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Home My Public Portal About9619 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION �1 CE 875 I hereby '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.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING / ADDRESS Certified copy is hereby furnished. BUILDESSING RT(J 7LOCALITY ADD 0 Certified copy is filed with the county building inspection LOCALITY NEAREST /� Ll department. CROSS ST. Date Applicant NEAREST / DISTRI O. %Ou�TYPE P CE 5ED BY CROSS ST. (�� CON!1 f CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �L_ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP MIGNWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO B (This section need not be completed if the work involved TRACT NOWOON LOT S USE ZONEISPEQIAL CION by the permit is for one hundred dollars ($100) or less.) SIZE OF LOT USOF BLDG.OF d I certify that in the performance .f the work for which this o permit is issued, I shall not employ any person in any manner OWNER �TE S y so as to become subject to the Workers' Compensation Laws. MAIL �t OCCUPANCY GROUP o ADDRESS / L Vl/ U Date Applicant w NOTICE TO APPLICANT: If, after making this Certificate of CITY LL TNo� 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION a deemed revoked. ❑ ❑ No 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) 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. /�� y PARKING REQ'D PROVIDED SPACES II��JJ License Number Lic. Class OC LIMITED TIME USE Contractor Date ` CIA 1 DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer. s+ae.o-a NO. OF I S TOR'S acting in my professional capacity (Section 7051, Bus Ems• / 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 =' �^ License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING - 5 ` SPACES PROVIDED { S -�••�:�- ' ❑ 1, as owner of the property, will do the work and the d� , structure is not intended or offered for sale (Section I}.? 7044,Business and Professions Code). �1.� :I_ , ,.,-a1�::= ••50 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING OAQ C65 i I hereby affirm that there is a construction lending agency `:n2 O !�1 I �!: ; 1, U-1for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. L.i�,.'..'_• W-I Lender's Address _ PERMIT FEE U {}+-•R { njsja :r 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, P51 by authorize re esentatives of this County to enter TOTAL FEE above-menti. d p erly for inspecti pu poses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign t of Permittee Date WC-RKEP,a+'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 RUILDING AND SAFETY DIVISION insatre, or'a'certificate of Workers',Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). FOR APPLICANT TO FILL IN BU Policy No. Company wooREILDING F-1 Certified copy is hereby furnished. u1LDiNG q LOCALITY � � ADDRESS ., + Certified copy is filed.with the county building inspection NEAREST department. LOCALITY a CROSS sr. Date •'t Applicant' EAREST - DISTRI T N G OUP TYPE ` PR CESS E;D'BY ' CROSS $T. + •. ' _ O� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ��4//// ffffJJJJ DESCRIPTION LOT NO. BLOCK • COMPENSATION INSURANCE '- "'aP (CIRc�G"`"A) .. $ NO. �e TATE MAJOR SECOND LOCAL d _ NO. OF BLDG ' (Thissection need not be completed if the work Involved TRACT NOW ON LOT USE ZONE" SPECIAL CONDITIONS .. 0 By the permit is for one hundred dollars ($100) or less.) " USE OF • _ _ SI E OF LOT EXISTING BLDG. _ I certify that in the performance of-the'Work for which this O -permit is issued, I shall notemploy any,person in any manner 0WNE F-. so as to become subject,to the Workers' Compensation Laws. OCCUPANCY GROUP U AIL - V� _ _ W ADDRESS v'r� - a Date -, Applicant 444 ^ W NOTICE TO APPLICANT: If, after making this Certificate of CITY CAL !/rv0� 5-2 OCCUPANT LOAD Z Exemption,. you should become subject to the Workers' Compensation APPLICATION-FOR ICATION'FOR EXITMARDWPyRE:. p provisions of the Labor'Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE'El GEOLOGY INSPECTION ❑ No Spec. Knowl. ❑ deemed revoked " _• ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ElPanic Devices. El Ihereby affirm that I-am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW_ ) ' NO. OF Exlrs ' 9 (commencing with Section 7000) of Division 3 of the Busi- ' ness and Professions Code, and my license is in full force and PARKING. effect. - REO'D. P2�gV DE .. . �,^ SPACES License Number Lic.Class LIMITED TIME USE, Contractor Date j onre iI ,l p1Te , FROM: TO: ..' i a. �. I.am exempt from the licensing requirements as I am a ai ; licensed architect or a registered professional engineer SIZE:OF NO. OF IN$�ECT(3rl~$ z acting In my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES - SIGNATURE iness and Professions Code). FINAL APPROVAL ESENT USE OF BUILDING- - Z Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. of EXISTING auILDINGs. 