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HomeMy Public PortalAbout9608, 9610, 9610 1/2 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76CE 8454(11-84) MISCELLANEOUS-APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure;bra certificate of Workers'Compensation Insurance,or a ceriified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BUILDING ADDRESS 7 �Je>✓e Certified copy is hereby furnished. BUILDING /� f•0 j a .� LOCALITY ADDRESS `7 FICertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP JTYE OCESSED BY CROSS ST. �/�O CONSTJ� CERTIFICATE OF EXEMP ON FROM WORKERS' LEGAL a!% o �/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This section need not be com leted if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hun red dollars ($100) or less.) USE OF n SIZE OF LOT EXISTING BLDG. I certify that in the performanc of the work for which this D �n �l�/// cam(/ permit is issued, I shall not empl any person in any manner OWNER C_C./V/)0N so as to become subject to the rkers' Compensation Laws. MAIL n OCCUPANCY GROUP ZE] o ADDRESSDI. �D /,oC I-- Date Applicant CU TEL, LV OCCUPANT LOAD NOTICE TO APPLICANT: If, of er making this Certificate of CIT-4- ���p� j J'G NO. z Exemption, you should beco a subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the abor Code, you must forth- with- comply with Such proviS ns or this permit shall be TRAILER USE El GEOLOGY INSPECTION El No Spec. Knowl. deemed revoked. LICENSED CONTRACT RS DECLARATION OCCUPANCY INSPECTION Panic Devices 0 I hereby affirm that I am license under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 70 ) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and y license is in full force and effect. PARKING REQ`D PROVIDED —J ��_�� elly SPACES J License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the li ensing requirements as I am a licensed architect or a r gistered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professiona capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code . /�IeiNT//V b FINAL APPROVAL _ PRESENT USE OF BUILDING Lic.or Reg.No. Date ( C� E RE— HOME OWNER-BUILD R DECLARATION No. of EXISTING BUILDINGS _+ ON LOT AND USE I hereby affirm that I am ex mpt from the Contractor's _)"ilrr` License Law for the following r ason (Section 7031.5, Busi /�� ( /U ness and Professions Code): No. PARKING V I I -`23•'y,`' 1. I, as owner of the property, will do the work and the SPAC$S PROVIDED I aS 3' 'xF.:LL structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address C J 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 EE upon the above-mentioned property for inspe ion purposes. /y� 2 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date WORKERS'COMPENSATION DECLARATION C CE 875{11-84) MISCELLANEOUS APPLICATION E 875 I hereby affirm that I have certificate of consent to self COUNTY Off' I.OS ANGELES BUILDING AND SAFETY DIVISION insure, or a•certificate of Workers'Compensation Insurance,or t a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APP LICANT TO F I LL.I N BUILDING j ADDRESS Certified copy is hereby furnished. ILDING ��O _ ADDRESS LOCALITY 0 Certified copy is filed with the county building inspection CALIT I- NEAREST department. a T CROSS ST. Date Applicant NEAREST L J DISTRICT NO. Gp�U TYPE ESSED BY CROSS S a I p /�(- CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL G �I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOF BLD GS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOW. OON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT ]STING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER afthmax so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ®_ ADDRESS ' - ® V Date Applicant uJ� TEL, OCCUPANT LOAD . NOTICE TO APPLICANT: If, after making this Certificate of CITY 1 NO. �'{- q-� 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 deemed Ievoked. TRAILER USE E3 GEOLOGY INSPECTION EJ NO Spec. KnOWI. 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 READ PROVIDED SPACES License Number Lia Class e-(as ��5, ©�� � LIMITED TIME USE Contractor Date DATE DATE 0 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. FROM: TO: OF INSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessandProfessions Code). FINAL,APPROVAL PRESENT USE OF BUILDING Lic.or RegNo. Date HOME OWNER-BUILDER DECLARATION No. of EXISTING BUILDINGSON LOT AND USE I hereby affirm that I am exempt from the Contractor's g E It t,?l 4-i fiil -r License Law for the following reason (Section 7031.5, Busi- "' ness and Professions Code): - ) NO. PARKING j'tt�� L' f } SPACES PROVIDED -• J.EJ•5 :rx, 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency N. Q for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE � 00 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 proper for inspection p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S gnature of Permittee Date K,` WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 L, I I li by a££irm t7iat i have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I{LJII ins or`a certcate of Workers'Compensation Insurance,or a cer iedcopy thereof(Sec. 3800,Lab.C.). PolicW Com an BUILDISS Y P Y FOR APPLICANT TO FILL IN ADDRESS y .Certified copy is hereby furnished. BOLDIN (�( �DRESSa/p /Z L.4$ "D LOCALITY DCertified copy is filed with the county building inspection LO ALITY L�- NEAREST department. -m)0 f 1.17. �I CROSS Sr. Date Applicant NEAREST •�T� �/1 ' f /7 * �L .I DISTRIC NO. GROUP TYPE ESSED BY CROSS ST. TE/"/PF G C.i V,�• < �� _ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Ae.:;? COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP .1 .-Y NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD GS.- ' (This section need not be completed if the work involved TRACT, NOW ON LOT USE ZONE 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 s,zE of LOT EXISTING BLDG. CD 0 permit is issued, I shall not employ any person in any manner OWNERi N AlIL D N so as to become subject to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP z ADDRESS H-+ Date Applicant LLI NOTICE TO APPLICANT: If, after making this Certificate of c,rY NO. / OCCUPANT LOAD Ter,R�F c T TEL-f 31 23 z Exemption, you should become subject to th6'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. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices E 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 effect. Q PARKING SPACES REQ'D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements. as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG, q(pQ 'j �+ j STORIES ' SI NATURE iness and Professions Code). .�AI� PRESENT USE OF BUILDING 61h T' FINAL APPROVAL F) Lie.or Reg.No. Date t/n P'r 9-9 FEE HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's T' ltFli —�jl j License Law for the following reason (Section 7031.5, BWi T.— ness and Professions Code): NO. PARKING lJ4i t Mill:;c:; z � ' SPACES PROVIDED -• ��������•�� __ _ _ _ "- •� ii •_t.+ 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency U7 `D 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 �,�&0 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, �T and hereby authorize representatives of this County to enter TOTAL. FEE W upon the above-mentioned property for inspecti n purposes. C3- SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date < WORKERS'COMPENSATION DECLARATION 76M444 CE875 (2-80) MISCELLANEOUS APPLICATION t--f 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'Cornpensation Insurance,of • a•certified copy.thereof(Sec. 3800 Lab.C.) Policy No, Company L J FOR APPLICANT TO FILL IN BUILDING. - 0 S I1 .�yL� A 5 ' ADDRESS U rl a Certified copy is hereby.furnished`. 6 wUILDINDRESl '. L� L J LOCALITY )OIL , Certified copy is filed with the county building inspection ` ryIEAREST city � Q ,l,n department. i OCALITY CROSSST. �h li t/�iV N� Date Applicant 3 AREST DISTRICT NO. _j.,GR UP TYPE PRO9;BY 5 .-. CROSS ST 1.- 'CONST.' ; o� CERTIFICATE OF EXEMPTION FROM WORKERS .- F LEGAL L ' DESCRIPTION LO NO. B LOCK MAF HIGHwwY `COMPENSATION'INSURANCE � s ECON OCAL NO. (CIRCLE). 0 TATE MAJOR S - NO.,OF BLDGS. ' - (This section need not be,completed if the Work Involved TRACT NOW'ON LOT USE ZONE. SPECIAL CONDITIONS U by the permit is for one hundred dollars (5100) or less) /^7 USE TIN .�✓ ` , SIZEOFLOT EXISTING BLDG:-.