Loading...
HomeMy Public PortalAbout9459-9473 LAS TUNAS DR_Miscellaneous__ 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 BUILDINGADDRESS { FICertified copy y is hereby furnished. BUILDING f^ y ADDRESS LOCALITY TLt-4 f r , Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT NQ. GROUP TYPE / PROC'€SSED BY CROSS ST. CONST, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF HLDGS. (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 LOTEXISTING BLDG. CD 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 I-I so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS r D Applicant Q L. NOTICE TO APPLICANT: If, after making this Certificate of CITY TNO. 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ 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. PARKING REQ�D E== PROVIDED D SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE E] I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineerSIZE of NO. OF NSPECTORS SIGNATURE acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING ' Lie.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 ElI, as owner of the property, will do the work and the SPACES PROVIDED r structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name { PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the 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 upon1he above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perinit�ee Date I _ WORKERS'COMPENSATION DECLARATION 76M4 11 A CE 875(2-80) MISCELLANEOUS APPLICATION I hczeby affirm. that I have a certificate of consent to self COUNT'Y'OF. LOS�ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec:3800,Lab.,C.) BUILDING Policy No. Company FOR.APPLICANT TO FILL IN ADDREss /7 r///r �J C� Certified coy i p s hereby furnished. UILDING _ /q 410 ADDRESSLoi LOCALITY 0 Certified copy is,filed with'the county building inspection NEAREST department. LocwLlTv ✓ CROSS ST. Date Applicant" EAR EST DISTRICT NO, G OUP TYPE 1PR ESSED BY CROSS ST'. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL > CONS COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP 'HIGHWAY } NO. (CIRCLE) STATE MAJOR SECOND LOCpL d 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) o"r.lesS.) USE of V SIZE OFLOT EXISTING BLD . ./ 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 o NER so as to become subject to the Workers,Compensation Law AIL '—OCCUPANCY GROUP W .' - i DDRESS - Date - Applicant TEL. ] NOTICE TO APPLICANT: If, after making this Certificate o TY NO �L 0 ��Q� OCCUPANT LOAD z Exemption, you should become subject to, the Worke ' Compensation provisions of the Labor Code,you must forth- with FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ ❑ No Spec. Knowl. ❑ deemed revoked Panic Devices LICENSED CONTRACTORS DECLARATION occuvpNCY 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 effect. PARKING REq.D PROVIDED ' SPACES �� License Number Lic. Class a LIMITED TIME USE Contractor Date ' DATE DATE OFROM: 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 Si URE iness and Professions Code). , j FINAL APPROVAL PRESENT USE OF BUILDING, �/ - fJ J I Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSr�� - 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- 1`i i i ness and Professions Code):, NO. PARKING _ _ SPACES PROVIDED _ ❑ I, as owner of the property, will do the work and the" he structure is, not intended or offered for sale.(Section 7044, Business and Professions Code). ROPOSED USE OF BUILDING a - CONSTRUCTION LENDING AGENCY _•L - �J /� O I hereby affirm"that there is a construction lending agency for' the performance of the work for which this permit is.- issued s issued(Sec. 3097,Civ.C.). Lender's Name '' PROPOSEDM AX. 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. ordinanc s and State laws relating to building construction, � and y auth riz repre ntatives of this County to enter TOTAL Fee. J,O� on above- e ion roperty for inspecti n purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE i a Pe ittee Date T ' WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereto affirm that i have a certificate of consent tself' COUNTY OF LOS ANGELES BUILDING AND SAFETY IVISION 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 co is hereby furnished. BU' LDwG copy y ADDRESS S (, LOCALITY Certified copy is filed with the county building inspection LOCALITYNEAREST department. ( 7 7 0 CROSS ST. .Date Applicant NEAREST DISTRICT NO. GROUP. TYPE P C SED BY CROSS ST. I/r, CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' U ti V LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP NO./ �JiI�' (C IRCLEI 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 slzE of Lor EXISTING BLDG. 0 permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. l p MAIL L OCCUPANCJAJ 4401 Ll 16 Y GROUP ;. ;� a ADDRESS. k^>' r. _ �'�\ I U Date Applicant - LSI NOTICE TO APPLICANT: If, after making this Certificate of cITY ,y rTro 0onc_C : 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 USEGEOLOGY INSPECTION ❑ ❑ E] No Spec. Knowl, deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 0- 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 PROVIDED SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE F.I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: To: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). IL ) FINAL APPROVAL 0 PRESENT USE OF. BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS Lam= =E ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, BUST E..i 8t'-h ail ness and Professions Code): NO. PARKING i -i ter SPACES PROVIDED I, as owner of the property, will do the work and the `W==��' � �`•s='°�I' structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address O Q 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, OD and hereby authorize representatives of this County to enter TOTAL FEE u n the above-mentioned property for inspection purposes. L EE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) M I.. /%-„,ELLANEOUS APPLICATION I hereby affirm that i have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND-kAFETY IVISION insure, or a certificate of Workers'Compensation Insurance, e,or ”, ,. a certified copy thereof(Sec. 3800,Lab.Q. bt' G �� Policy No. Company FOR APPLICANT TO�-I LL IN BUILDING a /QAC ADDRESS FlCertified copy is hereby furnished. BUILDING ADDRESS EJ Certified copy is filed with the county'building inspection LOCALITY NEAREST department: CROSS ST. Date Applicant NEAREST' 01l� I DISTRICT NO. GROUP- TYPE - CESSED BY CROSS ST. ` - -� n -� CONST. CERTIFICATE OF EXEMPTION,FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL • _ NO. OF BLDGS.- (This sec"tion '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)r or less.) USE OF f / 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 subjectr to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a ADDRESS - ` Date Applicant uW-1 NOTICE TO APPLICANT: If, after making this Certificate of CITY No ' C �3 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 oI this permit shall be TRAILER USE E] - GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION %occuvwNCY wsPEcrloNy 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 D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE . DATE FROM: TO: I am exempt from the licensing requirements as.I am a licensed architect or a registered-professional'engineer SIZE OF NO. OF _ __INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIESslcNwruRE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT.USE OF BUILDIN ~ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE - - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED J structure is not intended or offered for sale (Section 7044,Business and Professions,Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of.the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address 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 u on the above-mentioned'property for inspection purposes. .SEE REVERSE FOR EXPLANATORY LANGUAGE . Signature of Permittee Date WlrJRKERS'COMPENSATION,DECLARATION 76M444' - p p CE 875 (2-801. . WISC'.EL'LANEOUS. APPLICATION - Tiliereby.^affirm that 1have certificate of consent to self COUNTY OF L®S.ANGELES BUILDING AND.,SAFETY DIVISION �. ins.dre, or a*certificate of Workers'Compensation Insurance,�or , '.a cer,tified.copy:thereof(Sec, 3800;'Lab;•C:) Policy No: Company FOR'APPLICANT-TO FILL IN wooaEss7' N /�'" , "❑ Certified co is hereby furnished. BUILDING " ". Py Y LOCALITY - " A RESS _ D ' 94W61 WCs ❑ _ - - - Certified copy,is.filed with the county building inspection NEwg Eiee eT, LO ALITY { department. {/1} ,. CROSS ST, Date Applicant Y FOREST"Oak DISTRICT GF{,QUP TYPE' PR SED`B CROSS ST.' _ •� ,/J✓�7 CONST CERTIFICATE OF EXEMPTION FROM WORKERS ,. —LEGAL r COMPENSATION INSURANCE BCocic MaP ;I�rw^j E'MAJOR s.Eco D'LocaL DESCRIPTION LOT No. -• /)� }, -. "k. - NO..OF BLDGS. CIRCLE S (This section need not.be completed if"the work 1nVOlved TRACT NOW F. LD UsE ZONE, PECIA'L CONDITIONS , 'T O` by the permit is 'for one, hundred dollars',($100) or les`s.),. USE OF /" (/ SIZE"OF LOT- EXISTING, BLDG - I certify,that,in Ihe'perforinance of the work for Which this Q permit Is issued, I shall not employ a'ny, persoii'm any manner WNER /Jr! U so as to-become subject to the Workers' Compensation Laws. IL QCCUPANCY,GROUP Date Applicant p p p NOTICE TO APPLICANT%If, after--making-this Certificate of ITY Nol.' �O�O)20 _ 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. coin l with suchprovisions.-or" - is permit shall be TRAILER USE - -' GEOLOGY INSPECTION: p y th Q. No Spec. Knowl.. ❑ deemed revoked_ _ ' P8r11C Devices ❑•. ' LICENSED CONTRACTORS DECLARATION occuPArvcY INSPECTION, I hereby affirm that I am licensed Under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOWINO. OF.EXITS 9 (commencing with Section 7000)of Division 3 of the Busi- .. ness and Professions Code, and my:license is in gull force and Pw1iKING effect RE q'D PROVIDED ,`'. :, )c.' -, SPACES License Number Lic.Class - LIMITED TIME USE Contractor Date DATE DATE L FROM am exempt from th'e�lic,en'sirig'requirements,as a c : TO INSPECTOR'S NS IicBnsed architect or a registered professional engineer slzE of ry O. OF ECTOR s NP . l capacity'(Section 7051; BUS- EXISTING'BLD G.' STORIES G acting in my professiona NATURE inessand'Professions Code FINAL'APPROVAL. ' 1 P ENT USE OF BUILDING ® Lic.or.Reg.No Date (J "HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON.LOT AND USE - 2.5 2' I hereby: affirm that, I am.exempt from"the Contractor's' # o o © .a hicense;'Law for th&-Tollowing reason F(Sec tion 7Q31.5;.Susi; ness and Professions Code): rv`o. PARKING . o o-© o'® o o z SPACELS�PROVIDED _ I, .'s, owner of the property will do`the'work and the structure is not. intended or-offered for.sale, (Section' ],Z3 -. 85 <3.-85 7044;Business and.Professions Code):''. P. oseo"USE OF BuiuDirvG-> CONSTRUCTION'.LENDING'AGENCY I hereby affirm that'there is.a.coristruction'lending'agency for the performance of the ,work for which this permit:is issued (Sec: 3097,'Civ.C.). ¢ Lender's Name . +... _ .. "'PROPOSED MAX-.,.0C.C..,' Lender's'Address 'PERMIT FEE,-, .. '• I certify that I have,read'this application and state that the, above inforriation'is correct.I agree to comply with all'"County'...' .!SSLIANCE'FEE ordinances and State laws relating to building construction, and hereby authorize"representatives of this County to.,enter TOTaI 'FEE "v O upon the' boned pr erty for inspec on ' rpos ..SEE REVERSE FOR EXPLANATORY LANGUAGE' mi eate P-- . WORKERS'COMPENSATION DECLARATION CE 875(11-84) ISI I SC E L LA N EO U S APPLICATION CE 875 L 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. CompanyFOR APPLICANT TO FILL IN BUILDING J S ADDRESS Certified copy is hereby furnished. ApoRESS 1�) LAS TuuQS 1^ LOCALITY LL- 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST 'r/-� ,/� DI I Ijjj TYPE '''---�J���/// P ES BY CROSS ST. Ct.O y C-1 1 �/ — CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY • NO. (CIRCLE) STATE MAJOR S COND LOCAL NO. OF BLDGS. (This Section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. dCD permit is issued, I shall not employ any person in any manner OWNER PF•I5U( i'A y so as to become subject to the Workers' Compensation Laws. MAIL p, OCCUPANCY GROUP a ADDRESS 3 /�.. ` �`� U Date Applicant • L,.J TEL. � r J1 O CJ OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of, clr No. t7Vw-V O l� N Exemption, you should become subject to the Workers" z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be• TRAILER USEGEOLOGY INSPECTION F-1deemed 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 (1 D F effect. 1 [Ji PARKING REQ'D PROVIDED SPACES License Number Lic. Class r LIMITED TIME USE Contractor Date DATE DATE FROM: TO: { , SPE IC I am exempt from the licensing requirements as I air a - licensed architect or a registered professional engineer SIZE OF NO. OF , ATUR acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES /I iness and Professions Code). FINAL APPROVAL PRESENT.USE OF BUILDING / Lic.or Reg.No. Date S w P-S 2 ce—,% rs 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 70,31.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED 0 I, as owner of the property, will do the work and the ' i- — M 0:*771 i1 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 constriction lending agency for the performance of the work for which this permit is \ issued(Sec. 3097,Civ.C.). It Lender's Name PROPOSED MAX. OCC. r+\ 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 abo ioned propert or inspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D ate WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION • CE CE 875(11-84)875 I hereby -affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES. BUILDING AND SAFETY DIVISION insur0, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BUILDEINSSG ADDR FICertified copy is hereby furnished. BUILDING ESSq4J LOCALITY ADDR 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date - Applicant NEAREST �� DISTRICT NO. GROUP TYPE CESSED BY CROSS ST. / _� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /h 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 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 RAJ4ipew ­_ y so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP o ADDRESS ' `�•cfC•. Ltil A-S yI� �� U Date Applicant LLI TEL. OCCUPANT LOAD o_ NOTICE TO APPLICANT: If, after making this Certificate of CITY L NO. 