.00 .. Pay- to the.:C i ty :of Ternp.�e.0�t upon a ve-Menti a roperty for inspect' n,purposes. .. SEE REVERSE FOR EXPLANATORY LANGUAGE ' t igna ure of Permittee ate WORKERS'COMPENSATION DECLARATION •76M444 'CE875 (2-80)' I�IISCELLAI�IE®CJS 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'APPLICANTTO ELLE IN BUILDING 'ADDRESS Certified copy is hereby furnished. uILDING �,/ LOCALITY. ` DRESS _ L/ - - - Certified'copy is filed with the county building-inspection NEAREST department. .LOCALITY > /;7/' - CROSS ST. Date - Applicant " NEAREST - '/ DISTRICT NO. GROUP TYPE JPROCJfSSED BY CROSS'S T. ��Q - 1�2_ CONST. CERTIFICATE OF'EXEIvIPTION FROM'WORKERS': LEGAL /n COMP-ENSATION INSURANCE DEsc RIPr1oN Lor NO. 3 BLOCK MAP IGXWAV } . _ 4�J! NO. p�O�• 1clRc�e) � STATE MAJOR SECOND�LOC AL a NO. OF BLDGS.. -USE ZONE ;SPECrAL-CONDITIONS O (.This.section' need7 not be completed if the work involved TRACT S NOW ON LOT U by the permit is for one hundred. dollars ($1'00) or-less.) USE OF . IZE OF LOT EXISTING BLDG-. �� I certify that m•the perfoiinance 'of the work for which this O ` perriiit is issued I-shall not employ any person in any manner 0WNER Oaf`So41 . ,✓r �� H so as to.become'subject to.the Workers' Compensation Laws. AIL -�rf//. OCCUPANCY GROUP W' .. DDR ESSpI(B/� Sa,M ,Q74;gAI/� a Date - Applicant ..N TEL. .. `Z NOTICE TO.•APPLICANT: If, after making this Certificate of ITY �/(1"(/!/4•- C NO. OCCUPANT LOAD' Exemption; you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of,the Labor Code, you must forth - with comply with such 'provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION No Spec. Knowl. deemed revoked.' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices-* ❑ 1 hereby,affirm that I am licensed under provisions of Chapter. 1-1 ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Busi- SAFETY PERMIT (LIST NO. OF EXITS ness-.and Professions Code, and my license is.in full force and PARKING. effect. - - - - SPACES REO'D 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-,"" XISTING BLDG. STORIES SIGNATURE mess and Professions'Code). REseNT usE of BUILoiriG > FINAL APPROVAL Lic.or Reg.No. Date C �� S (/Y / �/ �!`Y-w-�-•a�/ V HOME OWNER- AN .BUILDER DECLARATION No. of D UNG BUILDINGS ON LOT AND USE 'I hereby affirm that, I am 'exempt :from the Contractor's 25 Q.9,2 A License .Law for the following reason (Section 7031.5, Busi- # D D o C 4 0- ness and Professions Code):. No. PARISING SPACES PROVIDED - - DI, as owner of the property-, will do the work and the o*m D o .0:0 D,z structure is not intended or offered-for sale (Section' 70_44, Business and Professions Code). USE OPOSEDSE OF,BUILDING Q E 0,(�..-.8 l 'CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). Lender's Name _ PROPOSED MAX. OCC. Lender's Address PERMIT FEE ghave-read this application and state that the n is correct.I e to c ply with all County ISSUANCE FEE State laws elat' bui g construction,orize re esen of Count to e terTOTAL FEEmentio ed ty f nspecti pur ses. SEE REVERSE FOR EXPLANATORY LANGUAGE D e 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.C.). Policy No. Company FOR APPLICANT TO FILL IN ' BUILDING ADDRESS ❑ ADDRESS Certified copy is hereby furnished. BUILDING / E LOCALITY ADDRESS Certified copy is filed with the county building inspection. .DDLR LOCALITY NEAREST department. �izv cd q w ceoss sT. Date - Applicant NEAREST /�` DISTRI T NO, G OUP TYPE /' P CESSED BY CROSS ST. L/a' n� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (/ V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIG Hw Av NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be completed if the work involved TRACT NOW. ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this d 0 permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a o ADDRESS U Date Applicant LL0 NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of,the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. _7 PARKING REQ'D PROVIDED ' � SPACES - License Number Lic. Class `a12 ZeII LIMITED TIME USE Contractor Date �dh DATE DATE FROM: TO: F1 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 SIGNATURE iness and Professions Code). 'PRESENT USE FINAL APPROVAL OF BUILDING Lic.or Reg.No. Date 1 ` '✓� HOME OWNER-BUILDER DECLARATION NO. o EXISTING BUIL INGS ON LOT AND USE !//f 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). S CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING � D 0ky I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is I issued(Sec. 3097,Civ.C.). Lender's Name ( PROPOSED MAX. OCC. � Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction; and hereby authorize representatives of this County to enter TOTAL FEE upon thea ove-men 'oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat WORKERS'COMPENSATION DECLARATION 5 (11-84) CE 87ISG I SC E L LA N EO U J APPLICATION •y CE 875 [, I I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'I�JII 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^ BUILDING ADDRESS Certified copy is hereby furnished. BUILDING // .l S LocwLir, ADDRES Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. - CONST. - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCKMAP HIGHWAY - NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT ' r 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 `` EXISTING BLDG. O permit is issued, I shall not employ any person in any manner OWNER `P so as to become subject to the Workers' Com ensation Laws. �F�V S L(SQt�` J P MAIL OCCUPANCY GROUP o _ ADDRESS }� �' /e I/e. ~ Date Applicant' ` y p Lail NOTICE TO APPLICANT: If, after making this Certificate of CIT q �j�C NO. (�!�' GO Z OCCUPANT LOAD z 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 G,OLO GY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl, .LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIo Panic Devices El 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. a,,pp �{i �a'C� vi PARKING SPACES REq`D O PROVIDED License Number Lia Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: F] I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF SPE CTOR` acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NAT R inessand Professions Code). . A Vq r FINAL APPROVAL ' PRESENT USE OF BUILDIN V ,JN ul ave 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- I `i. .! C#C l 0 9.176/9179 ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED +� i �{r #_ f I I# : ::5 :Itp structure is not intended or offered for sale {Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN • I hereby affirm that there is a construction lending agency for the-performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address - ' PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE u on e Bove-mentioned,propfor inspection p rposes. 'E REVERSE FOR EXPLANATORY LANGUAGE Signature o rm t Date ((VJ ► WORKERS' COMPENSATION- DECLARATION �``�'- � aaI M ISCELLANEOU,S APPLICATION �- ce a�„t I he,�by affirm that I have a certificate of consent to self insure. nr a certificate of Workers Compensation Insuran.e,or COUNTY OF LOS .ANGELES BUILDING .AND SAFETY DIVISION a certified copy thereof(Sec. 3801). Lab,C.1. L/ t Policy No. _Company FOR APPLICANT TO FILL INS BUILDING Ess l;'7//7 I Certified copy is hereby furnished. A ADDR NG ��// / �G n/1 ✓( LOCALITY ADDRESS Z. �i N/a L!/�C/c/ 1 Certifiedze- lope Is flied((ith the count building lnsrlt't I()n LOCALITYTem 7 �+�tV NEAREST e ' department. 1 P1 l ! CROSS ST. Date :Applicant NEAREST DISTRICT NO. GP ITYPE P CESSED BY • p ) I CERTIFICATE OF EXEMPTION ER(��1 '.iORI:ERS CROSS ST.. CONST DESLEGAL t LSO R• tt�r cc'.0 t.