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HomeMy Public PortalAbout9600-9602-9604 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have 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(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS Certified copy is hereby furnished AUILDIN �d ��� VI✓rz�j Alt 1:1 LOCALITY Certified copy Is filed with the county building inspection �� j NEAREST department LO ALITY I rn�t(` IT .�t CROSS ST Date Applicant EA REST �� 1 rye 1 DISTRIC NO G P TYPE O ED BY CROSS ST. I v G�L? L`t y� ( CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY HO ��d (CIRCLE) SPATE MAJOR SECOND LOCAL CL (This section need not be completed if the work involved NO. OF LOTLO USE ZONE SP CIAL CONDITIONS P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) U USE OF I certify that in the performance of the work for which this SIZk OF LOT EXISTING BLDG �• permit is issued, I shall not employ any person in any manner OWNER �L,< p.D.s 0 so as to become subject to the Workers' Compensation LawsAIL 'G OCCUPANCY GROUP U RESS `U � d AD Date Applicant c� � NOTICE TO APPLICANT If, after making this Certificate of CITY 1� EC�Gr NO.Lb OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked 0[_] — NOSpec. Knowl. ❑ Panic Devlces 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- ness and Professions Code, and my license is in full force and effect PARKING. REO'D � PROVIDED SPACES License Number Lic Class 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- EXIST NG BLDG STORIES SIGNATURE iness and Professions Code) /� ESENT U3E OF BUILDING t?�,I��s.�� �Y'1� � FINAL APPROVAL Lic.or Reg.No Date HOME OWNER-BUILDER DECLARATION NO O 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 ❑ 1, as owner of the property, will do the work and the 1 structure is not intended or offered for sale (Section 7044, Business and Professions Code). �+ ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY ,�'�AVCIJC', I I hereby affirm that there is a construction lending agency ' for the performance of the work for which this permit is 0510-81L 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 _ave information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upothe abov mentioned property for inspect n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date WQlZIS RS'COMPENSATION DECLARATION C CE 875 (11-84) M I SC E L LA N EO U S APPLICATION E 875 I hereby affirm that I have 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(Sec 3800,Lab C.). Policy No Company FOR APPLICANT TO FILL IN BUILDING O� ADDRESS Certified co is hereby furnished. BUILDING (,�Qa GLS TU copy y ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY U tL�f NEAREST department. f 5 cRoss sr. Date Applicant EAREST e ( ^f DISTRICT NO. GR TYPE P SSED BY CROSS ST. IeV1� �` �) {VCI �cV� /,7 CONST I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �? COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP ��Op'' HIGHWAY NO -+may (cIRc�E) STATE MAJOR SECOND L NO. OF LOGS. (This section need not be completed if the work involved TRACT NOW ONBLOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of 7n[ 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 wNER so as to become subject to the Workers' Compensation Laws. U V r U OCCUPANCY GROUP ?.� a E.D�F_SS 6 U Date Applicant :1 i J g Te Ci f- TEL OCCUPANT LOAD NOTICE TO APPLICANT If, after making this Certificate of Y NO.* Exemption, you should become subject to the Workers' gppLICATION 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 Busr 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 Lic. Class LIMITED TIME USE Contractor Date 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 IN PEcroR s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES GNATURE mess and Professions Code). FINAL APPROVAL / 1. RESENT USE OF BUILDING ` Lie.or Reg.No Date Qo-0, devOcJI 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 I, as owner of the property, will do the work and the SPACES PROVIDED 1 � structure is not intended or offered for sale (Section [ —4 5 9 4.9 A 7044,Business and Professions Code). V rr/° # 0 0 0 0 8 ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY Akovy ni I hereby affirm that there is a construction lending agency 0 0 0 0 0 0 0 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.) r 1. 17-86 Lender's Name PROPOSED MAX. OCC Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE up the above-mentioned property for inspect n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Permittee ofDate WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION i hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) ? Policy No Company FOR APPLICANTTO FILL IN ABUILDING DDRESS ❑ Certified copy Is hereby furnished BUILDING 'u�Z i ADDRESS V LOCALITY ❑ Certified copy is filed with the county building Inspection /p //�� NEAREST department LOCALITY '� A r I l µ CROSS ST Date Applicant AREST lei ��V �J ` DISTRICT NO. G UP TYPE ROC SS D BY CROSS ST „rte —� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY }. rvo (CIRCLE) STATE MAJOR SECOND LOCAL d NO. OF SLOGS. (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.) USE OF SIZE OF LOT EXISTING BLDG /�i� ir ] certify that in the performance of the work for which this (/ Q permit Is issued, I shall not employ any person In any manner wNER C A.