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HomeMy Public PortalAbout9449 LAS TUNAS DR_Miscellaneous__ • r E WORKERS'COMPENSATION DECLARATION CE 87575 (11-84) MISCELLANEOUS APPLICATION CE I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insu&, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby.furnished. U.ILDINESSG DDRLoc L r A Certified copy is filed with the county building inspection LOCALITY ��- ,� NEAREST department. CROSS ST. Date 'Applicant NEAREST DISTRICT N�j GROUP TYPE ' CESSED BY CROSS ST. /'^�1)y -� CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP RIGRWAY 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 d I 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 manner OWNER I q tZ 0rin uDr) y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADORES 'UU Date Applicant LU TEL' _ OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of clrY M- No. — cin 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 P RMIT E] (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING REQ'D PROVIDED SPACES License Number Lic. Class O 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 OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI E iness and Professions Code). FINAL APPROVAL Z �f PRESENT USE OF BUILDING Lic.or Reg.No. Date Inn HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I t! QI'I�ttt I hereby affirm that I am exempt from the Contractor's i License Law for the following reason (Section 7031.5, Busi- __. ness and Professions Code): NO. PARKING �I El1, as owner of the property, will do the work and the sPAces PROVIDED n 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 4rj for the performance of the work for which this permit is all C��Iq 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 the above-mentioned property for inspection purposes. � l `v -4 SEE REVERSE FOR EXPLANATORY LANGUAGE -Signature of Permittee �/ Date WORKERS'COMPENSATION DECLARATION ` 76M444 MISCELLANEOUS A P P L I C A T I O N c I hereby a certificate that I have a certificate of consent tself CE 875(11-84)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.). /I Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. UILDING �� f N�S LOCALITY D ADDRESS 7� Certified copy is filed with the county building inspection LOCALITY �7 / NEAREST department. T�`J�{-p�j�, r C]f! � CROSS ST. Date Applicant NEAREST yy DISTRICT NOyyyT-OTP E P CESSED BY CROSS ST. 7r- fre/ `D vNST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL !. 0 COMPENSATION INSURANCE DEscRIPTION 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.) ��jj,�� USE OF SIZE OF LOT , —P" �- EXISTING BLDG. d I certify that in the performance of the work for which this • �p o permit is issued, I shall not employ any person in any manner OWNER0�111 n�T/`l� Acct-tt, � s> so as to become subject to the Workers' Compensation Laws. MAIL ((��////�I- OCCUPANCY GROUP o ADDRESS �3 .l.T��, Date Applicant LU 01fGEL' p � OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. , /}- h3 -O�t�G C, 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 Exlrs ness and Professions Code, and my license is in full force and )' y effect. /mac PARKING SPACES REO'D � pROV ID ED • License Number Lic. Class N f �L LIMITED TIME USE Contractor Date DATE DATE FROM: TO: yY �I I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF P INSPECTOR S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. �yo �� STORIES j' _ AruRE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING �'� Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSJ. y - I hereby affirm that I am exempt from the Contractor's ON LOT AND USE License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ❑ 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ZS -Yy2�5 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See. 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMFENSATION DECLARATION 76M444 -CE 875 (2.80)- "[MISCELLANEOUS APPLICATION 1 hereby atTirrrz. that I have.a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of 1Norkers''Compensation Insurance,or 'a certified copy thereof`(Sec. 3800,Lab. C.) Policy No.'' Company FOR APPLICANTTO FILL IN BUILDING ADDRESS Certified copy is hereby furnis hed. BUILDING U• /T C� TUN±1/ {IV� LOCALITY ADDRESS l '1 ❑, Certified copy is filed with the county building inspection TY CROSS ST.NEAREST LOCALITY /^(" department. FiK� LE (� Date Applicant NEAREST DISTRICT NO. GROUP TYPE PR SED BY "- CROSS ST.' QA-r- - /{Q CON ST.� / - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL —� (/ DESCRIPTION LOT NO. BLOCK P } COMPENSATION INSURANCE" NO (cam CLE) , STATE`MAJOR SECOND LOCAL d NO. OF BLDGS., (This seetion need not be.completed if the work involved TRACT NOW ON LOT USE ZONE S PEC IAL-CONDITIONS 0 by the permit'is for one hundred dollars "(SI00).or less.) USE.OF - SIZE OF'LOT ` EXISTING BLDG'. I cerfify that in the performance of the work for which this r O ,permit is issued, I shall not employ,any person'in any manner OWNER LG i i�/ O�E�j rlEe�, so as to become subject to the Workers' Compensation'Laws.- 'MAIL T ^rt CE. OCCUPANCY GROUP 0 .. . A DRESS Date. Applicant' Ormsifte ZZ NOTICE TO-APPLICANT: If, after making this Certificate of CITY 5• N �L No�,2,j 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 C] GEOLOGY INSPECTION deemed revoked. ❑ NO Sp@C. KIIOwI. El LICENSED CONTRACTORS DECLARATION OCCUPANCY IivsPecrloN Panic D@VICBS I hereby affirm that I am licensed under provisions of ChapterSAFETY PERMIT q (LISTJTEMS-BELOW) a - 9 (commencing with Section 7000) of Division 3 of the Bust- No. of EXITS m ness'and Professions Code, and my license is-in full force and PARKING effect. /� q.. REQ'D PROVIDED . .. _ - (I •Q /VI��L 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 INSPECTOR'S _ acting in my professional capacity (Section 7051, B - EXISTING BLDG. STORIES SIG TURE PRESENT USE OF BUILDING mess and Professions Code). - r FINAL APPROVAL . r , Lic.or Reg.No. Date ✓ !/ HOME OWNER-BUILDER DECLARATION ON of AND USEEXISTING BUILDINGS O y ON.LOT AND USE `1 4.ITt3' l; _ .� s. I hereby affirm 'that, I am exempt from the Contractor's n U fVVV License Law for the following reason (Section.7031.5, Busi- '(,/' F� q S �'i ness and Professions Code): NO. PARKING SP C.0 ES PROVIDED r. I, as owner of the,property, will do the work and the' structuie is bot intended or offered for'sale (Section 7044, Business and Professions Code). - PROPOSED USE OF BUILDING' - CONSTRUCTION LENDING AGENCY I hereby affirm that there -is a construction lending agency for the performance of the work for.which this permit is - issued(Sec. 3097,Civ.C.). Lender's Name _ _ - PROPOSED MAX. OCC. .. - • - ` Lender's Address - PERMIT FEE • '. I certify that I have,read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State-laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the above.mentioned. property-fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE of Sign re of Permittee Date WORKERS COMPENSATION DECLARATION CE$75 (11-84) MISCELLANEOUS APPLICATION CE 875 1 hereby affirm that i have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN UDREss E] Certified copy is hereby furnished. BUILDING ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST, Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY P CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGA!- COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD65. (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. 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 OCCUPANCY GROUP Li ADDRESS - >_ Date Applicant Q TEL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. C!) Exemption, you should become subject to the Workers' a Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be �— deemed revoked. TRAILER USE ❑ GEOLOGY INSPECTION EJNo Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION [] Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW.) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'D PROVIDED SPACES 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 SIGNATURE iness and Professions Code). FINAL. APPROVAL PRESENT USE OF BUILDING ic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE ;i.. ereby affirm that I am exempt from the Contractor's ense Law for the following reason (Section 7031.5, Busi- s and Professions Code): No. PARKING t� I, as owner of the property, will do the work and the SPACES PROVIDED E•� U' L str&cture is not intended or offered for sale (Section 7044,Business and Professions Code). j1�,..f.t�Ftt� _. ..•. .'1 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING eby affirm that there is a construction lending agency e performance of the work for which this permit is (Seo. 3097,Civ.C.). ) s Name PROPOSED MAX. OCC. s Address PERMIT FEE that I have read this application and state that the ormation is correct. I agree to comply with all County ISSUANCE FEE s and State laws relating to building construction, y authorize representatives of this County to enter TOTAL, FEE bove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date 'WORKERS'COMPENSATION DECLARATION CE 675 (11-84) MISCELLANEOUS APPLICATION CE 875 C.