- • I certify that in the'.perform.ance of the work for which this` 0' permit is issued; I shall not'employ any person'in any manner I 4"WNER ry V so as-to becorrie'subject to the Workers Compensation Laws. OCCUPANCY GROUP' d IL (� , a.k ., , .. ADDRESS - .. - Date Applicant - � U)NOTICE TO APPLICANT': If,after making this Certificate of CI Tv No� OCCUPANT LOAD z Exemption, you .should become`subject to 'the. Workers' ' Compensation provisions of the Labor Code., you must forth- -APPLICATION FOR - EXIT.HARDWARE: with comply with,such provisions or this 'permit shall ,be TRAILER USE GEOLOGY.INSPECTION'❑ deemed revoked E No Spec. Knowl. LICENSED CONTRACTORS DECL'A'RATION- OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) P 9 (commencing,with Section 7000) of Division 3 of the Busi- NO. O Exirs ness and Professions Code, and my license is in full force and PARKINS. effect. SPACES REq'D PROVIDED D License.Number .Lic.Class LIMITED TIME USE ' Contractor Date • < _ DATE DATE - QI am exempt'from the licensing requirements as I am a: FROM: To: licensed architect or a registered professional engineer SIZE OF NO.OF INSP CTOR'S acting In my professional capacity (Section .7051,- Bus- EXISTING BLDG. - - •• STORI�Ey,S S NATURE 'me55 andPTOfeSSlOI1S Code). • RESENT USE OF BUILDING 1 ��"'�V,�. 4.1i1.i✓ FINAL APPROVAL f Lic.or Reg.No. ' Date 5lf�Jt ;HOME OWNER-BUILDER DECLARATIONN rNo. of AND UNG•Bu1LDINGs - ON�LOT' D USE I. hereby affirm that, I am exempt from. the Contractor's - 41 5 6,5 A License Law for the following reason (Section 7031:5, Busi- nessPARKING _ - # •.0,�.� and'PLOfeSSlOriS Code): ` NO.SPACES PROVIDED 8.8 M•I, as owner of the property, will do the work and the i0 structure is not'intended or offered for sale (Sectio'n '7044, Business and Professions Code), oP,osED USE of BUILDING' 0 2 21 $5'' •? ,,: IC CONSTRUCTION LENDING AGENCY' I hereby affirm that there is a construction:lending'agency '. 5 V� for the performance'of.. the work for,wJiich. this permit is - issued (Sec. 3097,Civ.C.): Lender's Name - ,:. • PROPOSED MAX. OCC. Lender's Address PERMIT FEE_ I;certify that'.1.have_ read- thisapplication and`•state that`the ISSUANCE FEE above information is correct.I agree to comply'With a1LCounty ordinances and State laws relating to buildlllg•cOn$truCtlOn'( TOTAL FEE' and hereby authorize representatives, this County to.enter - upon the abov nt'on property' inspection pu•poses. . SEE REVERSE'FOR'EXPLANATORY..LANGUAGE - p Signature f Permittee Date- ' ' WORKERS'COMPENSATION DECLARATION 76CE 8754(11-84) M I SC E L LA N EO U S APPLICATION I heYebo 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 APP LICANTTO FILL IN BUILDING Ut ��/t ADDRESS AM` Certified copy is hereby furnished. BUILDING k� A DRESS tiAs -rop LOCALITY Certified copy is filed with the county building inspection 16O ALITY NEAREST department. r=KPLE �, CROSS ST. Date Applicant EAREST /� `, DISTRICT 11yy�� GROUP TYPE PRO SSED BY pp CROSS ST. QI„ l..tT� �� v�' -!S,Dr CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL U 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 NOW ON LOT U ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF / ' _I SIZE OF LOT EXISTING BLDG. d I certify that in_the performance of the work for which this Q o permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. AIL Q OCCUPANCY.GR,CUP- (l o Date Applicant ADDRESS eje)) 2— C w NOTICE TO APPLICANT: If, after making this Certificate of CITYL. r- GLS '"( NO. OCCUPANT LOAD rz Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ . ❑ El 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 E] (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions.Code,and my license is in full force and effect. PARKING REQ'D D PROVIDED D 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 FROM: TO: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EX STING BLDG. STORIES IG ATURE iness and Professions Code). Lie.or Reg.No. Date NV PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.of EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's V License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1, as owner of the property, will do the work and the SPACES PROVIDED v� structure is not intended or offered for sale (Section 1 Sr g 7044,Business and Professions Code). 01U CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency �y'['��(7 t+ F—S / v 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 Ada' e and State laws rely ng to building construction, y a thorize se . fives of this Co my enter TOTAL FEE mentio ed pr rty for inspectio pur oses.1; I�[ SEEREVERSE FOR EXPLANATORY LANGUAGE If ignature of Permittee Da WORKERS'COMPENSATION DECLARATION 76M444 CE 875(2-80) MISCELLANEOUSAPPLICATION. "I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES. BUILDING AND SAFETY DIVISION insure, or a certificate Workers'of- Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C Policy No. Company FOR APPLICANT TO FILL IN BUILDING C� Q - ADDRESS Certified copy is hereby furnished. RdILDING ADDRESS G�O�' TkA"Q/S / .v LOCALITY ! (2 h El Certified copy is filed with the county,building inspection ' NEAREST. department:. � .LOCALITYJ � I � � O CROSS ST. y� � Date Applicant - NEAREST - 'DISTRICT N GRf`UP I TYPE PROC SSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL � g— COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK 9qP /�/� HIGHWAY } NO. (/(f (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (Thi section need not be completed if the work involved TRACT �J" NOW ON LOT USE Z E ECTAL CONDITIONS 0, by the .permit is for one hundred dollars ($100) or less.) 0 USE OF SIZE OF LOT EXISTING BLDG. I certify that.in the performance of the work for which this permit is issued, I shall not employ any person,in any manner NER O so as to become subject to the Workers' Compensation Laws. MAIL Q��9 O OCCUPANCY GROUP 0, LLI DRESS _ Date Applicant ^^ 1Ol/►LL�.�7 Z NOTICE TO APPLICANT: If, after making this Certificate of Iry 2 /Q rrio� 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 USEGEOLOGY INSPECTION ' deemed revoked. ❑ C3NO Spec. Knowl. ❑❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 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 r'- effect. ] !Cant s Name - o1•l o," ev �A ARKING• I � 7 SPACES REO'D L� PROVIDED License Number Lic.Class I eddrAeMs-s- -/��/3�—�+,`}�t*3tM NI 17 LIMITED TIME. USE Contractor Date L VA61 <C- ' • ` ' 1 DATEDATE I am exempt from the licensing requirements as I.am a hone - �)S' 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'ProfessionsCode). { FINAL APPROVAL RESENT USE OF BUILDING ST,�,/� ��/ (%! �L. ,�+eo► Lic.or Reg.N,o. Date U 47YZ V HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILD NGS 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 1.6 7,8 A structure is not intended or offered for sale (Section 7044,Business and Professions Code). # • • • • 4 0: R.POSED USE OF BUILDING' I CONSTRUCTION LENDING AGENCYI • 0.0 0.6 • • I hereby affirm that there is a construction lending agency . t • ' for. the performance of the .work for which this permit is 8 2;—$Q issued(Sec. 3097,Civ.C.). Lender's Name - PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating. to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned property.for inspection purposes. SEE REVERSE OR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 +' :.7 CE 875(11-84) MISCELLANEOUS APPLICATION {� I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LI insure, or a certificate of Workers'Compensation Insurance,or a certified,copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Q Certified copy is hereby furnished. BUILDING -ADDRESS ADDRESS �oC Tv �s LOCALITY Certified copy is filed with-"the county building inspection LOCALITY NEAREST department. L CROSS ST. Date Applicant N AREST DISTRICT NO. GRO TYPE O SSED BY l/ CROSS ST. / oy11.& C/ �.- CONST. - I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL / 15, 10 COMPENSATION INSURANCE DESCRIPTION LOT NO. (o BLOCK MAP HIGHWAY No,�6bG 9 (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT (I S� NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF I certify that in the performance of the work for which this SIZE OF Lor EXISTING BLDG. �I R O permit is issued, I shall not employ any person in any manner wNER r CA AJ'1J0,J 1 - `' so as to become subject to the Workers' Compensation Laws. MAr: OCCUPANCY.GROUP o g- -ADDRESS Date Applicant - 1C-3.J NOTICE TO APPLICANT: If, after making this Certificate ofclrY�;�P C 1 T[.L'ag-— 2ZZ'9 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 ❑ ❑ No Spec. Knowl. •0 I>Y P P TRAILER USE GEOLOGY INSPECTION deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 0 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) ISI 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS u 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 INSP CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). , / FINAL APPROVAL / PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOTANDUSE 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 G•"SPA.CES PROVIDED I, as owner of the property, will do the work and the G- structure is not intended or offered for sale (Section 7044,Business and Professions Code). ;2546.8A CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING -�-1/.