- so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP I 4 XAIL ADDRESS G ice oe, Lrh, T a Date Applicant A �/y� /� �}� Z �`\, l'i�V TEL. &_@D NOTICE TO APPLICANT If, after making this Certificate of CITY No. lJ OCCUPANT LOAD - Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPL TION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked ❑ Cl No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- yess and Professions Code, and my license is in full force and PARKING. effect SPACES REO'D F= PROVIDED D ,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 INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code) FINAL APPROVAL RESENT USE OF BUILDING Lic or Reg.No Date Y HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 7 Q 9 6A ON LOT AND USE *. I hereby affirm that I am exempt from the Contractor's 0 0 0 0 88 License Law for the following reason (Section 7031 5, Busi- m ness and Professions Code) NO. PARKING 0 0 0 0 0 0 SPACES PROVIDED p ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). RoPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY �f A I hereby affirm that there is a construction lending agency egW t l�p id gQv— Gyn 1q for the per of the work for which this permit is c� issued(Sec 3097,Civ C) Q� r5 / QJJ Lender's Name Po(- \*--Pq o t 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, 157 and hereby authorize representatives of this County to enter TOTAL FEEr — � upon the above-mentioned propertv for inspection purposes SEE REVERSE FOR EXPLANATORY GUAGE Signature of Permittee Date d WORKERS'COMPENSATION DECLARATION CE 875 (2-80) M OSC E LLA sEOU S A PPUC = T�® a /1 I hereby afrthat I have certificate of consent to self COUNTY ®F LOS ANGELES BUILDING AND SAFETY DIVISION msur�i or a c certt ificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No. Company FOR APPLICANT TO FILL IN BUILDING pL ADDRESS V 2— ❑ Certified copy is hereby furnished B LD ING D / LOCALITY DDRESS /—Ll ❑ Certified copy is filed with the county building inspection �-y-- 1 NEAREST department LOCALITY /-C7, �� e;ty CROSS ST Date Applicant NEAREST DIsrmcT NO. GROUP/ TYPE ESSED BY CROSS ST n CO y7' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lo O BLOCK MAP Jq� HIGHWAY Ho C.00 (CIRCLE) STATE MAJOR SECOND CAL - '- O OF BLDGS CL (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE s ECTAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) �\ US E: OF GJ SIZE OF LOT X ' �C) EXISTING BLDG. I certify that in the performance of the work for which this _ permit is issued, I shat[ not employ any person m any manner ER so as to become subject to the Workers' Compensation Laws MAIL rs 1 D OCCUPANCY GROUP U DRESS 0 O t1.1 Date Applicant TE NOTICE TO APPLICANT If, after making this Certificate of .5)T- NOT T C' . OCCUPANT LOAD Z Exemption, you should become subject to the Workers' I 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 USEGEOLOGY INSPECTION deemed revoked [J ❑ No Spec. Knowl. OCCUPANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ 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 I Can t I S Name — PARKING effect SPACES REO'D O PROVIDED D License Number Lie Class Rome Address — LIMITED TIME USE Contractor Date y DATE DATE ❑ I am exempt from the licensing requirements as I am a Plione 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 ) mess and Professions Code). SENT USE OF BUILDING FINAL APPROVAL b • Lie or Reg No. Date o HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) NO PARKING _ SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure isnot intended or offered for sale (Section 7044, Business and Professions Code) ;2 1 8 4.6 A OPOSED USE OF BUILDING Dew t4 CONSTRUCTION LENDING AGENCY # 0 0 010 4 0 I hereby affirm that there is a construction lending agency 0 0 0 0 0 0 0 for the performance of the work for which this permit is issued(Sec. 3097,Civ C.) &2 1 -8 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 TOTAL FEE upon the above-mentioned property for inspection 1purposes {� SEE REVERSE F E PLANATORY LANGUAGE AN Signatureof mitt — ' Date 1 WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm 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) BUILDING Policy No Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. AIUILDING ADDRESS LOCALITY �� 5 (t. DCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST Date ApplicantAREST r n/l r DISTRICT NO. GROUP TYPE CESSED BY ROSS ST. ` • !.G 'L/0I J -� CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL !J/7 COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY rvo (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. O I certify that in the performance of the work for which this L � ✓" v(� permit is issued, I shall not employ any person in any manner WNER • CJ4AM&W E:0(. so as to become subject to the Workers' Compensation Laws. IL �'v OCCUPANCY GROUP a Date Applicant DDRE559(p02 C_ L795 TVN�1S '—' C-3 �y� 1�J NOTICE TO APPLICANT• If, after making this Certificate of ITY�Em�E C r/NOL Bj'g Z$6—(p�'Z[� OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with Such provisions Or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'D PROVIDED SPACES License Number Lrc. Class .1 1M / �UCT/(!� LIMITED TIME USE Contractor Date DATE DATE El U I am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OF NO. OF SAF 1NSP R'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES mess and Professions Code) A(� I RESENT USE OF BUILDING FINAL APPROVAL f Lrc or Reg.No. Date raves d j;LM LAVI HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS -- ON LOT AND USE L! 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 f I, as owner of the property, will do the work and the SPACES PROVIDED pV1 structure is not intended or offered for sale (Section t 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY 11415ROPOSED USE OF BUILDING ,"J �� L I hereby affirm that there is a construction lending agency for the performance of the work for wluch 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.1 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. !