� ) I hereby'affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION IjLJI` insure.; or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR ADDRE APPLICANTTO FILL IN G ADDRESS Certified copy is hereby furnished. uIDLDRESS ING ,`[l t/ s r LOCALIT AD Certified copy is filed with the county building inspection LOCALITYNEAREST department. t CROSS ST. Date Applicant NEAREST DISTRICT NpO, G UP TYPE P CESSED BY CROSS ST. DU - �f CONS _ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL , COMPENSATION INSURANCE DESCRIPTION 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 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 so as to become subject to the Workers' Compensation Laws. MAIL �� C. rO I OCCUPANCY GROUP a ADDRESS S33 ''"" Date Applicant �`�, NOTICE TO APPLICANT: If, after making this Certificate of CITY o- 01 rvo� D. 3- 8 OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ 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) a 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 _NITm ,q�/ j n effect. O PARKING REQ'D PROVIDED a. License Number Lic. Class O r SPACES LIMITED TIME USE Contractor Date DATE DATE 0 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: TO: INSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date GV P, 1 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS }� ON LOT AND USE �(/ (/, IBJ_,4_l!t-S I_I?_;� if.�_. +•.' C. 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency1Q o ;vir, S ore SeAlinq for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). r to e�r hod<e. . 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 Ad upon t above-mentioned pr perty for inspection purposes. 4CLZ 106 SEE REVERSE FCK EXPLANATORY LANGUAGE, Signature of Per ittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm crt that I Have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING (/ as ADDRESS �, LOCALITY 7 0 Certified copy is filed with the county building inspection LOCALITY � NEAREST � department. � f CROSS ST. Date Applicant NEARESTDIrS CT NO. G$$$QQQUP TYPE t O ESSED BY CROSS ST. I / CONSy�/" 1 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL •�/) �/` COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP /HIGHWAY NO./.0$"V_24-5 (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 EXISTING BLDG. permit is issued, I shall not employ person in any manner p P Y an Y P OWNER &14613M`( P so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP- o Date Applicant ADDRESS 1��oZ 3eY k e - , W cs C ' L TEL. OCCUPANT LOAD tI NOTICE TO APPLICANT: If, after making this Certificate of clrY �Y1�C� mU�l C NO. (j ! y Exemption, you should become subject to the Workers' " Compensation provisions of the Labor Code,you must forth APPLICATION FOR i3 -16-� XIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REq'D D PROVIDED D License Number Lie. 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 OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING AkwI HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 66 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- -T ness and Professions Code): NO. PARKING FEE 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). V27 `8 Ii � Q,�� _ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ��-CJ�Y� -' ;-; L•°;.c .v i uE eaL3.! I hereby affirm that there is a construction lending agency _l_I 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 DO �\ 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, "gip and hereby authorize representatives of this County to enter TOTAL. FEE L� upon the above-mentioned property for inspection purpos S. �©`� / 3 i� SEE REVERSE FOR EXPLANATORY LANGUAGE // Signature of Permitt Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'fl insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BUILDING pr ADDRESS I Certified copy is hereby furnished. BADDUIESS LDING `•�;, j vN LOCALITY R �gf 0 Certified copy is filed with the county building inspection LOCALITY -/V NEAREST department. �/� l z `i�! CROSS ST. Date Applicant NEARESTD01S I NQTYPE P O E55 D BY CROSS ST. 0/�^vf� SY (J{/{/ ./l) CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR COND 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 SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner OWNER 'a vu6-` 7.z 5 so as to become subject to the Workers' Compensation Laws. ) OCCUPANCY GROUP MAIL ADDRESS f QJ. C-3 DateApplicant W NOTICE TO APPLICANT: If, after making this Certificate of CITY A ,!t ONle NE�J3 �Qa2 3 j V OCCUPANT LOAD o_ Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION SirPanic 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 �i +/� C effect. L / / FPARINGES REq'D D PROVIDED D License Number Lic. Class al'LS ¢ LIMITED TIME USE Contractor Date DATE DATE EJ �/yA) FOM: : I am exempt from the licensing requirements as I am a �"/��/ W RTO licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS 11 acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING �/�Cff�/ FINAL APPROVAL � O Lic.or Reg.No. Date v ngp,', I 1�� HOME OWNER-BUILDER DECLARATION y NO. OF EXISTING BUILDINGS ' C •J91. PeE'—' 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- 1313130-0 001 R/11/89 ness and Professions Code): NO. PARKING 0 1, as owner of the property, will do the work and the SPACES PROVIDED - : 74-01 1 AM ��:'4 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 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.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 b upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE D— Sig atu e of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I'SC E L LA N EO U S APPLICATION JJJ��� 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 s certified copy thereof(Sec. 3800,Lab.C.). Policy No.—Company FOR APPLICANT TO FILL IN BUILDING ,e /} ADDRESS (� FICertified copy is hereby furnished. ILDING 4 �rr�� LOCALITY ADDRESS �(�� EJ Certified copy is filed with the county building inspection oCALIT NEAREST department. / �' CROSS ST. Date Applicant NEAREST ,! DISTRICT NO., UP TYPE PROCESSED BY CROSS ST. �V� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR 5 D 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 EXISTING BLDG. O permit is issued,I shall not employ any person in any manner OWNER /*V/V/t/4�f ,q�,r� C' so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY'GROUPo Date,/ �--+ Applican ( ADDRESS33 NOTICE TO APPLICANT: If, aft making this Certifica of CIT 0/1/> No� SG� OCCUPANT LOAD Exemption, you should become subject to the Work APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions oI 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 PERMI ❑ (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 D SPACES 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUIL ING h7:?V A LL .,/ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 1 # 6 - 88 ON LOT AND USE �Y V � 6a'4 I hereby affirm that I am exempt from the Contractor's 0 0 0 0 0 0 o In License Law for the following reason (Section 7031.5, Busi `/ t ness and Professions Code): NO. PARKING Q Q.Q 8 8 I, as owner of the property, will do the work and the SPACES PROVIDED ,�r��� �.• �^� structure is not intended or offered for sale (Section r"`f' /-,A� 7044,Business and Professions Code). a CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING v 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.). � t E Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE01 I certify that I have read this application and state that the L(IO�V ove information is correct. I agree to comply with all County ISSUANCE FEE r ances and State laws relating to building construction, j d.hereby authorize representatives of this County to enter TOTAL. FEE �' © �\ p n the abo ve-me ti ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date \\t)Rhi:RS' • Q`.IPE\iS,\PIOv DFCL.\R.\f10?: 75�tnaa MISCELLANEOUS APPLICATION I 1 I herebyCE 975 I t Sal affirm that I have a certificate of consent to sett COUNTY OF LOS .-ANGELES.. BUILDING AND SAFETY DIVISION ' utsure. or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILD �Nc ❑ ADD. ss 7/ Certified opy is hereby furnished. % BUILDING ADDRESS / LOCALITY 1 Certified copy is filed with the county buildine inspection % LOCALITY NEAREST department. CROSS ST. NEAREST Date Applicant ...___-___.___-.-___-_____. OISTRI T NO. �Zl JTY�kP CESSED 9V CROSS ST. / cCOI II IC.