�..�, `_ # o • • • 8 8 1 hereby affirm that there is a construction lending agency P/ ti, �,�?„�_E�r �' . . • 6,0,0 • s for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. � � 0 9. 1 9,t 8 6 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 h by authorize representatives of this County to enter TOTAL FEE upo eabove-mentioned pro for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o ermittee Date WORKERS'COMPENSATION.DECLARATION CE M76(2-80) I S C E L LA.N E O U S APPLICATION ' I herel firm.that I have a certificate of consent.to self COUNTY:OF LOS.ANGELES. . BUILDING AND SAFETY DIVISION ` ins-qe, ��ri"certificatebf_Workers'Compensation Insurance,or a certified copy thereof(Sea.3800,Lab:C.) Policy;No. - Company FOR":APPLICANT TO FILL IN BurcDING ` ,• • 'ADDRESS - E7 Certified copy.is hereby'fuinished. ' (13 LDING9 ADDRESS , ad) ! �J ? ..'L LOCALITY ` f . a Certified copy is filed with the county building inspection .e-- C, NEAREST LOCALITY T.Y l al��.G . �., ' ..CROSS§T.- 7 e - department., r NZ Date ,Applicant - E'AREST- - DISTR/,I�T Q� GROUP TYPE PROC SED BY . - - cROSS'sT.� �E' _:.1�' J .I CONST CERTIFICATE,OF EXEMPTION FROM WORKERS LEGAL tJ 6� V COMPENSATION INSURANCE DEsCRIPTIoN LOT-110.1 BOCK, MAP (This section need not be completed if the'work ,involved TRACT NOW ONC40: OF LOT SLOGS. - USE ZONE i 'SPECIAL CONDITIONS TA O TE MAJOR SECO D LOCAL by the permit is for one hundred dollars ($100) or less.) U - USE OF SIZE OF LOT, 'EXISTING I certify.that in the performance of The work for which this O permit is issued, I shall not employ any'person in any manner : owNE so as to becorne subject to the'Workers'•Com_pensation Laws. Id�i 'r` CE K 1�IwwSt S OCCUPANCY GROUP, `?j W. .Date Applicant AODREss . .9,41qS e�.8©!/E N NOTICE TO APPLICANT: If;.after making this Certificate-of CITY�;�.� /T NO. OCCUPANT LOAD Z Exemption', you should become subject, to the. Workers' Compensation provisions of the Labor Code, you must forth APPLICATION FOR EXIT HARDWARE: with comply With such provisions' or this permit shall be TRAILER USE GEOLOGY.INSPECTION Q � No Spec. Knowl. ❑ ,deemed revoked �, PanIC DeVIC@S ❑ ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONkSl I hereby affirm that I am licensed under provisions of Chapter , swFErY PERmI n (usr ITEMS BELOW) �-7..� EXIT NO. OF E 9 (commencing with Section 7000) of Division 3 of'.the Bust- - ness and Professions Code, and my license is in full force and PARKING. effect. r SPACES RE6'D O PROVIDED D License Number Lia Class LIMITED TIME USE Contractor 'Date' DATE DATE '. 1:1, I am exempt from the licensing-requirements as I am a: F,eoM: ro:. licensed architect or a registered professional engineer SIZE OF rvb. of IivsPecroR's acting m my professional capacity (S.ection 7051, Bus- EXISTING BLDG. STORIES 9G NATURE �iness and Professions Code). - � .. PRESENT.USE,OF suILPING,�-� FINAL`APPROVAL 18'1 l�T Lic.or Reg.No. Date. �f HOME OWNER-BUILDER DECLARATION ON of-ANDEXISUSE BulcoiNGs ... ON LOT-AND.USE I hereby affirm that, I am exempt-, from the Contractor's License' Law for the following:reason (Section 7031.5, Busi-, -;9'7 4:&6 A ; NO. PARKING nessand'Professions Code): SPACESPROVIDED ,I�, gg$g d, as owner`of,the property, will do the-work,and the If t'. 14, / structure -is .not intended or offered for sale (Section O 7044, Business and;Professions Code). q PROPOSED USE OF BUILDING CONSTRUCTION _7 r� LENDING AGENCY I herebyaffirm that there is a construction'lending y !f Tl -V�S �O L� eT/S'� 'ES ��i agenc j ... for the• performance' of the work foc which this permit is issued(Sec..3097,Civ.C.). s e _ A Lender's Name PROPOSED ilwx. occ_ Lender's Address:`- PERM[T. I`certify'that,l have read this application and.state that the 77 above information is correct.I agree to comply with all County ISSUANCE FEE ordinancesand'State laws relating to building construction' TO rAt FEE Wdher,eby aut orize representatives of this County to enter e"above- rationed pr p 'ty for insp ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigriatu,re'of Permittee ' to WORKERS'COMPENSATION DECLARATION 76M444 �� CE 875(2-80) MISCELLANEOUS APPLICATION I,hereby affPrm '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 c%rtified copy thereof(Sec. 3800,Lab':C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy Is hereby furnished. ILDING LOCALITY ❑ ADDRESS Certified copy is filed with the county building inspection. NEAREST f department. ocwLITY epi �,�L CROSS ST. Date ,Applicant AREST �w DISTRICT NO. G OUP TYPE .PRO ED BY CROSS ST. �, (..._fJ l� D� i� CONST.. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL l Y COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY } rvo. (CIRCLE) STATE MA J OR'SE ND LOCAL d N0.'0 F BLDGS. (This section need not be completed if the WOIiC InVOIVed TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 1 O by the permit is for one hundred dollars ($100) or less.) _ USE OF SIZE OF LOT EXISTING BLDG. tY I.certify that in the performance of the work for'which this 19 Q permit is issued, I shall not employ any person in-any manner QXNER. so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP JJ{{//((JJ�� W D-DRESS (L Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate of TY NO- ©CCUPANT.LOAD z Exemption, you should become subject to the Workers' APPLICA ION 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 C3 , 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) �. 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 PAH KING. I� I effect. _ - SPACES REQ'D PROVIDED ,License Number Lie. Class LIMITED TIME USE Contractor Date DATE ""— DATE FROM: TO: I am exempt. from the licensing requirements'as I am a; licensed architect or a registered professional engineer sI F ^ NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- XISTING BLD 6. ` I✓ STORIES / fiiGNAT.UR mess and Professions Code). FINAL APPROVAL �, PRESENT USE OF BUILDINCz J Lie.or Reg.No. Date C HOME OWNER-BUILDER DECLARATION NO.OF EX #ISTING BUILDINGS e e e 8 ON LOT AND USE M I hereby affirm that' I am 'exempt from the Contractor's e e e o e 0.0 z 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 . .0 7. 1 8_85 structure is not intended or offered for sale (Section 7044, Business and Professions Code). POSED USE OF BUILDING CONSTRUCTION LENDING.AGENCY , pC� I hereby affirm that there is.a construction lending agency' 12c-2" ( 54c-e--s- /1/ for the performance of the work,for which this permit is " issued (Sec. 3097,Civ.C.). C_O c GCG,S,SIn. e. S Lender's Name PROPOSED MAX. OCC. , Lender's Address- PERMIT FEE f 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 building construction, TOTAL FEE and h by authorize representat' es o this County to enter \ upo t e above-mentione op ty echospur EEE REVERSE FOR EXPLANATORY LANGUAGE Ignat re of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444, CE875 (2-s0) MISCELLANEOUS APIN PLICATLO 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 BU'ILDING ADDRESS- ❑.\Certified copy'is'hereby furnished.• BUILDING / ++ ` LOCA DDRESS 1`L1Y " . V - - _ Certified-copy is filed with the:county building inspection - NEAREST <r� department,-. Lo ALITY ��� - ' CRoss'ST. _ Date Applicant EA'REST r �. y ' DISTRICT NO. UP TYPE - PRO ESSED BY - CROSS ST. 'I �� �- -� , `.�.�v .• ci^ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL / --t DESCRIPTION .LOT NO. BLOCK MAP HIGHWAY - } -- COMPENSATION•INSURANCE NO. (CIRCLE.) STATE MAJOR SECOND LOCAL d ' � � ' (This section need not be Completed' NO. OF BLOCS. ,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 OFLOTEXISTING BLDG. I certify,that in the performance of the.work for which this ' 'O permit is issued, I shall not employ any person in any manner" OWNER sous to become subject to the Workers' Compensation Laws. MwIL OCCUPANCY GROUP: ,'W. AIADDRESS " 1 Date: Applicantr� � a NOTICE TO.APPLICANT: If, after`making this Certificate.of clrY'�1�eI�11��(;Z NDl. OCCUPANT.LOAD' Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of }he Labor Code, you"must forth- wlth comply with SUCK piOVIs10Rs Or this.permit. shall be TRAILER USE O GEOLOGY INSPECTION a 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 W (LISTITEMS BELOW). 