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and -�l 5 . effect. w— Illi PARKING SPACES REQ'D PROVIDED License Number Lic. Class oo — ' N6- LIMITED TIME USE Contractor Date DATE DATE ❑ 1 am exempt from the licensing requirements as I am a ` licensed architect or a registered professional.engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STOFROM: TO:RIES SIGNATURE iness and Professions Code). 2 PRESENT USE OF BUILDING VAL FINAL APPRO '2 /' �J Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSI;_j_ _ • ON LOT AND USE I hereby affirm that I am exempt from the Contractor's >'`a'Fi License Law for the following reason (Section 7031.5, Busi- ness usi Hess and Professions Code): No. PARKING • ^ifisl= ❑ 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 Gly. 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 I certify that I have read this app)<ication 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 FOYIVXPLANATORY LANGUAGE_ Sign toe of Permittee Date WORKERS'.COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION ' _ " • CE 875 'fl 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. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS 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. G OUP TYPE PA60C ESSED BY CROSS ST. ' 'CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ro— (/ 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 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 so as to become subject to the Workers' Compensation Laws'. MAIL OCCUPANCY GROUP �—� a ADDRESS ~ Date Applicant Lt�I TEL' OCCUPANT LOAD. NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. 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 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- 4 NO. OF EXITS ness and Professions Code, and my license is in full force and p PARKING effect. SPACES REQ D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DA TH 0 I am exempt from the licensing requirements as I am a PROM: ro: 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). FINAL APPROVAL ��7�3 'PRESENT USE OF BUILDING Lic.or Reg.No. Date ftnl� HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS ; O FEF ON LOT AND USE ..I hereby affirm that I am exempt from the.Contractor's 1 'License Law for the following reason (Section 7031.5, Busies I � y,�4 ness and Professions Code): NO. PARKING �� 101 011-1i —01 0 1 - _ SPACES PROVIDED � � -'tlf� .... " -_ F-] ,, as owner of the property, well do the work and the ,C- a structure is not intended or offered for sale (Section v`It l 's °C" 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING,. I hereby affirm that there is a construction lending agency for 'the performance of the work for which this permit, is issued(See. 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 ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TAi:FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date fi 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 cer MicSte of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING S ADDRESS Certified copy is hereby furnished. BUILDING OCALITY 1 DDRESS -,J/ I (J F Certified copy is Filed with the county building inspection LOCALITY (� NEAREST department. CROSS ST. Date Applicant EAREST DISTRICT N GROUP TYPE PROC S BY CROSS ST. g - • � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' ILEGAL COMPENSATION INSURANCE _ DESCRIPTION LOT NO. BLOCK MAP HIGHWA No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. 0F.BLOGS. (This'section need not be completed if the work involved TRACT NOW ON LOT ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF IZE OF LOT EXISTING BLDG. r 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" WNER Z so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP _, , i "c/. ,, a DDRESS � "`'"VCC / I-- Date Applicant L� TEL. JUSE i W NOTICE TO APPLICANT: If, after making this Certificate of CITY NO, OC C8 CUPANT LOAD a Exemption, you should become subject to the Workers' Zo 92APPLICATION 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. • ElLICENSED 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 i PARKING effect. SPACES REQ'D D PROVIDED License Number Lic. Class T 1 LIMITED TIME USE Contractor Date �1r f� 7 I DATE DATE FROM: TO: 1 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 XISTING BLDG. STORIES IGNATURE iness and Professions Code). ✓� ' FINAL APPROVAL Lic.or-Reg.No. Date PRESENT USE OF BUILDING rT . HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS.. �EE 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 � 1 Gny SPACES PROVIDED � �'��'V• I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 4110 i PM 3:48 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency R€7*41L 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 10 I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, D d hereby authorize epresentatives of this County to enter TOTAL, FEE on the abov -ment' ned property for inspectionpurposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE to Signature of ermittee Date WORKERS'COMPENSATION DECLARATION C E 875 (11-84) MISCELLANEOUS, APPLICATION ` CE 875 I,he eby affirm that I have'a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ire, or a certificate of Workers'Compensation Insurance,or 1uIcIrtified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FELL IN BUILDING ADDRESS Sj Certified copy is hereby furnished. UILDING ADDRESS CA LITY FCertified'copy is filed with the county building,inspection ' ocwL,rY _ EAREST department. LO jam'_ U QV _f` cRoss ST. Date Applicant AREST •� JJ .f.� DISTRICT T< GR UP TYP ` PRO CE ED BY V CO .. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP' HIGHWAY NO. (CIRCLE) STATE MAJOR SECON LOCAL NO. OF BLDGS. (This section need not be completed if the work invbIved 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 o permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. AIL ? / OCCUPANCY GROUP, AD DR E S S%Z " ! ;�� Jt/° /GJZ Date Applicant u, NOTICE TO APPLICANT: If, after making this Certificate of CITY NOL Z- Q�/. &IAj OCCUPANT LOAD \0 :LWJ014t Exemption, you should become subject to -the Workers' I APPLICATION F R EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION deemed revoked. . ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices E I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM I (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. I I. License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 1 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 wruRE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING ') Lic.or.Reg.No. Date HOMEOWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 'License,Law for the following-reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED I, as owner of the property, will do the work and the 9.,1 9.'l A structure is not intended or offered for sale (Section 7044,Business and Professions Code). #•o .o o io 8'8 CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING 'o o ® c io e o z I hereby'affirm .that there is a construction lending agency for the performance of the work for which this permit is 1 7 r-8 8 issued(Sec. 3097,Civ.C.), Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE ' I certify that I h ve read this application and state that the above informatio is correct.I agree to comply with all County ISSUANCE FEE ordinances and t e laws reWing to building construction, and hereby au ize represe tatives of this County to enter TOTAL FEE the above- entioned perry for inspection purposes. I REVERSE FOR EXPLANATORY LANGUAGE S gnature of Permittee Date C� WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS ISCELLANEOBS APPLICATION [� I hereUo affirm that:I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 1ul 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. AUILDIN w LOCALITY DDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant AR EST. DIST T Nf�. • G UP TYPE P CESSED BY CROSS ST. �D (/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL. D COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT . EXISTING BLDG. / 7•• I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner owN o so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP ADDRESS fIL1^,�•V s�'{) U 6, Z/ l�, ® O Date Applicant LU NOTICE TO APPLICANT: If, after making this Certificate of CITY LA. �oL' IM OCCUPANT LOAD N Exemption, you should become subject to the Workers' Z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION No Spec. Know]. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION � _ 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 Exlrs ness and Professions Code, and my license is in full force and PARKING effect. REQ'D �#ovtb- D' ii -� SPACES - „- License Number Lie. Class LIMITED TIME USE s Contractor Date eE� DATE DATE 1 am exempt from the licensing requirements as I am a t FROM: TO: licensed architect or a registered professional engineer SIZE OF ` NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). I . FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING ^ Ty-i6-92_1 '^ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS '/x/1/1' /�� 1� 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, Busi- ness and Professions Code): NO. PARKING o VVV I, as owner of the property, will do the work and the SPACES PROVIDED " structure is not intended or offered for sale (Section 1 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is t issued(Sec. 3097,Civ.Q. dAl 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 fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of rmittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S 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. CompanyFOR APPLICANT TO FILL IN BUILDING , ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS •�-� Certified copy is filed with the county building inspection LOCALITY NEAREST department. S CROSS ST. Date Applicant NEAREST �� DISTRICT NO. GROUP TYPE ��/' P OCESSED BY CROSS ST. �� (1 CONST;-// - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL aI. _ 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 SIZE OF LOT EXISTING BLDG. �./ - C3 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/ Lip u/,lLPf�o so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY.GROUP o ADDR ES ~ EWi] Date Applicant S D uvt NOTICE TO APPLICANT: If, after making this Certificate of CITY ITvo�C -] (�— 16 OCCUPANT LOAD Exemption, you should become subject to the Workers' APPL CATION FOR EXIT HARDARE: Compensation provisions of the Labor Code, you must forth- W ❑ with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D I� PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE E I am exempt from the licensing requirements as I am a R M: licensed architect or a registered professional engineerslzE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL a PRESENT USE OF BUILDING Lic.or Reg..No. Date HOMEOWNER-BUILDER DECLARATION NO.,OFEXISTING BUILDINGS ON LOT AND USE /IIl I hereby affirm that I am exempt from the Contractor's 11� 6606 1 �� °�k 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 sawcEs PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address a�O 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 J ordinances and State laws relating to building construction, y and hereby authorize representatives of this County to enter TOTAL FEE up n the above- entioned pro erty for inspection purposes. `/ (( SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Vrmittee Dat WORKERS'COMPENSATION DECLARATION CE 8754(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of corisent to selfr insure, or a certificate of Workers'Compensation Insurance,or COUNTY'OF LOS ANGELES. {' BUILDING AND SAFETY DIVISION L� a certified copy thereof(Sec. 3800,Lab.C.). I. , Policy No. Company -' FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDROES LS LOCALITY �� C ADS, ❑ CerVied copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. G UUU��� TYPE o/� P ESS BY CROSS ST. ! �. ) �e • CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECON LOCAL oe NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT US JE ZONE SPECIA L'CO NDIT IONS 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 o permit is issued, I shall not employ any person in any manner OWNERf1 w` YL so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS /©� ~V LJ�' •� �' �,{�/ C�.S Date. Applicant TEL' , i OCCUPANT LOAD ° NOTICE TO APPLICANT: If, after making this Certificate of ' CITY O' - � No. / d CIOExemption, 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 INSPECTIO 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. A91essPARKING REq D PROVIDED p / SPACES License Number Lic. Class U S 1`v .fid ap, awl 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 sIGNATu iE iness and Professions Code). '1`� FINAL APPROVAL ? 1 r-1 VVV Lic. RESENT USE OF BUILDING or Reg.No. Date , HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE O 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 s�-I "%— SPACES PROVIDED 11�t;t l lsl l 211w/`t'0 I, as owner of the property, will do the work and the =2" structure is not intended or offered for sale (Section s�1�U. {; } i 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is /f issued(Sec. 309.7,Civ.C.). U 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 rep esentatives,of this County to enter TOTAL. FEE upon the above ntion pro erty for inspection urpgses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee I Dale WORKERS'G MPENSATION DECLARATION 76M444 Lt, J CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that 11Workers' a certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or . a certified copy thereof(See. 3800,Lab.C.). 