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HomeMy Public PortalAbout9532 LAS TUNAS DR_Miscellaneous__ �l WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L LA N F®U S APPLICATION CE 875 I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES I BUILDING AND SAFETY DIVISION insurrr.,or a„certificate of Workers'Compensation Insurance,e,or a certifted"copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FI LL IN BUILDING � ADDRESS ,✓/ Certified copy is hereby furnished. BUILDING �3Z �•IfIS Zua/A 1 ADDRESS LOCALITY ❑ 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. �{sIO �j_ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. V 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 SIZE OF LOT EXISTING BLDG.OF V/A/ C d I certify that in the performance of the work for which this C:) permit is issued, I shall not employ any person in any manner OWNER 01Zo w o i =� so as to become subject to the Workers' Compensation Laws. ��jj e /��j `,�j OCCUPANCY GROUP MAIL �R IIZ.4ft gt&Jy_100 //i "'� p ADDRESS ,T U � W�El Date Applicant TEL , 2 z NOTICE TO APPLICANT: If, after making this Certificate of CITY 4 (11W No. Zl�jwd J"'T�✓�� 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. Know]. 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 pROVID ED . � SPACES JJ License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG TURE iness and Professions Code). FINAL APPROVAL, PRESENT USE OF BUILDING Lie.or Reg.No. Date 5"9 HOME OWNER-BUILDER DECLARATION NO, OF EXISTING BUILDINGS O \ ON LOT AND USE I hereby affirm that I am exempt from the Contractor's © t I�' ir License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ^ f FEE DI, as owner of the property, will do the work and the 'PACES PROVIDED \\J. structure is not intended or offered for sale (Section , \ -.•-- - 71 7044,Business and Professions Code). '--'°='']='-'-°t=3' -• :''r 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 r ting to building construction, _-- and hereb tho a repre ntatives of this County to enter TOTAL FEE upon the b v�� tinned r ty for inspectio Pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE � � 6 Sigria`t r o P rrnittee Dat ' WORKERS'COMPENSATION DECLARATION CE87M54(11-84) MISCELLANEOUS APPLICATION I hereby-affirm thht I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or 'fl a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILD'NG r �A4 ��r1/� f�� Fr­ ADDRESS ♦ Cf'/� LOCALITY DCertified copy is filed with the county building inspection LOCALITY r,V NEAREST department. CROSS ST. Date Applicant NEAREST ^ ♦.A�p�� DISTRI U TYPE ��> PR ESS BY CROSS ST. y� (/1'�l V CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP RIDRWAY rvo. (CIRCLE) STATE MAJOR S ON LOCAL NOOF BLDGS. (This section need not be completed if the work involved TRACT NOW. ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF 2� I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG., permit is issued, I shall not employ any person in any manner OWNER �` so as to become subject to the Workers' Compensation Laws. �glll OCCUPANCY GROUP MAIL ADDRESS-A. �a ��� / O Date Applicant 'J,� /� TEL Lu IL-- � �/���/�1 2 7 OCCUPANT LOAD N CE TO APPLICANT:-If, after makingthis Certificate of clrY No. 2 -Z 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 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. V �st PARKING REQ'D PROVIDED ��� � SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: ro: 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 SIGNATOR 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- I D ness and Professions Code): No. PARKING 3 (`� 1 0C� ' I I �0 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 N I hereby affirm that there is a construction lending agency vlocao �4 mw-lc' 1e&v11—,f for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name Lender's Address PROPOSED MAX. OCC. Q 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, r and hereby authorize representatives of this County to enter TOTAL FEE L upon the abmenticne rty for inspection purposes. `q`✓ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) 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 cgrtificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800;Lab.C.). Pblicy,No. ' Company FOR APPLICANT TO FILL IN BUILDING �� yQ ADDRESS C Certified copy is Hereby furnished. BUIL°'SS 9s3 � CJNAs �!