()NIPENSATION INSURANCE!' CRIPT•ON LOT NO. 'BLOCK I MAv HIG Hw Ar I - yp IcIRCLeI STATE MAJOR SECOND LOCAL (This section need not be completed If the work im Dived TRNO. OF BLDGS.acT Now ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars 61001 or less.) i 1 SIZE USE OF OF LOT EXISTING BLDG. I certify that in the performance of :he •.(ark: for •.chic! -his 117 permit is issued. I shall not employ any aerson in atttTn::nner Ow ER so as to become subiect to the Rorkers• !'.nnrensation !.ams. MAIL ^t ye}(� OCC'JPANC'r 3ROUP - 1 AD OR ESS Date Xpr)licant NOTICE TO APPLICANT: If, niter making -!iis C r??iccre or $I CIT- OCCUP4N- '_OAC Exemption. you (hould become subiecr -o -he Wo ker;' lompens:tlion pro`:isions of ,hc 1-abor.."ode. you must forth_ APDL!CA71C1\1 =:�R = C!' - I with compiy with <uch nrovis:ons L. .his •-ermit shail be -PAILER USE GEOLOGY :NSPECT!ON No Soec. <nc'vl. deemed re(o ed. — LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONXX Panic Dev;ces I hereby affirm :hat 1 am licensed under precisions of Chapter i C SAFETY PERMIT (LIST IT E.•AS BE LOIV) 9 (cmm�rencing with Section 7000) of Di(ision 3 m the Susi- No. of EXITS ness and P-ntessiom Code. and my license is in fail fore:, and effect. 4 PARKINGj N _ SPACES REO.O 1 I PR O`J ID ED �.. License Number_ I_ic. Claes C� -l�il✓Gi G�= = �— LL LIMITED TIME USE y Contractor Date _ ,ATE oA-E w N I am exempt from the licensing reauLrements as I am .1 T.` m. I licensed architect or a registered professional engineer SIZE OF , of INSPECTOR'S z actin, :n my prote`.slon:al �ar::l::ti•� 1�::io:t _051. Ru( - EXISTING BLDG. � 3T ORI =5 SI? ATURE inessanLiProfessicns(adc). FINAL APPROVAL I / U -RES'ENT USE OF BUILDING (� `, i Lic.or Ree. No. _ D:i-e _- 1 q` HOME OXXNI R-BUILDER DECLARATION NO. OF EXISTING BUILDINGS Q I hereby af`irni that I am exempt from the Contractor's ON LOT AND USE �J UUP/ License"Law Co- the follow ing reason I Section -931.5. Busi- ness and Professions Code 1: No. PARKING SPACES PROVIDED I, as owner of the property. wil.1 do the work and the structure is not intended or offered for :ale +Se_•tion 7044. Busine�sand Professions Code). CONSTRUCTION LENDING AGENCl X PROPOSED USE OOF�BUILDING hereby affirm that there is a construction lending ai-ency l2r`Oli StyC27 i✓�- (� �— r 1_, _ for the performance of the .cork for which this permit is d•.. i-i �IAn issued (Sec. 3097.Civ.C.). Lender's Name t PROPOSED MAX. OCC. Lender's.address I l 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 nf( ordinances and State laws relating to building construction. and hereby authorize representatives of this County to enter TOTAL FEE �fC.00 ? '. f upon th a 1 ovc- ntioned property for inspection purposes. LJ SEE REVERSE FOR EXPLANATORY LANGUAGE v A V Signature of Permittee I ,/ I WORKERS' CUMY>✓NJAlluiv lltI;LHKAl1ViV 20-0063DPW.2/90 1!V)1�.11��,L..)l...H1dGUv� .Hi"I�Lit.Hl A.V1\t I herebyaffirm 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 (Seca 3800, Lab.C.)" J Policy'Nci Company FOR APPLICANT TO FILL IN BUILDING BUILDING- DD SS - ADDRESS ❑ ,Certified copy.is.hereby.,furnished. X �� 5 uN S F-M LOCALITY ❑ Certified copy is filed with the county building inspection cIL� zip q tment. l r deparNEAREsr. CROSS ST. Date ' '= - Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS_' OZoOU BL FT , 3 coNsr. O ?RACY BLOCK LOT NO. COMPENSATION INSURANCE AY NOP c Rc E) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars (5100) or less.) I usEzoNE SPECIAL CONDITIONS Q L certify that in the performance.of the work for which this T rf QQ permit is issued.I shall not employ any person in any manner U Sy � 3a Noag4 C3°�4 LU so as to become subject to the Workers' Compensation Laws. AD°t�15I T�«� l ll� OCCUPANCY GROUP 0. �j Z Date Q a'7 W'Applicant . 