//, (�i(�►. �� - ?uL o/I� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1;ORICLIZ3'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm atJl have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished BUILDING ADDRES LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department CROSS ST Date Applicant NEAREST DISTRICT NO GROUP TYPE PROCESSED BY CROSS ST. CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v1 COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY NO. F BLDG$. 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 � 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`( l ' ,a/"/�t/ 6V, EVIO =' so as to become subject to the Workers' Compensation Laws MAILOCCUPANCY GROUP o Date Applicant ADORES p2- /� rr1VA: w NOTICE TO APPLICANT: If, after making this Certificate of CITY � CG C/T NOL 2 OCCUPANT LOAD yy 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 INSPECTIO I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busr SAFETY PERMIT (LIST ITEMS BELOW) 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 LIMITED TIME USE Contractor Date DATE DATE F1I 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 FROM TO SIGNATU iness and Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING Gr 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 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). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 1 Hereby affirm that there is a construction lending agency �_i �� for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. i �f CICI� Lender's Address �t33 Ll J d PERMIT FEE rte' � mac'+' I certify that I have read this application and state that the 716 1 Fhb 3,•;? 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 — upon the above-mentioned property for inspection purposes �Sign 7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pe ttce Date WORKLRS COMPLNSAIION DE( LAR MIONolu�n,;oPvv1 � ol, MlSC.tLLANLULIS At- t'LIC.AI 1UN I' hereby affirm (11.11 1 IWVC a LCIIIIILaIC Ill LIln,enl III NLII COLIN FY Of I OS ANGFI FS BLIII_DING AND SAFETY DIVISION Insure, or a L.eitilIcate of Woikcls (0nlpulNa1111 111,11LtI1LC nr .1 certifled'ulpy thereof (Sec 3800 Lah C ) Policy No C ontpany FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ElCeiulied Lot)) I, hcichy IIIIIIINIILd 'Tu�Wep /aS gs ✓/T)P- —_ LOCALITY ❑ Certil led copy is I Iled with [Ile omni% building nr.pCLuon CITY q ZIP department ��.� le, / - 9i�pD NEAREST 1� 6 CROSS ST Date AppllLdlll SIZE OF L T i NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CONST 1 ( ERlll K AIL OI' LXI'MMION I ROM WORINI R6 -- ��-0� It (OlvIPLNSAIION INSURAN( I TRACT BLOCK LOT NO — R HWAY 1, N0 ICIRCLEI STATE MAJOR SECOND LOCAL (This seclion need nol be completed Il [lie \11111, 11 %olNed ASSESSOR MAP BOOK PAGE PARCEL USE ZONE I SPECIAL CONDITIONS t' b)' the perntll is lot one hundred dollar% (,,111(11 uI Ic%%) OWNER ° r TEL NO j I celitis that ssu in the pl not 01 I \\011 IIII i\ i Ih1N — (ayaCe permit is Issued. I shall nut employ ,ury pelNun III sols �ldllllel J Q� ! so as to be(ome Nub)eL1 to the Wo11,ersContpcn,.unnl I d\\'N ADDRESS ZZOD S ottiJl' A/ OCCUPANCY GROUP I Date - --- - Applicant CITY ZIP NOTICE TO APPLICANT It JIM Indking IIII, ( eltlllLate AA � F05, OCCUPANT LOAD of Exemption you sh0ldd become subleu lu the \ 011 eIN' APPLICATION FOR EXIT HARDWARE Compensation pru\1,lons of'the Labor Code you nu1Nt lollhwill) F-I comply with Nuch prof isions lir till, peek( Nhall be deelllCd TRAILER USE LJ GEOLOGY INSPECTION I-I No Spec Knowl ❑ revoked OCCUPANCY INSPECTIONIK Panic Devices ❑ l_ICENSI_D CONTRA( 1-016 D1( I BAR \1]()N 7''l I hereby' al I iris that I din licensed undCl pl ll\'1,1011, of ( 11,lp0 tci SAFETY PERMIT (LIST ITEMS BELOW) a y', I 9(commencing with Section 70001 Ill DI\Isnnl 3 of the Ba,IIIess NO OF EXITS s and Prote,;mons Code and my licen,e IN In lull IOILL and effectPARKING t1 �C cr tICS`>I,nN NII- LIMITED SPACES REQ'D � License Numhel I Ic ( PROVIDED --�1—../ (--- � r -- �-- ---- - --- - ---- L� cOnt1aL101 u.te TIME USE - DATE DATE ❑ 1 dill e\empt from the licensing reclimenlent, as i dill d FROM TO licensed aichnect or a registered pioleNNlonal cnl.lnecr - dellllg In Illy PIOICNNn{nal CallaUly (SL Ltion 70N 1 Bumm NN SIZC OF NO OF INSPECTOR S �) E%IS IINL,UI UC. __ --__- _ bIORILb SIGNATURE and PIUICN111111N (udcl -- - PRESENT USE OF BUILDING ��� ccn/er FINAL APPROVAL Lic or Reg No _ Date -7L o I qL IIOML OWNLR-BI111 DLR D1 ( I AR ANON No OF I%I5TING BUILDINGS ON LOT AND USE - 1 hereby alinin that I and c\cnlpt 110111 the (0nllaL101 N I ILCIINC Law for the following lea,on (SL(non 70315 l3u,mcNN and Professions (ode) NOPARKING SPACES PROVIDED as owner of the pl opel l\ \\Ill do I be \\of k nd 111L —- —- —-- --- ---- - ---- NIIlI0111C IN not Intended 111 1111CIed 101 NJIC ( )C011111 /01.1 PROPUSEU USE OF BUILDING Busme„ and Piofession, Code) - 1 CONSTRU(TION LI_NDIN(I AGI_N( ) --Fury<fU1'e Wa{ hereby dlllnn that thele IN a L011N(tuc1101) Icnding acenL\ IIII the perlornlance o1 the \\oil. lot \\Inch HuN pelnul 1N INNUCLI — — ---- - (See 3097, Civ C ) I PROPOSED MAX OCC Lenders Name -_- - _ APPLICANT(PHIil71 TEL NO I[f $'GOT7k &V4 1 �i�-2 z-c7L 1 Lender's Address ADDRESS p I I certify that I have read 1111, apphLauon and shoe I11,11 the 1�loa 17'S7y S7 i Cil 90,>o/ above Information is correct I agree to comply with all r aunty PERMIT FEE ordinances and State laws lelatlng to budding construction and hereby authonre representau\es of 1111, County to CntLl upon ISSUANCE FEE the above-mentioned property f01 InspeLuon P1111)o,CN TOTAL FEE � I 0 V SEC REVERSE FOR EXPI ANATORI' LANGUAGE i Signature of Pernlln, D,o; L WORKERS (UMPI_NSAl1ON DL( l_1R,�IlON „Ii11 MISCELLANEOUS AF'PL�C..A� �UN �u-uo(1:nevi 1 ,11 I•hereby affirm that I 11,1vC a LLIIJ11L,IIC 01 L1111,L11I 111 sell COUNTI' OF IOS ANGLI LS BUILDING AND SAFETY DIVISION I� ' Insure, or it ceiill(Cale of W(111cis (olllpUILI IJ UII IIl\(II,Itlle 111 II .t