9 (commencing with Section 7.000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force.and PARKING• - ' .effect:. I RE PROVIDED' -- SPACES license Number Lic.-Class LIMITED TIME USE CA�Ilntractor 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 70.51, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). _tom, FINAL APPROVAL ' RESE NTUSE OF BUILDING Ai° h_ D, 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 Q License Law for the following 'reason. (Section 7031.5, Busi- E A - ness and Professions Code): No,-PARKING, SPACES PROVIDED I, as owner.of.the pro ert1°"° ° ° 8 8 p p y,-will do the work and the structure is not intended or offered for sale (Section o D o 0 0 o-'o`In 7044, Business and Professions Code)., OpOSED USE O,F BUILDING - I l CONSTRUCTION LENDING AGENCY I hereby,affirm that there is a construction lending agency for -the performance of the work'for- which this, permit is issued(Sec. 3097,Civ.C.). Lender's Name PRoposeo MAX. bcc. Lender's Address` PERMIT FEE , I certify that I.have.read-this application and state that the. , above information-is correct.I,agree to comply with all County ISSUANCE FEE ,ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter up n the above- `epi tioned property for inspection'purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature'-of.Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I herelior affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BAUILDING DDRESS Certified copy is hereby furnished. BUILDING (.,� (� LocALrrY ADDRESS q _PC8 La Lx Certified copy is filed with the county building inspectio LOCALITY� vrt j., Gs"" NE R TRST - Date Applicant NEAREST Iy/'�� DISTRICT NO. GRO TYPE PR'OC SSED BY CROSS ST. �_ •(/_��D! 'OQ /.J•`Z CONST. �- CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (� COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which thisSIZE OF LOT EXISTING BLDG. (� L permit is issued, I shall not employ any person in any manner OWNER y sous to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP Al,)DR...AIL (1 , ^, p ADRESS Date Applicant ,,, ��/� TEL. OCCUPANT LOAD 0. NOTICE TO APPLICANT: If, after makingthis Certificate of CITY v No. Exemption, you should become subject to the Workers' z Compensation.provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: With comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION El No Spec. Knowl. El deemed revoked. If, LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code,and my license is in full force and effect. PARKINGSPACES • REQ'D PROVIDED License Number Lie. Class LIMITED JJTIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSP CTO R'S acting m my professional capacity (Section 7051, Bus EXISTING BLDG. STOFROM: TO:RIES S NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.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 fl SPACES PROVIDED 7--c:'7I, as owner of the property, will do the work and the .. structure is'not intended or offered for sale (Section I eibe- e,ir 5 ILIA 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency `©r--� for the performance of the work for which this permit is f;.:-.-f issued(Sec. 3097,Civ.C.). A' = _" Lender's Name syr 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 E `'' 'F•l�'= -r { `� ordinances and State laws relating to building construction, _ 3:106 • £ and hereby a rize repres9tatives of this County to e ter TOTAL FEEQE5 li:"._ - AM upo the a ve- entioned operty f r inspection purpo S. ` SEE REVERSE FOR EXPLANATORY LANGUAGE OWA Signature of Permittee at WORKERS'COMPENSATION DECLARATION 76M444 -�; CE 875(11-84) MISCELLANEOUS APPLICATION I hereborcertificate 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.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BAUILDING D DDRESS Certified copy is hereby furnished. "'LDING'•- ��u ADS/' LOCALITY DRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. ern GST CROSS ST. Date Applicant NEAREST I / DISTRICT NO. GROU TYPE P O SSED BY CROSS ST.��M lQ, Vl� L�.LvIP� �'^ •CDNST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY HO. (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. C I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER CA-vi h,OA Com' so as to become subject to the Workers' Compensation Laws. MAIL �' /7 OCCUPANCY GROUP o Date ADDRESS Applicant LL, TEL' - OCCUPANT LOAD O_ NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. ,'Z'Z Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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. PARKING SPACES REQ'D O 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 INSP CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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 �1 r L. �7 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1'"C—' F '}--'°— ❑ 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). E I_:L'I z4,0I', PROPOSED USE OF BUILDING 'l��,.f.l"t fi+3 •'+ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency "� �7t—� GI ^, for the performance of the work for which this permit is `;UC 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, O and hereby authorize representatives of this County to enter TOTAL FEE , up n the above-mentioned property for inspection purposes. • SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELESBUILDING 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 ABUILDING DDRESS "/' - 4 •-� ❑ Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS ..,.�L;y^e - ."�".•-..- '"""'rs;.".- ❑ Certified copy is filed with the county building inspection NEAREST AT department. LOCALITY CROSS ST. :E{ I .NEAREST DISTRICT NO. ,G OUP TYPE PRO 'SSED BY III .Date Applicant CROSS ST. - r{ CONST. '"1' '!� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL } COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY q 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 FCIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) USE OF LU SIZE OF LOT EXISTING BLDG. J I certify that in the performance of the work for which this LL 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 ?- ADDRESS --- Date Applicant < NOTICE TO APPLICANT: If, after making this Certificate of L, CITY NO. OCCUPANT LOAD 0 Exemption, you should become subject to the Workers' a 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 INSPECTIONW deemed revoked. ❑ No Spec. Knowl. ❑ H 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- ness and Professions Code, and my license is in full force and effect. PARKING SPACES REq'D PROVIDED LL.��11 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). PRESENT USE OF BUILDING FINAL APPROVAL 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 �„ AA License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED N'• �'� • C1 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section • • • • • • m 7044,Business and Professions Code). ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY Q n + I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL. FEE and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature"of Permittee Date J WORKERS'COMPENSATION DECLARATION'' 76M444 CE 875cz-so) ' MISCELLANEOUS -APPLICATION 1 hereby affirm that.1 have a certificate of consent to selfCOUNTY OF LOS.ANGELES BUILDING AND SAFETY DIVISION insure; or a certificate of.Workers'Compensation Insurance;or acertified copy thereof(Sec. 3800;Lab:,C.) Policy No. - Company FOR APPLICANT TO FILL IN - BUILDING. ADDRESS' Cerhfied.Copy is hereby.furnished. 1W BUILDING - .. - LOCALITY - ADDRESS_ . O Certified copy is filed with the county building inspection, NEA REST d LOCALITY I CROSS ST. - epartment:. - • ` or Date Applicant N AREST �� DIS TRI�a O. G UP' TYPE PROC SED BY - ROSS ST. 11 �• CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' ; LEGAL COMPENSATION INSURANCE DESCRIPTJON LOT NO. BLOCK MAPHIGHWAV } "N O. - (c IRCLE) STATE•MAJOR SECOND LOCAL (Th15 section needbetie completed.if theNO.