�fi:l)F E CE}II'fIUN f RU?I t%ORI:ERS LEGAL ! COMPENISAFION INSLR,\',CE OE SCR IPTION LOT NO. BLOCK '•,� fCIRCLC) STATE MAJOR SECOND LOCAL NO. OF SLOGS. IT his section need not he completed If the '.Fork involved TRACT NOW ON LOT USE :ONE SPECIAL CONOIT IONS by the permit is Inr -me hundred dollars IS1001 or less.) uSE DF SIZE OF LOT EXISTING SLOG. I _ratify that in 'he ll not a 'hr rson .'o: •.chick Itis permit is issued, i ;hall nut employ any person in ati manner O•.yNER (� so as to become :uhie o the '.�'nrkers' Compensation Lams. % •AF1L r CCCI;PaNCY GROUP ADDRESSv7,9 !� U ��r. 2 1 % v _ —=-�-r-- E n I"ll �!� 1 OCCUPANT LOAD NOfiCE ftp :aPPL1C.)NT: If, .iter mak nc :his ;;Attu irate of c1- �.� NO. V - Exemption, you should become subject ro :he Workers' Compensation procislrns of the Labor Code. -c)u must forth- APPLICATION FOR 17 HARCWARE cith tnrnnl`: ill: _I:_'1 t•ncistons `r i u tr:ni; ;imil he — _ellll'll "R:-IL_.R 'JSEiEO LJ GY IN SP�-._-• :,N _ tslo Spec. Knoavl. LICENSED CW: TR.aCFORS DEC L.W.i,T10'; occ7PA:,CY INSPECTION B Panic Devices I hereby affirm :hat I am licensed under prot'IsiCns oC Chaotti SAFETY PERMIT 1 LIST ITEMS 3E LOlV! 9 (commencing `•yith Section 1000) of Division 3 of the Busi- I NO. OF EXITS ness and Prttfessions Cade. and my license is in .`till :'orce rind is lel:t. - ?PARKING _1.SPACES REO J PROVIDED �� License liuntber _ Lic. Cass LIMITED TIME USE t_Jnr- ctor - n I :In 'n1Ct iilaltlle :hell Sillg ;rUll lrCatrnCi is i 1I:1 J licensed Jrc!utec: or :l re^_istel"'d rntessiomil .nci r_,cr zE DF „o. of NSPE CTOR S ? _,cz;tg in :,n nrwe,sional .:aDat::I \e1::ion I 311.1- =!'(IST::IG 3LO G. --DRIES SIGNATURE mess and P701eSSMIS(.Jde I. —_- ------ E;E',T 'ISE OF 3UILOING FINAL APPROVAL Lic.or Rc_. No___ - I IiO')IE O))NFR-I ALDER DE('L.aR.,,NWI NO. OF EXISTING BUILDINGS ON LOT AND I hereby affirm :flat i .un exempt -nm :Ile Contractor; n l License La,.y for :he :ollun in reason Se.:iun -')_I._. 3u,i- v ness 'Ind P'otessions Code): NO. PARKING - ;PACES �ROVIDEO I, as ,-,%knrr of :he omperrc. will du die cors: and lie structure is not Intended ur offered aie Sr ;fen Buiine::sand Ptofessionst .)del. % PROPOSED 'JSE OF BUILDING t:ONST!tl CTiO\ LENDING .kt.;E�t"l I herebc affirm that :here is a construction lending :vent: for the performance of the work tor which this permit is issued [Sec. 300-,Cit'.C.I. Lender i N:nnc --- — t PROPOSED MAX. OCG. p Lendcr i .\ddress—_ H I PERMIT FEE 25.00 ry� I certify that l Race read this application and ;tate 1iiit the above information is correct. I agree to comply%%ah all County ISSUANCE FEE ordinances and State lairs relation to building construction. :Crtl hereby a lorize eprewntat.lv'es of this Count' to enter TOTAL FEE 25.00 •YI I opo t t e:bt v n nt re pop ) f inspects n pito u' SEE REVERSE FOR EXPLANATORY LANGUAGE ;,�} i WORKERS' COMPENSATION DECL.IRAT10` CE 875 17 184i• - MISCELLANEOUS APPLICATION CE 975 Hereby affirm that I have a certificate of consent to self insure. or a certificate of Workers'Compensation Insurance,or , a certified copy thereof(Sec. 3800,Lab.CJ. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDADDR S�NsG �`�,/C� / 7 7 Certified copy is hereby furnished. XBUILDING �1 / � �� ADDRESS !fl L� j LOCALITY { Certified copy is filed with the countv building inspection X LOCALIT j/� NEAREST department. 2,e- ,1 I CROSS ST. Date .applicant NEAREST DISTRICT NO, GROUP TYPE ESSED S CROSS ST. - - "!D� CONST i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK vw .Gww wv NOv (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLOCS. (This section need not he completed If (he work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ISI110) or less.) USE ' '� SIZE OF LOT [ certify that in '.he per •I urmance of the or,, 'o: �vhich 'his EXISTTI NG BLO G. permit is issued, [ shall ❑uf employ any pe^on in any manner g OWNER so as to become �ubjec: -.o the '.Porkers' Compensation Laws. MAIL .Ty OCCUPANCY GROUP ADDRESS ' ! T U ' cN Date p aprlicant X NOTICE TO APPLICANT: If, atter making :his Ce~° icate of CITY /� v ��� �!� OCCUPaNT LOAD Exemption, you should become subject -o the Porkers APPLICATION FOR EXIT HARCWARE. Compensation Drovisiens of the Labor Code. •ou must forth- ! with*comp[} 't ith <Ucii provisions .'r :i:ns :e:mi( ;hail l,e r deemed revoked. 