ceitilied cup) ihereol (Sec 3800 1 ah ( ) J Policy NO (onlpan)• FOR APPLICANI TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ (ern(led cop) IS hcrehp 1Ulnnhcd 9&. /� ( tee,A�� � .,cam � LOCALITY ❑ Certified cop) n Med Will) the Lounl) hllddlllg Im,p101011 CITY �c� f--' `'�T ZIP F -� depart nlelllG7 NEAREST 91 _ CROSS ST Date __ Applicant SIZE OF LOT NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CONST ( ERI-11 K All- OF LXLMPJION I ROM WORK I R', TIIACT BLOCK LOT NO (" ,�I (0N1PLNSAI ION INSIJRAN( I HIGHWAY 1. NO ICIRCLEI STATE MAJOR SECOND LOCAL (This seclion need 1101 he completed If (he \11111 til\OI\ed ASSESSOR MAP BOOK PAGE PARCELr= by the permit is loo one himtlred dollars (ti 1001 UI less) USE ZONE SPECIAL CONDITIONS OWNER TEL NO Celufy that In the pCrlulnlanLC 01 11110 11111 111 WhILfl Ihn -- permit Is Issued, I Shall not Cniplo) ,nl) pc150n UI in) m inucl — - I --- t i 1 ' so as to become ulblc(­t to the Wrnn 1e ( ompcnsauon !aWADDRESS s � OCCUPANCY GROUP ! Date_____ _ Appllc,int CITY ZIP { "" NOTICE TO APPLICANT It altCI 11]111U]g ihl5 CclullLale ` OCCUPANT LOAD of Exemption, )oU Should become subject to the W011eis' APPLICATION FOR Compensation prmislons of the Labor Code yOu nn15t 10[PIW1t11 EXIT HARDWARE comply With Well proAIsions or th)s peirint diall be (ICCIned TRAILER USE❑ GEOLOGY INSPECTION❑ ! y No Spec Knowl revoked ❑ LIC ENSLD CONFRAC IORS IN ( I AR '01()N OCCUPANCY INSPECTIONIK Panic Devices ❑ I hereb) all Irin that 1 1111 licensed Uhler piovisioils of ( haplel SAFETY PERMIT O )LIST ITEMS BELOW, i mil I 9(commencing\v)Ih Section 7000)of Dn kion 3 Of the Bu-, neSs NO OF EXITS and ProtesSions(ode and 111) license n In lull t0ICL and Lffect ? Uhr-l( Ci ht1 .It.IrSS PARKING License Nlll]7hCi I IL ( las', SPACES REQ'D PROVIDED --/7LnlP. - (-- _�--rH�'--- LL�� LL��JJ COMIJI-1 a D,IIc LIMITED TIME USE DATE DATE ❑ I am e\enlpt Iroin the 11CCn,1ng re L1tnicinents ds I all] a FROM TO licewed alchnect or a regntercd piofesil0nal ent ineer - dCtlllg In Ill) PIOICss1111,11 LapdClt) (So,k,no 1 7081 )))))Hies\ SIZE OF NO OF INS TOR S t EX 15(INC.BL DG SIORIC S 1 ATURE and Pn11Ls,ulns (odc) -- - — - _ -- Lic or Reg No Uate PR ESC NT USE OF BUILDING47 RILy FINAL APPROVAL 1 i IION4E OWNER-BUR DLR DI ( I AR ANON NO OF I XISIING BUILDINGS \ \� ON LOT AND 11SE hereby aline] ilial I ,lin c\umipt 110111 the( olltlaLWI s I rLLYlse ----- --- — Al Law for the I0II0Wing leason ISCLna on 70315 Bushes, nd Professions (ode) NO PARKING SPACES PROVIDED I as owner 111 Ills plopell\ 11111 d1. 111c 111111 ,Intl 111k. -- -- - — \IIIILIIIIC Is not intended 01 011CIed 101 \a IC (1LLtIL111 /041 PROPUSCD USE OF BUILDING BLISHIC',S and Profession,, ('ode) -- ✓ . I CONSTRU(TION L ENDING AGI NO 1 herchy alllrnl that thele Is a conSOucuon lending IgCnl\ 101 - the perlurmancc of the \1011 lot \\h1Lh [hl', pClnlll Is ),sued (SeL 3097, 0v Iv ( ) PROPOSED MAX OCC �I Lender's Name APP IC NT(PHlar) TEL NO X ((m ( r—� Lender's Addles ADDR�55 I certify that I have read this application and Sl,uc 1111 a the e, ri above Information Is correct I agree to comply N111h all(unnty PERMIT FEE ordinances and State laws relating to budding constrULuon and hereby authorize IepresentatiNes of this Count) to enol LIPoH ISSUANCE FEE the abo -mentioned property for inspection purposLs U! I TOTAL FEE 0 SCC REVLRSE FOR LXPI ANATORY LANG(IAGF Signature of Perinmee Dale t WORKLRS ( 0 NI IT NSAI[ON DI_( LARAII()N M15CELLANLOU'6 At-jt'L1C.:A1 IUN' ► hereb} affirm that I flake a celllllL,uc 01 LOU,Lm (u ,L11 COON'I')' OF IOS ANGELES BUILDING AND SAFETY DIVISION � I� ensure, or a LeItII IC,ue of Woiker1 (0111171LII ,d 110]1 In,u1.InLL 01 ,1 certil led cup} thereof (Sec 1800 1 a ( ) 1 d PohLy No Com p..;y FOR APPLICAN I TO FILL IN BUILDING B ;L DING ADDRESS ADDRESS ❑ Certified cup}' 1`. Ilerchv IulnuhcLl dZ u t ❑ Certified copv IS I lied With the Count} budding m'.pLLtion CITY �T ZIP department ( �7 R O NEAREST 1 (V CROSS ST Date APPIIL,llll SIZE OF L T NO OF BLDGS NOW ON LOT DISTRICT NO GR UP TYPE PROCESSED BY J'►Q CONST I (LRM I(Al L 01• EXLMP 'I ION I ROM WOR k I RS TRACT BLOCK LOT NO V V (" C UMPENSA"I ION INSURANCE AY NO ICRCLEI STAT MAJOR SECOND LOCAL ` (This section need not be complc(ed If (lli' NUI►. !II\UI\Cd ASSESSOR MAP BOOK PAGE PARCEL 1= by the permit is for one hundred dollals 11,1O0) UI less) 115E ZONE SPECIAL CONDITIONS I Lclufy than in the perl0lmanLc of till Nulls IIu NhILh IhOWNER TEL NOl, permit Is Issued, I shall not emplu} an} pcllon In ml} matin i t l so as to become ,tlblect to the Woiken u ( ontpcn,ann I aw" ADDRESS OCCUPANCY GROUP i.. 1 Date_____ Apl)IlLallt CITY NOTICE TO APPLICANT It alicl making till, (el[it Irate OCCUPANT LOAD of Exemption, }ou should become ,ub)ett to the WoILeis' APPLICATION FOR Compensation prou,lons of the Lab01 (ode you must 1olthN1111r 1 EXIT HARDWARE I COITIPly Will) ,,ILII pio( ISI(111, lir till, ptirmt ,hill hl' deCRIC'd TRAILER USC L� GEOLOGY INSPECIIONLI No Spec Knowl ❑ I revoked L-1 ❑ LI(ENSL-D CON FRA( I'OR� DI ( I AR }f l()N OCCUPANCY INSPECTIONK Panic Devices a I I hereb} affirm that I ,lin IlLensed Under piovt ooii, Of ( Iwplel SAFETY PERMIT IJ ILIST ITEMS BELOW, 1 1 9(commencing With SeLllon 7000)of DI\1111111 1 Of IIIL ftUSHICSS NO OF EXITS s '`• I and Professions Code and nl} license I1 In lull lolce and MCLI PARKING License Numhel I IL ( I.1„ aLu� - SPACES REO'D O PROVIDED D COtiaLtOl Dale �J fV`T LIMITED TIME USE DATE DATE ❑ I am e\elmpl from the Ilcenling reyullenientl ,l, I .Illi a FROM TO licensed alchltect or a registered plofCl,u\n,Il utLnleer acting Ill Ill} pl(lll'1,i1111J1 Ldpdell) (tielll(tll 70,I 1{l1,I IlLN SIZE OF NO OF INSPECTOR S EXIS rING BLDG 51 ORIF 5 SIGNATURE and PIOILllionl (ode) LIC or Reg No I m, PRESENT USE OF BUILDING FINAL APPROVAL