3Hu3UN t CITY �� A�� ZIP p�n NOTICE T APPLICANT: .If: after making this Certificate KV I CY1 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. ❑ revoked. LICENSED CONTRACTORS DECLARATION occuPANcv 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 BusinessNO.OF EXITS and Professions Code,and my license is in full force and effect._ame of Busimess PARKING• REO'D PROVIDED i License Number Lic. ClassRd C�?bt APPAREL LLC SPACES I Contractor Date LIMITED TIME USE I ❑ I am exempt from the licensing requirements as I am a - DATE DATE FROM: To: licensed architect or a registered professional engineer ]r `� IN acting in my professional capacity (Section 7051, Business SIZE OFEXISTING BLDG. and Professions Code). GD b sl7l CT s OR ES SIGNATURE, T LIC. or Reg. NO. --- -Date PRESENT USE OF BUILDING M-7(A I L S FINAL APPROVAL 2 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 O ❑ I, as owner of the property, will do the work and the SPACES PROVIDED i REIMS(LS structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING l /i Business and Professions Code). 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 (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. Lender's Name —[.. ADDRET PLI NT(PR TR ) Iv T O, an 81 Lender's Address 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 I hereby authorize representatives.of this County-to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. . i �/ TOTAL FEE - - X i` 1 0 0.). SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76V1444 C".875 (11-84) M ISCELLANEOUS APPLICATION 1 het-by arfi[" HIM I' l;Ve icertificate OfCOJIS0111 to Self (A_)1JN'FY OF LOS AN(-,ELI,,,insure, Or :lccttificatcolWorke-s'(oi )eis;itiiiinsurince,Or IWII )INGANI) SAI"I"'I'Y DIVISION a certified copy thereof(Sec. 3800,Lab.C.). Poli I cy No.. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. FIU ILD I" f�/ 7 Zes 74"r, de feld'e. ADDRESS LOCALITN� ElCertified copy is filed with the county building inspection LOCALITY !4EARESI department. CROSS ST. Date-Applicant--.- NEAREST DISTRICT NO. GROUP ITYPE D By -CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. eo f LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL 0. OF BLDGS. (This section need not be completed if the work involved RACT ____��OW ON LOT USE ZONI- SPECIAL CONDITIONS by the permit is for one hundred dollars (5I00) or less.) USE OF I certify that in the performance of the work for which this -,IZE OF LOT EXISTING SLOG. permit is issued, I shall not employ any person in any manner OWNER cAft so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP Date-Applicant > ADDRESS /711 S. k--64 :f;f- I . CA,)1y.3 TEL OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of >( CITY 141AAAIJ�r^ 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 IRAILER 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 E] (LISTITEMS 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 License Number Lic. Class SPACES REWD PROVIDED TIME USE Contractor Date ATE DATE I am exempt from the licensing requirements as I am a FROM: TO: 7 licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOPf S acting in my professional capacity (Section 7051, Bus- 1.,XISTING BLDG. STORIES S,GNA;eRE Lic.or Reg.No. Date RESENT USE: OF BUILDING ft IVf _T iness and Professions Code). FINAL APPROVAL L�_q HOME OWNER-BUILDER DECLARATION :40. 