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Home My Public Portal About9601-9603-9605 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATIONDECLARATION CE 84541280) 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 cer%ified copy thereof(Sec:3800,Lab,C.) Policy No. BUILDING Company 3 FOR APPLICANT TO FILL IN. ADDRESS o ❑ Certified copy is hereby furnished'. B1NGDD SS 14 W LOCALITY R 5:El Certified copy is filed with the county''building inspection , department.: LOCALITY C CROSS ROSS S CST. Date Applicant NEAREST DIST ICT GROUP TV PE OCE SED�ElyCROSS ST. .CONST. - le CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �' G COMPENSATION INSURANCE DESCRIPTION LOT No. sLocic inAr HIGHWAY (CIR CLE) STATE-MAJOR SECOND`LOCAL j- ...OF BLDGS. NO. (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),o. less.) NO --d SIZE of //y� U SIZE OF LOT .� -.EXISTING BLDG. I - r( s I certify that in the performance of the work-for which this l•/ permit is issued, I sliall'not employ any person in any manner OWNER so as io become subject to the Workers'.Compensation Laws. AIL OCCUPANCY GROUP 0 ADDRESS ' ER;1 _ 0 Date Applicant U? TEL. NOTICE TO APPLICANT: If, after making this Certificate of CITY NO.. . " OCCUPANT LOAD. � - Exemption, you should become subject to the Workers' APP�iCATION FOR EXIT HARDWARE: ®' Compensation provisions of the Labor Code, you must forth- wit h orth-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 q (LIST IrEins 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,!cant t'S Name � o PARKING effect: REQ`D PROVIDED . - �jf�y A.� SPACES License Number. Lic.Class me Address �l /J 7 LIMITED TIME USE Contractor Date - �' - DATE DATE 1:1 I am exempt from the licensing requirements as lam a Phone - 7 7,3 3 O • 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 inessand Professions Code)., FINALAPPROVAL ) �� - - RESENT'USE OF BUILDING � .. �ld'� ,)^ �•°t�'1•'rkr:41-„ Lic.or Reg.No. Date f 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 - NO. PROVIDED- - ❑ I, as owner of.the property, will do the work and the structure is not"intended or.offered- for sale (Section r 7044, Business and Professions Code). 'G -� 7.8'A .ROPOSED USE OF BUI'LDING'- - CONSTRUCTION LENDING AGENCY -` - t'7' O 0,0 O 4 Q: I hereby affirm that there is a construction lending agency - /d. - r for the performance of the work for which this permit .Is 0.0 a o 0 0 0 ' issued(Sec. 3097,Civ.C.). Ge Lender's Name 0 9.•1 8,-8o 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 ISS AN E E I ordinances and State.laws 'relating to building construction,' and hereby authorize representatives of this County to enter -. T A upon the above-m toned property for inspection purposes. SEE REVERSE NOR EXPLANATORY LANGUAGE At r o ittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 f� I hereby affirm that I have•a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION `Tial' insure,'or a certificate of Workers'Compensation Insurance,or a citified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING740 ADDRESS Certified copy is hereby furnished. BUILDING W() j � �• „Q /�-!� LOCALITY ADDRESS (�,� Nr'Sa�� UA Certified copy is filed with the county building inspection v LOCALITYNEARESr department. Tei le Cu CROSS ST. Date Applicant NEAREST �//� (' DISTRICJJJ��r,/.{v G p TYPE PROCESSED BY V GROSS ST. G T �Tj ` /JO CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v IVL COMPENSATION INSURANCE DESCRIPTION LOT NO,. BLOCK MAP HIGHWAY - NO. (CIRCLE) STATE MAJOR S OND 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 T certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. CD permit is issued, 1,shall not employ any person in any manner -4 OWNER so as to become subject to the Workers' Compensation Laws. MAIL 4� y OCCUPANCY GROUP ADDRESS ��LL=✓_-�J Date Applicant TEL. NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. 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. LICENSED CONTRACTORS DECLARATION occuPwNCY 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 D PROVIDED D SPACES License Number Lie. Class 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 ' INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I" ATURE iness and Professions Code). `i PRESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg.No. Date ` �y 0, 04 til(0 QC-TAIL, .5 fflR� 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 6 8 3,4 A 0 I, as owner of the property, will do the work and the SPACES PROVIDED • O • • 30 structure .is not intended or offered for sale (Section 7044,Business and Professions Code). � PROPOSED USE OF BUILDING O O O O 6.9 • 2 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency . 01®- 4 i 3 o 2i}T-h ( i-tb lL. e 0 G"0 9—817 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 t_ Q upon the above-mentioned"property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � V , Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76 876(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 ce;:tified copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL INBUILDING ADDRESS (/ NMI ❑ Certified copy is hereby furnished. BUILDING 03 y A C LOCALITY ADDRESS CV/ t�(/�W�„) Certified copy is filed with the county building inspection NEAREST department. LocwuT-Y ` CROSS ST. Date Applicant - - NEAREST. DISTRIC V. O_ TY JPR SSED BY CROSS ST. `� -� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o DESCRIPTION LOT NO. BLOCK I,q AP HIGHWAY COMPENSATION INSURANCE. STATE MAJOR SEC D LOCAL CL - � NO. OF BLDGS. NO. - (CIRCLE) (This section:need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars' ($100) or less.) U USE ' SIZE OF LOT I I EXISTING BLDG.. I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person'in any manner C OANIIE:R' so as to become subject to the Workers' Compensation Laws. L LL ��/�r�7 OCCUPANCY GROUP �I /��.,�i �I w CL ADDRESS L V ! .� i --� U) Date - Applicant _ z E NOTICE TO APPLICANT: If, after making this Certificate of TY �(M Q TL.No.. `a— I ' 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. Panic D@VICES LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ I hereby affirm NO. of EXITS that I am licensed under provisions of Chapter SAFETY PERMIT Q (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 SPACES REO'D PROVIDED D License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ - FROM: TO: I am exempt from the licensing requirements a as I am licensed architect or a registered'professional engineer SIZE OF NO. OF INS ECTO R'S acting in,my professional capacity (Section-7051, BUS- EXISTING BLDG. STORIES S GNATURE mess and.Professions Code). - PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION ON LOT AND U No.of AND US BUILDINGS Jt I hereby affirm.that, I am exempt from the Contractor's R 4 1 4. C. A License Law for the following reason (Section 70.31.5, Busi- - ness and Professions Code): No. PARKING a # • • • ! 8 8 ) SPACES PROVIDED , ❑ I, as owner of the property, will do the work and the '• • • •"•.• • �2 structure is not intended or offered for sale (Section 3,03178 � L 7044, Business and PiOfeSS10S Code). PROPOSED USE OF BUILDING' 0 3 O 8 6 CONSTRUCTION LENDING AGENCY I hereby affirm that there is.a construction lending agency' for the performance of the work for which this permit is issued.(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. occ. Lender's Address PERMIT FEE I certify that I have read this application and state that the J 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'ab -mentioned pro er y for inspection pur oses SEE REVERSE FOR EXPLANATORY LANGUAGE. 60 `"3Ture of Permittee V JDate 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 APPLICANT TO FILL IN BUILDING ADDRES S ^� ❑ Certified copy is hereby furnished. uILDING .96Q3 La's Tunas' D T LOCALITY + A -sss. ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST.' Date Applicant - NEAREST DISTRICT G U TYPE C SED BY CROSS ST. CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE MAP "IG""A� } STATE MAJOR SECOND LOCAL This section need not be completed if the work involved' NO. OF BLDGs. "O. (CIRCLE) a ( p TRACT � NOW ON LOT � USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) U .. USE OF , SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this permit is issued,.I shall not employ any person in any mannert NER �hcL—'/�� y49U/o , so as-to become subject to the Workers' Compensation Laws. IL / //II /JOCCUPANCY GROUPVe Date Applicant TEL.NOTICE TO APPLICANT: If, after making this Certificate ofY No. Jl 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[] GEOLOGY INSPECTION❑ No Spec..Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION occuPwrvcY 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- 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 Contractor Date DATE DATE - FROM: TO: ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS EXISTING BLDG, STORIES SIGNATURE iness and Professions Code). - RESENT USE OF BUILDING FINAL APPROVAL / - . Ta•to •n et � v& Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND'USE I hereby affirm that, 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING h O FJ Q A SPACES PROVIDED ❑ I, as owner of the property, will do the work and the #1c,o 0.