11 A Policy No. Company FOR APPLICANT TO FILL IN BUILDING 4_ ADDRESS FICertified copy is hereby furnished. LOCALITY BUILDI2 LAS ( ADDRESNG 3 �4S 0 Certified copy is filed with the county building inspection OCALITY / NEAREST department. �(( 0 CROSS ST. Date Applicant EAREST Cu�1/cr`L�j /� DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. / / '�� CONST. .CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF IZE OF LOT EXISTING BLDG: I certify that in the performance of the work fot which this //11 0 permit is issued, I shall not employ any person in any manner OWNER ] A-1 -F /Y A�(l(`( J I so as to become subject to the Workers' Compensation Laws. MAIL , ;OCCUPAN`�`CY�GROWP , �� .� ry a DDR ESS .o ''4' Z5. ,�1'•. .1...� ~ Date Applicant _ =• L`" TE NOTICE TO APPLICANT: If, after making this Certificate of CITY44t N. Og d`d'b 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 oI this permit'shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICF,NSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm,that I am licensed under provisions of Chapter SAFETY PE IT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions 11 Code,and my license is in full force and effect. PARKING READ D PROVIDED SPACES JJ License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a - PROM. TO. licensed architect or a registered professional engineer slzE of I �7v r NO. OF IN S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. , ula- , ` STORIES GNATURE iness and Professions Code). Lic.or Reg.No. Date PRESENT USE OF BUILDING FINAL APPROVAL - / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's f License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED �Vt, ".7 x 2.9.3 a• I, as owner of the property, will do the work and the # structure is not intended or offered for sale (Section o o a o o e .e z 7044,Business and Professions Code). Q 4I 1 4 8 8 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm.that there is a construction lending agency a, j for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name 6 PROPOSED MAX. OCC. V Lender's Address �I PERMIT FEE c,2 ( (� 1 r I certify that I have read this application and state that the rF/ above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, 1,and hereby authorize representatives of this County to enter TOTAL FEE ` 4ution the above-mentioned property for inspection purposes. m D , 2 ?IV SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P mittee Date 1 WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that 1,have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,'•[ii a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab..C.), 13U I LDPolicy No. Company FOR APPLICANT TO FILL IN ADDRESS SS U ADDRESS Certified copy is hereby furnished. ADDRESS �l y G /�is TU VIA& �f�-C DAY LOCALITY Certified copy is filed with the county building inspection OCALITY „�`j '( �I'1$D NEAREST. department. 1 V r Y CROSS ST, Date Applicant EAREST ,J q'/�) / DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. Ci.WV VF�Vr/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK Mar HIGHWAY. NO. I CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE of Lor EXISTING BLDG. I certify that in-the performance of the work for which this CD permit is issued, I shall not employ any person in any manner i OWNER /1/jq QL( =' so as to become subject to the Workers' Compensation Laws. MAIL /� �Q �/ (/[��_ n OCCUPANCY GROUP ADDRESS �'L 19Z pE1IQ7J } !'✓ v I -1 i .= CS Date Applicant uJ NOTICE TO APPLICANT: If,after making this Certificate of CITY (L 1 (/lJQ' No �, o OCCUPANT LOAD Exemption, you should -become subject to the Workers' APPLICATION F EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions. or this permit shall be TRAILER-USE ❑ GEOLOGY INSPECTION ❑ , No Spec..Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION occuPwrvcv INSPECT1oN Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. OF EXITS ness-and Professions Code,and my license is in full force and effect. I - In PARKING REQ'D SPACES PROVIDED - W!'w ' License Number Lic. Class LG G . (�►nf(S LIMITED TIME USE Contractor Date DATE DATE TO: I am exempt from the licensing requirements as I am a FROM: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES J SIG AruRE iness and Professions Code). FINAL APPROVAL Lic.or_Reg.No. Date PRESENT USE OF BUILDING U • L HOME OWNER-$UILDER DECLARATION No. of ExlsnryNO EEE G BUILDINGS- 9 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 += ��L SPACES PROVIDED I, as owner of the property, will do the work and the 52265 f FM 4:37 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING S%one, CI hereby affirm-that there is a construction lending agency ofor the performance of the work for which this permit isissued(Sec. 3097,Civ.C.). .Lender's Name PROPOSED MAX. OCC. Lender's Address ��. ®0 PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE up n the ve mentioned property for inspectionpurp es. �1 SEE REVERSE FOR EXPLANATORY LANGUAGE - S' ature of Permit ee Dat f WORKERS'COMPENSATION DECLARATION 87 CE 85 (11-84) plel� iSCELLANEOUS APPLICATION - CE 75 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'insure, or a cer?;.ficate of Workers'Compensation Insurance,or a certified cop ['areof(Sec. 3800,Lab.C.). Policy No. ilt�� Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY DDRESS El Certified copy is filed with the county building inspection -LOCALITY NEAREST department. Rfz �. CROSS ST. ! INV P_Y } Date ApplicantNEAREST DIS RICT NO. O TYPE PROCESSED BY ROSS ST. F . Of./ CONST. i./ .CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL `I7 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP G. AY No. / Q (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. C d permit is issued,I shall not employ any person in any manner WNERP o C:) so as oto become subject to the Workers' Compensation Laws OOCC'UPANGYGROUP .-� ` " MAIL AD.11- SS Date ApplicantLTJ NOTICE TO APPLICANT: If,.after making this Certificate of C"ITY No� � 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) 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 ' J��P10 SPACES License Number Lie. Class `/ LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or- a registered professional engineer SIZE OF NO. OF INS SSP NATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL ' PRESENT USE OF BUILDING - Lie.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- (JQ — (Ji 7/17/89 ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 45101 AM10:06 structure is not intended or offered for sale (Section 7044,Business and Professions Code). ; CONSTRUCTION LENDING AGENCY 'PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, an .hereby authorize representatives of this County to enter TOTAL FEEL n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE _ Signature of Permittee Date rNORKERS'COMPENSATION DECLARATION76M444 - 'B S.�"' A C�1 1 E C A l �'` A O A 1 ' CE,875 (2 80) ` C /"�1 C.�d! P1 L. C A N tl 0T hereby. affirm that I have'.`a certificate of consent to self. COUN I Y OF L®S'ANGELES BUILDING AND SAFETY DIVISION' insure,''or a certificate.of Worers Compensation.Insurance,or -; a certified-copy thereof(Sea..3800,Lab' C) Policy No:_ "L Company CANT TO FILL FNLai FOR APPLI AYJLD DDR S 9 AD.DRE55 { . •Certified copy is'hereby'furnished,, ,` ADDRESS ' .LOCALITY Y 4�G.�9 p �> ❑, Certified copy is filed with the county building inspection, ///y a NEAREST /�•O {�p� ` LOCALITY ''.department. „ ceoss sr. Date Applicant , 1 IR OC:NEAREST DISTRICT NO. GR�U� .TYPE P OC S D BY -. CROSS ST. /}}ff✓✓''//�� CONST. GERTIFICATE`OF EXEMPTION TROM WORKERS LEGAL, �•.' D.ES CRIPTION LOT NO. BI:OCK (x� Y COMPENSATION INSURANCE' "AF '�""AY 0- IRCLE) (Th1S section need not be,.completed,if-the work Involved ', TRACT IND. OF NOW.ON LOT S USE'ZONE 'SPECIAL CONDITIONS TA _ TE MAJOR SEC LOCAL 0-, by the:permit is., for;one.'hundred,dollars'.($100) or less_.) USE of ' -SIZE OF,LOT �, - EXISTING BLDG. �• 1 I certify that in.the'performance-of-,the Work.for which this O permit-.is issued;'I•shall not employ any-person in*any'manner OWNER so.as.to become subject to the Workers' Compensation Laws.. OCCUPANCY GROUP. - , AI 'R/��� J .1�� r5 a " .. D'D R E S S /Y^' (-I/ 'rJ.... © U) Date Applicant r: • TEL.' .. - Z NOTICE TO,APPLICANT. If,-after making this Certificate,of ° ei4v nO. p O (/ g OCCUPANT,LOAD Exemption, -you should ,become •subject `to the;,Workers' AP: ICATION FOR EXIT HARDWARE:. Cgmpensation.provisions of the Labor Code, you must forth- with such provisions Or this permit- shall be. ' � GEOLOGY INSPECTION❑ - -with comply TRAILERUSE •� •. 'No Spec: Knowl'. ,❑ deemed revoked ' LICENSED CONTRACTORS DECLARATION". OCCUPANCY`INSPECTIory ce Panic Devis: ❑ I hereby affirm that I am licensed under provisions Of Chapter SAFETY PERMIT f (LIST ITEMS BELOW). EXITS NO. OF . 9 (commencing with Section 0) of Division 3 of.the.Busi= ❑ ` "ness and Professions Come, and my license is in full force and PARKING,: REq'D ----------- effect.' PROVIDED D SPACES License'Number' Lic.Class -LIMITED. TIME USE - Contractor Date' ' DATE, DATE .: a .. FROM .. TO: .. ❑ I am exempt-frorn the•licensing requirements as I am a licensed architect or a "registered professional,engineer SIZE OF. rlo. OF. INS TOR's,. acting in, my.pr'ofessiofiaf-,capa6ty (Section 7051„Bus EXISTING'BLDG. STORIES SI ATURE mess and•PiOfeSS10 rIS"Code). a PRESENT USE oF.B u1LDIN�., ;INA.L,AP.PR.OV AL Lic..or Reg:No. f Date (/ t I - NO.-OF EXISTING BUILDINGS' - Z 3 4 7, HOME OWNER-BUILDER-DECLARATION; / # ® "o 0 0 _ ON LOT AND USE �A U hereby, affirm that, I am exempt, from the Contractors,'':_ o o a o 6 0.0 . License Law for.the following reason (Section 7031.5, Busi= . NO. PARKING ^ ness,and Professions,Code): / _ SPACES PROVIDED � - � 11,..1 5 ;:$'5 � .. ❑.I, as owner of the,property, will di the work and the •structure- is not intended'or' offered 'for sale,(Section;. 7044,Business and Professions Code)"' O ' PR POSED USE OF BUILDING. CONSTRUCTION LENDING.AGENCY.,, I herebyr .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 l Lenders Name Lenders Address ., PERMIT FEE _ PROPOSED MAX OC•C' I'.certify that :I ve'read'this ap 'cation and state that the ~- - Ain' is correct. ee COmply'Wlth a1h000ilty ISSUANCE FEE'. ate laws ti building conStrUCtlon, TOTAL FEErize,'re t e "ofthis County to enter i r e y for insp c wn purposes': SEE REVERSE FOR EXPLANATORY LANGUAGE mitt Date l• " �y WORKERS'COMPENSATION DECLARATION C CE 875 (1 7-84) M I SC E L LA N EO U S APPLICATION E 875 I hereby, affirm that I have a certificate• 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. BUILDING LOCALITY ADDRESS L5 ^ eK Certified copy is filed with the county building inspection NEAREST LOCALITY department. d L Im r LR C I ` CROSS,ST. ell Date Applicant NEAREST . y^� DISTRICT NO. GROUP TYPE P SSED BY CROSS ST. C,LO vao, 119 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO.;��(cIR CLE) 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 n C� o permit is issued, I shall not employ any person in any manner OWNER Arlt EV�rk1 6tO C�(Z r I` y so as to become subject to the Workers' Compensation Laws. MAIL `h'_L`,/� eL�I �/j_ _ Z _ O�CCUPANCY,GROIJP.. �. o ADDRESS DZ I L C Vo �11' �\ S -# 103 _ F' Date Applicant w g Co�- w102 TEL W'i D —(��>9 t7 OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. `F �, 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 ❑ GEO OGY INSPECTION ❑ No Spec, Knowl, deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITIEJ% (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 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING,BLDG. STORIES NATURE SAG iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Of Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS aCyP ^ 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 , ' -_ 4 1-;J ; ness and Professions Code): NO. PARKING A=.I � 1, as owner of the property, will do the work and the SPACES PROVIDED 3 q} .,ria i 3 it E i'-: -IY 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 Q P F ( C C 0 K Co . for the performance of the work for which this permit is > issued(Sec. 3097,Civ.Q. Lender's Name O PROPOSED MAX. OCC. Lender's Address D ��✓ PERMIT FEE I certify that I have read this application and state that,the 1 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby author' a representatives of this County to enter TOTAL FEE upon he above-m t' n property for inspection purposes. �•9 l SEE REVERSE FOR EXPLANATORY LANGUAGE o ermit Date WORKERS'COMPENSATION DECLARATION 76M444 GE 875 (2-80), R>AISCEL.LANEOUS.., APPLICATION. I.hereby affirm. that,I' have a certificate of consent.to selfCOUNTY OF LOS'A1�IGELES- insure, or a certificate of Workers'.Compen'sation-Insurance,or., ' BUILDING.:AND SAFETY DIVISION a certified copy thereof(Sec:3800,Lab.C.) Policy No. Company FOR APPLICANT TO-FILL IN uDEss Certified copy is hereby furnished. Bu1Lo1rvG j ( LOCALITY DDRESS O Certified copy is filed with the county building inspection . NE-Aeesr "• ". LOCALITY . fr/ : .CROSS ST c • department. .Date' Applicant - EAREST,� /I" - _ - DISTRICT,NO.' G UPJTYPE,�7 - PROC SED BY - pp CROSS ST. (�:v;c�.✓ CONS ' CERTIFICATE OF EXEMPTION FROM,WORKERS' LEGAL'- r1. [ .. .. BLOCK .. MAP'. " „f HIGHWAY .}. / - COMPENSATION INSURANCE DEscRIPTwN 'Lor No .;, -\ > p .-,,... . - TR A'C.T NOW ONBOT,S. Ho. (Gr+ C-Y (CIRCLE) 'S This section,need.not,be Com leted If:the Work involved " USE ;ONE SPECIAL'•CONDITIONS TA .. by`I the.'permit is.for one hundred dollars'($100) or less.): TE MAJOR SECOND LOCAL a - USE OF r•.. , � .h �' SIZE OF LOT EXISTINGBLDG'. - I certify that in the'performance"of the work for which this / 0 ermit is issued, I shall"not employ a'n'y person in any manner, p.. P Y' OWNER J y .0,t so as"to become subject.fo the Workers' Compensatlon.Laws. I!rwIL s OCCUPANCY GROUP w, •• - `ADDRESS �. ps`L✓�,�t�rl—q {, �C��'. -� ...