<OF BLDGS.' ' WOrkInYO1Ved TRACT : NOW ON LOT USEONE SPEfCIAL.CONDITIONS ' - ®� by the permit is for one hundred dollars'($100) or less.) ' USE OF' - - SIZE OF LOT EXISTING BLDG. . CC I certify'th'at 'in the performance of the work for.which this Q permit is issued, Lshall not employ any person in any'manner, d. WNER F- so as to become subject to the Workers' Compensation,-Laws.' n1I OCCUPANCY GROUP e� :LU. L Date • Applicant rEL. . g p�-yy► IC>, (%/ 22 OCCUPANT LOAD z' NOTICE TO�APPLICANT•: If; after making this'Certificate of ry • rvo. � - ' Exemption_ you should-become subject to 'the Workers' APPLICFiT10N.FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- Wlth comply with such provisions-or this permit Shall be TRAILER USE .GEOLOGY INSPECTION'a 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'q (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the BUST- No:of exirs ness and Professions Code, and my'license is in full force and effecPARKINt. SPACESG'. 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 arii a licensed architect or, a registered'.professional engineer srzE of NO. of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG-. STORIES SIGNATURE' iness-and Professions Code).. - - FINAL APPROV A'L ' ESENT USE' BUILDING • Lic.or-Reg.No.'' Date HOME OWNER-BUILDER DECLARATION" NO:O T ANDEXISUSEING BUILDINGS '1 (� - ON LOT AND.USE - - .1��1/Y 2,,2 A' - I hereby affirm :thiCl -am,exempt from 'the Contractor's # o o e 0t8,8 License Law for the following reason (Section'7031.5, Busi ness and Professions Code):. NO. PARKING r y SPACES PROVIDED O 0.0 O O O O . I, as owner'of,the property,,will do-the work and the structure is not intended or„offered. for sale (Section o:5, 1 2—8 3 7044, Business and Professions • Code) _ OP OSED'USE OF BUILDING - CONSTRUCTION LENDING AGENCY' .I hereby affirm that there is a construction lending agency / for the performance of the work 'for which this, permit is issued(Sec. 3097,Civ. 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'FEET�- and authorize representatives.of this.County to enter (� upon=b e-mentione op for inspection purposes. SEE REVERSE FOR EXPLANATOR'�GUAGE ,/• ,rte-c.. � d-- _ • - Signa:t&fe of Permittee Date '• WORKERS",COMPENSATION-DEC LARATION CE 87544(2-80) '' I SCE L LA N E O U'S A P P:L K A T I O N \ "b;hereby affirm- that I have a wcertificate of consent,to sel f insure', or a certificate of Workers':Compe`ns`ation Insurance;or COUNTY OF'LOS ANGELES BUILDING"AND SAFETY DIVISION . a certified copy thereof(Sec.'3800 Lab C); �.•''.'` ' FOR XPPLICAvTTO FILL INPolic ComR,aY AeuD1�ioINsG Certifiedcopy'is"hereby=:furnished.- A_Do_ REss.^�� (Q LocAL'ITY-, ^ ICertified,copy.is filed with the county building mspectwn ,��. rveARE T department,.. pL' ?� .41 k ITY CROSS ST-PP ST' DIST ICT NO ;.'t G UP, TY PRES ED BY Date A licant �ST�E - CONST - .. : LEGAL .-. /r�•'. L � -(Pik ��L "CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSAT++ION INSURANCE DESCRIPTIory LOT•NO BLocK .'.i. :.,. ' :.NOP (C RCVLE)� ,a� ne'e`d'not•be completed if the,WOrk 1RVO1Ve01 d USE'Z E SPEC IAi CONDITIONSTA (This section y p TRACT NOW ON LOT 60, S by:they permit is for one hundred dollas ($100).'or less.) TE MAJOR SEC D LOCAL USE OF SIZE OF LOT.�.- _ EXISTING BLDG Icertify.that m the"'°'performance of,"the-work,for which this permit is,issued, I Shall not employ any person`in any manner WNER 6k F_ : `�.A.N Al O,•N •~ .J so.as to become subject to lthe Worker`s' Compensation Laws: OCCUPANCY GROUP U J a !� ,."... ADDRESS �,© �Q"A" Date -, APPllcdnt z .. TEL .NOTICE-TO APPLICANT: If; after-.making:this-.Certificate of iYvl IC >✓ "' 130: Z� �z 2 � P OCCUPANT LOAD Exemption youyshould ;become subject ,to`the Workers' EXITHARDWARE- Compensation,provisions•of''the-Labor,Code, .yo must'forth- APPLICATION,FOR ', with comply with;such`,provlslons or"this'permit`shall be . , _ TRAIL"E4 USE GEOLOGY INSPECTION� NOS Spec.�KIIOWI. �'. deemed revoked LICENSED CONTRACTORS'DECLARATION occuPArvcv,wsPEcriory . Panic Devices a I.hereby affirin,that I am licensed under.provisions of Chapter`, swFEry PERMIT 11--II '(Lis r`�TEMs.:6ECow) 9`(commencing with-Sect ion•7000) of Division 3'of.the Busi- ness and Professions Code,,and my license is in full force and effect:' REQ'D PROVIDED' "- - - f .. PARKING •, SPAC ES , License Number Lic.Class i 'LIMITED TIME USE Contractor". Date;, DATE, DATE ' , EJI am_exempt'from the"licensing requirements_as I am a licensed,architect or'a'registered professional engineer,• SIZEOF,, No 0F, TO: + _ FROM:: 'acting'in. my professional capacity°(Section -705I Bus- 'EXISTING BLDG. STORIES . ...• k' .INSPECTOR'S ineSS and I'rO feSS10RSCOde) 3. �y ESE NT..USE OF BUILDING f ;GNAT - , •' FINAL APPROVAL Lic.or Re No. •. . Date.. • , D . NO OF EXISTING B .. 1. " . HOME OWNER-BUILDER,DECLARATION „ oN LOT AND USE—' u ILDINGS' ' ",` I ,hereby. affirm ,that I amF>'exempt from the Contractor.'s License�Law for the following reason (Section 703'1.5; Busi n*,and Professions Code): '• 1iOKING "+ SPACES PROVIDED �t,I :as owner of,:the property .wi11 do the`woik and the d structure Is n`ot..inter ded-or=offeied-or (Section a '7044 Business and Professions*Code) ROPOSED USE OF, BUILDING - yp CONSTRUCTION`LENDING AGENCY Y g'agency q ,b I hereby affirm-that.there is a.construction•I dm h®pK Au1l�QD S L£S - .for..ahe��performance of the :work•for wJllch, this,permnt is 'issued(Sea;3097 Civ.C) Lend'Ps Name - ': PROPOSED MAX. OCC # O O • * 88 , r' Lender s'Address <,--.- .. _ _, -.' P ER.M.IT'FEE'._ 'f I certify that I'have'read this;:application and state that the FEE o o'� o • •:e' above informatiowis correct:'l'agree to;comply with all County IssuANcn •ordinances"an State- laws relating to,building construction,-` TOTAL.FEE- Q 2 Jr . 8 Je a d here y- thorize,representat'ives-of:thi's County t e'ntec r „ A n .t ov entiored ro ert`, for..inspec purposes_P P Y P - p p, SEE.REV"EASE FOR:EX•PLAN;?.TORY LANGUAGE', . .• , .,.'= <- � - •- i Taref Permittee Date F. WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISC E Lm LA N EO V S APP U CAT IO N I hereby affirm that.I have a certificate of consent -to self; COUNTY'OFLOS.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 EJCertified copy is hereby furnished. ILDING LOC ALIT.Y r: (/ _ DDRESS - OCertified copy is_filed with the county building inspection rveAREsr department. LOCALITY ceoss sz_ Date Applicant ' .NEAREST DISTRICT!IJ7 GROUP- T E P CESSED BY ' CROSS ST. - - CONST. CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL • COMPENSATION INSURANCE 0EscRIP ]ON LOT No., ?� LoCK MAP R,GNwpr >. - • - NO. �p�-� (c,RCLEI STATE MAJOR SECOND LOC-AL NO.-OF BLDGS. (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:) U -. - - USE OF - 'SIZE OF LOT' EXISTING BLDG. •G!Jj I certify that in the performance of the work'for which this r 0 permit is issued, I shall not employ,any person in any manner .NER DY b.U1� — F--' so as to become.subject`to the-Worker s' Compensation Laws.. MAIL GC OCCUPANCY GROUP• Z W . . - DDRESS .. Date Applicant. U TEL. z NOTICE TO APPLICANT: If, after'making this Certificate of CITY, /G NO. OCCUPANT LOAD _ Exemption, you should become subject• to the Workers' Compensation provisions of the Labor Code, you must forth- APPLi AT,ION FOR. EXIT HARDWARE: with comply with Such-provisions or this permit shall be.� TRAILER USE" GEOLOGY INSPECTION a "' El deemed revoked No Spec. Knowl. LICENSED CONTRACTORS DECLARATION occuvwrvcY InlsPecrlory a Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF�EXITS' a' ' 9.(commencing with'Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in`full force and effect. PwRKIrvG. SPdC ES REO'D E== PROVIDED ' License Number Lie.Class ( LIMITED TIME .USE ,, Contractor Date DATE .' PATE FROM: TO•' I am exempt•from the`licensing requirements as,I'.am a - licensed architect or a registered::professional engineer SIZE of rvo. 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 - JZ 70 E - Lie.or"Reg.No. Date /! (, > HOMEOWNER-BUILDER DECLARATION No:oF,Exls TIrvG BUILDINGS ; COT AND,USE - - •� - I hereby 'affirm^ that I am exempt .fro> e:,Contractor's License Law for the following reason (Section 7031..5, Busi Hess and Pr 4 (]Q 8'A ofessions'Code K NO.PARING ), .,. - SPACES PROVIDED ' I,.as owner; of the'.,property, will do the work and the _ # 0, 4'0; structure is• nct intended or offered for sale (Section- 7044;Business and Professions Code). ROPOSED USE OF BUILDING _ CONSTRUCTION LENDING AGENCY :, 2 0 9.8' 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.'