� LOCALITY ADDRESS �,/ /� /`j 0 department copy is filed with the county building inspection LOCALITY r' i�7/ /� /-I NEAREST L= ✓_L" C CROSS ST. Date - Applicant NEAREST / "�' r, DISTRICT NO, GROUP TYPE P CESSEDIB Y CROSS ST. /��a�Lr /gJ e , G _ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o ` 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. D_ C:) permit is issued, I shall not employ any person in any manner `OWNER 6,C ,a T® �/Q/11G', ® '' • so as to become subject to the Workers' Compensation Laws. /` OCCUPANCY GROUP MAIL p� o ADDRESS i Q. BDX I ®9 U Date Applicant L" TEL' NOTICE TO APPLICANT: If, after making this Certificate of c,TY�®�/�'�jQ,�'Y` ^/Q No. °�,, ����35 OCCUPANT LOAD Exemption, you should become subject to the Workers' Ir 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. Eldeemed 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. - 1 _w S ` PARKING REQ'D PROVIDED V/ SPACES ��y� 7_Z).License Number Lic. Class /M/� 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 m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIESD� SIGNATURE iness and Professions Code). FINAL APPROVAL /7 PRESENT USE OF BUILDING O� /'- Lic.or Reg.No. Date II�� Y/ / — 997 Z_ -',946 W1 04-IE $9 F HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USEiIIJ ((JJ IVP/ =;i I hereby affirm that I am exempt from the Contractor's i_'s111 's E—E i!It i i _E; J s. License Law for the following reason (Section 7031.5, BusiI �tv ��loip ness and Professions Code): NO. PARKING AM 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 C I hereby affirm that there is a construction lending agency Q `CE � �,� '51-11,Efor 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 ev upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Lf Permitte`""� f Date WORKERS' CUMY M.AituN llCl LHtCH1rVlV 20-0063DPW,2/90 ivi-d+.7`r L..Lr L! 1141...iV s/v i a< a s..... 1 I hereby affirm that I have..a certificate of consent to self COUNTY OF LOS ANGELES BUILDING:.AND SAFETY DIVISION Tinsure,or a certificate of,W(itkers' Compensation Insurance, or a certified copy thereof (Sec 3800, Lab- C.) Policy'NO. Company FOR APPLICANT TO FILL IN BUILDING UILDIqNG,ADDRESS ADDRESS ❑ Certified copy-is.hereby furnished. g J _ L'LA `1 u I\/R S /Z _ LOCALITY ❑ Certified copy is filed with the county building inspectio CITY ZIP cosdepartment. Q ?90Rs sr. Date Applicant SIZE OF LOT NO.OF,BLDGS.NOW ON LOT DISTRICT No. I GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. conlsT. O 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 by the permit is for one hundred dollars ($.100) or less.) tisE zoNE SPECIAL CONDITIONS 0 • y EL NO, a_ I.certify that in the performance.of the work for which t s r rr`f er permit is issued.'T shall not employ any person in any man r � � w bN , TT �'2� 2'7► w so as to become subject to the Workers' Compensation La ADDRESS n >' 1"T T P- b l0`3 OCCUPANCY GROUP Date Applicant . clTv ZIP NOTICE TO APPLICANT: If, after making this Certificate � R ,4R V— f7 . OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the.Ubor Code.you must forthwith EXIT HARDWARE: comply with Such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knows. ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E)l Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapte SAFETY PERMIT❑ (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Busin NO.OF EXITS and Professions Code,and my license is in.full force and e t. .Tame or Bus3_uess ° f PARKING• REO'D E PROVIDED 1!❑ . License Number Lic. Class i SPACES L G i I Contractor Date LIMITED TIME USE ❑ I am exempt,from the licensing requirements as I am a DATE PATE licensed architect or a registered professional engineer FROM: To: acting in my professional capacity (Section 7051,Business SIZE OF NO.OF INSPECTOR'S and PIOfeS$IOnS Code). EXISTING BLDG. STORIES .SIGNATURE, Lic- or.Reg. No. Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION No.OF EXISTING BUILDINGS I ON.LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and PIofessions Code): NO.PARKING SPACES PROVIDED, ❑ I. as owner. of the property, will do the work and t i structure is not intended or offered for sale(Section 70 , PROPOSED USE OF BUILDING Business and:Professions Code). I I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issu (Sec. 3097, CIV- C.)., PROPOSED MAX.OCG I Lender's Name APPLICANT(MA(T) TEL NO. �4 tic, cv 2 r5-�gf Lender's Address ADDRESS I certify that I have read this application and state that the F N-ARA AZ g -7 b2 above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives.of this County to enter Upon, ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE `��� p X `T/2�jO2 SEE REVERSE,FOR EXPLANATORY LANGUAGE Signature ennrttee Date f WORKERS'COMPENSATION DECLARATION 76M444 F4 IS�:ELLANEOU� APPLICATION c I hereby a certificate that 1 Have a certificate of consent tsett CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure. or a certificate of Workers'Compensation Insurance, e,or ltilr I a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING s ADDRESS Certified copy is hereby furnished. X BUILDING S3 � S LOCALITY /` ADDRESS 2 Us i Certified copy is filed with the county building inspection ' LOCALITY NEAREST i department. i CROSS ST. Date Applicant NEAREST stn ��[[ DISTRICTN' GROUP TYPE CESSED BY CROSS ST. IM�VDI_ o(/ li{ 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 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. V ?. I certify that in the performance of ;he work for which this _ permit is issued. I shall not employ an,, person in an),manner OWNER 'j""(—C) ITS 6nf so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP _ MAIL rj_O- /I O� ` ADDRESS t` {/� EZ] Date Applicant _ TEL r OCCUPANT LOAD NOTICE TO .APPLICANT: If, after making this Certificate of CITY PSG-� _� NO. 62� 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 I—I No Spec. Knowl. deemed revoked. _ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I liereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) a ` 9 (commencing with Section 7000) of Division 3 of the Busi- Of NO. OF EXITS ness and Professions Code. and my license is in full force and effect. PARKING SPACES REO'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FRC M: TO: 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 capac;ty 'Section Oc 1, Bus- EXISTING BLDG. STORIES SI TORE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg. No. Date �6 — I HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE n I hereby affirm that I am exempt from the Contractor's NO FEE I License Law for the folloxving reason (Section 70:1.3. Busi- �/ � 0 /� �s�—i]t]lR' � � Z&4971ness and Professions Code): NO. PARKING �/� SPACES PROVIDED I, as owner of the property. will do the work and the Ca structure is not intended or offered for sale (Section 7041.Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCYii 11 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 1 . PERMIT FEE 5 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 Countv to enter TOTAL FEE 2 6O upon the above-mentioned p.*onerty for inspection purposes.. I 11 fYK to � SEE REVERSE FOR EXPLANATORY LANGUAGE Signal e of P_rmit ee Date W0RKI_RS' (0NIP1:N5AII0N 04)06:d'JPVII:, �,() PA15L.' LLLAr4t:.UL1ti At— t-'L1LA1 IUN I hereby affirm that I have it certificate ol' consent tosell' COUN'll' OF LOS ANGELES BUILDING AND SAFETY DIVISION il� I insure, or a ceitil'icate of Workers' Conipcosalion Insumilce.or it certified copy thereol (See. 3800. Lah. C.) Policy No. Collipally FOR APPLICANI TO FILL IN BUILDING BUILDING ADDRESS ❑ Certil'ied copy is licreby kiniishcd. ( -�.ADDRESS f L/ . LOCALITY El Certil'ied copy is Idled \'Vitll the COLIIII\ building ill'.pcclioll CIT TilZIP 1-0 71 e/ NEAREST department. -1\-/ :F0 CROSS ST. Date Applicant SIZE OF LO NO.OF BLDGS.NO ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. M CERIII-WAI'l OF EXEMION FROM WORKLI,"" C COMPLNSM]ON INSURANCE TRACT BLOCK MAF HIGHWAY NO. ICIRCLE) STATE MAJOR SECOND LOCAL (This section need not he completed if the work imol\ed ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars (s, 100) oi- less.) USE ZONE SPECIAL CONDITIONS T NO Oj I certify (Iiiii ill the performance III' (lic woik 11-i which ihiN permit is issued. I shall not employ any person