I IIOI\1L OWNLR-ftllll DLR DI ( I AR \I ION NO Or I-XISI ING BUILDINGS \�\ I ON LOT AND USE — hereby allnn) th,lt 1 1111 e\ClIIpI 110111 the ( 011Llallol I Ilcn,c law for the following season (SCLl1Ul1 7011 5 l{u,ule„ and Professions (fide) NO PARKING SPACES PROVIDED 1 a1 owner of the plopcll\ \\III III. the \\,.IIS ,Ind Ill( — — -- — 1ll llLtlllt' IS ,lot 1111e11d I'll 111 11llCl ell II II ,,Ile (tiLLllllll �n1{ PROPUSCD USE OF BUILDING � ftuslne„ and Plolesslom ('ode) ' I 1�--meati CONSTRU(TION l I_NDIN(, ,AGI N( 1 hereb} all Inn that thele IS a Lon111uetl0n lending ,IeenL\ 101 the performance of the Noll, for Much Ihr1 pclnut I, n,11Cd �I (Se(- 3097, (Iv ( ) PROPOSED MAX OCC � Lendcr'1 Name _ _ � APPLICANT 1PH1',7J TEL jJ0 Lender's Addles, ADDRE s C� � I certlly that I have read this apphLauon and '11,11L (hat the -I�ZS z-\Io ! `A�' above Information IS LorreLl I agree to Lonlply \\Illi all(runty PERMIT FEE ordinances and State laws relating to bullding Lon,tru,:tion and hereby authorize reprelentatr\cs of till, (ounl) to c 1tt i upon ISSUANCE FEE the above-mentioned property for InspeLtlon Pu1po,L, �) TOTAL FEE 51 1 RIM RSI- [OR I X111 ANAiORY I ANGUAGL n - .0'- Signature til 11cnnlilLL D.IIL '1 .L � WORKERS' COMPENSATION DECLARATION 0-006'3UPW 12/00 MISCELLANEOUS APPLICATION 0-006 I l--reby affirm that I have a certificate of` consent to Sell COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Ij insure,ora certificate of Workers' Compensation Insurance or a certified copy thereof (Sec 3800, Lab C) Policy No Company FOR APPLICANT TO FILL IN rNEAREST NG / `� ----- - - - - �1 g�ry� Fps ESS (^7(/ ❑ Certified copy is hereby furnished `�n U L ALAS S TUNAS DR. #2 0 3 LITY ❑ Certified copy is filed with the county building Inspection CITY TEMPLE CITY, CA. ZIP 91 780 department S ST Date Applicant_ SIZE OF LOT NO OF BLDGS NOW ON LOT I�Nfl GRo TYPE ESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS CC!!/ CONST ' TRACT BLOCK LOT NO I COMPENSATION INSURANCE MAP HIGHWAY i 1 NO (CIRCLE) STATE MAJOR SECOND LOCAL (This Section need not be completed if the wort. involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars 1$100) or less) OWNER NO 1 certify that In the performance of the wort. for which th s MRS . GRACE CH I� 28 645 0 permit is issued, I shall not employ any person ut any manne so as to become subject to the Workers' Compensation Laws DREs 6�� LAS TUNAS DR. OCCUPANCY GROUP " Date Applicant_ __ CITY TEMPLE CITY, CA-1Zip91780 NOTICE TO APPLICANT If, after making this Certificate OCCUPANT LOAD of Exemption, you should become Subject to the Workers' 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 OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a 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 PARKING REO'D D PROVIDED D I License Number __-- _— Lic Class ___—___ _ C SPACES Contractor Date _ LIMITED TIME USE DATE DATE ❑ I am exempt from the licensing requirements as I ant kI FROM TO licensed architect or a registered professional engineer acting in my professional capacity (Section 7051 Business SIZE OF (NATOURE and Professions Code) EXISTING BLDG STORIES SP Lic or Reg No _ Date — PRESENT USE OF BUILDING FINAL APPROVAL t I 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 l�V 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 PROPOSED USE OF BUILDING Business and Professions Code) OFFICE USE FOR INPORT/EXPORT 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 iI 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 j hereby auth, rize representatives of this County to enter upon ISSUANCE FEE the above- enuoned property for Inspection purposes 1 -fir TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee I Dale WORKERS' COMPENSATION DECLARATION °"444 M15L k:,LLANr_UUS 20-0063DPW 12/90 I ht•.eby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Sec 3800, Lab C.) Policy No Company FOR APPLICANT TO FILL IN : ► BUILDING / BUILDING ADDRESS ADDRESS (G O -7 , HCertified copy is hereby famished ) _ 960c ZAS 7u'I'a5 LOCALITY Certified copy is filed with the county building inspection CITYZIP /) q/ Q NEAREST department e-- CTyyI/A� D CROSS sr Date _ Applicant _ [SIZE OF LOT NO.OF BLDGS NOW ON LOT DIST J T ryO GR TYPE OCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' 6/�J CONST COMPENSATION INSURANCE TRACT BLOCK LOT NO ///���" MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONC SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I certify that in the performance of the work for which this oPTEL NO permit is issued, I shall not employ any person in any manner Prroo perty so as to become subject to the Workers' Compensation Laws 4DDRES I OCCUPANCY GROUP Date Applicant CITY_ ZIPS,(��b NOTICE TO APPLICANT If, after making this Certificate e 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❑ 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. tZtA PARKING REO'D PROVIDED iI�I II�I License Number Llc Class / SPACES Contractor Date _ LIMITED TIME USE ❑ DATE I am DATE exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer acting in my professional capacity(Section 7051, Business SIZE OF NO OF INSPECTOR'NATS and Professions Code) EXISTING BLDG STORIES Lic or Reg No Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION No OF EXISTING BUIL INGS 1 herON LOT AND USE eby affirm that I am exempt from the Contractor's License Law for the following reason (Section 70315, Business and Professions Code) NO PARKING SPACES PROVIDED El [, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044X PROPOSED USE OF BUILDING 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 (Sec 3097, Civ C) PR AX occ Lender's Name APPLICANT(PRINT) TEL NO l _e Lender's Address ADDRESS I certify that I have read this application and state that the