*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' ITOTAL FEL* upon the 'above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Da WORKERS'COMPENSATION DECLARATION CE 87575(11-84) MISCELLANEOUS APPLICATION CE 8 I here4?affirm 'ihat'I have a certificate'of consent to self •.;: insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES ^' -BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.Q. Policy No., Company FOR APPLICANT TO FILL IN BUILDING/O -_ ADDR E SS 19 Certified co is.hereb furnished. BUILDING ` _7 L / ' copy y ' ADDRESS LOCALITY. ECertified copy is filed with the county building inspection LOCALITY NEAREST 17 department. 721 CROSS ST. Date Applicant NEAREST DISTRI T I/,�1p GROUP TYPE ' P CESSED BY - CROSS ST. OV �" �f CONST. - CERTIFICA'TE OF EXEMPTION FROM WORKERS' LEGAL ���JJJJ Jd/ pC COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP MIGHW AY NO. (CIRCLE) STATE.MAJOR SECOND LOCAL NOOF SLOGS. (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 permit is issued,I shall not employ any person in any manner OWNER i o mss✓ y " so as to become subject to the Workers' Compensation Laws. MAIL _ a OCCUPANCY-GROUP W;K] ADDRESS '� �i� (1 ` I /� G~..S Date Applicant TEL, L,I OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. N Exemption-, you should become subject to the Workers' Z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR. EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION deemed revoked. ❑ El No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ tLiST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and, , effect. PARKING SPACES REQ'D PROVIDED ' License Number Lic. Class LIMITED TIME USE Contractor Date 0F IrF I toe- ��' DATE DATE � . DI am exempt from the licensing requirements as I am a I 7�A FROM: TD: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING B G. STORIES s' E inessandProfessionsCode). FINAL APPROVAL PRESENT USE OF BUILDING �.'��-ICY• � - Lic.or Reg.No. DateNO FL� t HOME OWNER-BUILDER DECLARATION No'. OF EXISTING BUILDINGS O ON LOT AND USE O 1 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi (� i:_ ;' r ness and Professions Code): NO. PARKING C::-,ice -tea DI, as owner of the property, will do the work and the. SPACES PROVIDED f y structure is not intended or offered for sale (Section- 7044, Section7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF-BUILDING - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name _ PROPOSED MAX. OCC. Lender's Address 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 o erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date - WORKERS:COMPENSATION DECLARATION; 76M444 �E8�5iz8o, : M15" Ll CATION I,hereby affirm .that'I _have a certificate of consent•to self insure 'or:a'certificate.of.Workers'Compensation Insurance or-' " COUNTY 0F.-LOS-ANGELES '`"' BUILDING AND SAFETY DIVISION ; a certified copy-tn'ereof.(Sec. 3800,,La6''.C) Policy No' Company FOR•APPT LICANT O FILL IN- ` BuILOJNG ' f - -, -` •. ADDRESS • .O 'Certified copy, is hereby furnished:: ILoilvc` LOCALTr .•, , ADDRESS -- < ,, - - Certified copy`-is filed'with the county buldln Ins action �' g p - ir^� �l NEAREST _ "IfOCALITY. •^ - dePartment. CROSS ST + , EAREST r" - - DISTRICT N GROUP YPE ED-BV Date 'Applicant' - >.- .F O CROSS CONST CERTIFICATE OF EXEMPTION FROM WORKERS ".LEGAL _ 1/r' DESCRIPTION LOT NO BLOCK I,gwP NIGH WAv _ -:� COMEENSATION INSURANCE STATE"MAJOR §ECOND LocAL _ .-,', Y, .".. : "NO .. `r. (CIRC LEIa. .F.. -• _ NO OF BLDG This section-,need:not be ',completed if:the Work"invOlved'r TRACT• NOW ON LOTS USE ZONE SPECIAL CONDITIONS{ by the permit, isj6r. one hundred.dollars ($100) orwless:) • _ � USE`OF ' 0 ..-. - - _ ' ,, ..• `I certify'tliiat in the`perform<ance of the,work for which this LDG y SIZN.EORF LOT•" ` T EXISTING B" Y ." permit is issued-,I:shall.not employ-any,person in any manner O ' '•",so as to become subiect'-.to the Workers',Compensation Laws: IL ;OCCUPANCY"GROUP w W l " .4✓d •.. -ADDRESS Date` Applicant- I' TELZ ` , z "NOTICE TO'P PP.LICANT': I€ after making this Certificate of CITY ��� ,L? ryo, G OCCUPANT LOAD Exemption, ,.you -should :become subject Ao .the Workers'. APPLI„ ATION F R EXIT HARDWARE Compensation provisions'of the Labor Code, you must forth with complywith such'provisions 'or this,permit„shall be' TRAILER USE' - GEOLOGY INSP,ECTION.❑' - NO.Spec;1\I�OWI. deemed revoked. LICENSED."CONTRACTORS DECLARATION,` OCCUPANCYINSPECTION ''Panic Devices _ O 1`fiereby affirm..that L am']icensed under provisions of Chapter'_ •sA FETv PERb1IT q (LIST ITEMS BELOW) 9.-{commencing with Section7000) of Division 3 of the Busi O iiess and Professions Code;`and'my Iicen`se is in full force and PARKING N O F EXITS, effect.' REQ D PROVIDED, - - -T � :- :. _. SPACES`_'. License Number”" Lic.'Class p LIMITED, TIME .USE n ' 1.O11traCtOr': -- ,Date DATE • _ +.D ATE < „• _ .. t .I•am exempt'fiom the'lic.ensing',requirements as I am a' u ,'• ` ." FROM: TO .-• - INSPECTOR'S licensed"•architect or a'•registered professional engineer.', slzE-oF No. oF.: IN in my professional capacity (Section 7051,EBus- ExrstlrvG BLDG sroRIEs- c .'mess and Professions.Code). "' FINAL"APPR`OVAL SIGNATURE Lip:of Reg_No Date; : P o�B CN UILDING < I� r (yam-. .-- - t No,OF-EXISTING BUILDINGS, A HOME OWNER-BUILDER DECLARATION , -7j ON LOT AND USE•; - O 8�, • - I=".hereby affirm"Ithat I• am"exempt'.frorti,the Contractor's License Law%for the '.following reason:(Section"7031:5, Busl ' o:o D'.e.1. . s cn ness•and,Professlons Code):, :,. K p SPACES RV IDED ❑ I, as' owner of'the property will'do'the work and the r 05 '3 i -Structure` is not',intended r or.;offered-for sale�(Section ' 7044;Business and,Professions•Code) ;-, : . " r �• - - f G POSED USE j0 FBUILDING , 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 4A•X: OC•C Lenders Address PERMIT FEE - I:certify that 4•have read-this application`and state that the ISS II,ANCE,FEE "above information is correct:.I'agree to comply with all�County • I ordinanc nd.State laws relating"to building.consttuction, and.h eby`authorize.represen trues of this 'Countyto'enter`' TOTAL FEE ' on he bove rnentioned:pr party for inspecti n purpo s. SEE REVERSE-'FOR EXPL-'" TORY LANGUAGE" u p'' Signature of Permittee' te:. ORKERS'COMPENSATION DECLARATION CE 87544 (11-84) MISCELLANEOUS APPLICATION I l;ereby affirm that 1 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.Q. Policy No. Company FOR APPLICANT TO FILL IN ADDRESS '�OLV Certified.copy is hereby furnished. XX ADDRESS CN LITY E-Certified copy is filed with the County building inspectionLOCALITY NEAREST department. $X caoss sT. Date Applicant NEAREST - - DISTRICT NO. GROUP' TYPEij& CESSED BY CROSS ST. D� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL l COMPENSATION INSURANCE Des CRIPT10N LOT NO. BLOCK' MAP NID Nw wv NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO: OF,SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit, is for one hundred dollars ($100) or less.) USE or .. SIZE OF LOT - EXISTING BLDG. ' 1 certify that in the performance of.the.work for which this ���..e ° n permit is issued, I shall not employ any person in any mannelEX OWNER.Of bulldin ® __3 sir as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS V Date - Applicant uI NOTICE TO APPLICANT: If, after making this Certificate of CITY 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 or this erntit shall be ❑ ❑ No Spec. Knowl. P Y P P TRAILER USE GEOLOGY INSPECTION deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ 'Panic Devices ❑ I hereby affirm that.[ 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 mylicense is in full force anix Name of busines PARKING effect. - SPACES REpD PROVIDED License Number_- _.____. Lic. Class LIMITED TIME USE Contractor Date /J _ DATE DATE . .•. FROM: - TO: El 1 am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE of No. of INSPECTOR'S uRE acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES iness and Professions Code). PRESENT OP BUILDING - FINALAPPROVAL Lic.or Reg.No. Date ( G �?/J72-�/� �G-a-•-e. to , HOME OWNER-BUILDER DECLARATION NO. OR EXISTING BUILDINGS ON LOT AND USE hereby affirm that I ani exempt from -the Contractor's License Law for the following reason (Section 7031:5, Busi- ness usi ness and Professions Code): NO. PARKING I :•, ❑ SPACES PROVIDED .ti,•)}J(]-•i�li it_}•_ .:,.,•.•:..•,.,r'•;:;�. 1, as owner of the property, will do the work and the structure is not intended or offered'for sale (SectionrI 1.6 9 E'F'E..r' "•(I I"j.' 