'RAIL=R 'JSE GEOLOGY INSPECTION ILIO Spec. KnOWI, LICENSED I:ONTRAC"CORS DECL RATION OCCJPANCY INSPECTION B Panic Devices I hereby at'irm :hat 11m licensed under provisions of Chapter a 9 (commencine with Section /0001 of Division J UI the Bust- SAFETY PERMIT '(LIST ITFMS 9E Low) NO. OF EXITS ness and Professions Code. and my license is in 'Lill :urce and effect. PARKINGREO'D lel n SPACES PROVIDED License Number_ Lic. Class LIMITED TIME USE ContractorDat'..' _ DwTE DN TE I Em e,.empr (cont 'he licensing eyuirements :s i am 1 I� I INSPECTORS licensed arcltirec: Lir :7 re^_iste:ed �rniessiunal :n_tneer ;IZE OF >,o. OF ? acting in .,t%, pruie;sional :apaC;V. section _;ifl. 1311.6- -XIST::IG 3L=G. STCRIES SIGNATURE inessand ProfessiunsCudet. — — (FINAL APPROVAL LI14-20-'re I;. Ur Rcz. N,1 �RESE`IT 'ISE OF 3UILDING--_ D:Itc _ IiO\IE OWNER-BUILDER DECLAR.>,I[ON No. OF EXISTING BUILDINGS �a oQ�a ON LOT .AND USE I hereby affirm :liar i .Int exempt i:nm :he Conrractor', _{WE ( License Law for the io Mowing :e:ison !Se fun -03I.:. BU,i j'fj X. { j ness and ProfessionsCode): NO. PARKING !i'-44 ❑ SPACES �ROVIDEO 1, as owner Lit :he property. will do the cork Ind :he structure is ;tor intended Lir offered (qtr :aie Section 704.1. Business and Processions(-odea. R PROPOSED 'JSE OF BUILDING CONSTRUCTION 1_LNDING.IC;ENC'l I hereby affirm that dtere is a construction lending a=ene 1 for the performance of the work fur which dtis permit is issued (Sec. 309 CiV.i.(. Lender'i Name PROPOSED MAX. OCC. Lender's Address 25.00 { - PERMIT FEE I certify dint I have read this application and stare ihut fl-.e above information is correct. I agree to comply',vith all County ISSUANCE FEE ord"utances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 (--u—ponilie above-mentionedp rtl• for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I WORKERS'CONIPLNSATIO�4 DtCL.\R:\rloN CE 87 4 ;�� I�CELLANEOU:� APPLICATION. ce s�5 11 a4I �^ Ihe-, by affirm that I have a certificate of consent to self .;sure. or acertiticateof\Porkers'Compensation Insurance.or COUNTY OF LOS ANGELES BUILDING .-IND S.kFETY DIVISION �( a certified copy thereotiSec.'_800. Lab.C.I. 4 Policy No._ -l=itnpan}'-- BUILDING APPLICANT TO FILL IN BUILDING BU DRESS Certified copy is hereby furnished' �• aooR ess LAS V A•5 LOCALITY /R n I E Certified ,:opy is tiled\cith the count\ limiding inspection NI:AR EST LOCALITY department. Temple City CROSS ST. Date---Aor,ltcant NEAREST DISTRICT N GR P TOP CESSED BY CROSS ST. o� CONST CERrI'FIC-ITE OF L\E\iPTIO\ FRO\I '\"CRI:ER5 LEGA4 ! COMPENSATION (NSI.R.\N( !_ DESCPIPT!ON LOT NO. BLOCK Ov (CCR STATE MAJOR SECOND LOCAL NO. OF BLDG S. [This section need not he -omplered if the cork involved I TRAC' NOIN ON LOT r5ETONE 'SPECIAL CONDITIONS by the permit is for one hundred dollars iS1001 or less.) 1� USE of SIZE OF LOT I EXISTING BLDG. ! I ertify that in ;he nerfnr[nance of lie .,.o;1. 'c •%Lich '.his Operty ---� -_ permit is issued. I ;Hall :totlanInc-son W/77:n-in,* manner o'vNER S��/,Qi9 D so as to hecome ;ul>icct 'n the the `.\orkers• C�nint:lensation Lacs. � � OCCUPANC" 3ROl.'P I - •na1L L /J AD OR --r.i'�/l I Date __ \pnlic - 11� - TEL. NOTICE T[) APPLICANT:: if, III-.Or rnakim= :is '�'�r.�icare �[ .�cr. � ao.,r'� 3 ��o'�-?" OCCUP^.u- L0 Exemption. %ou ;iiould belome ;ubiect 'o 'he \.... _ Compensation ^ro'.isions of the Labor . .lde %ou mus[ rorh_ 1 AP°L'CA71 CN = �� fat I l\-Ith com:w. •all)[ .tiih :lrl)1't\,n= "ilk "crnlir shall lie -R A;L=? 'J,E +EO LJ GY I--^ deemed ,e - - Stec. '<ne'.'.i. Eli ?:\SLD CON,i R.\CTORS Dr_;L.xR.�TIt)`: JCC'JPANC'f INSPEc-1oN gg n31110 2`i'Ce5 _ I hereby affirm :fiat l Itin licensed under oro\isions of(Aacter SAFETY PERMIT (LIST ITEMS 3F_LO-1) u I 9 IconnrCM111g %%id) Section '0041 of Division : . i:he Buri- - NO. OF EXITS ness :Ind P-,fcssiln, I.odcind nlc livens% i 11 :ml il,rce and --"T- - PARKING �I ! CIIect. -PACES REO'D L PR C'J ID ED I � 11��.. LLL.. JJJJ License \umber-- -_-_-- Lic. Cla>,_-- _--- LIMITED TIME USE W Contractc,r - -- I):ue W Z ❑ - lam exempt con the :icrnsinL requirements :is I and .l - m I licensed archirect or s re^isiered n-niessional rngineer ?IZE OF I No. J- ,sPE CTOR S i z actin' in :n\' prcf•_s:iunal :r: it} ":;lila :I Bus- ZXISTIv:. SLC.. s77)21. -- v A - - -- -------------- ---- sl R -=1Iei�IC I1\t od,,,- U "RE_ENT USE OF 3UILDING �FiN A L opRO 1\ 4 L Lic-or 11WIL 0\1N'i R-BIALDFR NO. OF EXISTING BUILDINGS /Yyt' g [• ON LOT AND USE G+ 1':lE"S 3!i_ .