•.tn -Date Applicantelrz NOTICE TO APPLICANT-: If,-after making this Certificate.of CITY Q � `� ��- mol OCCUPANT LOAD Exemption, 'you should become subject 'to the. Workers' Compensation provisions'.of the Labor Code,you must.forth- .APPLIC_ ION FOR EXIT HARDWARE; .with comply with such provjsions or this.permit shall be rRILER USE GEOLOGY INSPECTION❑ deemed revoked A No Spec,Knowl-.EJ L "LICENSED CONTRACTORS DECARATION OCCUPANCY 1NSPECTIory Panic Devices I hereby affirm that.I'am-licensed under provisions of Chapter SAFETY PERMIT [] (Lisr I,iEMS BELOW) rvo. of EXITS- Sk(commencing with:Section 7000)'of-Divi_sion.3 of.t he,Bus i- ress'and Professions Code,-and my license is in full force and effect. - R.EQ'D PROVIDED, SPACES -- ,..,. PARKING• O fJicense Number Llc.Class LIMITED. TIME USE Contractor_ '. Date' DATE DATE - _ FROM: '' TO: QI am.exempt, from the;licenslrig,requirements as.I am a licensed, architect or a registered professional engineer SIZE OF 'j NO,.;OF INSPECTOR s acting in my professional capacity. (Section.7051, Bus- `, exlsTlrvG BLDG STOR 5 D''hAIG'PatNRE mess and Professions Code) FINAL APPROVAL,• �> q�� _ SENT USE SOF BUILDING / Lic.or Re'g No. Date HOME OWNER-BUILDER DECLARATION ivo. oF-ExlsriNG BUILDINGS • to 0 0 0 0 ON LOT'AND USE .. .. Z I hereby - - •_ _ � Q 2'8 8 3 y -affirm thaf'I.am exempt 'from the 'Contractor's. License-Law for the'following reason (Section,7031.3, Busi • ReSS and PrOfe5510I15"CO de): : - NO.-P:ARKINGSPACES PROVID ED - - EJ I 'as.owner' of the properiy,'will do the work and,the structure is .not intended 'or offered' for-sale (Section ,7044,Business and Professions Code)....'- . - •'a POSED USE OF BUILDING a 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.)': .Le'nder's Name .. ..... PROPOSED MAX. OCC'. _ Lender's Address _ PERMIT FEE +- I certify that I have read this application and state,'that .the above informationincorrect.I agree to comply with all County- ISSUANCE'FEE ordinances.and State lawsrelating:to building construction, and hereby, authorize representatives of this County to-enter TOTA�'FEE: © C� upon the above-menti ed property for inspect' purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Z-b-2S s ignature of rmittee Date WORKERS'COMPENSATION DECLARATION '76M444 CE 875 (2-80) 1��'1AGI"SCELLANEOu5 ApI®LlC1 ION I herelFy 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 BUILDISS NG. (1,116 191 • - ADDRE _ e' Certified copy.is hereby furnished. Oil uILDING ' LOCALITY . ADDRESS roct �. G� ,�/Ir► \�7 O- Certified copy is filed with the county.building inspection,. NEAREST I - LOCALITY _ - department. ft C CROSS 3T. I Date Applicant' - AEA REST /'� n - DIST RjZ`T p{Q. rOUP TY IPROCI;S!iAD BY ti CROSS ST. •L LJ�J�{�� 6 /'SVA/ IY}'J� CO T., J i CERTIFICATE OF EXEMPTION'FROM'WORKERS' LEGDESCRIPTION' LOT NO. - BLOCK V v' COMPENSATION INSURANCE M.AP HIGHWAY • _ _ - - No: (CIRCLE) .STATE MAJOR SECO D LOCAL d NO. OF BLDGS. I (This. section need not,be completed if the work Involved TRACT NOW ON LOT USE ZONE SPEC IAL'CONDITIONS 0 by the permit is for one. hundred dollars ($100) or".less.) ^ USE'OF ,/•/ ' SIZE OF LOT. EXISTING BLDG. .V 1 - cc I certify that in the performance of the work for which this Y �� � 0 permit is issued,'l shall not employ any person in any manner wNER ti 1FN�� ��' so as to become'subject to the Workers' Compensation Laws; 'loRrAIL OCCUPANCY_GROUP ' .I W ADDRESS ^'�- I ,-... _ ����JJ a- I 'Date Applicant _ z NOTICE TO APPLICANT:1f,'after making this Certificate of cl Y �� 9�� NO. (�('� OCCUPANT LOAD Exemption, you 'should become subject ,to the Workers' Compensation provisions.of the Labor Code, you must.forth- APPLICATION FOR EXIT HARDWARE: with comply' with such provisions or this permit shall be TRAILER USE O GEOLOGY IN a. No Spec. Knowl. ❑, deemed revokeI d ' - " LICENSED CONTRACTORS DECLARATION occuvwrvcY INSPECTION I es Panic Dev•c I hereby affirm that Iam 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" REO'D O PROVIDED License Number -Lic.Class-'- LIMITED TIME USE, Contractor Date DATE_ -.DATE FROM: TO: El. I am exempt,from the licensing requirements as 'I am a. ` licensed architect or a registered -professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (SS ection.7051•, BUS- EX TING BLDG. _ STORIES S NATURE `iness and Professions Code).,, .RESENT iJSE•OF BUILDING FINAL APPROVAL" _ Lic:or Reg.No.' Date HOMEOWNER-BUILDER DECLARATION No. of EXISTING BUILDINGS ' • ON LO T'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, C q SPACES PROVIDED EJ`I, as owner of the property, will do the work and.the iMT v structure .is not, intended or offered for sale (Section', 7044„ Business and Professions•Code). . - o 0 0 0 0 0 o z- • ". 'PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY.' 7 8'6 I hereby affirm that there is a construction lending agency for the performance,of the,work forwhich this,permit is issued,(Sec. 3097;Civ.C.). 1W : Lender's Name" PROPOSED MAX:'.00C. c O 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 - - - v. ordinances and. State,law relating to building construction, and eby no or prese to ' of this County to enter TOTAL FEe' up o t above- enti ed pro erty or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE " Ignature of Permitte Date WORKERS'COMPENSATION DECLARATION CE 8754(11-84) M I SC t;L LA N EO U S APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION J insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). I Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS FlCertified co is hereby furnished. BUILDINGS /�/� copy y AD OR ES Sjic..�4-6 _ TUNAS 'Pr, LOCALITY Certified copy is filed with the county building inspection LOCALITY /y��G� `� NEAR ES � � T ( department. TT-_ CITY ` G ! I / 0 CROSS ST. Date Applicant NEAREST �/ DISTRICIT NO. GROUP TYPE P CESSED BY I CROSS ST. CLQVEg LY D� Z CONST'/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Y COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one 'hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certifythat in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER , " so as to become subject to the Workers' Compensation Laws. MAIL ^yQ[�/ �j `/� OCCUPANCY GROUP o ADDRESS/ 4� Dr. U Date Applicant " UJ NOTICE TO APPLICANT: If, after making this Certificate of CIT T,t le— �i rvo� Q1g-Z _"6p 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 oI this permit 'shall be TRAILER USE GEOLOGY INSPECTION E) No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITpDf (List ITEMS BELow). 9 (commencing with Section 7000) of Division 3 of-the Busi- r Y� 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 U S DR f�EY TA(-,,, —,Q,I CA C_ LIMITED TIME USE Contractor Date SNS 7110 T-T DATE DATE FROM: TO: 0 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. q STORIESy SIGNATURE iness and Professions Code). FINAL APPROVAL �J PRESENT USE OF BUILDINGIry►� �� Lic.or Reg.No. Date / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 1 ON LOT AND USE I hereby affirm that I am exempt from the Contractor's i License Law for the following reason (Section 7031.5, Busi / I»;I»I_`•�-1'• -'x '�`= ness and Professions Code): NO. PARKING �•7 Nig -r , 1, as owner of the property, will do the work and the SPACES PROVIDED _i; I structure is not intended or offered forsale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PeovosED USE of BUILDING' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. - Lender's Address g 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 uppn the above-mentioned property for inspgction purposes. 1(� CJ,4SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date OR rWKERS,COMPENSATION DECLARATION 76M444 1 ,CE`875 (2-80)' - 3-` '�•SC _L�L.P�N., OUS APPLICf'1,-1• ION .. I hereby a ffirm that I have:a certificate of consent-to self' COUNT`Y`'OF:LOS ANGELES BUILDING AND SAFETY-'DIVISION- ^insure, or a certificate of Workers'•Compensation Insurance or a certified copy thereof(Sec( 3800;Lab.C.),,- poi cy .),_Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADD�RE SS' ."• Certified copy is,hereby furnished. BUILD['Nd _ 'ADDRESS ^'ru, LOC.AL TYITY Certified copy is.filed"with the county building inspection NEAREST deparfinent• _ .• '' , LOCALITY . LG�.Gr��f COS&ST. itl�l�td(' S - , R' Date "Applicant, ry .// IcJRocE ED BY CROSS ST.' L.�Y.S .. 'DISTRICT G�LOUP CONST. '.P�,- - JL Uri CERTIFICATE-OE.EXEMPTION.FROM WORKERS'. . LEGAL MAP. HIGHWAY COMPENSATION INSURANCE BLocK STATE MAIOR sEc D LOCAL ..,. NO. OF BLDGS.' NO. '(CIRCLE)'; - T NO a (This section need',not be, completed if the work•Involved TRACT NOW ON LOT USE-ZONE `SPECIAL'CONDITIONS O by'-the permit is'for one=hundred;dollars"($100) or less.) V USE OF - " - - SIZE.OF LOT- EXISTING BLDG: •I certify that. In:the performance of the work-for"which this. permit is issued', I shalLnot employ any person many.manner,, OWNER Sy � �" F so as to Become subject to'tfie Workers Compensation Laws. _ OCCUPANCY GROUP i-J W MAIL ADDRE /Q�• �Y�,r d... Date` Applicant.' NOTICE TO APPLICANT. If; after makm this Certificate of CGT NO. •OCCUPANT LOAD Exemption, g ?d CJpO p you, should _become- subject- to: the Workers :F. APPLICATION-FOR EXIT HARDWARE: ' Compensation provisions of the Labor Code, you must forth with comply with such'provisions,or Ahis permit shall be TRAILER USE_ GEOLOGY INSPECTION ' deemed revoked. I. i No Spec. Know'.-❑' LICENSED CONTRACTORS DECLARATION:. OCCUPANCY INSPECTION O., P an'c Devices 0 I hereby affirm that I am-Iicensed-under'provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW); a 9 (commencing with Section 7000) of Division 3 of the-Busi- No,. of E. ness and Professions Code,and my license is In full force and effect.' PARKING SPACES REQ:D PROVIDED' - - - " License Number Lic.Class`: LIMITED TIME USE i .. Contractor Date ... DATE DAZE •a .-I mFROM - - TO: am exempt from the licensing requirements as9I am a'• licensed .architect or'•`a.registered professional engineer SIZE OF No. of, wsPcroR s acting.in my professional capacity' (Section'7051, Bus-. EXISTING BLDG. STORIES 1 NATURE inessand Professions Code). FINAL APPROVAL .. • PRESENT USE OF BUILDING. G-dJ Lic.or Reg.No. Date o�o Deo •� HOME OWN ER-BUILDER"DECLARATION rvo:of EZIsrING BUILDIrvys z ON LOTIAND USE �e C I hereby affirm that I =am exempt from the Contractor's License "Law.'for the following reason (Section 703,1.5, Busi riess'and Professions Code) NO. PARKING", ` - SPACES PROVIDED 1, as owner. of'the.property, .will do the work,and the structure is not intended' or`offered for' sale (Section 7044,$usiness.and Professions_Code) V, p PRS POSED U'SE OF BUILDING CONSTRUCTION`LENDING AGENCY T Ihereby,affirm that there is.a construction lending agency 111 e for the performance of,the work for which this permit is '�/� 4 issued(Sec. 3 097,Civ.C.),.„ O s Lender's,Name dROPoseo MAX. occ. ' Len'der's Address ; PERMIT FEE 6V I,"certify that:l,have read'this application'and state,that the „ above informationis.correct. I agree to'comply with all County IssuArvcE FEE ordinances and State laws relating fo building construction, and he eby'authorize rep sentatives of this,County to enter Torai FEE upon e above-mentio d property for inspection purposes. SEE REVERSE-FOR•EXPLANATORY LANGUAGE .Signature of Permittee Date; " WORKERS'COMPENSATION DECLARATION 76M444 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 i4Mre, or a certificate of Workers'Compensation Insurance,or I fl I a certified copy thereof(Sec. 3800,Lab.C.). Policy No. - CompanyFOR APPLICANT TO FILL IN BUILDING, ADDRESS Certified copy is hereby furnished. wooRe.S ��pJ r yfpr pj ,12: LOCAL. , J Certified copy is filed with the county building inspection, oCAL.. . NEAREST department. CROSS ST. Date Applicant NEAREST ' DISTRICT NO. G1;OUP TYPE IPRM7 . CROSS ST. � CONST. CERTIFICATE OF.EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPr ION nor NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SEGO LOCAL NO. OF BLDGS. (This' section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or-less.) USE of SIZE OF LOT EX-ISTING 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 — CD y so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP o DDRESS s� , �a4, - C~- Date Applicant C-3 TEv -�' - o_ NOTICE TO APPLICANT: If, after making this.Certificate of CITY No. ��—7� 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 OI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION E] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION c' OCCU!,ANCY IDISPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT 9 (commencing with Section 7000) of Division 3 of the Busi- ❑ (LIST ITEMS BELOW NO. OF EXITS ness and Professions'Code,and my license is in full force and PARKING effect' SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt. from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE of No. of FROM: TO: INSPECTOR'S acting in my professional capacity (Section 7051, BUS EXISTING BLDG. STORIES SIGNATURE inessand Professions Code): FINAL APPROVAL Lic..oI Reg.No. Date PRESENT USE OF BUILDING a i HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE - Z 9,0.Q:3 A 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 ��Q 0 I, as owner of the property, will do the work and the SPACES PROVIDED 0 0 0;o z structure is not intended or offered for sale (Section 7044,Business and Professions Code). ( " 3 n Q 0 d. 8 8 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is`a construction lending agency J for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address ^v - PERMIT FEE I certify that I have read this application and state that the O above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, Q and hereby authorize representatives of this County to enter TOTAL FEE , u on the above-mentioned property for inspection purposes. i^ Z SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of terfittee Date i WORKERS'COMPENSATION DECLARATION CE 875(1 i-84) MISCELLANEOUS APPLICATION ' CE 875 4hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DI ISION insure, or a certificate of Workers'.Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL 1N BUILDING / [ ADDRESS � 6 Certified copy is hereby furnished. BUILD1 NG G 5 i/ ADDRESS LOCALITY Certified copy is filed with the county building inspection NEAR EST LocALlrr C1 i r, department: Chin {� t _J t (J CROSS ST. Date Applicant '. NEAREST DISTRIC/J,(y/p GRCCC���U P' TYPE PRO MESSED-6Y CROSS ST. 3 5 T '� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP 7 / HI CwAv NO. �5�� cIRCLE). STATE MAJOR SE ND 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 Z Deli =' so as to become subject to the Workers' Compensation Laws. mAI� OCCUPANCY GROUP MAIL o ADDRESS �' - ! '� Date Applicant u-.I NOTICE TO APPLICANT: If, after making this Certificate of CITY O TNO.' 70IJ _ 4-6-UM 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 GEOL cY INSPECTION E] No Spec. Knowl. deemed revoked. El 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 nessand Professions Code, and,my'license is in full force and effect. PARKING REq'D D PROVIDED SPACES JJ License Number Lia Class LIMITED TIME USE 'Contractor Date DATE DATE F] I am exempt from.the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer Z. of NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus' XISTING BLDG. STORIES 1GNATURE iness and Professions Code). IJ Reg. PRESENT USE OF BUILDING LH �Y ' FINAL APPROVAL Lie.or Re 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 ElI, as owner of the property, will do the work and the sPAces PROVIDED structure is not intended or offered for_sale (Section '8 7.i,8 A 7044,Business-and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING �.C—T--A( f }T}® a 8 0 o o.8 0 z I hereby affirm that there is a construction lending agency v R N 1,-ru Z S;ro(Z't for the performance of the work for which this permit is Q Ll 2-8.7 issued(Sec. 3097,Civ.C.). Lender's Name \(' - PROPOSED MAX.'OCC. `0 Lender's Address n 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 authorizerepresentatives of this County to enter TOTAL FEE /J upon the abov rpent'o ed'property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat e of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) M I SC E L LA N EO U S 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 FI LL IN BU AUILDING DDRESS 7 �rOo Certified copy is hereby furnished. BUILDINGADDRESS,�-- EJlhl DR pLE OCALITY ElCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST / �y DISTR T NO. GROUP TYPE P ESSED BY CROSS ST. �-�� GLo y � V, D O —� CONST.k/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ��// a 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 OWNERf =' so as to become subject to the Workers' Compensation Laws.' MAIL N_ l�{TrN OCCUPANCY GROUP –p2 0 ADDRESS 4, Date Applicant V TE ry L�LI NOTICE TO APPLICANT: If, after making this Certificate of CITY, L�' �t^ NOL —O' 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 M o e ,'w„ ,JL�� effect. �(� PARKING SPACES REQ•D D PROVIDED O License Number Lic. Class t C ` 0� C" LIMITED TIME USE Contractor Date DATE DATE FROM: TO: 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPE TO R'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES sl TORE iness and Professions Code). PRESENT USE OF,BUILDING � Lic.or Reg.No. Date FINAL APPROVAL n Kr tTH r--1,PL HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS b ON LOT AND USE I hereby affirm that I am exempt from the Contractor's I� •'?' '_ "%?%; License Law for the following reason (Section 7031.5, Busi :~ _ 220. .'y ness and Professions Code): NO. PARKING SPACES PROVIDED AM •= ElI; 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). 'Wi CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINA-' 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 represe tatives of this County to enter TOTAL FEE upon the above-ment' ned pro erty for inspection purposes. �SEE REVERSE FOR EXPLANATORY LANGUAGE t ( I / Z- ignature of Permittee Date WORKERS'COMPENSATION DECLARATION E 875 (11-84) CE MISCELLANEOUS APPLICATION C 875 I•hereb}f a_firni 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 certifie$copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDI DNG C. ^ uy S Locwy�ry ADRESS Certified copy is filed with the county building inspection LOCALITY U NEAREST department. Z a,S y - CROSS ST. Date Applicant NEAREST DISTR IC NO,y G OUP TYPE CES5ED BY CROSS ST. LaS �� Y.0 D Y - 2 CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY - " NO. (CIRCLE) STATE MAJOR'SECOND LOCAL NO. OFB LDGS. (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 SIZE OF LOT EXISTING BLDG.per of the work for which this IS permit is issued, I shall not employ any person in any manner OWNER 6W- )V so-as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCYGROUP o ADDRESS r La+ �./. F-- Date Applicant c.3 TEL. LLl NOTICE TO APPLICANT`. If, after'making this Certificate of CITY No. 8/ -��— 6 Z OCCUPANT-LOAD C/3 Exemption,.you should become subject to the Workers' z APPLICATION FOR EXIT HARDWARE: Compensationr 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, .0 deemed revoked. LICENSED CONTRACTORS DECLARATION' OCCUPANCY INSPECTION ❑ 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. /r PARKING REQ'D E:= PROVIDED ' SPACES LL��JJ License Number Lic. Class , Q 144 -,J S S LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No. of PROM: TO INSPECTOR'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 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 9"IfO FEE ON LOT AND USE , I hereby affirm that I am exempt from the Cori tractor's License Law for the following reason (Section 7031.5, Busi -( ) !i _ n : t�,+ ness and Professions Code): No. PARKING \ ( - +i�� InI=+ rr?� SPACES PROVIDED I, as owner of the property, will do the work and the 6979 4 i `` structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. 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 IssuAN'CE FEE ordinances and State laws relating to building construction, I t and hereby authorize representatives of this County to enter TOTAL FEE �`/•'V D upon the above-me tioned"proper for inspection purposes. n SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PeriiittA ^� Date J WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I haveka certificate consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation on Insurancc e,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BUILDING _ ADDRESS �.Certified copy IS hereby furnished. ADDRESS/ � A LOCALITY r Certified copy is filed with the county building inspection OCA Y NEAREST department. j Ross ST. Date Applicant EARESTDIST CT Wcar, I GR UP TYPE PROCESSED CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL yr COMPENSATION INSURANCE DESCRIPTIONLOT NO. BLocK MAP HIGHWAY _ NO. (CIRCLE) STATE MAJOR SEC 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 SIZE OF LOT EXISTING BLDG. 87- 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 NleWNE- 1As� so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP_ l� o ADDRESSO Date Applicant LLJ NO. OCCUPANT LOAD o_ NOTICE TO,APPLICANT: If, after making this Certificate of ITY No. rn Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION E] No Spec. Knowl. F deemed revoked.' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION' Panic Devices a I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (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 REgD D PR QJV IDED SPACES �¢ 0 OO License Number Lie. Class LIMITED TIME USEO�e o 0 0.0 a uy Contractor Date DATE ' DATE PRDM: To: 0 6.2 3*t 8 8 ElI am exempt from the licensing requirements as I am a licensed'architect or a registered professional engineer SIZE OFND. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). �J J P/-S---1 FINAL APPROVAL USE OF BUILDING � !/L Lie.or Reg.No. Date4— �- ;ez a-till— 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 ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED usE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address �� PERMIT FEE 4 h� 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, O And hereby authorize representatives of this County to enter-- TOTAL FEE o the ab e mentioned operty for ins ection- u i �'J E REVERSE FORLANATORY LANGUAGE ign ure of Permittee Date E KERSCOMPENSATION DECLARATION a CE 875 (11-84) VI SC G L A ! E O S APPLICATION PPLICATIoN affirm that I.have a certificate of consent to self or a�certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Foh'.ty ified copy thereof(Sec. 3800,Lab.C.). No. Company FOR APPLICANT TO FILL IN ADDR SS _ ADDRESS • 1 Certified copy is hereby furnished. BUILDINSG I r 111,4CS = LOCALITY DRES L J Certifiedcopy is filed with the county'building inspection V LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. CONST.- - - - - - CERTIFICATE OF EXEMPTION FROM WOR_ KERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY .. - NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. :(This section' need not'be completed if the work involved TRACT NOW ON'LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF 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 > y so as to become subject to the Workers' Compensation Laws. AIL y_`J1 /^�J�/� OCCUPANCY GROUP 7fftj/l� C/ o A= SS Z YV 1i 4tki P)' Date Applicant / w TEL 7 D -1 OCCUPANT LOAD D NOTICE TO APPLICANT: If, after making this Certificate of CITY - Y NO. � 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 ❑ 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 p ^� effect. A ..l PARKING /� SPACES REQ'D PROVIDED License Number Lie. Class 44 S LIMITED TIME USE Contractor Date J`• eOj' "I n�d DATE DATE e6l ' FROM: TO: 0 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- ExI TING BLDG. STORIES S NATUR iness and Professions Code). FINAL APPROVAL Lie.or Reg.No. Date RESENT USE OF BUILDING � . HOME OWNER-BUILDER DECLARATION NO. OF EXI TING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi Hess and Professions Code): No. PARKING I, as owner of the property, will do the work and the' SPACES PROVIDED � z 99 2 7 A structure is not intended or offered for sale (Section - 7044,Business and Professions Code). # o,o c l0 8 8 CONSTRUCTION LENDING AGENCY PRoao`D USE OF BUILDINGIZ o,o 0 0"0 0;00 I hereby affirm that there 'is a construction lending agency for the performance of the work for which this permit is 4 2.0' 8 8 issued(Sec. 3097,Civ.C.). Lender's Name - PROPOSED MAX. OCC. - Lender's Address o� '1 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, hereby authorize representatives of this County to enter TOTAL FEE n the ve-menti e property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ;� ignature of Permittee Date x WORKERS'COMPENSATION DECLARATION 76M444 875. CE 875 (11-84) M I SC E LTA N EO U S 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.). BUILDI=n Policy No. Company FOR APPLICANT TO FILL IN ADDRESS ' � ts�LaG z� ADDRESS �`' _ Certified co is hereby furnished. BUILDING ( L/ J ❑ copy y ADDRESS ? Lg5 SA%o_5 �L(M LL- G(� LOCALITY /_ FCertified copy is filed with the county building inspection LOCALITY NEAREST (�(/ department. ceoss sT. Date A llcant NEAREST DISTRICT NO. GROUP TYPE P ESSED BY pp CROSS ST. ClDw4 CONST. CERTIFICATE.OF EXEMPTION FROM WORKERS' LEGAL tl 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 CONDITION_S 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 s,zE of LOT EXISTING BLDG., a 0 permit is issued, I shall not employ any person in any manner INNER kt��l ft -re&, G. � so as to become subject to the Workers' Compensation Laws. MAIL c I� OCCUPANCY GROUP � AD DR ESS,CO Date Applicant �p � �y ,L I� NOTICE TO APPLICANT: If, after making this Certificate of CITY C TNoL �, �S�3�3� 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) 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. Nam 0'1 5gs;n P_5s ,• PARKING REq'D PROVIDED ' (+� SPACES License Number Lic. Class R'e't'C A4,x e C Ae cf,-r 5 e 2v 1 C L-S LIMITED TIME USE Contractor Date DATE DATE ❑ 1 am exempt from thelicensing requirements as I am a PROM. TO. licensed architect or a registered professional engineer SIZE of No. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING �lylpy�.e �•.- FINAL APPROVAL I- G{ Lie.or Reg.No. Date `0��� 1 � , (3F.•C�CG S aGG /fO A` HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ' ON LOT AND USE / �s��'• I hereby affirm that I am exempt from the .Contractor's (� "i i(.II is l-- 0o 1 5.r =/` License Law for the following-reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 130015 i tae I, as,owner of the property, will do the work and the SPACES PRov,DEn structure is not intended or offered for sale (Section , 7044,Business and Professions Code). �• CONSTRUCTION LENDING AGENCY' PROPOSED USE OF BUILDING e2Lc:,V C�",Gr I hereby affirm that there isa 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 R� V d 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, C and hereby guthorize representatives of this County to enter TOTAL FEE 015. U0 upo the above r ntioned propert for in ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of Permittee Date I i WORKERS'COMPENSATIONDECLARATION • 4 CE 875 (11-84) MISCELLANEOUS ipPLICATIOtl I hereby affirm that I have a certificate of consent. self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insui'E�, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(See. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING _ ADDRESS , UN&S Certified co ,is hereby furnished. BUILDING I�E,C? J S 7(�/�AS V�f'. PL- I Py y ADDRESS LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST - DISTRICT NO. TYPE P CE D BY CROSS ST. �In lJ.r� �• (�/' CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (lX 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 ZONESPECIAL CONDITIONS by the permit is for one.hundred dollars ($100) or less.) USE OF I certify that in the�•perforniance of the work forwhich this SIZE OF LOT EXISTING BLDG. permit is issued I shall not employ any person in any manner ,OWNER e , "ft ' so as to become subject to the Workers' Compensation Laws: MAIL ` /n��j OCCUPANCY GROUP C3 Date Applicant � ADDRESS �7�q 9 �-Of /i�lb Q i3 TEL. P/cc LV NOTICE TO APPLICANT: If, after making this Certificate of CITY LlLei�lq e1 )' No. F�' ' ' T� OCCUPANT LOAD a z Exemption, you should become subject to the Workers- APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor.Code:; you must forth- with comply .with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION - ❑ deemed.revoked. ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 Ne Q ;,uS/4Pss effect. PARKING REq'D PROVIDED �� - �p SPACES � License Number Lic. Class L p1J� S �r LIMITED TIME USE - Contractor Date UJL A/V DATE DATE El I am exempt from the licensing requirements as I am a FROM: To: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my.professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). 