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): r;O. PARKING El1, as owner of the property, will do the work and the !:I PACES PROVIDED— structure ROVIDEDstructure 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 -ev 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 S' I certify that I have read this application and state that the PERMIT FEE 00 above information is correct. I agree to comply with all County ISSUANCE FEE ordinahces and State laws relating to building construction, and hereby authorize representatives of this County to enter "rOTAL FEE 5 OO upon the above-mentioned property for inspection purposes. SSE REVERSE FOR EXPLANATORY LANGUAGE •Signature of Permittee Date ► LL'ORl;ERS' CONIPENSATIONDECL,U2.LTfON 7en444 MISC.ELLANEO� S APPLICATION CE ass :11 aai 1 herebv affirm that I have a certificate of consent to self 7 , insure. or a certificate of Workers'Compensation Insurance.or COUNTY OF LOS .ANGELES BUILDING .AND SAFETY DIVISION 'I a certified copy thereof ISec. 3800. Lab.C.I. 7 Policy No. —Company FOR APPLICANT TO P!LL IN SooRess Certified copy is hereb}' Curnished. X BUILDNG ADDRESS 941 7 Las Tunas Dr Ste Annex,LOCALI Y ! I Certified copy is filed with the count buildinc inspection" LOCALITY NEAREST department. LTemple city CROSS ST. Date Avolic-ant NEAREST DISTRICT NO. GR P TV PE OCESSED BY cRoss ST. Live oaks --0.�i ' CONSr� CERTiFICATE OF EXEMPTION FROM '"IC-RKERS LeGAL !% uCi-r� COMPENSATION O!x I\SI. 1\.LNt!_ OESCRIPT'ON LOT NO. BLOCK MAP HIG Hw Av "10. iclR CLs) STATE MAJOR SECOND LOCAL 1. (This section need not be completed If the '.work involved 'RNO. OF BLOGS.AC� NOW ON LOT ;USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars +5100) or less.) (((((( 1I USE OF I ceItlfy That In the rc;fonnance o �!te '.lork 'U' 'l'hich 'his f SIZE OF LOT EXISTING BLDG.fLU ! permit Is issued. I iliall not employ any oe-tion :n any manner O'NNER Susan_ Chan so as to become subject ;n the Corkers' C,,mpencation !-a cs. %1 MAILw OCCUPANC', •;ROUP _ AD DRESS 1712 S. 8th St 1 Date \pplicant NOTICE To .LPPuc.LNT 1r. of e: making c,r -iC:lte 'It XI CIT- Alhambra 626-284-8245 OCCUPr N- LOAD Exemmio'1, you <lioluld become iubiec-, -o -he 1i"„rker Compensutiun pro,. 1>t the Labor c:,id . You must ti>rth_ APDL!CATICN! ��F j =X!"' Fio rlF T� i with compiy rritll :uch nrolis;ons or -lli ^emit ;hail be RAILER uSE )—� deemed :eloked. GEOLOGY :NSPECT�ON No Soec. LICENSED CONI DEC L.LR.a TiO`: OCCUPANCY INSPECTION gg Panic Dev;ces I hereb} affirm :hat l am licensed under previsiens of C ilaoter i `. SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 ,it the Busi- NO. of EXITS ness and Professions Code. and my license is in tuil io_rce and etteC:. I, PACES PARKIREO'O I PRCVID ED License Number_ LEl'. C!atii LIMITED TIME USE Contractor DATE oA-P w --– ? I am exempt from the licensing reauL*etnents :Is I am m I licensed archirect or a registered nrrfessional en_ineer SIZE OF Np_ pF INSPE TO R'S z actin" in my professional :ira::it�." ��:;ion 11:7, Bll1-" EXISTING BLDG. a ro 940 Sl:' STORI== SIG TURE 9 iness and Prutessicns(ode I. — _ ---T U ".RESENT USE OF BUILDING '.: 1NAL APPROVAL - J�`�7r� Empty ` // Lic.or R:__ No.____ Dave___ , l n 1I0\IE OXLN1 11-131 ILDER DECLARATION NO. OF EXISTING BUILDINGS �"Ll( ON LOT AND USE lj hereby affirm that l am exempt from the Contractor's i License Law for the follo\�ine reason (Section '(l L Busi- ness and P-,ofesslons Code): NO. PARKING - 1 ❑ 1, as owner of the properti, will do the work and the SPACES PROVIDED structure is not intended or offered for :ale (Section I 704.1. Business and Professions code). CONSTRUCTION LENDING AGENC � PROPOSED USE OF BUILDING I i hereby affirm that there is a construction lending :Lgencv. Medical. LaboraTORY for the performance of the work for %%hien this hermit is issued (Sec. 3097.Civ. c.). := V5 I:r y,'• Lender's N:une PROPOSED MAX-:IO.C;C. ? Lender's.address ' 3 q _ i' PERMIT FEE'" 25.00 Fa 1'f? p_s 1 .I l certify that I have read this application and Mate that the 1 above Illforination IS correct. I:Free to compo'R'ith all f'01111tV ISSUANCE FEE j f3 i 1Ai ordinances and State lalvs relating to building construction. .j " and hereby authorize representatives of this.County to enter TOTAL FEE } upon the above-mentionedproperty for inspection purposes. 