-.8,8 structure is not intended or offered for sale (Section ;o 'D'o;o!o',o o z 7044, Business and Professions Code). '0'3,'1'6'-'813 OPOSED USE OF BUILDING Tailoring/Re-tail ela• l •n - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name _ PROPOSED MAX. OCC. Lender's Address PERMIT FEE. I certify that'I have read this application and state that the • above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE ypda hereby authorize representatives of. this County to enter on the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1"4plo o ' F— 8' 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 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 Lqq ADDRESS Certified copy is hereby furnished. BUILDINGADDRESS VvANaA LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST \ DIST G TYPE PRO SS Y CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK HWAY NO. (CIRCLE)CLE) STATE MAJO R'SE OND OCAL NO. OF BLDG S** LbGS. (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 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 C:) ADDRESS, Q �"' (--- Date Applicant TEL OCCUPANT LOAD w NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. o 1 Z Exemption, you should become subject to the Workers' APPLI TION 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 ❑ 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 �Q��/ QF� effect. n&r • (/�` ��V� F47 PARKING REq'D PROVIDED I I SPACES License Number Lic. Class b o 0 DrgAtM LIMITED TIME USE Contractor Date DATE DATE FROM: TO: F I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OFNO. 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 ` •� , Lic.or Reg.No. Date pp HOME OWNER-BUILDER DECLARATION 'NO. OF EXISTING BUILDINGSn�� SEE 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 , h ness and Professions Code): NO. PARKING ``0i,-0100 1 if 91I SPACES PROVIDED 1i ,, s�'� 1, as owner of the property, will do the work and the 1245 Ph a 4I 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 RAIAIX 03Y,ILD 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 w 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, FEEj upon the above-mentioned'property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee ate WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION + CE 875 I hereby affirm at'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 Q ADDRESS Certified copy is hereby furnished. BUILDINGADDRESS PR (flry LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST d� p/ l �dy� DISTR CT NO. GR P TYPE P SSED BY CROSS ST. �/K ter 91-VP l . CONST. � CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL , C f COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP){. 2 H G WEY STATE MAJOR SECOND LOCAL - N V 'yam ) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOTI� USEZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF �1 ✓ y. I certify that in the performance of the wSIZE OF LOT EXISTING BLDG.ork for which this D_ permit is issued, I shall not employ any person in any manner OWNER (/ul a4glAVD. YZV-1 AI 72v/ y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o: ADDRESS CD Date Applicant AN& P 2� G/T � NOTICE TO APPLICANT: If, after making this Certificate of CITY /7 j N-.'01-0_30-1-172-7 OCCUPANT LOAD N Exemption, you should become subject' to the Workers' APPLICATION FOR EXIT HARDWARE: Z Compensation provisions of the Labor Code,you must forth with comply with such provisions or this permit shall be TRAILER USE E] El INSPECTION ElNo 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 C �!�[ effect. R J ess O PARKING �7I SPACES REQ'D D PROVIDED D License Number Lie. Class ,1� Contractor Date LUGS/ l ��""T��/ TN� DATE DATE TIME USE 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 NSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I SIGNATUl E iness and Professions Code). FINAL APPROVAL 1 ' PRESENT USE OF BUILDING Lie.or Reg.No. Date Clol�l�S 3110 IP4C. 0 91g HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 9 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, Busi- ness and Professions Code): NO. PARKING 0000-0001 111 i'• SII ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 8i3 4 1 All 9:35 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 &z 07r/7 S/+ 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 OV upon the above-mentioned property for• spection purposes. ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affiith that I have a certificate of consent to selfT LOS ANGELES BUILDI ND AFETY DIVISION insure;.or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company OR P ANT TO FILL IN BUILDING ADDRESS Az, J( 1AJ Certified copy is hereby furnished. BUILDING c �� S -r U S y //}} /] //�� _I ffi ADDRESS LOCALITY �� ( � Ir �.1 J'd/ / Certified copy is filed with the county building inspection LOCALITY t I P L C C S tJ� g l �j' NEAREST ii 7(/V department. CROSS ST. Date Applicant NEARESTL, I� r �-`�� DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. �j r` L 1✓ CGZ T_' V 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 7.. 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 U L N I-N-0 (2) T-t1 ! y so as to become subject to the Workers' Compensation Laws. MAIL �i OCCUPANCY GROUP Date Applicant ADDRESS V O 6 L A 5 TU N (.� 5 D - I— U NOTICE TO APPLICANT: If, after making this Certificate of p( CITY TC M p L ( �LT– NIL `�) - g _503 OCCUPANT LOAD y 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 ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PER MIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF Extrs ness and Professions Code, and my license is in full force and effect. � iv" PARKING SPACES REQ'D D PROVIDED D License Number Lic. Class b— 0 t� � (. S LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVA.[..._............ PRESENT USE OF BUILDING ...... - Lie.or Reg.No. Date � . 5 rl ............. ... ............. ..... I HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE - 140 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 0000-0001 12/13/89 PROVIDED I, as owner of the property, will do the work and the SPACES ��17 1 PM 4:26; ` structure is not intended or offered for sale (Section 7044,Business and Professions Code). ^CONSTRUCTION LENDING AGENCY yam• PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency oc'cJ . I for the performarice of the work for which this permit is issued(Sec. 3097,Civ.Q. Lend'er's Name Il 1 I/ PROPOSED MAX. OCC. Lender's Address PERMIT FEE 5—.o U 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. SEE REVERSE FOR EXPLANATORY LANGUAGE w Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS APPLICATION J� • CE 875 I hereby affirm .thuF 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 APP LICANTTO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. ADDRSS BUILDING CALITY /^ E _ tL/'• FCertified copy is filed with the county building inspectionLOCALITY �. NEAREST department. CROSS ST. Date Applicant NEAREST I, DISTR ICT P G•oT�UP TYPE PR CESS D BY CROSS ST. (/ \/ J�y� CONST.i/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ��JJ LL �/ COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY NO. ('CIRCLE) STATE MAJOR SE ND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT OW 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 Lor exlsTl BLDG. o permit is issued, I shall not employ any person in any manner OWNER , k =' so as to become subject to the Workers' Compensation Laws. OCCUPANCY`GROUP - MAIL /n/ ` ® O ADDRESS �� v �/ I- Date ApplicantC.3TEL. LI.J NOTICE TO APPLICANT: If, after making this Certificate of CITY . h��'.�� No. OCCUPANT LOAD ° Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions oI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec. Knowl. El 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 effect' PARKINGSPACES REQ•D D PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING - - Lic.or Reg.No. Date t HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDING 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 aI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7 8 9..1 A 7044,Business and Professions Code). # *'o• . 88 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 • o o • • o • In PROPOSED MAX. OCC. ' z Lender's Address O I;certify that I have read this application and state that the PERMIT FEE 9A 1 "8 7 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances DIV and tate laws relating to building construction, ' and hefty au ize representatives of this County to enter TOTAL FEE ,up bov - entioned property for ins tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGEX: 111W V Signature of Permittee Date yVi CE 875 (11-84)KERS' MISCELLANEOUS APPLICATION CE 875 r � 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 certify d copy thereof(Sec. 3800,Lab.C.). PolicY-No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS a Certified copy is hereby furnished. uILD ING f�/� 3 hN�S, LOCALITY A RESS :!�!