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Home My Public Portal About9615 LAS TUNAS DR_Miscellaneous__ 76M444-DBS 75 11-55 Mi CE LLAEOUS APPLICATION �t DIVISION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS _ Department of County Engineer most I OF= County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING -�'• �- LOCALITY FOR APPLICANT TO FILL.IN NEAREST l s OWNER (j CROSS ST. f MAIL / QDIST 7R NO UP I TYPE CONST. ADDRESS � .�TEL. _ (4 CITY VO 41 D�? NO. r NUMAP MBER HWY—STAT YES NOS TEL. CONTRACTOR NO. USE ZONE SPECIAL CONDITIONS ADDRESS LEGAL /`�/> DESCRIPTION I LOT NO. /X/ I BLOCK BUILDING EXIST. SETBACK YARDI HWY I TREET NAME I WIDTH NO.OF BLDGS. TRACT 44, I NOW ON LOT FRONT P. L. f USE OF SIDE SIZE OF LOT I EXISTING BLDG. P L ' APPLICATION FOR INSPECTION RECORD OCCUPANCY INSPECTION I SAFETY PERMIT TRAILER USE I LIMITED TIME USE ....._._.____...I ......................._..........I.................................. DATE DATE FROM: TO: USE OF STRUCTURES OR DEVICES I . .___..�._I ..._.__...... - .....-._ ....._._L.....I...................._..... ._ ....I......._...................... .. .......................... ............. ..._.-- INSPECTION FOR OCCUPANCY AS APPROVALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS DATE INSPECTOR'S SIGNATURE APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES OCCUPANCY APPROVAL AND STATE LAWS REGULAT_IN BUILDING CONSTRUC- GROUP OCC.LOAD TION. SIGNATURE OF TRAILER USE P9RM ITT SAFETY PERMIT ADDRESS TEMPORARY STRUCTURE APPROVED TEMPORARY STRUCTURE REMOVED Q,� FEE$ FINAL APPROVAL JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION—) CLYDE N.DIRLAM,CHIEF BLDG. INSPECTOR CK MO CASH L 1 97 �. 3 � DEC 12 7 D 500 WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers,rs'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. wDDREss 9�/s'�.`Q$ �( A ' E, LOCALITY . ❑ Certified copy is filed with the county building inspection NEAREST R department. 4ZRSST ALITY �JT CROSS ST.. Date Applicant I DISTRICT NO. GROU TYPE RO SSED BY CROSS ST. C CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL Q NO. (CIRCLE) - O (This section need not be completed if the work involved NO. OF LOT USE ZONE SPECIAL CONDITIONS l p TRACT NOW ON LOT (� by the permit is for one hundred dollars ($100) or less.) USE TI O SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER Lv U so as to become subject to the Workers' Compensation Laws. AIL e �J /' � / OCCUPANCY GROUP LU Date Applicant ADDREss g /Yr 6y apf l'ela( Cl) TEL U 4 7 Z NOTICE TO APPLICANT: If, after making this Certificate of CITY yyl No.y �—(, /•/ OCCUPANT LOAD Exemption, you should become subject 'to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SXFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ❑ (F9 (commencing with Section 7000) of Division 3 of the Busi- � � Fless and Professions Code, and my license is in full force and fect. PARKING REO D PROVIDED SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE i 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 SIGNATURE iness and Professions Code). EsENT 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 F.� 1. 1 n License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING o c o f SPACES PROVIDED I, as owner of the property, will do the work and the structure isnot intended or offered for sale (Section `' ° c ° ° f 7044, Business and Professions Code). PROPOSED USE of BUILDING0—!: t2 _4- 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 and hereby authorize representatives of this County to enter upon tIle above-mentioned operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Per tee Vuate 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 certifitiate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No' Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING ADDRESS "d�� Q �Q LOCALITY Certified copy is filed with the county building inspection LOCALITY ['-� �•-� . /`7++- NEARES department. / 1 CROSS ST. Date Applicant I/ NEAREST J��e� DISTRICT NO. GROUP TYPE I PROCESSED BY f�(\ CROSS ST. 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 SIZE OF LOT EXISTING BLDG.OF 7••• I certify that in the performance of the work for which this CD permit is issued, I shall not employ any person in any manner OWNER �� _ s�, so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP 01-1MAILIl /�- .