above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon sSUANCE FEE the above-mentioned property for inspection purposes / TOTAL FEE I R vO SEE REVERSE FOR EXPLANATORY LANGUAGE YA Signature P rmitt e D e I \\ORKLRS�CO\IPLNS\TION DE( L\R\FIO\ 7GM444 ^ • CE 875 11 84) MISCELLANEOUS APPLICATION r, I hereby affirm that I have a certificate of consent to self , insure or a certificate of \\orkers Compensation InsuranLe or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof iSec 3801) Lib C I Policy NO —1 mmpanyFOR APPLICANT TO FILL IN ADDRESS Certdied cop} is hereb% turnrshect BUILDING /' O kI ADDRESS (, LOCALITY 1 Certified cop% IS tiled%%Itll file LVnnt% bulldm2 inspection LOCALITYJE AR EST department Temple City CROSS ST Date \pplicant NEAREST DISTRICT NO GR P TYPEST OCESSED BY CROSS ST p CON I CCRTIC[C\TE OF LSE�.1PTfON FRO\I 'iORI:ERS LEGAL �Q (O\IPENS\TION INSL R\\L l_ DESCRIPT'ON LOT NO BLOCK 1 MA✓ NO%YJF SLOGS 11D STATE MAJOR SECOND LOCAL GRWgv I 1CIRclei (This section need not be completed if the Mork Involved -RAC NOON LOT LISE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollar, IS100) or less ) i I— USE OF I I SIZE: OF LOT EXISTING SLOG I I certify that In the rcrrorman,:e of -he :o- %hick -ills permit is issued 1 shall not zmpim in% •,e-x%1l n in, manner OWNER as Io beLeme ,ublect to the \\orkers i'omrensanoD La%%c MAIL 9/o.Z J _ , (� OCCUPANC" GROUP Date \prllca it I I _ ADDRESS `]((�� ka/J �G ` P)- ____ NO FICC FO \PPLIC\Nm:T If. ,u•e, maki -'u, l er'!1 tie %t $I CIT- vc (DCCUPe N` LOAD E,,emptro-1 %uu .hoidd becopie ,uoiect -u -lie \%o-he-, Compens,�non cm•isions Ili the Labor -_ode %ou must for*h- APDLIC `,I C,\ F _y 17 4ocp,' tae - V %%ith comm% «uh ,uth ru%i,„n, ht, er•nit ;flail be ­AILED JSE 11 3EOLJGY N=Pec-'cN — NO SOP.0 '<nC„/� deemed rc� Ked — OCCJPANCY INSPEC-IONgg P3111C Dev'ces ❑ - LI(LNSLD CONI R\CTORS DLCL�R\TIO`, _ I hereb} affirm :liat Iam licen_sed under r)rC%,isicns of Chapter SAFETY PERMIT LIST ITEMS BELOW) 9 (commenLing c with .rection 000) of DI%(Sion 3 m the Bllsi- NO OF EXITS nesS Lind P-ntessiom Code. and m% license Is in -ud tore: and effect f FARKING ES 9PACREO,D I PROVIDED VI ES License \urnber L,c Cla,, LIMITED TIME USE N Contractor _ Date— DATE DATE W Z ❑ 7 M p lam exempt troln the lieensine reauLre;nentc is i am a M I licensed archltec, or a registered orniessionat ene_meer SIZE OF yp OF INSPECTOR S z actin--, .n n% prctc'clon,tl .ari..iz ,e_,tn1 1 flnc- EXISTING SLOG 5'0P Ie, SIGN TURE 9 messanu P-ntessiun.l.,del --- J LIC or Reg \l, _ D L r'4 ES'c NT USE OF BUILDING FINAnt. OVAL ✓w_ w_ 2 I HOME O\\NI-R-131-ILDER DECL-\R FION NO OF EXISTING BUILDINGS ON LOT AND USE r5 I hereby alfunl that I ani e\cmpt from the Contractors All 5 License La%% for the follo%%ulg reason iSeLnon -031 5 Bu,l- ness and ProtessionsCode) NO. PARKING / +6�fG 1, as .Ti%ner of the property. %%Ill do 'he %%ork and the SPACES PROVIDED strucn re [s not upended or offered for .,tie (Section 7044,f{il,irle,s and Prote59ons(ode) X CONSrRLClION LENDI\G \Gi_NC1 PROPOSED USE OF BUILDING / 1 hereb% affirm that there is a constriction lending agencvand, % 1 for the performance of the %ork for Much this permit is issued (Sec 3097,CN C i Lender s Name PROPOSED MAX OCC Lender's %ddress I certify that I have read this appiication and state that the PERMIT FEE 25.00 above Information Is Lorrect 1 agree to comply %%ith all Count,, ISSUANCE FEE ordinances and State la%%s refacing to building construction, : and herebv authorize representatr6es of this County to enter TOTAL FEE 25.00 1 upon the abo%e-menI vned propert • for mspeLnon purposes- � �• /�,�o SCL REVERSE FOR EXPLANATORY L,1NGU\GC Stenatur of Permittee Date WORIh1-RS (ONIVENSAHON DL( I-a\R-\HuN ;;1;x' MISCELLANEOU`':) APPLICATION hcrcb\ .lffnni that I ha\e a1 (c1t111La le oI (on,cnt I,. ,\!1 ( ()l!N i Y OF I OS ANGI I i S IWILDIN(i AND SAFETY DIVISION �I Insure, of a Lelhl lCate of Wo11\ers (ompLllsmion Insul.lnl c of .1 Lei(if ied Lops thereof (SCL 3800 fah Pollcl No (o111pa n1 FOR APPLICANT TO FILL IN BUILDING BUILDIN ADDRESS DRE/55- ADDRESS ❑ (citified L.,py is hereby IunusheCl _ OU La-4 /-0-6 G �� LOCALITY 1 ❑ (erlll led cop\ Is I)led with the,loutll\ htnldim-, IIr,I) Edon CITt j� ZIP �.�I Q,, NEAREST depaitnlent l�q�'r /J/� cfy FI��ID _ CROSSST Date ApPI IL.1111 SIZL OF LQt NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CONST ( LRIII I( All. OF LXI MIIIION I ROM \\ORkl R`, �h-Ac) BLOCK LOT NO -- t r (ONIPLNSAIION INSURAN( 1_ RIGHWA` .CIRCLE) STATE MAJOR SECOND LOCAL ('111i" scelion Ileed Ilol he compIC(C'd 11 (he \\011a Iii\111\ell ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS I In the pclRul is lol one hundred dollars (1,100) of I(%% ) - OWNER/�/ TEL NO I Lcrllf) lh.tl UI ill. !'"'10II17di1LC of IIIL \\UTI. 11II \\111L'I Ih1, v/�a �R �. /•. �� � - / --- - - 1 poWWII is 10,01ll• I Shall I II LIlllplll\ dll� pClton III .III\ it,•IIIILI —_ v/o (-/7� _ so as to hcumlc suhlru In Thr \No11.r15 ( unlpul..11nln I ,nes nnnlaEss � OCCUPANCY CROUP 1 33 L (, as i _ Date-- -- AI,PIILant CITY / ZIP t17 NOTICE 10 APPI I(AN-1 11 alte1 n1.11,1ne this ( ellllir.11c y G) '00 OCCUPANT LOAD 01 EvCnlpUon you should hCLOI11C suhIC0 to the A\oilers APPLI &TION FOIi (onlpensauon p1o\Islonsof (he L'Ibol (ode \0u Illlt,l Imth\\Ith EXIT HARDWARE CoIIIPIi \\1111 ,)ILII 1)10\1,1011, UI 11111 pe11110 ,h,lli hC d-e111etI IN\II-ER USC!- I GEOLOGY INSPECIION!—! No Spec Kllowl ❑ revoked — I IC L NSI_D CON 1 R•\( I OR's IA ( I AR \11()� OCCUPANCY INSPECI IONX Panic Devices F1 I helchy allnni that 1 .1111 11CCI)SCd LIIidLI 1110\1"11111, 01 ( ��dpICI SAFETY PERMII ! ! .LIST I I-EMS BELOW. ❑ t 9(COIIIIIICI1CIIIL\\'111)SCLt111n 7000)of DI\Ision 3 of the 13l'slllcss ---- NO OF EXITS and Professions Code and mN license Is 111 I1111 I01LC .Ind 'IICL( ,1 l: ^lA 1-'. �`-`� _ PARKING REO'D PROVIDED License Nunlhel 11r ( lass - -- T SPACES i �� V � �J —✓� ( ortti'Mol D.11c � - LG G� S� Cy�2eO _—LIMITED TIME USE — �/'� ---❑ DATE DATE I ani e\elilpt front tile hLensing re Climelnellts is I .1111 .1 FROM TO hLensed allchltect or a reglsleled plolcssional el'-'1111421 - 'ICtll)' In 111IOICSs1011.11 Ld),icm (St t[1011 701 Io silk ss 517E OF N.