� D Ceitified copy is filed with the county building inspection OCALITY' /�^ , C> T CROSS sr. department. Date Applicant EAREsr 1� Cr7 /w/ DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. Y CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or. less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this Cn 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 / AD OR ESS 1 / CD i�vA /� ��44 `2'/ 40 c3 Date Applicant TELW NOTICE TO APPLICANT: If, after making this Certificate of TY 1 S NO. 9-I�-2-97 COV72 OCCUPANT LOAD � CI Exemption, you should become subject to the Workers' Vz 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 ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El 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. PARKINGSPACES REQ'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 engineerslzE of NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- ; STING BLDG. STORIES SIGNATURE inessand Professions Code)• , ,faG ` FINAL APPROVAL PRESENT USE OF BUILDING V 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 29861 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # o a • 0 88 I, as owner of the property, will do the work and the SPACES PROVIDED N structure is not intended or offered for sale (Section o o.e o • ® • 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 6 1 '0-88 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, OU_� an hereby authorize representatives of this County to enter TOTAL FEE II"'�` n th ove-mentioned property for inspection purposes. b SEE REVERSE FOR EXPLANATORY LANGUAGE c Signature of Permittee Date WORKERS'COMPENSATIONDECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hereb�yy affirm that 1 have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insurer 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. BUILRESDING //]�J/JL LO DCALITY ADS v� .✓ Certified copy is filed with the county building inspection LOCALITY D^ NEAREST department. cRoss sr. Date Applicant NEAREST I DISTRICT NO. GRO TYPE P SSED BY CROSS ST. I 5,0` 6I CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION-INSURANCE DESCRIPTION LOT N BLOCK MAP -�// RIGRWAY No��'-(�(p (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 0 permit is issued, I shall not employ any person in any manner OWNER y so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL O ADDRESS F- Date Applicant LLI TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY £ No. �� G. Exemption, you should become subject to the Workers' z APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or,thrs permit shall be TRAILER USE ❑ GEOLOGY INSPECTION p No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices E I hereby affirm that I am licensed under provisions of Chapter SAFETY-PERMIT/E:]- AFETYPERMIT ❑ (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. PARKINGSPACES REQ'D 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 acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). n PRESENT USE OF BUILDING - ly FINAL APPROVAL ✓j` 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 •'._:? I F License Law for the following reason (Section 7031.5; Busi- ness and Professions Code): NO. PARKING L F=E ❑ 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). I; PROPOSED USE OF BUILDING r. ��i CONSTRUCTION LENDING AGENCY Wil:= 1 nj( e=1_I I hereby affirm that there is a construction lending agency CX for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. AA 9%4 (� Lender's Name (" �J�/ ROPOS D MAX. OCC. V irYa. Lender's Address (,I [APERMIT FEE I! 1 I certify that I have read this application and state that the IQ 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 the above-mentioned property for inspection purposes. as Q• SEE REVERSE FOR EXPLANATORY LANGUAGE Z,4 V z�! «,� e� A/ O Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION CE 875 I lie r�by aff*.h that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insuiE;, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). _ Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS l�yj Certified copy is hereby furnished. UILDINO -3 J LOCALITY DDRESS0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST l— /j P DISTRICT OUP TYPE P OCESSED BY pp CROSS ST. �" C�71` CONST. CERTIFICATE OF EXEMPTION FROM WORKERS'• LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need 'not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I USE OF SIZE OF Lor EXISTING BLDG. I certify that in the performance of the work for which this C3 0 permit is issued, I shall not employ any person in any manner OWNER Lauf E PW( so as to become subject to the Workers' Compensation Laws. MAIL 1/ ; ) � OCCUPANCY GROUP o ADDRESS b ~ Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY Ve/U� (�'(� TE 3(O 7 OCCUPANT LOAD Exemption, you should become subject to the Workers' -29 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 El E] 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. G�Z��G--JC_4��K.r.