�— Date Applicant ADDRESS ` V /� �L J T p Q��jjj, , G1ty TEL. / ��o�� OCCUPANT LOAD "J NOTICE TO APPLICANT: If, after makingthis Certificate of CITY NO. _/fes / N Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- PPLICATION FOR EXIT HARDWARE: — with comply with such provisions oI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 Of the Busi SAFETY PERMIT E] (LIST ITEMS BELOW NO. OF'EXITS ness and Professions Code,and my license is in full force and �� q effect. 1 % PARKING REq D PROVIDED License Number Lic. Class -SPACES LIMITED TIME USE Contractor Date DATE DATE DI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: TO: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATUR iness and Professions Code). + FINAL APPROVAL �O Lic.or Reg.No. Date PRESENT USE OF BUILDING 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 Vii:lid;`s-r[! 1l u/ 51/90 ness and Professions Code): NO. PARKING ElI, as owner of the property, will do the work and the SPACES PROVIDED ';+2y. PM 02'1 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name ` PROPOSED MAX. OCC. I Lender's Address D 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, D and hereby authorize representatives of this County to enter TOTAL FEE upon the above-menti d ropert for inspection purposes. ` SEE REVERSE FOR EXPLANATORY LANGUAGE 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 ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) BUILDING Policy No. Company FOR APPLICANT TO FILL IN tBRESS S_ S RESS ❑ Certified copy is hereby furnished. ADDRESS �6/S £. �Q y/may, n ALITY ADDRESS {/y.�, G..• Certified copy is filed with the county building inspection REST department. LOCALITY ss sr. AJI Date Applicant EAREST T Blvd. TRICT NOorl. G O P TY PR SSED BY ROSSST. �� CONSIT.CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �2COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK �f Cyl HIGHwny }d�ts�J ( (CIRCLE) STATE MAJOR SECO LOCALThis section need not be com leted if the work involved NO. OF BLDGS.( P TRACT NOW ON LOT ZONE SPECIAL CONDITIONS L) by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. t 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 J,9KWNER Ojber.t hens V so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP LV /// 7A. Wa/ �e e-/-. e 5 DRESS L' Date Applicant W NOTICE TO APPLICANT: If, after making this Certificate of clTr J lQ NO. !0)9 q54-50(6 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 Cl 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 I (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING effect. SPACES 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 INSPECTOR'S TUR acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S GNA iness and Professions Code). FeESENT USE OF BUILDING FINAL APPROVAL C Lic.or Reg.No. Date — e- HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE p I hereby affirm that, I am exempt from the Contractor's #!-11'� License Law for the following reason (Section 7031.5, Busi- ® V ness and Professions Code): NO. PARKING SPACES PROVIDED y y p EJI, 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). POSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency fIn 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 arod hereby autllp4ze representatives of this County to enter t Fm -me t' n roperty for inspect; purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE / S' nature of ermitt Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION ^ CE 875 r I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, �:a certificate of Workers'Compensation Insurance,e,or a certified'copy thereof(Sec. 3800,Lab.C.). — BUILDING Policy No. Company FOR APPLICANT TO FILL IN V/L ADDRESS Certified copy is hereby furnished. Bp'D`RESS 9615 Las Tunas Dr. , Temple Cit LOCALITY 7- C r 0 Certified copy is filed with the county building inspection LOCALITY CA 91780 NEAREST department. CROSS ST. Date Applicant EAREST DISTRICT G O P TYPE PROCESSED BY CROSS ST. Las Tunas Dr. & Temple -City CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 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 USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF T d I certify that in the performance of the work for which this S ZE OF LOEXISTING BLDG. o permit is issued, I shall not employ any person in any mannerINNER s' so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP -� ce DDRESS - G _ �' Date Applicant Ar Lam,., TEL' OCCUPANT LOAD D-- NOTICE TO APPLICANT: If, after making this Certificate of CITI NO. Exemption, you should become subject to the Workers' ppLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth- ❑ with comply With such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION F] 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 PARKING effect. SPACES REQ'D = PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: licensed architect or a registered professional engineer SIZE OF NO. OF INSP CTOR'S g p g sl NATURE acting in my professional capacity (Section 7051, Bus XISTING BLDG. STORIES inessand Professions Code). FINAL APPROVAL _/�/r ❑ / ' PRESENT USE OF BUILDING ,/ Lic.or Reg.No. Date C/ D 1D D D g g HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS _ ON LOT AND USE 0 0 0 0 0 0 0 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ( 2 06-:--8 7 ness and Professions Code): NO. PARKING I, as owner of the property, will do the Work and the SPACES PROVIDED structure is not intended or offered for sale (Section \�\ 7044,Business and Professions Code). �> CONSTRUCTION LENDING AGENCY ROPosED usE of BUILDING \� I hereby affirm that there is a construction lending agencyEl Jt7-C_- for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Cc LTD. Lender's Name PROPOSED MAX. OCC. Lender's Address `.1. l 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 ,Zen bove-meyined property for msp tJ n urposes. �J SEE REVERSE FOR EXPLANATORY LANGUAGE I Signa re of Permittee bAe KLk CE 875 (11-84)S'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION CE 875 1 e eby affirm that I have a certificate of consent to self COUNTY OF LOSANGELES BUILDING AND SAFETY DIVISION insure,"ora certificate of Workers'Compensation Insurance,or fl a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN ILDING DRESS Certified copy is hereby furnished. uILDING `_ � s ' DDRESS YJ LOCALITY Certified copy is filed with the county building inspection department. LOCALITY NEAREST UA CROSS ST, �. Date Applicant NEAREST /� 'r DISTRICT6N GypI.Lp TYPE' PROCESSED BY CROSS ST.7Qfj Q C( V d s 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 this cn slzE of Lor EXISTING BLDG. permit is issuedI shall not em p , employ y an y person in any manner , / so as to become subject to the Workers' Compensation Laws. wNER �.� OCCUPANCY'GROUP '✓ � Date Applicant PIP oREss 's yl�;j,TEL. / v NOTICE TO APPLICANT: If, after making this Certificate of TY �(� NO. j JFYT6 OCCUPANT LOAD N Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPL CATION 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 OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and _ effect. PARKING REQ'D D PROVIDED License Number Lie. Class G� 1 j��(ct�jw S 1 SPACES LIMITED TIME USE Contractor Date ' Llht�l ` DATE DATE ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: To. INSPECTORS acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES S.PECTURE iness and Professions Code). FINAL APPROVAL a 6 A Lie.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS D D 8 0,Jr 0 ON LOT AND USE I hereby affirm that I am exempt from the Contractor's o o D 8.0J O License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I F11, as owner of the property, will do the work and the SPACES PROVIDED I 1 5-87 structure is not intended or offered for sale (Section 7044,Business and Professions Code). �(JJ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN ®r I hereby affirm that there is a construction lending agency 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 ' 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, Can hgJreby authorize representatives of this County to enter TOTAL FEEM-rd e ove-mentiVed property for i spection p rposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of Per ittee ate.1 7 WORKERS'COMPENSATION DECLARATION 75 (11-84) CE 875 MISCELLANEOUS APPLICATION � CE 8 � I hereby .affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING r ADDRESS Certified copy is hereby furnished. BUILDINGJ LOCALITY ADDRESS 'W 0 Certified copy is filed with the county building inspection LOCALITYNEAREST department. ��J L CIT CROSS ST. C, Date _ Applicant NEAREST z R)) DIS/�'�R ICT\NO G{�'�O P TYPE PROCE SED BY CROSS ST. LL C 64 v IV ✓J ONS). CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK MAP HIGHWAY NOOF LD S. rvD. (CIRCLE) STATE MAJOR SEGO LOCAL . . (This section need not be completed if the work involved TRACT NOW ONBLOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT EXISTING BLDG. } I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNERT so as to become subject to the Workers' Compensation Laws. MAIL d �/ �./{� OC:CUPANCY,- ROUP _v o ADDR "' �� Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY Q� r)io� OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'D D PROVIDED SPACES LL�� License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: El I am exempt from the licensing requirements as I am a TO: licensed architect or a registered professional engineer SIZE of n//^) NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING SLOG. � OVV STORIES SIG ATURE iness and Professions Code). T j/— ,9 FINAL APPROVAL �- „r Lic.or Reg.No. Date PRESENT USE OF BUILDING _,. HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS J., �. ON LOT AND USECj//(` „h' " - 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 DI, 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 �7, fL -S I hereby affirm that there is a construction lending agency5 G 8 8 A for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name 8 8 PROPOSED MAX. OCC.. - Lender's Address 0 0 0 0 'o s D _ I certify that I have read this application and state that the PERMIT FEE 0 7. 8 6 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 ignature of Permittee Date WORKERS' COMPENSATION DECLARATION "UM444 M15CtLIL ANL-Vut) HL"'1''LIL.HI IVIY ..0-0063DPW 1 2/90 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 13UILtD[ING ADDRESS ADDRESS ❑ Certified copy is hereby furnished. 7v Is- Lq S 7U A).4 S Ive. LOCALITY Certified copy is filed with the county building inspection CITY / /[� ZIP LA /ry{, NEAREST department. T-g–m 1E Gr'� , Com/ //7V`� CROSSST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. COMPENSATION INSURANCE MAP HIGHWAY 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 OWNERTEL NO. permit isProperty 626, issued,.) shall not employ any person in any manner AqD Ess _ so as to become subject to the Workers' Compensation Laws. ?bp)sT {�5 (uK)JV /�� OCCUPANCY GROUP Date Applicant CIT L ' �� ZIP f�� (NOTICE TO APPLICANT: If, after making this Certificate L6 L( jl OCCUPANT LOAD ':of Exenptiori, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. ❑ OCCUPANCY INSPECTION❑ P3111C D@VIC@S LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a j 9(commencing with Section 7000)of Division3 of the Business No.of EXITS and Professions Code,and my license is in full force and effect. PARKING• REQ'DE= PROVIDED License Number — Lic. Class sPAces Contractor Date LIMITED TIME USE ( - _ DATE DATE '❑ 1 lam exempt from the licensing requirements as 1 am a FROM: TO: licensed architect or a registered professional engineer INSPECTOR'S SIZE OF _ NO.OF acting in my professional capacity (Section 7051,Business EXISTING BLDG. STORIES SIG RE and Professions Code). _ r --] (Z LIC. or Reg. No. _ _ Date PRESENT USE OF BUILDING (A Aj I( y % FINAL APPROVAL td 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 ! C Professions Code): NO.PARKING V VVI ❑ 1, as owner of the property, will do the work and tileSPACES PROVIDED structure is not intended or offered for sale(Section 7044X PROPOSED USE OF BUILDING i I f rt/✓ �/ /�lt''�% (. Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097,CIV. C.). PROPOSED MAX.OCC. ,.(Sec. Name APPLICANT(PRINT) TEL NO. Lender's Address ADDRESS I certify that I have read this application and state that the above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby aut rhe representat� of this County to enter upon ISSUANCE FEE the abov. -mentloned proFrty for in pection purposes. TOTAL FEE X � i ,W! l /I y'J SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of/Permittee Date