25.00 .::r. SEE REVERSE FOR EXPLANATORY LANGV AGE �L L 9 _. Signature of Permittee D to 1 hereb-', _1�flrm that I have a .L Cat' of ,oncen- u sel-* C, or a certificate of Workers' C in-inensation lrlsuranc�'..Jr 0 0 F LCUS AN' B U 1 LD I N G AND SAFETY DIVISION! C_L Z a certified copy -hereof(Sec 'So() Lab C. Policy 41� -623 pany SlAtZ f"-DL�LING C R F PL�C A i\J 7 7 C. R��C_-zified copy is hereby furnished. X11 9417 La.S TunaSDr I +=OPESS L 0 C A LITY Certified co-tiv is filed with she counr%,building insvection I ------------ 'JEARES7 department. XX Temple City -ROSS'ST. Date_AppLicant :)ISTR[ -ROUP YP� _6CESSEO BY C_ - I NEA _R 1 "C­`1 E Rosemead Yd CERTIFIC.A,TE OF EXEMPTIONFROM WORKERS- COMPCOMPENSATIONNSATION IN-SUR -E OEZCRjpTjON i OT NO. IC­LE) STATE 'AAJCP SECOND LOCA L (This section,need not be completed if the or� . -RAC� J involved NC. JF -3 LD G 5. . I, W :DI v :. ON L.OT SE -ONECONDITIONS by the permit is for one hundred-dollars (S 100) or ess.j ; -_ - !, I USE OF ;ZE T- -1 I certify that in the periormance of --he .cork :o. :his SOF 0BLDG. permit is issued. I shall not.emptov ariv oerson in any.marin, -Hann,. E.- OL buildinCr so as to become sublec- to the_Wl'rkers' Compensation. Lass. , N M.�i L CC P,�,M C Y C_F.C U P Date -kppiicant 7lCa[e )l _ E NOTICE TO .APPLICANT: If:after makingmakingmakingThis C,-r� 1 -!7 0 CC.i LCA D I i � E:;emptlon, you. should become suble'., :0 :!­,e Workrs provisions of the Labor Code. "'Ou `_n11Isz io .11- =:<;7 with colnoi-v with sura provisions or -,?is OeAli' iiaLl !-,e J.I Z GY N c -c°c. K,iovji. deemedcvoked. n C F ANC. :vs. E Z 7:C _x C [�Iev;ces LICENSED CONT R.kCT ORS DECLARAT'C1• hereby :farm I � 1 , 1icz s nc c . . SAFE—" FIE:R.-AIT 9 icommencim, ��,iih Se :on _000 :s- ,> >=_c V 1 1 rens and Pofessions Code. arLl 71.1%- x N eft.ec-. di 12 of business F�11!z ED License Number PAPER WONDERS INC. TIME'r-il I T E C- ME US Contrac.or Da.,-e am exeln- o: --on -he licensed archIL111_1 or a F acting Tny proressional -_F2 SIGN,: iriess and Professions Cod:). office space A FP FR C V A L_ Lic.or Re-— '14 o HO%IE Ok%NER431 �L-m I I 'IM rebv aft 'hat e.'�e,-1 T�1. 7: I he, 1. .- :. =. 1 '0 License Law for the Ing -,-_�son ness and Professions Code): 'ICP,RK!NG as owner Of 1 .7r0Z)0-71,'. ',�;H JCI 5t7UC7UrCIS iloz 1-nCl terGeOr 71044.-Bu s ine ss and Professions ocie). PR. CPCSZZ: J_3F_ OF EBU! 1 N C; CONSTRUCTION LENDING AG�L��C_', I hereby affiriii that -here is :2 for Eli, --rerforniance c Che kt07 it,::I "s -issued i Sec. 309'.Civ. C. Lender's Name =s P0'3 i Lender's Address 7�, FERN117 I certify fliat I have read this appiicauon and star: -,Iia: LI., 25 . 00 above information is-correct. I a2rec io comInv I-LII:III CoullISSUANCE ordinances and State taws relaltim to bull n, and herebv authorize.representatives ives )I* this CcLIrIl\ 7o ,ter I TOTAL. FEE 25 OD i upon bove-mentioned proper;%,for inspection Oil SEE_ REVERSE FOR E\?L.kNA-,ORV LA xx - -zh� NC C i2nature0rm Dart 0 WORKERS' COMPENSATION DECLARATION 76M 20-0063DPW'2/90 MISCELLANEOUS APPLICATION I hereby affirm that I havea certificate of consent to self COUNTY OF LOS ANGELES BUILDING>AND SAFE-T—Y—DIVISION - . l Iinsure,or a certificate of.Workers'Compensation Insurance, or a certified copy thereof (Sec. 380Q Lab. C.). — Policy No. Company FOR APPLICANT TO FILL IN BUILDING JrBUILDING ADDRffSS. - - y/- ADDREss �/ '_I G ❑ Certified copy,is hereby:furnished. X / T / a T /D LOCALITY 14 eL ❑ Certified copy is filed with the county building-inspection CITY tt�{ j / ZIP }^�+ ' department.