�� PARKING REQ•D PROVIDED - SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: Ej 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 SIGN TURE ) iness and Professions Code). FINAL APPROVAL ,S PRESENT USE OF BUILDING r (` Lie.or Reg.No. Date r HOME OWNER-BUILDER DECLARATION NO. OF EXIAND USE STING BUILDINGS •\, `v I hereby affirm that I am exempt from the Contractor's ON LOT I�- - 7 r,c/ License Law for the following reason (Section 7031.5, Busi + ness and Professions Code):. NO. PARKING Pri6216 ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ) .PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency Q AC - 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 I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes.' % OGS T,0 ' I . V1_ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DELLUZ:\TION CE 375 (t t 841 M ISCELLANE0U --(-CAT ! 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 ou1LD Nh P Y FOR APPLICANT TO FILL IN /rj AD DR�SS Certified copy is hereby furnished. v euILD UNG ��nw t _T( qAS A ADDRESS �W `lµ'�r Y/ LOCALITY I F Certified copy is tiled with the county building inspection g LOCALITY I VI��pLE �o T i/ NEAREST department. CROSS ST. Date Applicant NEARESTi � �/ DISTRICT NO. GROUP TYPE P ESSED BY TEMPLE G CROSS ST. CITY LP's T((f��° CONS CERTIFICATE OF EXENIPTION FROM WORKERS' LEGAL i ' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP c wqv NO. (CIRC LCI STATE MAJOR SECOND LOCAL NO. OF BLDGS. (Tills section need not be completed If the Work involved TRACT NOW ON LOT USE :ONE SPECIAL CONDITIONS by the permit is for one hundred dollars ISM) or less.) use OF I - Icertify that in the rrrurmance of :he ^:nrk :o, which` which 'hSIZE OF LOT EXIST( G BLOC.is permit is issued, f ;hall ❑ut employ any person in any manner OWNER so as to become subjecr o the ''\orkers' Compensation Laws. g :4AIL OCCUPANCY GROUP t ADDRESS Date \or!icant X NOTICETO APPLICANT: If. liter makim: :his ,__:!n ficate of CIT re 3f� OCCUPANT LOAD Exemption. you should become subject to the \Vorkers�-.. ovforth- _ APPLICATION FOR EXIT HARCWARE. Comoensation orisions of the Labor Code. you must forth with comely %ith mein provisions -r J,.is -ermit shall ' be — — f revoked. TRAIL.R JSE GEOLOGY INSPECTION SIO Spec. 1\ fowl, deemed �j LICENSED(.:ONTR.\C"POIZS DECL.\R.\TIO ' OCC7PAaCY INPanic Devices SPECT1oN B I hereby affirm that I am licensed under provisions of Chanter —t 1 SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of :he Busl- NO. OF EXITS ness and Professions Code. and my license is in toll .'orce and effect. PARKINGl�I REO,D PROV ID ED � SPACES License Number Lc. Class LIMITED TIME USE t-UnIraCU)r Dere DATE OA re =>u+c I '.un exenip[ rom -he !icensing requirements u 1 stn a � 1 1 -licensed arc,nitec: or a ;glistered -)rotesstonal .n;!nee: ;rzE OF -,o. of INSPE CTO R'S ? actin! in my orutessiunal caoactt 'Sect:on '): (. Bus- XIST::IG SLOG. STCRIES SIGNATURE 'inessand Professions Code I. N- -RESE`IT 'JSE OF 3UILDING FINAL APPROVAL Lic. ur Re,.!. Nn. ---_.----- Y I —_ HOME OWNER-BUILDER DECL.AR.\NO`. NO. OF EXISTING BUILDINGS I hm hereby affirm that i azsempt from :Ute ContractorCN LOT AND USE; '1 License Law for the t0410%ki11e reason 'Sec:iun "031.3. Bu,i- ness and Professions Code I: NO. PARKING ❑ 1, as owner of :he on)per[y. will do the cork Ind :he SPACES -40VIDED structure is not intended or uffercd !1)r .aie •Section 1 044. Business and Professions Codel. - c:ONSTRI CTION LENDING .\GEN('1 X PROPOSED USE OF BUILDING P 17 arvil QCi I hereby affirm that :here is a construction lendin2 agent: for the performance of the work for which this permit is issued(Sec. 309 Civ.C.). Lender's`lame — PROPOSED MAX. OCC: Lender's Address I I certify that l have read this application and state that the PERMIT FEE 25.00 above information is correct. I agree to comply%%ith all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby author, e rc�sentzitiveslbf this County to enter TOTAL FEE 25.00 upon the above m tit propert )r' spection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE >< = R % 'q { I WORKERS'COMPENSA11UN DLCLARAIIUN2o-oossDPvv:2iso 1VIl�C:�LLAN1_L)U ' AY'eL_1L;AI IVN 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 (Seca 