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 ; 1I-;(j_(1€II'1 Icf rl; ness and Professions Code): NO. PARKING •' - Ila G' I, as owner of the property, will do the work and the SPACES PROVIDED "7C i•.I�rtJ 1 All structure is not• intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING . I I hereby affirm that there is a construction lending agency <<e rr / / -0 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 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. y SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKhRS'COMPENSATION DECLARATION 76M444 ) 'APPLICATION CE 875 (11-84M ISCELL®® NEOUS I hereby'affirmcertificate have a certificate ti consent to c 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 G ADDRESS Certified copy hereby is , furnished. BUIL D - /DING �iJ� ' ADRESS LOCALITY' G Certified copy is filed with the county building inspection LOCALITY NEAREST department. `G� 9/ -7�'d CROSS ST. 67 Date Applicant NEAREST a DISTRICT7. G 1,, UP TYPE CESSED BY .CROSS ST. _ Y' CONST.. . 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.) USE OF , , SIZE OF LOT EXISTING BLDG. - d I certify that in the performance of the work for which this permit is issued, I-shall not employ any person in any mannerOWNER y so-as to become subject to'the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a _ ADDRESS `� Date Applicant TEL 411 - uj NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. v OCCUPANT LOAD CL, Exemption, you 'should become subject to the Workers' z 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 PERMIT43E (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. REp'D �. PROVIDED SPACES License Number Lie. Class61 LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a . FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPE OR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG A URE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING - j{.,; HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS n 2� g 4I, ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): No: PARKING - - t�-.j f�t,i ("•� - I, as owner of the property, will do the work and the SPACES PROVIDED ,,_,;.� _ l=`,•�s�;�._; structure`is not intended or offered for sale (Section 7044;Business and Professions Code). IVI CONSTRUCTION LENDING AGENCY PROPOSED USE'OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work• for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC: - - - Lender's Address 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 ISSUANCIE Fes ordinances and State laws relating to building construction, and hereby authoriz' epresentatives of this County to enter TOTAL; FEE upon above me i ned'pro frf r inspection pu• oses. SEE REVERSE FOR EXPLANATORY LANGUAGE 30 3 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES 131JILIANG 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 Certified copy is hereby furnished. BUILDING X — ,�/ ADDRESS S ((J�I/tS (9r. �Jeqfl . LOCALITY • ��i. Certified copy is filed with the county building inspection LOCALITY NEAREST, C- department. CROSS ST. Date Applicant NEAREST / 0-�� DISTR��IICT q. GROUP TYPE P ESSED BY CROSS ST. („� �"f7� _ CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d j/ � '1116--e- /* 1�'�- - COMPENSATION INSURANCE DESCRIPTION LOT NO. ltJ—Ti1 BLOCK MAP HIGHWAY NOOF BLD GS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT. NOW. ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars •($100) or less.) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. C:)permit is issued, I shall not employ any person in any manner OWNER (af� _D so as to become subject to the Work %Compensation Laws. qqOCCUPANCY GROUP ce MAIL�j ADDRESS ,� U Date:i%!�/ Applicant E3 NOTICE TO APPLICANT: If, after making this Certificate of CITY ew I- 0 NOL ��_/3�'" OCCUPANT LOAD D_ Exemption, you should become subject to the Workers' AP LIGATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth with comply with such provisions or this permit.,shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section.7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and / effect. PARKING SPACES REQ'D PROVIDED LL�� License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM. To: licensed architect or a registered professional engineer SIZE of ,^ NO. OF INSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. ' 66U S/ STORIES , SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING T (V Q FINAL APPROVAL 3� ii�lf_ II Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSO N0 FE_E ON LOT AND USE � O I hereby affirm that I am exempt from the Contractor's J���A'(J _ �f License Law for the following reason (Section 7031.5, Busi �1 �j1 ) !{!s l—i_i4�li 4 ness and Professions Code): NO. PARKING . I, as owner of the property, will do the work and the SPACES PROVIDED 105 AM i_t structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. ' Lender's Address PERMIT FEE I certify that I have read this application and state that the 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 5 Bb upon the abov - tioned property for inspectio pur ores. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P rmittee Date }CORKERS'COMPENSATION DECLARATION E 875 (11,-84) CE MISCELLANEOUS APPLICATION ' C 875 , ;Lhereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BAUILDING L DDRESS F-1Certified co is hereby furnished. Bu1LDING L/, copy y ADDRESS V La h LOCALITY ❑ Certified copy is filed with the county building inspection OCOCALrryNEAREST department. e—m l e (4A CROSS ST. Date Applicant EAREST �} DISTRICT NO G UP TYPE PROC SED BY CROSS ST. 01 k 61 C NS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SEC O LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this J. o permit is issued, I shall not employ any person in any manner OWNERq 1` " Q �yf f N Ve,%+rhp Grp e� y so as to become subject to the Workers' Compensation'Laws. AIL `� �,t+• OCCUP,AgNCY,GR OU PCS ! o DRESS 21 021 5 e* 1G3' �.,'� Date Applicant ,` w TEL. OCCUPANT LOAD NOTICE TO'APPLICANT: If, after making this Certificate of CITY C�la{S y No.�?,$ p _/:L Qpp 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 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 PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and, effect. PARKING SPACES REQ'D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor • Date DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineerslzE of No. of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- ISTING BLDG. STORIES GNATURE E iness and Professions Code). FINAL APPROVAL F - PRESENT USE OF BUILDING Lie.or Reg.No. Date + ail ! /L HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE / y� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED I, as owner of the property, will do the work and the1# 0;i a g g structure is not intended or offered for sale (Section o 0 0 0 7044,Business and Professions Code). r ,o!o o Io 0 0 o z CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING S�jM} ��17 0 71 I hereby affirm that there is a construction lending agency aGA+" �/(a�w vl l�e�'� L ` (((r� 4 8$ _ for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Pa 4 Lender's Name PROPOSED MAX. OCC. A Lender's Address 0 3 So. Ni c%o I so n Ay 4y �' Mosi erg rQr CJt,. PERMIT FEE I certify that I have read this Ipplication and state that the V- ( above information is correct.I agree to comply with all County. ISSUANCE FEE ordinances and State laws relating to building construction, n44 ailo hereby authorize representatives of this County to enter TOTAL, FEE t r on the oZntioned propert for inspection purposes. J�-� 7 / g a$ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' CUMYI NJA11VlV LJCI LHKHi1V1V 20-0063DPW?2/90 1ldl(->131.C.LLH11lGVtJ� f''\I—I—i..lt�tli 1V:lll I hereby.affirm that I havea certificate of consent to self COUNTY OF LOQ ANGELES BUILDING'. AND SAFETY DIVISION ;Insure,or a certificate of.Wgrkers' Compensation Insurance,or a certified copy thereof (See:3800, Lab. C.)• Policy'No.— Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified copy.isw hereby,furnished. g 9453 -LAS TUNAS DR. , LOCALITY ❑ Certified copy is filed with the county building inspection CITY ZIP T department. TEMPLE CITY,CA 91780 cRosssT: Date ;;1 Applicant SIZE OF LOT _ NO.OF?LDGS.NOW ON LOT - DISTRICT NO. I GROUP TYPE PROCESSED BY coNsr. CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT 0. Q COMPENSATION INSURANCE MAP HIGHWAY V ' NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($.100) or less.) 0 TEL NO. I.certify that in the performance.of the work for which [his INVES RVE e INC. (626)458-343 permit is issued:l shall not employ"any person in any manner I so as to become subject to the Workers' Compensation Laws. ADDRESS OCCUPANCY GROUP �� Z 1300 E. MAIN''ST.#210, Date Applicant . CITY )nT zIP NOTICE TO APPLICANT: If; aafter-making this Certificate A7 IiAMBRA 91801 of Exem tion. you should become subject to the Workers' OCCUPANT LOAD p APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forthwith 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 Business NO.OF EXITS and Professions Code,and my license is in.full force and effect. Name bF Bus]Lness � I� PARKING• REQ'DPROVIDED I . i License Number Lic. Class L & C ENTERTAINMENT INC. SPACES 4 Contractor Date LIMITED TIME USE I El I am exem t_from the licensing requirements as I am a DATE DATE I P �� FROM: TO: licensed.architect or a registered professional engineer acting in my professional capacity (Section 7051,Business SIZE OF 2,200 SQ 1'1 '40.OF INSPECTOR'S and PIOfe$$IORS Code). EXISTING BLDG., STORIES 1 .SIGNATURE. Lic. OC.Reg. NO. - Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 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, PROPOSED USE OF BUILDING Business and Professions Code). RENTAL SERVIE AND RETAIL GROCER 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 'Pt" NT tNTERTAIN.METN, l�hLNO ( 626 309-1682 Lender's Address LAS TUNAS DR. TMEPLE CITY,C- 91 780 j I certify that I have read this application and state that the above information is correct. I agree to comply with all County PERMIT FEE ' ordinances and State laws relating to building construction,and hereby authorize representatives.of this County to enter upon ISSUANCE FEE 5 ;I the above-mentioned property for inspection purposes. . TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE' nature of Permit e Date WORKERS'COMPENSATION DECLARATION CE 8454(1184) MISCELLAIVEOUSAPPLICATION hereby affirm that 1 have a certificate o£ consent tself 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 J. /L I �//� ADDRESS /. Vl�I l� / �/ FICertified copy is hereby furnished. X}� aoILDIN L LOG ALlrr FCertified copy is filed with the county building inspection LOCALITY NEAREST department. $y, CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP ITYPECESSED BY CROSS ST. ", n� /L 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 slzE of Lor EXISTING BLDG. d C3 permit is issued, I,shall not employ any person in any manne3CX OWNER of building Q} �` -'., so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP � ADDRESS Iyn r Date Applicant a/,,� 4 C-3 NOTICE TO APPLICANT: If, after making this Certificate of CITY TNOI. 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ❑ ❑ No Spec. Knowl. deemed revoked. occu]PANcr INSPECTION ❑ Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that'l am licensed under provisions o£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 anJX effect. iName Of buS1nESS PARKING SPACES REQ'D F= ]PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF 1 59PEC TTORORE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES . iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL �7 Lic.or Reg.No. Date G✓ 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 El1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address 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 ereby autho ize representatives of this County to enter TOTAL FEE 25 . 00 upon e a ve- tinned property for inspection p p ses. XX ( s IC (/gEE REVERSE FOR EXPLANATORY LANGUAGE XX 11 S n' turC of Permittee Date i 1()IZI:ERS •.JO',!PL 5.111t)N DLCL.VZ.\TIU; -E s-, p M ISCELLANEOUJ APPLICATION I hereby affirm that l have a certificate of consent to seer 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.). Policv No. Company FOR APPLICANT TO FILL IN UILDNIAODR4S Certified opt is hereby furnished. pJ'UILD ADORISOR ESS f (� > `� ""'�l^`-'�� LO Ca LIT Y' F Certified copy is tiled with the county buildine inspectio R cAUTY n 14EAREST department. - ':ROSS ST. Da It! .._ __--. .\pt1111:1 I1t _-_--_-_ _ --___ NEAREST DISTRICTNO. 1:R0 P ITYPE P CESSED 9Y C.ItOSS ST. CONST. ('P!Z!II It \11:01 EXENII'IION I RWI %MRKERS' �--LEGAL — --- — — CONIPE`:SA110N I`'SI,R.\`;CE DESCRIPTION LOT NO. BLocK �P aHw s• STATE .`AA JOR SECOND LOCAL TIN--- OF BLOCS. (This section need not he '.ompleted if the work involved TRACT OW ON LOT I.SE ZONE SPECIAL CONDITIONS bv the permit is Im one hundred dollars iSI110) or less.) f usE of j SIZE OF LOT E;(ISTING BLDG. I _-ertifv that in 'he oer,-L=ancc •tf :he -Aori< :or •,hich :Iris �_ permit is issued. I shall not emnlo} an.t ne:;on inanv manner X! OWNER � N_r S r✓^�, fit✓ (� so as to become alh!ec- -o the 'Aorkers' Comeensation Lasts. OCCUPANCY GROUP X' AD OR ESS 130,0 , R NOTJCE .M0 PPLIC.\N'T: If. .uter,makun: :his C: —, ica(e of ;'DITL (-d_ vo - �3� OCCUP4NT LOAD E:cemption, you should become subject -o :he Workers Compensation orotistens )[ the Labor Code. :ou ;oust forth J APPLICATION FOR -XI, HARCWARE � itlt cornnh: 'pith _u:il n7misions r :i`IN :ermir ;hall I)e — �'rRA.IL=R 'JSE GEOLOGY INSPE._r:O rt \Jo Spec. Knot,vl. LICENSED i(D".TR.),CiORS DECt.\IZ.\;lt)"; , ocr•DPa:,c'� INsPEcTIoN B I Panic Devices _ I herebv ai`irm :hat I `nt licensed under provisions of Chawc, SAFETY PERMIT 7LIST ITEMS BELOW! - 9 (commencine -•lith Section 7000) of Ditision 3 of the Busi- NO. OF EXITS ness and Prnfessions Codc. and mt license is in :till :orce and —. CPARKING n :!ecr. i. - SPACES REO'J D PROVIDED !