• - /�I Ll.. Cir Y g/.,7.V 0 NEAREST CR055 ST. Date Applicant SIZE OF COT f NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY } CERTIFICATE OF EXEMPTION FROM WORKERS*. coNsr. C I COMPENSATION`INSURANCETRACT BLOCK LOT NO. MAP - HIGHWAY No. (CIRCLET STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL i by the permit is for one hundred dollars ($100) or'less.) USE ZONE [70NDITIONS C e p f I certify that in the performance.of the work for which this � j TEL�ZO _ /a��1 permit is issued,I shall not employ any person in any manner ADDRESS C ^71 / (� j aw. so as to become subject to the Workers' Compensation Laws. 9 7 TUNA �/ OCCUPANCY GROUP Date i3 O Applicant HC- W,4 0/1--/14 clTv_ ' NOTICE O APPLICANT: If; after making this Certificate` C C( T v/ ZIP �O of Exemption. you should become subject to the Workers' I APPLICATION FORM OCCUPANT LOAD Compensation provisions of theLaborCode.you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE[] GEOLOGY INSPECTION❑ 1. No Spec.Knowl. revoked. ❑ OCCUPANCY INSPECTION E)l Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 'I I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) ❑ t 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. .. ame O uslness r� �r /� G �T PARKING• REQ'D PROVIDED C� License Number Lic. Class PARKIN J i t i Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered .professional engineer FROM: To: f acting in my professional capacity (Section 7051,Business SIZE OF NO-OF INSPECTOR'S I and Professions Code). EXISTING BLDG.. STORIES- - SIGNATURE. Lic or Reg. NO. Date PRESENT USE OF BUILDING FINAL APPROVAL � ©C7 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, Business and d 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 7044,1 PROPOSED USE OF BUILDING Business and Professions Code). t r-F— 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 APPLICANT(PRINT) TEL NQ. Lender's Address 1, ADDRESS g(�/ I- -, �INL'a GX. I certify that I have read this application and state that the (✓1 Cwt T y a 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 above-mentioned property for inspection purposes. - -- 1 TOTAL FEE g SEE REVERSE FOR EXPLANATORY LANGUAGE Sienat of Permittee ate W- COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 9911020004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 6561 LT: 348 SQ. FT STORIES TYPE OCCUP GROUP 9417 LAS TUNAS DR STRUCTURE: 1 VN B TEMP CA 917802124 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OAK 8587-007-012 EXIST BLDG USE: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY EXIST OCC GRP: B USE ZONE: TENANT: ISSUED ON: PROCESSED BY: EXPIRES ON: UNITED HEALTH LABORATORIES, INC. BLDGS. NOW ON LOT: VALUATION: 11/02/99 UT 04/30/00 0 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: KO CHING-TSAN;CHEN S;HSEU FWU-LONG; - LIST ITEMS: 2400 ROARK OR I J ALHM 918034630 DESCRIPTION OF WORK INSPECT AND VERIFY PROPOSED OFFIC SPACE OCCUP LOAD EXIST: APPLICANT: TEL. NO: I OCCUP LOAD NEW: SAME AS OWNER (PARKING SPACES REQUIRED.: SPECIAL CONDITIONS: 1PARKING SPACES-PROVIDED: ;EXIT HARDWARE, C® CONTRACTOR: TEL. NO: ��/�� LIMITED TIME USE SAME AS OWNER - NBR OF EXI%TS: FROM TO LIC. NO /.' „ ,✓^�� FEES ��� RLP. ON_ QUANTITY:PUOM AMOUNT; APPROVALS DATE INSPECTOR SIGNATURE ARCHITECT OR ENGINEER: TEL. NO: // 1 L TRAILER USE N IOA PERMIJ ISSUANCE 27.75 LIC. NO: 101 R/M-OCC/.USE INSPECT 1111111 X145.95 SAFETY PERMIT IL TOTAL FEES 173.70 TEMP. STRUCT. APPROVED MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: liu 1n Q ��� �� /1 /J��n/J TEMP. STRUCT. REMOVED NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:-- IU ,"//\1"(/ lu^u5 iu�`� NO0 V J, i I� SCHOOL WITHIN HAZARDOUS ���`-,I AIR QUALITY: 1000 FEET MATERIALS N 0 El NO NO NO 0 REQUIRED TOTAL SETBACK FROM EXIST pI®A SET BACK YARD: HWY: PROP LINE: WIDTH: %%�, Vtl FRONT PL Service SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508