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction-tending 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 -__ ' 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, ;he,eby authorize repres tatives of this County to enter TOTAL FEE 25.00 hnspection purposes: SEE REVERSE FOR EXPLANATORY LANGUAGE XX WORKER S'COMPENSATIONDECLARATION CE76M444 875. •- ;�j;.ISCELLAN17-u APPLICATION'" CE 875,(11-84) + I•hereby affirm,that 1 have a certificate of-consent to self, COUNTY OF LOS ANGELES BUKDING.AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified,copy-thereof(Sec. 3800,Lab.C.). / p Policy No. • Company FOR APPLICANT TO FILL IN nc eess, FICertified copy is hereby furnished. BUILDING LOCALITY O9 Lf)S 7dr E1�5LOCALITYj, LXX ADDRESS // - Certified copy is"filed with the county building inspection LOCALITY �? /�G� crT (� !7�! NEAREST department. ]XY. / CROSSST. PE OCE Date Applicant NEAREST >� 61 �0. D13TTUP TY53ED BY., CROSS ST.' ! O L .�h CONST CERTIFICATE OF EXEMPTION FROM WORKERS'' LEGAL (/ COMPENSATION INSURANCE DESCRIPTION: dT NO. BLOCK MAP HIGHWAY (This section need not be completed if the Work Involved TRACT NOW ON LOT NO; OF SLOGS., 31_ Z SPECIAL CONDITION STATE OR C _ NO. (CIRCLET T TE MAJ SECOND LOCAL •U ONE S AL CO ONS by the permit is ;for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. - I certify that in the-:lierformance•of the work for which this 0 n permit is issued;1 shall not employ any person in any manneXX OWNER Of bulldin -r/ L Q� so as,to become subject Jo the Workers' Compensation Laws. OCCUPANCY GROUP ' _ L` ADDRESS - 13. `�� .(.-�` l %J'f/G.. _ i .! - C-3 Date ;Applicant4, NOTICE TO APPLICANT: If, after making this,Certificate of, CITY S� F, B�r i Nor.• 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. El. deemed,revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONE] Panic Devices a I hereby affirm that I-am licensed under.provisions of Chapter SAFETY PERMIT ❑ (LIST ITE.MS.BELOW) 9 (commencing wiiii,Section•7000) of Division 3 of the Busi NO. OF EXITS' ness and.Professions Code, and my license is in full force an JX r effect. .Name.--Ol busineSS//� - y.� _ -PARKING REQ'D U' PROVIDED - .. .. - � ��I BSI-•: D �.�l.A•GL,f1 �LL � 'C.!'n� CO'1'I SPACBS License Number Lic..Class LIMITED TIME USE Contractor Date DpTE DATE '.. _ • - FROM: TO: a '1 am exempt from,the licensing requirements as I am a " licensed architect .or a registered professional engineer SIZE OF /! N0. INSPECTOR'S acting in my-.professional,capacity (Section 7051,.BUS- EXISTING'BLDG. ! Y O 5-'Q ZDI STORIES 31 RE iness and Professions Code). / F114AL APPROVAL PRESENT USE OP BUILDING Lic.or Reg.No. Date «!! ^( L HOME OWNER-BUILDER DECLARATION NO. OF.ERISTING BUILDINGS ' ON LOT AND USE /Lr/ 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 ✓� [, as owner of the pro per4y; will do the-work:and the SPACES PROVIDED structure is not intended or offered for;sale -(_Section •7044;.Business and Professions Code), CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency Cor 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. 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 25-00 upon the above-mentioned property for inspection purposes.' -7SEE REVERSE FOR EXPLANATORY LANGUAGE XX a lln✓� XX p�y p Signature of Permittee Date WORKERSCOMPIENSAVION DECLARMION .(.I I 14 MISCELLANEOUS APPLICATION _ l,hereby affirm that I have it ccrtificale of coil,;,�Ill to sell COLKIN 01- I.OS ANGELES BUII-DING AND SAFETY DIVISION ,,Il l insure,or a certificate of Workers'Compensation histlialicc, oi. a certified copy thereof (Sec. 3800. Lab. C.) Policy No. Company' FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified copy is hereby furnished. X ;M0,? 4X' LOCALITY El Certifiedcopy is filed with the county building iwsi)ccliwZIP CITY NEAREST '7 department. �r�,Ole_ ( CROSS ST. Date Applicant SIZE Orl OT NO.OF BLDGS.NOW ON LOT D I S Tat� TYPE,0. GROUP PROCESSED BY CONS ER1 IFICAI I OF EXEM11"11ON FROM WORKLI' COMPILN'S/VVION INSURANCE TRACT BLOCK LOT NO, AP HIGH~ L NO. ,CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the %%ork iH%0I%Cd ASSESSOR MAP BOOK PAGE PARCEL Us NE SPECIAL CONDITIONS by the permit is For one hundred dollar~ or less.) I certify that ill [lie pCITolillillicc ol, lilc work lot wlucll Illy OWNER TEL NO. permit is issued. I shill not employ any licison in any manner tioll Laws. ADDRESS ® tr, so its to become subject to the Workers' (onipciisa OCCUPANCY GROUP Date Applicant CITY ZIP NOTICE TO APPLICANT: . 11'. after making this Certificate OCCUPANT LOAD of Exemption, you should become SUbject to the Workers* APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor('ode.you must I"VIIIWil h Comply With SLICII provisions or this permit shall be IlCeilled TRAILER USE❑ GEOLOGY INSPECTION No Spec.Knowl. ❑ revoked. -RACI-ORS DF(T-ARAHON OCCUPANCY INSPECTIONK Panic Devices ❑ LICENSED CON] I hereby affirm that I iiin licensed Under provisions of Cliapici SAFETY PERMIT O LIST ITEMS BELOW, NO.OF EXITS 2 9(commencing with Section 7000)of Division 3 of the FLISiliess El and Professions Code,and my license is in full force asci effect. AG cr PARKING REQ'D PROVIDED License Number Lie (lass SPACES Contractor Dille • LIMITED TIME USE DATE DATE El I am exempt from the licensing requirements Lis I aril it FROM: TO: licensed architect or it registered professional engineer acting in irty proficssional capacity IScction 7051. 1:11siiicss SIZE.OF NO.OF INSPECTOR'S EX IS TING BLDG. STOP SIGNATURE and Professions (,ode). Lie. or Reg. No. Dale PRESENT USE OF BUILDING FINAL APPROVAL 11ONlE OWNER-BUILDER DIATARAHON NO.OVUXISTING BUILDINGS ON LOT AND USE VV \�A I hereby affirm that I am CXCIIII)i I'l-011( IIIC('0111101210l'S IACIAII;C Law for the Following reason (Section 7031.5. Business and Professions Code): • NO.PARKING SPACES PROVIDED 1: LIS ONVIler of the propelt). \611 do llic \\,,i(, mid llw* StrIICI1IrC is 1101 illtelldCd Or 011CICkI 1'01 SAC(SCC6011 PROPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is it construction IClIdIIlL lit!C110 for the performance of the work ['or which this perillit'is i!sSUCd (Sec. 3097,Civ. C.). PROPOSED MAX.OCC. I Lender's Name APPLICANT TEL NO. J4LPRINT) CPO— 4Z42!W--71Hv_ Lender's Address ADDRESS 'A I certify that I have read this application and stoic that the above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building consirLICliOrl,and hereby authorize representatives of this County to entCl- LIPOII ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE )( D N111�y6 � SEE REVERSE-FOR ,,,,,N.0RY LANGUAGE 0 :0 :j S Permittee Da I C L I WORI:E[tS'CONIPENSAr10N DECLARATION 76M444 M ISCELLANEOUa APPLICATION CE 875 111 841 I hereby affirm that 11:ave a certificate of consent to sett COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,,.•oi a LerWiate of Workers'Compensation Insurance,or bj.�, a certified copy thereof(Sec.3800,Lab.C.). P771.11 Policy No Company FOR APPLICANT TO FILL IN Gu1LD�NG /_a 0 ADDR sS /® Certified copy is hereby furnished. pp BUILDING P- A ADDRESS - L! ,...(�W C`l� ZU S') r�L� LOCALITY I ( ❑ Certified copy is tiled with the county building inspection X LOCALITY �!� Cl t (� NEAREST department. e C-tiT -t 6u 'Ross ST Date Applicant - NEAR.ESTfJ OISTR NPS. GROUP TYPE CESSED BY CROSS ST. ^P'C' - C,Z (Z-L y CONST. I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Y^ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK no iC'.c C; STATE MAJOR SECOND LOCAL NO. OF BLOCS. (This section need not he completed If the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars IS100) or less.) USEOF •"1 SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which 'his = permit is issued, I shall not.employ any person in any manner N OWNER 61Lo - so as to become subject to tine Workers' Compensation Laws. � OCCUPANCY GROUP _ 71 ADOR ESS 4 I �•olm �v� Date Applicant J _ NOTICE TO APPLICANT: If, after makine this lortificate of CITY —�' 0 TEL (0�- OCCUPANT LOAD Exemption, you should become subject to the Workers' AppLICATION FOR _�� E'<IT HARDWARE: - Compensation provisions of the Labor Code. you must forth- ! with comply with <uch provisions ar :his permit dull be TRAILER 'JSE !1 GEOLOGY INSPECTION No Spec. Knowl. deemed tev ked. - - '7 OCCUPANCY INSPECTION B 'Panic Devices N LICENSED CONTRACTORS DECL.k1tA rION - _ El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF,EXITS ti 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code. and my license.is in bill force and ---' effect. PARKING SPACES REO'D �OVID ED X License Number _ Lic. Class LIMITED TIME USE s Contractor Date •.un exempt tnnn 'he licensing •eyuiremems is L.:m a - -----"---- - s !, Jicensed architect or a re_istered -lrofessional _nginee. 