� F OINSPECTOR 5 E%ISIING U10G __—_--___----_ S10RIC�.-__- —_ SIGNATURE aand P1oILssluns ( odc) Lie of Reg No [).Lie PRESENT USE OF BUILDING c!NAL APPROVAL Q� HOR11. OWNI R-111111 DI R DI ( I AR \I ION N0or I%IS I ING BUILUwGb IIN LOT AND USE hereby all nIli that 1 1111 C\cnlpl 110111 IhC ( 0n1.1001 , I I\CIIsC Law for the 10110\\1ng 112.1"011 (SCLtlon 71131 � Btt,me s and Professions (ode) NO PARKING SPACES PROVIDED El I as 0nnel 01 the piopelt\ \\III If,, the \\olk Tod Ihl - --- - -- - -- - - -- sli llcllllc Is not 111(ellded OI 011CICd )III s•11C ("I 12 01.11 i1i 1 I PROPOSED USE OF BUILDING I 1311" I .Ind ,I01Css1ons ( Ude) -- _ CONSTRITION I LNDIN(I aVCJI-N( 1 IQ(2 ,���� v �JYy. tlYe I( hercb� altunl that thele 1s a Lon,llUCtIon ICnd111e .1eCuu LII the pellornialnce of the \\oik lot \\IIILII this pCIII'm I, ,sued - - - --- ---- -- - - - (ScL 31)97 ( iv ( ) PROPOSED MAX OCC Lender s Name APPLICA VI'JI) TEL N 6 LL'I1del s Address nDDRC / -7 I cernly that I hdve 1Ca(I this aIPPI1Cdu0II and slue 11.11 the 660 /LJN�? �Y �t" above lnlornl.ltlon Is Lorrc(I I algrec to LOIIIpI) \\I(h .111 ( 011111v PERMIT FEE ordinances and Stale lan\s ichmig to building Consuuul( n .uld _ hereby aUtholue leplesentatnes of this (Ullilll it) eiitI• upon ISSUANCE FEE the above-nientioned propelt� for mspcLuon pulposL, TOTAL FEE J � X / ��/� til I RI \I RSI I OR I \111 ANAIOR) I AN(,ll,\(,I i ��Xnaltlie of Vernimce D.0 W0RKLRS' ('O1,IPENSATION DECLARATION 76MA44 M ISCELLANEOUS APPLICATION OE ass ill aa) t he- affirm that 1 have a certificate of consent to self COUNTS OF LOS ANGELES BUILDING AND SAFETY DIVISION insure. o or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.). Policy No Company FOR APPLICANT TO FILL IN BUILnINc �j� ADDRESS ((oO Certified copy is hereby furnishedaulLDlnG L ` / /I LOCALITY xx ADDRESS �7 Certified copy is filed with the county building inspection LOCALITY NQAREST department xV CR 099 ST Datc_ ___ Ipnlicant NEARESTDISTRICT NO GROUP TYPE ESSEO a CFOSS ST �� G �CONgT .R 111 iC iTE OF E EMPTION t ROM WORKERS LEGAL ` CMIPEN'SAIION 1NSURANC'i- DESCRIPTION LOT NO (BLOCK wP wlGww•r n0. ICIRCLc) S_ATE MAJOR SECOND LOCAL( NO OF BUGS 111115 1Cctllln nee'( not Ile completed if die `cork involved -RACT NOW ON LOT USE �ONEISPEC,AL CONOITIONS 1n the pemm 1s flit one hundrea doilars ISI00) or less.) FUSE OF /�/� , I .c•,if that 11) 'he �eru,nndnLe ,,r .he mora .`or `>.nic;t this SIZE OF LCT EXISTING BLDG (= [r I I mac*nit is issued, I sn.ul wt entrim m nerson in anv manne OWNER r I i i ' II, IIctonic .nhw,,• a 'It,, rlers Compensation Lams �:� Oi Ll:__..iIIE MAIL OCCJPANC` GROUP ADORsss I I TEL CCCJP,N T LOAD NOTICI_ i'O APPLI( aNT If after maKtne this Certificate of CITY NO i ,emotion. "om snouid become sunlect to the WorKers' (,,rlrensnunn aro%,sicns of 'lie Lauer Code you most forth- APDLICATION =0R .;{1- RpV,SRF i al�n cmmnls muh Cti,,i nro,Is,ons or this penin snail be — ,/ now) I TRAILER USE GEOLOGY INSPE C-ION etc^.Ilea re'ol.cK No CCec a � � p;nlc Devices C 1 1( , NSL 1)1 '.)ti I R�� (ORS DEC L%R A 110N OCCUPANCY INSPECTION I il.�l ll\ iifirni ghat 1 _ ,- fit Ii —isec unser xcivislons of (-It'I SAFETY wERM17 J (LIST ITEMS BELOW) o comment-1112 pith Section '000) of Division of the Bust- No OF EXITS nese ,ins r'-oto,swn, : tie :ne ms license is Ln :till force artL;x ,e i a le O_ 'J L..-_ .ess PARKING (��1 " SPACES REQ C 1..��' PAD•-'O E. I — - - LIM1 7 ED TiME USE I ant a\e•nnt 'tom .he NL=sine reoutrements as I am a LLenSeo arcnllet' U• a r-oistered professional enelneerSi.£ OF NO OF INSPEC-OR S j aLune in nn prote ., s;ional _ 'aLlt. ISec:Ion ,0_1. Bus- EXISTING BLDG STORIES SIGNA-URE iness and Proiessiuns(ore' I IL 1)r RQ-_ VI, Do I c PRESENT USE OF BUILDING FINAL APOROVAL j _ _ —-- -- //�•rp/� V I;O` ri'\ •11 t) 1 R-Ill IL;)ER DEC!.\RATIO,i No of EXISTING BUILDINGS © I� ON LOT AND USE I her—w .iffirtn th.it I .un e,cnipi from tine Contractor's - I ;Lense I i1 ;or he tl,llumuio ;c.lson (Section 70+1 5, Bii;i- l� ;1 ) - ' Hess inti Pro tessin ns' ode' No PARKING I as owner o: the orope• }t gill do the worK and the SPACES PROVIDED structure Is not mienaeo or offered for sale (Section 1044 Business and Professions Cooe) (ON51 RI'( I ION I LNDING AGENCt PROPOSED U!! Or BUILDING I hcrcby affirm that there is a Lonstruction lensing agency for the perforniame of the work for which this permit is tinted (Sec 3097,Civ C I. i ender's Name_— ___ ____ PROPOSED MAX. OCC I ender s Address 25 . 00 - t certify that I have read (his application and stale that the PERMIT FEE above infurmauun is correLt I derce to-eomply with all County ISSUANCE FEE ordinances and State lams relating to budding construction, and hereby authorize representatives of this County to enter TOTgL FEE 25 . 00 up il he ah e-I entiu ied propert} for Inspection purposes Signature: - V-r SEE REIvERSE FOR EXPLANATORY LANGUAGE i \\ORE;LRS' COM PLNSaT10NDECLUtarlO.\ CE 875 ill� 241 MISCELLANEOUS APPLICATION r, CE 875 I hereby infirm that I have a certificate of consent to self i insure or d certificate of \\orkers Compensation Insuran_e or COUNTY OF LOS ANGELES BUILDING AND S.XFETY DIVISION f d certified copy thereot ISec 3801), Lab C t -- Policy No. _Comnan� FOR APPLICANT TO FILL IN Bu1LD NIC /vp ❑ ADDRESS �I' Certified cop} is hereby turnishca BUILDING ADDRESS 1.