3800, Lab.C.),' Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILLDDIlt ADDRES ADDRESS ❑ Certified copy.is hereby:furnished. X ( b D UN� ��1�� LOCALITY ❑ Certified copy is filed with the county building inspection CITE ZIP 1 department. ( �e 9 Ty 0 NEAREST CROSS ST. .. Date Applicant - SIZE OF Lot NO.OF SLOGS.NOW ON LOT DISTRICT NO. I GROUP TYPE I PROCESSED BY CONST.CERTIFICATE OF EXEMPTION FROM WORKERS,' (` I COMPENSATION INSURANCE TRACT BLOCK LOT NO. HIGHWAY MAP - 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.) I certify that in the performance.of the work for which this TW_per _uuko eL TEL NO. permit is issued:I'shall not employ any person in any manner �b `u°_2 7-101? so as to become subject to the Workers' Compensation Laws. ADDRESr. �1 It -Jeo .IZ? lvc� OCCUPANCY GROUP ( Date Applicant CITY -7 zIP 9` v NOTICE TO APPLICANT: If. after making this Certificate 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. ❑ I. revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Cg Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) # I 9(commencing with Section 7000)of Division 3 of the Business No.of EXITS ! and Professions Code,and my license is in full force and effect.A, ame o usiness ��e S E �Yom^ PARKING _ I License Number Lic. Class SPACES ' REQ'D O PROVIDED O r I I I Contractor Date LIMITED TIME USE ! ❑ I am exempt from the licensing requirements as I am a DATE DATE _ I � FROM: TO: licensed architect or a registered professional engineer n acting in my professional capacity (Section 7051,Business SIZE OF NO.OF INSPECTORS t I EXISTING BLDG. STORIES SIGNATURE, and Professions Code). Lic. or Reg. No. Date PRESENT USE of BUILDING FINAL APPROVAL 17 Z�0Z �— HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE - I hereby affirm that I amexempt 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 7044,31 PROPOSED USE OF BUILDING Business and Professions Code). { I refia i ale CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued I (Sec. 3097,CIV.C.).' PROPOSED MAX.OCC. Lender's Name APPLICANT INT) T TEL NO. Mn III t4 r ►'i �rosb 4Z1.-286- o - Lender's Address ADDRES / { I certify that I have read this application and state that the SO 2Nt V (Q 7 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 10 XD(p p SEE REVERSE FOR EXPLANATORY LANGUAGE il Si nature of Permittee Date L t l WORKERS' COMPENSATION DECLARATION 76M444 -, 20-0063DPW12/90 E:_ -ISCLL,ANEOi. �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 FILL.IN BUILDING !r BUILDING ADDIRESS/ ADDRESS ❑ Certified copy, hereby;furnished. X L_ 7 Ilry/t✓ �r 56(ij; LOCALITY i, ) ! ❑ Certified copy is filed"with the county building inspection CITY ZIP / �{/q� "NEAREST department. d CROSS ST. Date '' Applicant SIZE OF LOT I NO.OF/LDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' 2,00 fj contsr. O ( I COMPENSATION INSURANCE TRACT BLOCK LOT NO. " 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.) use ZONE SPECIAL CONDITIONS 0 I certify that in the performance.of the work for which this U 1 permit is issued;I shall not employ any person in any manner r�� rhe G ^ &, TEL NO �L�� so as to become subject to the Workers• Compensation Laws- ADDRESS OCCUPANCY GROUP 3 ) ( Date Applicant . CITY- - E ITY zlPry/� NOTICE TO APPLICANT: If; after making this Certificate 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❑ I• No Spec.Knows. revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY IN5PECTIONEj INSPECTION[ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) r ) 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 ot Business j PARKING• REQ'D I I PROVIDED License Number Lic. Class SPACES LLJJ LL�� / t I Contractor Date LIMITED TIME USE ElI am exempt from the licensing requirements as I am a DATE DATE FROM: To: licensed architect or a registered professional engineer t, 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 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 El 1. as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044,li PROPOSED USE OF BUILDING Business and Professions Code). )Lnp - t t CONSTRUCTION LENDING AGENCY j Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( i (Sec. 3097, Civ.Q. - PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINT) TEL NO. A L o 6"6 z G Lender's Address ADDRESS I certify that I have read this application and state that.the t 6 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 s I the ab ve-mentioned roperty for inspection purposes. ,. ,..✓. t,� TOTAL FEE X (/2- I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date - i