�I 1 L License Number _ LIL. I LIMITED TIME USE CJnI-, tiir --- Dat' _ ..TE o„rE lin ntC` :oin -lie :ICenilnH :equir-,menti :s 1 11;1 J V, ,•. � licemed 1rc'li.ec: or :r :e=istered rniessiorml encm:_, ;,zE JF o. DF _ OR'S ? loin_ in Int oruIe,slonal �ap1':a' 1ei:;on _ 15Ils- I =X�ST:NG BLDG. -iORIEJ 1NsveT SIGNATURE mess.a std P"1)[eSSll ns pt,Jdel.- -- -- E- E•Ir •lsE of BUILDING IFINAL APPROVAL Lic. or RSL. 'J, .--------. _ _ D;1: = I li0\IE O"NER-RLILDER DECL.\RAF10`, �NO OF EXISTING BUILDINGS ON LOT AND USE , I !lerebt atfunl :hay i -mi exempt 7nrn :Ile Contractor'; I License La•.t for :he I:.Ih)+'in^_ season 'Se.:wn "11.1.:. 31.1.1- ness find P-otessionst ode): No. PARKING SPACES I4:OVIDE.O f� 1, as a�sner of :he prnp�:rtt. '.till d'o :he sari: Ind :he strucnue is nut intended or offered :o! aie Section Bu<iness:tnd Pro[essionsr .)del. ROPOSEO 'JSE OF BUILDING - CONSI!ZlC1l0\ LENDING u;E\t11 l llerebt lffum that :Isere is :1 construction lendinL' u�-encv Sad for -the performance of the work fur sthich this P__ is issued.ISec. 300-,Civ. C.I. ' Lel' - --- _ ----- ------------- tilt's';Nainc _. PROPOSED M-ITl OCC. 1_cilder s \ddress — 1 25.�� . { - --`-- PERMIT F.CC y 1 certify that t have read this application and Stare 'hat :he it abote information is correct. l agree to comply:s ith all Counn• 'ISSUANCE FEE ordinances Arid Sr to lasts relatim-, to building construction. and [I,y by auth0 Sze [CprCSCnlatl�'l'S Of this CUU❑tt t0 enter TOTAL FEE 25.00 (' I Ipo11 tft abovz-I entioned prone; s' lilt inspection purposes. ' 1 (i EE REVERSE FOR EXPLANATORY LA\GUa]E R r % La 11'OR)`1::RS'COhIPENSATION DECLARATION CE 875 875 111-841 M ISCELLANEOUS APPLICATION ' CE 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 8u1�DINc El Certified co is hereliy furnished,. BUILDING T 7 7� copy XX ADDRESS. 9469 malas tna'`S IJr i LOCALITY Certified copy is filed with the county building inspection NEAREST department. Temple City or. Dale- _ _Applicant _ NEAREST- DISTRICT NO. GROUP TYPE �/ CESSED BY CROSS ST. - �j,d CONST," CERTIFICATE OF EXEMPTION FROM WORKERS'' c LEGAL v - 1 IF COMPENSApION INSURANCE:' OE SCR IP TION 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 SIZEOF LOT EX .NG BLDG. - p I certify that in the-performance of the work for which this permit is issued, I shall not employ any-person in any manne3CX OWNER O )iridin so as to become subject to the Workers' Compensation Laws. MAIL V �� OCCUPANCY GROUP - C ADDRESS 13.00 E•Main St . -#210 r.. Date -_--- Applicant11 .- — LL NO 'ICE TO APPLICANT: If, after.niaking this Certificate of CITY Alhartlbra NO 818-458—?4-435 OCCUPANT LOAD v 'T 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 sliall be TRAILER USE E] GEOLOGY INSPECTION E] No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION,�' 'Panic Devices ElIC'ENSEU CON"I RACTORS DECLARATION - I hereby affirm that I ain licensed under provisions of Chapter SAFETY PERMIT E] (LIST ITEMS BELOW) - a XITS 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF E ness and Professions Code, and my license is in full force an X" r 7� effect. Name Ol business PARKING REq D PROVIDED I I AK:I INTERNATIONAL- CO. SPACES LJ .License Number Lic. Class LIMITED TIME USE Contractor_.-.___--_--- Date - DATE DATE FROM: TO: F-1 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). PRESENT USE OF BUILDING FIN-AL APPROVAL Lic.or Reg. No.---- — Date— HOME OWNER-BUILDFR DECLARATION NO, OF EXISTING BUILDINGS ON LOT AND USE I hereby affirna that I ana exempt from the Contractor's V.VI�J License Law for the following reason (Section 7031.5, Busi- ness and Professions Codc): - NO. PARKING SPACES PROVIDED EJ 1, as owner gf,tlie property, will do the work and the structure is not intended or offered for sale .(Section 7044,Business and Professions Code). . CONSTRUCTION LENDING AGENCY PRoaosee USE of BUILDING hereby "affirm that there is a construction lending agency. for the performance of the work for which this permit ,is issued(Sec. 3097,Civ.C.). Lender's Name_ PROPOSED MAX.'OCC. .. l.ender's:Address— _ _---- — ! _ PERMIT FEE .25 . 00 certify--that 1 have read this alapiication and state that the above information.is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State lairs relating to building construction, and hereby authorize representatives of this County,to enter TOTAL Fee 25-00 . r upon the above menti d proper y for inspection purposes. _ SEE REVERSE FOR EXPLANATORY LANGUAGE xx Si!n:Ilnrc Ilf Pc rnlillcr I)ate i r I WORKERS' COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION - 20-0063OPW.2/90 I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES BUILDING. AND SAFETY DIVISION I, rinsure,or a certificate of.Workers'Compensation Insurance, or ( a certified copy thereof (Sec. 3800, Lab. C.)• Policy'No. Company FOR APPLICANT TO FILL IN BULDINADDREs -. AWILDING AMS ❑ Certified copy.is hereby:furnished. X LOCALITY ❑ Certified copy is filed with the county building inspection CITY ZIP I NEAREST, department. ary CROSS ST. Date `-= Applicant SIZE OF L6T NO.OP BL GS.NOW ON LOT DISTRICT NO. GROUP TYPEPROCESSED BY C CERTIFICATE OF EXEMPTION FROM WORKERS' CONST. COMPENSATION INSURANCE TRACT 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 USE ZONE I SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) N . r I.certify that in the performance.of the work for which this serf et TEL 14 permit is issued.I shall not employ any person in any manner 11 so as to become subject to the Workers' Compensation Laws. ADDRESS e a OCCUPANCY GROUP v � 1 t Date Applicant CIT NOTICE TO APPLICANT: If, after making this Certificate OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of theLaborCode.you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Know]. ❑ 1- revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION C� 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 Business NO.OF EXITS a and Professions Code,and my license is in full force and effect. t) }ls nes SPACES • REO'D I I PROVIDED _ License Number Lic. Class sPAces U t I i Contractor Date LIMITED TIME USE ` ❑ I am exempt 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 NO.RI INSPECTOR'S { I EXISTING BLDG. STORIES / SIGNATURE. and Professions Code). LIC. or Reg. No. -- Date PRESENT USE OF BUILDING (FINAL APPROVAL HOME OWNER-BUILDER DECLARATION N&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 { I 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, PROPOSED USE OF BUILDING Business and Professions Code). � 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.). PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINT) TEL NO. _ r y Lender's Address ADDRESS I ML { I certify that I have read this application and state that the above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE I the above-mentioned property for inspection purposes. TOTAL FEE _ .. d SEE REVERSE FOR EXPLANATORY LANGUAGE Sie ature of Permits e Date \oR1:LRs' CoyIPLVSATION DECLARATION CE 87e n i-aa)a ce M ISCELLANEOUS APPLICATION ay 1 hereby affirm that I Have certificate of consent to self COUNTY OF LOS .ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec. 3800• Lab.C.). Policy No. —Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS / '/ / 3 -�,••1 G.-'Z�.>L..o Certified copy is hereby' furnished. (BUILDING r _ g ADOR E55 '3 /�.AST4 ha rl' R LC CA LITY I Certified copy is filed with the count- buildiniz inspection LOCALITY NEAREST department. Temple City CROSS ST. Date :\pphcalll - NEAREST DISTRICT NO. GR O TYPE OC ESSED 6Y CROSS ST. CONST. ) i CLRT1171C TE OF L\L�IPT10` t=RO\1'�'CRI�LRS LEGAL vj �V! COMPENSATION I`SL 10NI,i`. DESCRIPT'ON JL.T NO. BLCCK MAP NIG..Ay ^C. ICIR C '_I STATE MAJOR SECOND LOCAL NO. OF SLDGS. (This section need not be completed if the N%ork Involved 1.TR AC 7 Now ON LOT 1USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) (USE OF l l' I i SIAL: OF LOT EXISTING SLOG. { ccrtifv that in the rerforinan.e of e .cor!< 'or ,-chid :his permit is issued. I shall not employ my nelson :n am' manner , OWNER C f}I�Isf —MIN D so as to become subject to the F1'orkers' (. mpensatien LawS. _ AAIL I OCCUPANC'= GROUP — t Date Applicant _ NOTICE 1'() APPLICANT: lf. :utcr nuk n :.':i:: Cert team If gy clrr T�tllt Cl'-lX vo` ((rrL)1C�6—�g �j (� OCCUP4N7 LOAC Exemption, you inould become subiect -0 7110 tVor-, i D I- � � I = Compensation orgy,isions of die Labor _'ode. you must forth- a L.(ATiO�. = R _,`<i- HJ C!i!?; =. i with co=p%- a iih >uch nrovis;ons er .itis ermit ;hall be _... — I I 'R AiLER 'JSE EO LJ GY :NSPE:..T:CN No SL'2C. ����.0'''! Lr deemed rr%vked. LICENSED CONTRACTORS DLCL.\R.�TIO`< OCCUPANCY INSPEC-IONkX Panic ✓2V'0?S I hereby affirm :hat I am licensed under-revisions of C Iia-ter -- 9 (cotnmencine %vith SeC ion 000) of Division ?t the Busl- SAFETY PERMIT (LIST ITE-AS BELON) NO. OF EXITS ness and P-ofessions Code, and me license is ui rhil force and effect. PARKING REO.O PR C'✓ID ED CES License \unibeT Lic. Class _' 2• �. /_'L 'PcLL .. !�! LIMITED TIME USE ti Contractor mate ,AT= DA-E w Z ❑ To: am esempt atom the iicensine reyuiremeats as 1 m i licensed ;architect or a resistere(i professional -n-incer ;IZE OFO. of INSPECTOR'S z actin'-, in :m proCr. LDj ;Sionai _ar.;cit. e:uo;i I)fl. Btu EXISTING B G. -ORI-; SI TUR l � tress and I'rofessicn (. s .Qel. 1 � I V I PRESENT USE OF BUILDING FINAL APPROVAL Lic. or Rec. Da_e HOME JWNE.R-11LILDLR DECL.- RAII0 G BUILDINGS ON LOT ANO USE I Hereby affirm that 1 am exempt front the Contractors I License Law for the folloscin-, reason (Section U l.o. Busi- ness and P-ofessions Code): NO. PARKING 1. as owner of the property'. will do tiie work and the SPACES PROVIDED ��• structure is not intended or offered for -,ale iSection 1 7041. Business and Professions Code). CONSTRUCTION LENDING AGLNC1 X PROPOSED USE OF BUILDING I hereby affirm that there is,a construction lendine :L--encv for the performance of the �vork for ishich this permit is issued(Sec. 3097.Civ. C.). Lender's Name Iy! PROPOSED MAX. OCC, t.Wi Lender's Address—__ — I I:r 1 certify PERMIT FEE 2S�oo that l have read this application and state that the 4 I"jJi above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relatine to buildinlz construction, I 'i and herebv authorize representatives of this County to enter TOTAL FEE 25.00 , f upon the ahme-mentioned property for inspection purposes. N f � SFE REVERSE FOP EXPLANATORY LANGUAGE --I; Signature of Peat Date I . 'f: RKERS'COMPENSATION DL'CLARATION 7eM444 CE 875 (11-84) M ISCELLANEOUS-APPLICATION affirm that I have a certificate consent self COUNTY OF LOS ANGELES. BUILDING AND SAFETY DIVISION a certificate of Workers Compensatiti on Insurance,e,or copy thereof(Sec. 3800,Lab.C.). CompinyFOR APPLICANT TO FILL ADDRESSeuiLDING / . - Ified copy is hereby furnished.:_ BUILDING -T le XX ADDRESS ` 41'3_ L% Tunas Dr, IC/ {( l/� LOCALITY Ified copy Is filed with the county budding inspection LOCALITY NEAREST rtment. ][}; CROSS ST. Applicant NEAREST / DISTRICT NO,. GROUP TYPE ...���jjj CESSED B.Y- ` -- ' CROSS ST. C'.lvverf - �/ CONST. {IFICATE,OF EXEMPTION FROM WORKERS' LEGAL If COMPENSATION INSURANCE DESCRIPTION LOT,NO. BLOCK MAP HtGHW qY No. (cIR CLei STATE MAJOR SECOND LOCAL NO. OF BLDGS. tion need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS erinit is for one hundred dollars ($100) or.less.) USE OF' i . SIZE OF LOT EXISTING BLDG. .hat iil.the performance of the work for which this C-7) issued, I shall not employ any person in any manneXX OWNER of building lhvue'ril2- " Ieconie subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ® crt Ci ADDRESS r- _ Applicant_ LL, O APPLICANT: If, after making this Certificate of CITY No� OCCUPANT LOAD CL rr- you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: ition provisions of the Labor Code, you must forth- )ply with such .provisions or this permit shall be TRAILER USE .GEOLOGY IN SP.E CTION Elyoked. E] _ El No Spec. Know,. I ❑ Panic Devices ICENSED CONTRACTORS DECLARATION occurarlcr INSPE,CTIO N, 11 affirm that I am licensed under provisions of Chapter SAFETY-PERMIT ❑ (LIST ITEMS.BELOW) encing with Section 7000) of Division 3 of the Busi- NO. OF EXITS Professions Code, and my license is in fulhforce a nix: Name of business PARKINGREp E� SPACES D �_ PROVIDED 1 I lumber Lic. Class !it ME I�1 HI.VeVSCtK SG�1 o a .• J LIMITED TIME USE Date DATE DATE FROM: TO: I exempt from the licensing requirements as l am a { Ised architect or a registered professional engineer SIZE OF , NO..OF INSPECTOR'S 1,g in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SIG ATURE jandProfessions Code)_ FINAL APPROVAL PRESENT USE OF BUILDING Ig. No. _ Date kIOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS w �� ON LOT AND USE - iffirm that 1 am exempt-from "the Contractor's lo' aW. for the following reason'(Section 7031.5, Busi Professions Code): f NO. PARKING oCvner of the property, will do the work and the SPACES PROVIDEDJU it 13 f11 I AU I I :tore is not intended-or offered for sale (Section 1, Business and Professions Code), ut i PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY . affirm that there is a construction lending agency 5erfornlance_ of the work for which this permit is .-3097.Civ:C.). PROPOSED MAx.-OCc. .. 'lddress-- I that FEE _ that l have read this application and-state that the . M1rmation 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 25--00 . bove-mentioned prriperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - 5 xx (� N — --- G ) WORKERS'COMPENSATION DECLARATION CE 875 (71-84) MISCELLANEOUS APPLICATION CE 875 1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insiAe, 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 BUILDINGAD�REss Certified co is hereby furnished. BUILDING ORESS , GaSTC!/lG�s Ari copy y xx ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. Xx CROSS ST. Date Applicant NEARE �� CROSS ST. l vet- / Sr-,} DISTRICT NO, GR94 TYPE PR ESSED BY - , �/) CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VU COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF BLOGS. NO.. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NO.W ON LOTUSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) -us OF of SIZE OF LOT 4Px f'��s�•'c EXISTING BLDG. } I certify that in the performance of the work for which this 1 CD--, permit is issued, 1 shall not employ any person in any manneXX OWNER of building -r c. Ceneur S ctare so as to become subject to the Workers' Compensation Laws. MAIL n t OCCUPANCY GROUPELI n, ADDRESS /31oo �{Main�L t.i +-)-10CJ Date Applicant LLJ NOTICE TO APPLICANT: If, after making this Certificate of CITY AlAambka TNo� B/8- -3 � 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 E No Spec. Knowl. deemed revoked. E] Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (] (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force anx effect. Name of business A SPC ESS REQ'D PROVIDED ' SPAC License Number Lie. Class �C �ra(.> i'r.S' 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 SIGNATURE iness and Professions Code). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING _ HOMF.OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (�ON LOT AND U9B - •• •• I hereby affirm that I :un exempt from the Contractor's -• •-•-,: License Law for the following reason (Section 7031.5, Busi I�� '-`'%`••"'—'''-''•''•i 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 1 hereby affirm that there is a construction lending agency for the performance of the work for xyhich this permit is •issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCG Lender's Address - 25 .00 Icertify 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 25.00 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE xx j�,��-.�- - - - Xx�61 Signature of Permittee Date WORKERS' COMPENSAHON DECLARATION 76M I MISCELLANEOUS APPLICATION I herebv affirm that I have it Gc"tlficii _, (31, con.":11t to "J!* COUNTY 01- I-OS ANGELES BLIILDIN.6 AND SAFETY DIVISION i� iiisure,or­i�,certificate of RloiKefs' CIVIIPCII>:I1:011 IIISLII;uICC.0I it certified copy thereof (Sec. 3800. Lila. j Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS El Certified copy is liereb} furnished. X LOCALITY Certified copy is filed with the comm building 111"I)CCtIon- CITY Fz_1P NEAREST department. o CROSS ST. Date­-­ . Applicant SIZE C5F LOT NO,OF BLDGS.NOW ON LOT 'DISTRI GROUP TYPE !OCES D BY 5;��T NO. CON CERI WK A[1 01' LXEMP-1 ION FROM N%'OR K I.RS* LOT NO. -_ -, V HIGHWAY COMPLINSAHON INSURANCE TRACT BLOCK NO. ICIRCLE) STATE MAJOR SECOND LOCAL (This section need no( be complefed If the %%ork imoked ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS' by the permit is for one hundred dollars (~,100) III ICS0 I certify that in the performance of the work 10i whichihi� OWNER TEL NO. permit is issued. I shall not employ any person III miv manner so its to become subject to the Workers' Couipen,imon laws. ADDRESS OCCUPANCY GROUP Date------ - Applicant CITY ZIP NOTICE TO APPLICANT: If. after making this Certificate OCCUPANT LOAD of Exemption, jou should become subjec.t to the Workers' APPLICATION FOR Coin pensat I on provisions of the Labor('ode.you joust I"wilmilli COMPly with SLICK provisions or this permit ,Mill be LlCefflCd TRAjt_ER USE LEXIT HARDWARE: LJ GEOLOGY INSPECTION No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTIONN Panic Devices El LICENSED CONTRACTORS Dl:(-I_ARAII()N I hereby affirm that I and licensed under PI_0�iSiOnS Of (IILIPter SAFETY PERMIT LIST ITEMS BELOW) 9(commencing with Section 7000)of Di%ision 1 of the Business NO.OF EXITS I F and Professions Code,and my license is in full force and effect. PARKING• REQ'D PROVIDED License Number Lic. ('lassSPACES Contractor Date LIMITED TIME USE DATE DATE El I ani exempt from the licensing recloncillents its I art it FROM: TO: licensed architect or a registered Professional engineer acting in my professional capacity (Section 70>1. Business SIZE OF 1.OF INSPECTOR'S EXis rING BLDG, STORIES SI� ATURE and Professions ('ode). PRESENT USE OF BUILDING :vea FINAL APPROVAL Lic. or Reg. No. Date 0----------- HOME OWNER-BUILDLR DIA LARAIION NO.Of E XISi ING BUILDINGS 01 ON LOT AND USE I hereby affirm that I am exempt front the (,oIItiiICjoI,S iCCIjsC Law for the following reason (Section 703I5. Business and Professions (ode):- , NO.PARKING ❑ Las of the propert I. trill (it, the \%oik and IIIL' SPACES PROVIDED_______ structure not intended or ollcied 1-0i salt.' (Scciion 7044.• PROPOSED USE OF BUILDING Cg — Business and Professions Code). CONSTRUCTION LENDING AGEN( Y I hereby affirm that there is it construction Iciulio- iigenc\ ) ,it4J1 #/tWI-e Q (A- the performance of the walk for which mis pein'lit Is issued — 1 11 " I ____V (Sec. 3097. Civ. C.). PROPOSED MAX,OCC. Lender's Name _-- APPLICANT WRIN TEL NO. Y /Li iwCr Lender's Address ADDRESS I certify that I have read t1iis'application and state that the :� 2 above information is correct. I agree t0Cons Ply with aII COLID(y PERMIT FEE ordinances and State laws relating 10 building COFISMIC6011,and hereby authorize representatives of this County to MCI' LIPon ISSUANCE FEE the above-mentioned property for Inspection purposes. TOTAL FEE X S1-F­REVERSE FOR EXPLANATORY LANGUAGE Signature of'Wermittec Dale WORKERS'COMPENSATION DECLARATION CE-875 (1 t-84) MISCELLANEOUS APPLICATION • CE-875 1--hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES AND SAFETY DIVISION IILJ'1 insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereoflSec. 3800,Lab.Q. Policy No:. _—CompanyFOR APPLICANT TO FILL.IN BUILDING ADDRESS �� 1 ADDRESS / J3r FiCertified copy is;hereby furnished. BUILDING XX - _ LA OCLITY . AD DRE 55 j7 -Certified copy Is filed\vlth'the county building inspections LOCALITY - NEAREST ' -department.Cfinellt. 3t CROSS ST. - - Date__; _Applicant - _ :NEAREST _ DISTRICT NOGRQUP TYPE P E55_ED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE' .- DESCRIPTION LOT NO. BLOCK MAP HIGHWAY - rO. (clR CLe) STATE MAJOR SECOND LOCAL NO, OF BLDGS. (This section need not be completed if the work involved TRACT ,NOW ON.LOT ..USE ZONE SPECIAL CONDITIONS -, by the permit is for one hundred dollars ($100) or less.) )� USE OF (�/ SIZE OF LOT' EXISTING BLDG. - O} I certify that'ili the performance of the work for which'this 0 permit is issued, I shall not employ any person in any manneX OWNER of buildinvD�E'��E s„ as to hcronar suhjcct to flit. Workers' Compensation [.a\vs MAIL D �T "/a OCCUPANCY GROUP �a °: AD DR ESS ii L Date_--- Applicant u. TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, afteT making this Certificate of CITY NO. L u Exemption, you should become subject:to the Workers'- / Compensation-1.provisions of the Labor Code,you must forth- P LICATION FOR- �4OEXITHARDWARE: with 'comply with such provisions or .tills permit shall be TRAILER USE - GEOLOGY INSPECTION deemed rooked. E] ❑ No SpeC..KnOwl. LICENSED ENSED CONTRACTORS DECLARATION OCCUPAEl'INSPECTION . Panic:Devices 11lcrchy affirm that I am licensed under provisions of Chapter SAFETY PERMIT LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division.3 of the Busl- No. OF EXITS:" nes-, and Professions Code,-andmy license is in full force anjX; t� effect..- - Name Of business .PARKING RE6'D-� PROVIDED I I - r - - - SPACES lJ License Number Lic. Class v Q LIMITED TIME USE Contractor— __ Date _ DATE DATE ElI-am exemm pt frothe licensing requirements as I am a = FROM: To: licensed architect 'or a registered .professional engineer SIZE,OFNO.OF INSPECTOR'S. acting In my professional capacity (Section_ 7051, Bus-- EXISTING BLDG. STORIES SIG TORE iness and Professions Code). LIC:Of Reg. N(1. D3t0,_ PRESENT USE OF BUILDING Q FINAL APPROVAL r HOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGS ON LOT AND USE hereby affirm that I am exempt from the Contractor's- License ontractor sLicense Law for the following-reason (Section 7031.5, Busi ties, and Professions Code): NO. PARKING 1, as owner of the property, will do-the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044;Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED-UTE OF BUILDING T v" hereby affirm-that there is a construction lending agency �-77 for the performance of the work'for which--this permit is issued(Sec. 3097,Civ. C.): Lender's Name _ PROPOSED MAX.*OC Lender's Address _, PERMIT FEE 00 a certify that I have read this application and state that the - above infonnation'is:corrcct. l agree to comply:With all County ISSUANCE�.FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25. 0Q - u it the above-mentioned property for inspection purposes. -' SEE REVERSE FOR EXPLANATORY LANGUAGE XX - " .Si��nalinr (I'rrn,illri• 11a(c "_ .. ." . t 1 _ WORKERS'CO)1PENSATIONDECLARATION 45 (11-84) CE 875 MISCELLANEOJSAPPLICATION CE 8 hereby affirm that I have a certificate of consent to self i COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION nsure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). u Policy No. CompanyFOR APPLICANT TO FILL IN pDDRE55`y�3- Certified coy is hereby furnished. qpBUILDING.. j p" pAD DR:E 55 3" S�Z ek. Td e�_ LO C:A LITY - // Z. < •-/ I Certified copy is filed with the county building inspection g 'LOCALITYNEAREST department. CROSS ST. Date Applicant ''NEAREST - DISTRICT NO. I GROUP TYPE P ESSED BY CROSS ST. • � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MOAP HIGHWAY STATE MAJOR SECOND LOCAL (CIRCLE) 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 (5100) or less.) USE OF SIZE OF LOT EXISTING BLDG.- v(/ I certify that in the performance of the work for which this 'M permit is issued, I shall not employ any person in any manner g 'owNER so as to become subject to the Workers' Compensation Laws. v )�1 Q OCCUPANCY GROUP — A� AD OR ESS S\ /"'v C/ , _ i Date -applicant - NOTICE TO APPLICANT: If, niter making this Certificate of�/ CITY 9'IrJa oL. 6 — I OCCUPANT LOAD - Exemption, you should become subject to the Workers APPLICATI N FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- ❑ } with comply with such provisions or this _permit shailt be TR \ILcR USE 1 GEOLOGY INSPECTION 1 No Spec. Knowl. deemed revoked. J Panic Devices LICENSED CONTRACTORS DECLARATION OCC PAN CY INSPE CTlON ° 1 hereby affirm that I am licensed under provisions of Chanter SAFETY PERMIT E] (LIST ITEMS BELOW) a iNO. 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 SPACES effect. REO'D PROVIDED � J /� License Number Lic. Class q i LIMITED TIME USE Contractor Date 1 l N GATE DATE'{ FROM: :O' I am exempt from -he !icensine requirements s t am a 7 04r 211- IN SG>JU s � ! licensed architect or are^istered professional n ince- s,zE of No. ? actin_ m Ind proiesslonal carmclt!: 'lection (1_ i. Bus- =XIS ING BLDG.` �� tSTOR ..SIGN URE inessandProfessionsCode)• / 3� v2/O FINAL APPROVAL PRESENT USE OF BU ILD IIG-i m�•""�+ Lie.or Ree. No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS F1 RE ON LOT AND UsE ` Vt I hereby affirm that i am exempt from the Contractors s n ioo-itoo, 41/17;"9'-r License Law for the fulloiving reason (Section 7031.5. Busi- I - L// ness and Professions Code): NO. PARKING 5 o 1 zit 9 j' - )SPACES PROVIDED i 1, as owner of die property, will do the work and the structureis not intended or offered for ;ale (Section 7044.Business and Professions Code). CONSTRUCTION LENDING AGENCY g, ROPosEo USE of Bu1LnSvG I hereby affirm that there is a construction lending agency for the performance of the work=for which this permit is 1 issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. ' Lender's address 2r,��B ( PERMIT FEE I certify that I have read this application and state that the above information is correct. I agree to comply 0.lth all County ISSUANCE FEE ordinances and' State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 > upon the ab e' i o��property for inspection purposes. IJ % SEE REVERSE FOR EXPLANATORY' LANGUAGE CA Siena ,of nL2r7iittee Date r' I WORKERS' COMPENSATION DECLARATION 20 oos DPwiziso MISCELLA-NEOUS APPLICATION I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION t; I ,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 - - BUI ING ADDRESS - ,ADDRESS ❑ Certified,copy,is hereby,furnished, X LOCALITY ❑ Certified copy is filed with the county building inspection CIT ztP' ' - department . NEAREST de p CROSS ST. Date Applicant SIZE of LO NO.OF BLDGS. OW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' �<1 consT. C TRACT BLOCK LOT NO. V 1 I COMPENSATION INSURANCE MAP HIGHWAY NO. (CIRCLET 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 ($100) or less.) USE ZONE SPECIAL CONDITIONS r ' I certify that in the performance.of the work for which this 11---fer€y er TELN permit is issued.I-shallnot employ any person in any manner LU 37Q so as to become subject to the Workers' Compensation Laws. ADDRESS.—, 4 OCCUPANCY GROUP Z t Date - Applicant CITY zte, NOTICE TO APPLICANT: If; after making this Certificate �j OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: ( comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION.❑ revoked: No Spec.Know[. ❑ _ ❑OCCUPANCY INSPECTION C Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a f I 9(commencing with Section.7000)of Division 3 of the Business Name o us mess NO.OF EXITS and Professions Code,and my license is in full force and effect. r- PARKING• REQ'D i .❑ PROVIDED i License Number Lic. Class PACES LL__ Contractor Date LIMITED TIME USE ❑ I am exempt 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 S ZE OF NO.OF INSPECTOR'S and Professions Code). ( ! EXISTING BLDG. STORIES SIGN A RE. Lie. or Reg. No. - Date PRESENT USE OF BUILDING FINAL APPROVAL to o3 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 I Professions;Code): SO.PACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or.offered for sale(Section 7044, PROPOSED USE OF BUILDING i 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 t (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. Lender's Name AF LICANT(PRINT) TEL NO. Lender's Address ADDRESS i I certify that I have read this application and state that the above information is correct. I agree to comply with•all County PERMIT FEE ordinances and State laws relating to building construction,and ' hereby authorize representatives.of this County to enter upon ISSUANCE FEE the above-mentioned property r inspection purposes. 1 .s.. .� ./� TOTAL FEE ... -. 124 % ! i/ � E REVERSE FOR EXPLANATORY LANGUAGE Signature of Pennitte Date