ill am mawwr so as to become SUbject to the Workers' Compensation Laws. ADO 0Box OCCUPANCY GROUP , Date Applicant CITY ZIP NOTICE TO APPLICANT: 11'. after making this Gert;!irate OCCUPANT LOAD of Exemption, you should become stiff lect_to the \'r... kers' t APPLICATION FOR Compensation provisions ol'the Labor G;dc.you must I")idiwithEXIT HARDWARE: comply with such provisions or this permit simll he Ll.'Cilled TRAILER USE GEOLOGY INSPECTION 0 revoked. No Spec.Knowl. ❑ OCCUPANCY INSPECTIONK Panic Devices LICENSED CON VRACI'()RS DI'( I-A RAI]()N 1 hereby affirm that I iiiii licensed Under provisions III' hapter SAFETY PERMIT O LIST ITEMS BELOW I 9(commenciniz with Section 7000)of'Division 3 of the Business NO.*OF EXITS F and Professions Code.and lily IiCCIlSe is in 11111 I'OrCC and e I'le C 1. t-i V;5 PARKING REO'D PROVIDED License Numbei LIC. Class SPACES Contractor 1111C LIMITED TIME USE DATE DATE El I am exempt froth the licensing requiienients :Is I mil it FROM: TO: licensed architect or a registered professional crgineer acting ill Ill)' prolessional capacit) (Svction 7(61, Bw SjIICSS SIZE OF NO.OF INSPECTOR'S EXisrING BLDG. SIGNATURE and Prolessions ('ode). PRESENT USE OF BUILDING Lie. or Reg. No. DoteFINAL APPROVAL NO.OVEXIS I INC,BUILDINGS HOME OWNER-BUILDER JILDER D141ARAHON ON LOT AND USE I hereby alTimi thm I mii cwmpl I'l,0111 ]lie ('011n;1clol's I iccllsc Law fol the lollowing reason (Section 70.11j- lillsille.'s mid Prol'essioris Code): NO.PARKING SPACES PROVIDED ❑ I. its owner of the propert\. \\ill III, the Ikoik zi!id i1w Sil-LIC1111C is 1101 illtelldCd Or 011CICd 101 S:IIC (SCCHOil /04-1,$ PROPOSED USE OF BUILDING BLISi[ICSS and Professions Code). CONSTRUCTION 1-1'NDING A(iI_N(*) I hereby affirmdiat there is it cOlISIHIC6011 ICIldiol! d2Ci10 101 the performance of the work Ior Mitch this permit is I.SSLICd Sec. 3097, Civ. C.). PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINT) TEL NO. Lender's Address ADDRESS I certil'y that I have read this application and state that the above information is correct. I agree to comply with all(Aninty PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to emc­ "Poll ISSUANCE FEE the above-mentioned property for inspection PLII-P(IsCs. L FEE SEE REVERSE EOR EXPLANATORY LANGUAGE 0 dot 1P L Signature of I'Villiltee Daly; �VURKLRS'CU:\IPLNSA 10,0' L&CLARAil(Jh ,a4 CF 87501-$4) MISCELLANEOUS : PPUCAiICON r I hereby affirm::hat 1 have a certificate of consent to self COUNTY OF LOS ANGELES 1kUILFING AND SAFETY DIVISION insure, o_ a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3500,Lab.C.). Policy No._ Company _— FOR APPLICANT TO FILL IN BUILDING • ADDP-ESSCertified copy is hereby furnished. CILD DRESG qUt f-'r �,S, MM .Df-. .AD DR ESS {i'►1 LO CA L:T]'� y Certified copy is filed with the county building inspection ocquTY fi=t, L� G NEAREST department. j���Qp1� JJ�� TI/��t qj_� /7 ,/_ G cRoss sT. �� Date Applicant -NRos=ST, TJ�1��1 AVF </�V */y, DISTRi T h0 G P TYPE CESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL j [n/(J�! J/ CONIPENSArION INSURANCE DESCRIPTION LOT NO. �BLOCIC r MAF HIC Hw AY NC. (CIRCLE) STATE MAJOR Sir COND LOCAL INO. 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 (S100) or less.) usE of I certify that in the performance of the work for which this '1zE of Lor EXISTING BLDG; permit is issued. I shall not employ any person in an} manner OVlNER 4--0kf0V/6QR, JJ S(f so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL Q �O S Date Applicant ADL ESS �I��(/ TEL. NOTICE TO APPLICANT: If, afm ter aking this Certificate of ff ITY �{L. No. O';CUPANT LOAD '- Exemption, you should become subiect to the Workers' Compensation provisions of the Labor Code, you must forth_ fff APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE u GEOLOGY INSPECT.IOi4 Lj ::"Jo Spec. Know(. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION �! Panic Devices 1 hereby affirm that I ani licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencine :With Section•. 