-�-.. ( hereby .Irian that ( :uu exemptiron[ the Contractors License La\v for the following reason 'Section -111.5. Busi- ness and Professions Code): No. PARKING 1 1, as .,k%ner of the property, \%Ill do the work and till` SPACES PROVIDED --- struc:ure is not intended or offered for :ale (Section I 7444. liusines and Professions code). CONST RUC11ON LENDING AGIFNC PROPOSED USE OF BUILDING - s hereby affirm that there is a construction lending ,--envy for the performance of the .cork- for nhich this permit is issued I See, 309'.Civ.C.1. Lender's Name- Lender's ene - - —"-- ------- --- PROPOSED MAX. OCC. Lender's.Address--- _ 1 I certify that l have read this application and ;tate that the PERMIT FEE 25.00 above information is correct. I agree to comply\vith all County ISSUANCE FEE ordinances and State lays relating to building construction. and hereby authorize representatives of this County to enter TOTAL FEE 2500 upon the above-menti ned p�nsper/tion purpGoJses. " Cv1C/ /url 9 SEL REVERSE FOR EXPLANATORY LANGUAGE I — t ' Siena[ of Permittee Date WORKERS'COMPENSATION DECLARATION 8a> CE 875 (11-84) MB S C— `RN EO U S APPLICATION 1 hereby affirm that l have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or - W.17 kI 1 'I a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BL7 ILD ING �, AC-DRESS Certified copy is hereby furnished. X BUILDING ADDRESS LOCALITY I FCertified copy is filed with the county building inspection LOCALITYTeNEAREST department. mple City CROSS ST. Date Applicant NEAREST DISTRyCT NO. GR p TYPE OCESSED BY CROSS ST. D�/ CO CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL / a COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD GS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE =CONDITIONS by the permit is for one hundred dollars (S100) or less.) 4vusE OF I SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which thisUFc;2. ) ��� permit is issued, I shall not employ any person in any manner OWNER Uf}h! � M O so as to become subject to the Workers' Compensation Latvs. MAIL OCCUPANCY GROUP I Date Applicant ADDRESS ZZs T�n1is Or NOTICE TO APPLICANT: If, after making this Certificate of X CITYj TEL. OCCUPANT LOAD = Exemption, you should become subject to the Workers IAp LIGATION FOR .XI T HARDWARE: —' Compensation provisions of the Labor Code, you must forth . 1 with comply with such provisions or this permit shall be TRAILEP. USE 1 GEOLOGY INSPEC-ION _ p r deemed revoked. — No Spec. Knows. IJ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION� Panic Devices ( i 7. 1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT — LIST ITEMS 3E LO't:) 9 (commencing with Section .0001 of Division 3 of the Busi- No. OF EXITS n ness and Professions Code. and my license is in full force and effect. PARKINGI L� n SPACE_ 4E0'D ' PROVIDED I License `umber Lic. Class 2� LIMITED TIME USE Contractor Date /��� n Are DATE L I am exempt from the iieensine -eauirements as I am ,�iu� To: i licensed architect or a MNSIered nroiessional en_inee: ,rE of i NO. 0= INSPECTOR'S z acting in m> professional capacitl :Se,_ion 7051. Bus- EXISTING BLDG. STORIES // SI NATURE I z iness and Professions Lode). FINAL APPROVAL � PRESENT USE OF BUILDING Lic. or Ree. No. Date - I HOME OWNER-BUILDER DECLARAT"ON NO. OF EXISTING BUILDINGS ON LOT AND USE 1 hereby affirm that I am exempt :rem the Contractors I VI n ''">r�iii-••t"y"ii F =..•- ;=.!"`, i i I License Law for the followina reason ISection 7031.5, BUsi ness and Professions Code isNo. 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 X PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency ih i ) 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 25'00 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and herebv authorize represe atives of this County to enter TOTAL FEE 25.00 t. f upo a above-mentioned p o erty for-nspection urposes. 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perms ee Date (.. 1 1 WORKERS' COMPENSATION DECLARATION 2tiM444 PW 12/90 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING:.AND SAFETY DIVISION insure,or a certificate of;Wdrkers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab.C.)'" - - Policy•No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADORE SS ADDRESS El copy.is hereby:furnished. X f D,—. LOCALITY El Certified copy is filed with the county building inspection CITY ZIP department. NEAREST CROSS ST. Date Applicant SIZE OF LOT O.OF BLDGS. OW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' O CONST. TRACT OCK LOT NO. MAP HIGHWAY 0 i COMPENSATION INSURANCE NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL IW i by the permit is for one hundred dollars ($100) or