✓'� I/91� �V LOCALITY 1 �J 1 ElCertifiedcop% is filed\kith rhe wont, budding inspection department LOCALITY Temple City CROSS ST Date aprh-:dnt NEAREST DISTRI T NO GRQQQ��}11P TYPE CESSED BY CROSS ST eT :5,22S D� �{ CONST 4 CCRTiFIC\TE OF CXEMPTiO\ FRO%[ '\C'RKERS LEGAL /�' t/Z, t %)\IPI_N5 MON INS1 1\\`\l,1_ OESCPIPT'ON L T NO BLOCK t�nAN 1 Hw— 'Ia (clncLE) STATE MAJOR SECOND LOCAL NO OF BLDGS (This section need not be completed if the Mork m%olved �-qAC- NOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollar, IS100) or less.) «illi ! i OF USE SIZE: OF LOT I E xISTTNe BLDG i I certify that til the. 5,'rrorman.e of !ie %n:l, •o- %hic'i -Itis property permit is issued. I simll oo; :mpim im �e on n an% manne- OWNER so as ro become ,ubrect ;o the `lor4.erc meenedtmr, r a%%c MAILn j OCCUPaNC' ]ROUP Date \policant ADORE SS 960� /��5 NOTICE TO \PPLIC\\T if ave- al,kinc -lus r:rc'?i Ire 'Ir gi CIT LCm C z+ Nc- 'A � t OCCUPaN_ LOAD E\emovo t %ou Awi..a become ,umecz -e •he '7" Compensation em•ismr_ I,t the Labor • ode %ou must to,th- L_ APDL'CA`1C'%I c,p t _NI yo^rI•r%-= i \%till comet% %%uli uch -,,ro%ts,ons r hr. •ermit ,hill be -PAIL_-- ,JSE aEOLJG. NSPFc-'cNNo Soec— 1 I<nc^JI deemed :e%nI,ed — I l LI(, \CTORS DLCLR\TiO•, OCCUPANCY INSPEC-ION ! Panic Dev cgs C -\ ❑ I hereby atitrm ;hat l am licensed under nreer%iOns of Chapter i SAFETY PERMIT LIST ITEMS 3EL0'V 9 tCommencing %vtth Section -0001 of Dnision 3 .)t tht Bua- i ! NO OF EXITS ness and P-ntessionc Code, and m% license is In -utl torte and ellec. PARKING SPACES REO D F i �R O'✓ID ED T License \unther -- -- L,C C!a,, _-- LL LIMITED TIME USE Contractor _ 1)ate DATE W z ❑ a w p lam e\empt from the licensing reauuements is I dm i m I licensed architect or a re_sulered c-ntessionat engineer saE of No of INSPECTOR S z actmc in .n% prot_•`wn.d ,ri_lt* �1� ;10l -I% ! 1311 C- =XISTIVG SLOG 370PI S ATURE 9 iness.;wP-ote,slcnsl.Idcl FINAL APDROVAL- - �j �q ECENT USE OF BUILDING � Lic or Re^ No — Di-e _- 1 110`.IE Ot\NFRAMLDER DECL\R Nilo\ NO OF EXISTING BUILDINGS ON LOT AND USE V �1 _ - I hereby ,itum that I ,un e\empt from the ('ontr'CIOrc 1 License Lass for the follo%%ur: reason (Settion -031 ` Busi- ness and P:otessionsCode) NO PARKING GV 1• as ,%%ner of the propert\, %till do he (cork and the SPACES PROVIDED structure is not intended or otfered for Ile (Section 1 7044 Itu,nte,s and Protecsnnls(ode) Y PROPOSED USE OF BUILDING CONSrRLCT10N LCNDI\G aGl:Nrl 1 hereb% atfinn that there is a construction lending agency for the pertorniance of the I%ork tot %%finch this petmr: is issued (Sec 3097.Ch C ) Lender s Name PROPOSED MAX OCC Lender's \ddress _—_ I certil% that I have read this application and state tLat the PERMIT FEE 25.00 above information is wrrect I agree to cotnpl) %\ith all(oiiiity ISSUANCE FEE ordinances and State la%%% relating to building consWILtton, ' and hereby authorize representdtl%es of this County tc enter TOTAL FEE 25.00 1 upon the ibo%c-mentioned property for incpeLtion purposes - I � n SEE REVERSE FOR EXPLANATORYL,\NGU \GF. a v "t Signature of Permittee D to I ' t I WORKIRS'COMPENSATION DECLARATION 2000 3DPW12190 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION =insure, or a cenificate of Workers' Compensation Insurance, or ( RI a certified copy thereof (Sec 3800, Lab. C) ` J Policy'No Company FOR APPLICANT TO FILL IN BUILDING BUILDIN ADDRE S ADDRESS ❑ Certified copy is hereby furnished X 6 Z s IL,Kk CSV fie 70 LOCALITY ❑ Certified copy is filed with the county building Inspection CITY r TPQ department .,p t„ri 7 C .f• t o NEAREST CROSS ST Date _ Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY A CONSTCERTIFIC,\TE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. C I COMPENSATION INSURANCE NOP HIGHWAY I- (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONESPECIAL CONDITIONS cc i by the permit is for one hundred dollars ($100) or less.) C -_Ierfy et TEL NO. a I certify that ni the performance of the work for which this e e L 6 L�C LL I permit is issued I shall not employ any person In any manner ADDRESS so as to become subject to the Workers' Compensation Laws a 1 N, }�K,p �,� (��VG( OCCUPANCY GROUP tl. ( I Date Applicant CITY d� � 1_n zIP a f ,I� z NOTICE TO APPLICANT If, after making this Certificate ��i I 6 G OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code you must forthwith EXIT HARDWARE ( comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a I 9(commencing vith Section 7000)of Division 3 of the Business NO OF EXITS and Professions Code,and my license Is in full force and effect ame o us ess PARKING• REO'D DPROVIDED License Numbe) Lic Class , L L ����ha�'lam / L k SPACES t i i Contractor — Date 4� LIMITED TIME USE 1 ❑ I am exem)t from the licensing requirements as I am aDATE DATE licensed aichitect or a registered professional engineer FROM To 1 /' t acting in try professional capacity (Section 7051, BllSlneS$ SIZE OF NO OF INSPECTOR'SEXISTING BLDG `� G S�✓�ave STORIES SIGNATURE, and Professions Code) i Lic. or Reg No Date PRESENT USE OF BUILDING eJ .CO 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 70315, Business and ( Professions Codc) NO PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the t structure is not intended or offered for sale(Section 7044,.l PROPOSED USE OF BUILDING CJ Business ant Professions Code) 1 , I CON:ITRUCFION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( I (Sec. 3097, Civ t ) PROPOSED MAX OCC. Lender's Name _ [ADDRESS PLICANT(py)NT) � TE?NO�n -7-73 Lender's Address I certify that I have read this application and state that the84-- C-d' Avg_ AP-L above information is correct I agree to comply with all County PERMIT FEE I ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentic ned property for inspection purposes i I i TOTAL FEE X � Z11�� � SEE REVERSE FOR EXPLANATORY LANGUAGE _/ Slgnatu a of Permittee Date