7000) of Division 3 of the Busi- I NO. OF EXITS ness and Professions Codc. and my license is in full force and effect. I O'PARICISPACE_ RED �License Number Lic. Class 1\ L J LL II��JJ — --' LIMITED TIME USE I � Contractor —_—Date _ DATE DATE TO: I am exempt from the licetlsin^_ requirements as I am.a licensed architect o: a registered professional engineer i_IZE. OF NO. OF INSPE R'S actinin 111v professional Capaciiy (Sectio /051. BLS- [EXISTIN.,' BLDG. STORIES 57G A U ; n( RE iness and Professions Code). ,I /� _ PRESENT USE OF BUILDING �p� &+tp�p T ItINA h.?PROV AL Lic. or Reg.No. _— Date �/I HO\I% OWNER-BUILDER DECLARATION NO. OF EXIS7ING BUILDINGS j ON LOT AND USE: J e I hereby affirm fila-, I ani exempt from the Ccntracto` o t License La:: for the following reason (Section 7031.5. Busi- ness and Professions Code): Ni o. PARI:,NG 71 !. as o«vner of the property, «iLl do the work and the rSPAc=_s PROVIDED — s'rucrUre is not intended or caterad for sal= (Section 7044, Business and Professions Ccd:_). f i CONSTRUCTION LENDING AGENCY �PROPOSED USE OF 6 1LDI G ! 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097: Ci':.C.). ! I-I 'q Lender's Nafac— PRC;'OSED MAX. OCC. Lender's:iddress_ 1 I'PERMET FEEq I certify that I have read 'this application and state that the above information,is correct. !agree to comply:vith all County i ISSUANCE FEE ordinances and State Jaws relating to building construction, (. and hereby authorize representatives of this County to enter i TOTAL FE= CIOpop the "love-mc,'rcned property for inspection purposes. 6� SI. -J SEE REVERSE FOR EXPLANATORY LANGUAGE ._-[ `.0 CCI Sia cure of Permittze D to �.J ., i WORKERS' CUMPt NJAliIJIN L1t_k.LAttA11U1N 20-0063DPW'2/90 ITl-A.J`-I'A— —AL.—X­Vl V 16-%./Vti/ L--sa a I hereby.affirm that I havea certificate of consent to self COUNTY OF LOS ANGELES BUILDING:.AND SAFETY DIVISION 'T insure,or a certificate of,Workers' Compensation Insurance, or' Ll a certified copy thereof (Sec.3800, Lab. C-) Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING.ADDRESS ADDRESS i ❑ Certified copy.is'hereby:furnished. X` 953 2 LA-5 1 0 Ai AS __v LOCALITY ❑ Certified copy is filed with the county building inspection CITY zIP ` ( NEAREST. ' department �CN 1 P L Gi TY - 1 7�Q CROSS ST. Date ' - Applicant SIZE OF LOT NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS CONST. COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY O - - NO. (CIRCLE) 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-) tisE zoNE [!�7DITIONS 0 y TEL NO. I certify that in the performance.of the work for which this T erf et permit is issued.I shall not employ Any person in any manner o Tfl �6>v D `T (�zF�.2e,- 7, so as to become subject to the Workers' Compensation Laws. ADDRESS no O X f M OCCUPANCY GROUP z Date Applicant . CITY ZIP NOTICE TO APPLICANT: If, after making this Certificate ► 917 5 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the-Labor Code.you must forthwith EXIT HARDWARE: comply with Such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION 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 and Professions Code,and my license is in full force and effect._ ame o 11S1IIe5s e PARKING• REQ'D PROVIDED ❑❑ License Number Lie. Class r^ SPACES 11����JJ I Contractor Date LIMITED TIME USE ❑ I amexempt from the licensing requirements as I am a DATE pwrE licensed architect or a registered professional engineer FROM: To: acting in my professional capacity (Section 7051,Business SIZE OF NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. STORIES .SIGNATURE, PRESENT USE OF BUILDING Lic. or.Reg. No. - Date FINAL APPROVAL `/ L HOME OWNER-BUILDER DECLARATION No.OF EXISTING BUILDINGS I ONLOTAND 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 El 1, as owner of the property, will do the work and the i structure is not intended or offered for sale(Section 7044,)( PROPOSED USE OF BUILDING Business and Professions Code). I MA�1iCt,' ;ST - 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 Lender's Address , .ADDRESS I I certify that I have read this application and state that the /C112) !-}iCr,3cry S T A-4-N T& "5173) above information is correct. I agree to comply with all County ordinances and State laws relating to building construction,and PERMIT FEE hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. . „. TOTAL FEE ' X - kw� - Q�Q. SEE REVERSE FOR EXPLANATORY LANGUAGE silrn Nee Date