less.) usE zoNE SPECIAL CONDITIONS I certify that in the performance.of the work for which this rrIerfy e T L o °— permit is issued. I shall not employ any person in any manner � 55a W so as to become subject to the Workers' Compensation Laws. ADOREs OCCUPANCY GROUP Date Applicant . CITY NOTICE TO APPLICANT: If; after making this Certificate -� G� ZIP(•, f 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. Elrevoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[k Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) I 1 9(commencing with Section 7000)of Division 3 of the Business ame o Business NO.OF EXITS .. and Professions Code,and my license is in full force and effect. ic. Class PARKING REQ'D E= PROVIDED i License Number L7� 7�G SPACES i Contractor Date LIMITED TIME USE ElI anexempt from the licensing requirements as I am a DATE DATE FROM: TO: licensed architect or a registered professional engineer acting in my professional capacity(Section 7051,Business SIZE OF IN BLDG. STOR ES S E T I URE. and Professions Code). PRESENT USE OF BUILDING //O? Lic. or Reg. No. Date FINAL APPROVAL 7 HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS j ON LOT AND USE ' v 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 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). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 4 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). PROPOSED MAX.OCG Lender's Name APPLICANT(PRINT) " TEL NO. Lender's Address ADDRESS T !� I certify that I have read this application and state that the y y r l 72,,, o Pr C uj above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize presentatives of this County to enter upon ISSUANCE FEE the above-menti d prope y for inspection purposes. . I ! .I TOTAL FEE X A Ilia I b 17 SEE REVERSE FOR EXPLANATORY LANGUAGE 7 azure of Per tree D.te {. I WORKERS' COMPENSATION DECLARATION 20-0063DPW12/90 MISCELLANEOUS APPLICATION I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES BUILDING;AND SAFETY DIVISION -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 BUILDING ADDRESS ADDRESS - ❑ Certified copy.is.hereby:furnished. (,w Y• LOCALITY ❑ Certified copy is filed with the county building inspecti c-TY Zip �`� a ( ' department. NEAREST CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' TRACToc LOT NO. I COMPENSATION INSURANCE MAP - HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL usE zoNESPECIAL CONDITIONS i by the permit is for one hundred dollars ($100) or less.) I certify that in the performance.of the work for which t s rpi�rfy er TEL NO. permit is issued:'I shall not employ any person in any mann 2 1 so as to become subject to the Workers' Compensation Laws. ADDRESS tvqr, 144OCCUPANCY GROUP ! { Date Applicant . CITY IP NOTICE TO APPLICANT: If. after making this Certificate ` �D 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 of this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[� Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a { ) 9(commencing with Section 7000)of Division 3 of the Busine 3tIIe o Business NO.OF EXITS and Professions Code,and my license is in full force and effe !• . PARKING• REO'D1 I PROVIDED L I i License Number Lic. Class C) SPACES L�� JJJ __ 11 Contractor Date LIMITED TIME USE i ElI am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer FROM: TO: n acting in my professional capacity(Section 7051, Business SIZE OF NO.OF INSPECTORS and PIOfe$$lOn$ Code). EXISTING BLDG. STORIES SIGNATURE, Lic. or Reg. No. Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS I 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 SPACES PROVIDED ❑ I. as owner of the property, will do the work and t structure is not intended or offered for sale(Section 70}1 ROPOSED USE OF BUILDING i Business and Professions Code). CONSTRUCTION LENDING AGENCY' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( I (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINT) EL NO. S s�tt3 Lender's Address DDR(s { I certify that I have read this application and state that the a'Ga�v►' ¢� �,, Z above information is correct. I agree to comply with all County pERM1T FEE ordinances and State laws relating to building construction,and -. hereby authorize representatives.of this County to enter upon ISSUANCE FEE the above-mentioned pro rty for inspection purposes. .' '` I '• TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o1111ennittee Date L !1