31ZE OF NO. OF INSPECTOR'S ? actin_ in my professional capaclt•: I_,)ecuoll I).I. Bus- EXISTING 3L G. I STORIE:: ----- SIGNATURL' R inessandProfessions(:ode). FINAL APPROVAL PRESENT USE.OF 3UILDING - Lic.-or Ree. No. __...". _._.---:.__ Date - - - -- � . n flO!!E OWNER-BCILDER DECLAR"\CION NO. OF EXISTING BUILDINGS / .t/ ON LOT AND USE hereby affirm that i am exempt from the Contractor';' 1 License Law for the tc•Ilowin; reason i Section -031.5. Busi- ness:and Pro fessions Code l: NO. PARKING SPACES PROVIDED �'$9�® �� 1, as bsvner of ;Ile oroperp': �xitl do 'the cork Ind : �@p p he -- structure is not intended or offered for tale -Section 1 044.Business and Professions C ides. ! _(I - _ PROPOSED USE OF BUILDING 0000—+�f�001 •�/' 4j 98 (:ONSTIZL'C"rEON LENDING A(;E\I"1' J� 1 PM 5'04I hereby affirm that there is a construction lendinL, e�enc% S� for the performance of. the work for which this permit is 1 issued tSec" 3097,Civ.C.1. Lender's Nanne_---_ —__—"--__--- PROPOSED MAX. OCC. - Lell(IL'r 5 Address 5 2 .00. 1 I certify that I have read this application and state iliat the PERMIT FEE 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 argntatives of this County to enter TOTAL FEE 25.00 ` upon tile bov e Ie one p IPerty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE g ` 3 2 c WORKERS' COMPENSATION DECLARATION a CE 87s It t-aa( M ISCELLANEOUS APPLICATION CE su 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,Yorkers'Compensation Insurance_or a certified copy thereof(Sec. 3800.Lab.C.I. Policy No. Company G7 FOR APPLICANT TO FI LL IN BUILDING S ADORECertified copy is Iierebv furnished. BUILDING ,� y� ADO.ESS'. \ LOCALITY SC. -- ) Certified copy is filed with the county building inspection LOCALITYNEAREST department. Temple City CROSS ST. Date applicant NEAREST DISTR I,C/Jy(N/�j/�/�f UP TYPE / P SSED BY CROSS ST. C`/ CONST/� . CERTIFICATE OF EXEMPTION FROM'MRURS LEGAL I IT I COMPENSATION' INSURANCE � oe SCRIPT:ON LOT NO. 1 BLOCK 1 uov HtGH A} STATE MAJOR SECOND LOCAL I NO. OF SLDGS. (This section need not be completed If the work involved 1 TRACT' NOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USE of I SIZE OF LOT EXISTING BLDG I certifv that in the performance of :he ,work .'or which :his permit is issued. I shall not employ an} person in any manner OWNER I i� so as to become subject to the \Yorkers' Compensation laws. MAIL OCCUPANCY 3ROUP I� — ADDRESS i Date .applicant /J c, _ g� f-2,�1,', C/ _ NOTICE TO APPLICANT: If, wirer making t!tis Certfic:ue or CITY NO. OCCUPANT LOAD - Exemption, you should become slit) iect r0 the Wn-kers Compensation provisions of the Labor Code. you must forth_ APDL!CATiCN F F =X IT HARC':VaR.E: } with comply with such provisions or :his ermu shad be TRAILER USE GEOLOGY :NSPECT.ION NO SDZC. KnO':^1I. deemed:evoked. — OCCUPANCY INSPEC-rIONXX Panic Devices ❑ LICENSED CONTRACTORS DECLARATION' — I hereby affirm :hat I am licensed under provisions o f C.iauter SAFETY PERMIT u (LIST ITEMS BELO's) a i 9 (commencing with Section 7000) of Division 3 of the Busi- No. OF EXITS ness and Professions Code, and my license is in fuil force and � effect. PARKING REO O PRC`J ID ED N 1 � SPACES 1� License Number Lic. Class LIMITED TIME USE LL N Contractor Date GATE OATE y W Z TO: [ am exempt from the licensing requirements as l am a m } licensed architect or a registered professional en (neer SIZE OF NO. OF INSPECTOR'S Z acting in my prof csslonal�:apacriy '�Se,dolt -(. I..,"I" EXISTING SLOG. STORIES SIGNATURE mess and Professicns Gode). FINALP?ROYAL C PRESENT USE OF BUILDING Lic. or Rea. No. Da-e :� 71: 1 HOME OWNI R-BUILDER DECLARATION NO. OF EXISTING BUILDINGS f ON LOT AND USE V I hereby affirm that 1 am exempt from the Contractors i License Law for the following reason (Section 7031:5. Busi- ness and P-ofessionsCode): NO. PARKING SPACES PROVIDED El I, as owner of tate property• will do the work and the structure is not intended or offered 'for sale (Section i 7044.Business and Professions Code). CONSTRUCTION LENDING AGENCY' g aROPosED USE of BUILDING I Hereby affirm that there is a construction Iending aLencv ' W j1 for the performance of the .cork for which this permit is 1wl } issued ISec. 3097,Civ.C.). Lender's Name t PROPOSED MAX. OCC. lyt 1.�'• Lender's Address l - PERMIT FEE 25�QQ F•-z t� I certify that l have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEELf ordinances and State laws relating to building construction, �3 . and hereby authorize representatives of this County to'enter TOTAL FEE 25.00 mr. •.: f upon the above-men ned property for inspection purposes. J F• I e n� ,O SEE REVERSE FOR EXPLANATORY LANGUAGE I ' I=t Signature of Permittee Date t ttOR1:ERS ( 0MPLN5.tT10NDECL.tR.1CIO` 78MISCELLANEOUS APPLICATION 875 :11 CE �� I hereby affirm that I have a certificate of consent to self COUNTY OF LOS .ANGELES BUILDING .AND SAFETY DIVISION insure, or a certificate of Workers*Compensation Insuran::e.or a certified copy thereot iSec. 3800. Lai).C.I. Policv No. —t•)mr.anl' IL BUILDING 7 FOR APPLICANT TO F LIN ADDRESSr�� Certified cope is hereby furnished. BUILDING O LOCALITY ADDRESS I Certified copy is tiled with the count buildinc inspection LOCALIT.YNEAREST department. Temple City CROSS ST. 'TQM C3— Crrr ✓�). Date Apniicant NEAREST / /��J�) ',DISTRICT NO. GR UP TY CESSED BY CROSS ST. b L& GIT �V- �/+� CO I CERTIFICATE OF E\EN[PTIO\ FROtI 'tORLERS LEGAL (/ t ()SIPENSATION INSI R.tN(L DESCRIPTION LOT N. C. BLOCK "A' c wAv +o. IOTROL_) STATE MAJOR SECOND LOCAL 1 NO. OF BLDGS. (This section need not he completed if the work involved -RAC' N 0 W ON LOT USE TONE 'SPECIAL CONDITIONS by the permit is for one hundred dollars iS100) or less.) usE DF I SIZE: OF LOT I EXISTING BLDG. ! I certifv that in the verformam.:e '!:e '%071. :o- 't;lich 'Alk 'L J - permit is issued. 1 shall not employ nm -�e-sen :n.lm'manner e'.vNER u- - so as 'o become subiect ;o the .torl:e-c' ^nrensatior. Larcc. OCCUPan!C':' 3ROUP — tit A l l Date applicant �(, t ADDRESS 6(0 !AS (T�/y� NOTICE TO APPLICANT: I? :o'er m kir.'_ ..is -_._ i :uc g] �M (�'� Nc G QCCUPsV- LO C E.xerno i -I, roll :[)mild become iv.,Iect -tie Compens!liun r.rn':ision< .It -IleLnhrr Voll must nu'Ir i aPDL!Cd'IC -,R = (I- y�-rl`.;n=- I - i with cnitl:)i\' «ill'. :u ch ^ro)i.il,!;: , . !t i' •cc:ai! ;hail he — I _ PAlls. :Js �EOL�GY :NSP=�-tcv NO J�P,C. :�:�C`.`il j deemed Ll( ENSED CONTRACTORS DE!L.AR.a`IO : OCCUPANCY INSPECTION 3niC (✓e`.` res i 1 !le rebv af`linl .hat I am IIIc used Und:r DLCviSlO ns:l' (ilapter SAFETY PERMITLIsT ITEY s BE LC:vI (- 9 Icommencine with Section ?000) of Dirisien ? .)! the Busi- _ NO. of EXITS ness and P-nfecsions Code. .ind m•: license in :oil frr.e and ettec:. 4 PARKING License LIMITED TIME USE � �l)ntr:ll tl�r. �� . Tp: I im :cmpt :tom :he :icensinc reauue:nents :1h f m .1 t licensed architect or .1 7A21stercd 7rniecsional en .r ;aE D� NC. +sPECTO R's z actin'_ in -n-, prrfe<;iona .... ._ .. Ru:- EKISTI.1 SL_G. 1)�! S GNAT:JRE "RE ENT USE OF BUILDING FINAL ARDRO`/AL / LIC.or R:-. \I` --_ ---- D.i;. --_-._---. I l /^l�n -a" i '1�"t; •'fir _ I HOME Oti NFR-h I. ILDER DE(:LA!,1AT!0`N NO. OF EXISTING BUILDINGS -'--44 i° I- ON LOT AND USE �� .,, . .. ✓:^... I hereby ai,-irnl :flat I :un c.Nempt from the Contma tor'c License Larsfor the follorrine renson (Section -'I:l.:. Buri- - ness and Professions Code): NO. PARKING El 1, as owner of the property. will do the work and the SPACES PROVIDED stnhrurc is not intended or offered for :ale (Section 1 7044. liusine<s and Professions Coder. CONSTRUCTION LENDING AGLNCI X PROPOSED USE OF BUILDING I llercb% affirm that there is a construction lendine :Lcncv tAIZ-PDIN fY&UIJ5, &VA�t//N C70WIus t for the performance of the work tilt which this Permit is issued (Sec. 3097.Civ. C.I. ( L �ZoA 2--- Lender's -Lender's Name PROPOSED MAX. OCC. L'ender's.address -- t [ certify that i have read this application and state that the PERMIT FEE 25.00 above information is correct. I mree to Conlpl}'with all County ISSUANCE FEE ordinances and State laws relating to building Construction. and herebv authorize representatives of this County to enter TOTAL FEE 25.00 J ! upon the above-mentioned property for inspection purposes. I 'I SEE REVERSE FOR EXPLANATORY LANGUAGE } Sign ur f Pere- tee Date 1