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 O \ SPACES PROVIDED - 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). PROPOSED 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.C). Lender's Name PROPOSED MAX, OCC.' - do 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 tate laws relating to building construction, TOTAL FEE 47 janWerebaut rize represe atives of this. County to enterenticned p peryfor'inspection purposes. SEE'REVERSE FOR'EXPLANATORY LANGUAGEmittee to WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L LA N E O U S APPLICATION /--� .>� CE 875 I fiereby -affirm that-1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Cbmpensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). /// Policy No. Company R APPLICANT TO FILL IN BUILDING ADDRESS (� Certified copy is hereby furnished. BUILDIN ' 2 ADDRE S , I� LOCALITY Certified copy is filed with the county building inspection LOCALIT`- NEAREST department. CROSS ST. Date Applicant - NEAREST DISTRICT NO. G UP CYPE ONST. PR ESSED BY CROSS ST. /I�1 IT� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL f COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY 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. 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 OWNERE2� y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a o ADDRESSqZ- F-- Date Applicant 42 TELW NOTICE TO APPLICANT: If, after making this Certificate of CITY (� NO. 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 PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date - DATE DATE FROM: ro: 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING _ FINAL.,APPROV.4L /3 Lic.or Reg.No. Date 43 Ube HOME OWNER-BUILDER DECLARATION NO. OF EXISTIN BUILDINGS ON LOT AND USE �EE I hereby affirm that I am exempt from the Contractor's � License Law for the following reason (Section 7031.5, Busi- All tib' �� r}� i / ness and Professions Code): s ACES PROVIDED 0019 -�i1i11 j,/ I, as/owner of the property, will do the work and the -,it_, o structure is not intended or offered for sale (Section _ ..,_..... t'Ft. ��I� �o f 7044,Business and Professions Code). i 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 PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby author' a representatives of this County to enter TOTAL FEE' upon the above-m do d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat e of rmittee Date 'i1:• I. WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS �J Certified co is hereby furnis d. BUILDING PY Y LOCALITY i ADDRESS9619 rya Certified copy is filed with th c my build' g ins ction LOCALITY NEAR EST department. CROSS ST. Date Applicant EARESTDISTRICT NO, GR P TYPE P C SSED BY CROSS ST. 'D U CONST .. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY (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 t slzE of LOT EXISTING BLDG. _ O permit is issued, I shall not employ any person in any manne OWNER so as to become subject to the Workers' Compensation Laws. MAIL /7��/j S /y+-/_ OCCUPANCY GROUP .•, a ADDRESS /. -I f �.. _ .._4Y'" U Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of clrY< �. '>TNo� �„� OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT/f] (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 D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as 1 am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSP --OR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I NATURE iness and Professions Code). FINAL APPROVAL l PRESENT USE OF BUILDING STORAGE Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USEi. 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 ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section ?i f;Tl 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINGQFFTCs I Hereby affirm that there is a construction lending agency 0 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 'J Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE � 0 1 certify that I have read this application and state that the above inf r ation is correct.I agree to comply with all County ISSUANCE FEE ordinan s d State laws relating to building•construction, a and her by thorize repr enta es of this County to enter TOTAL FEE n th ab e-mentione p oper for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee IDAe WORKERS'COMPENSATION DECLARATION CE 875 (11-84) l,, CE 875 MISCELLANEOUS APPLICATION r I I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ,lull insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANTTO FILL IN BUILDING / ADDRESS Certified copy is hereby furnished. [ADDRESS ING ` yy LO CAL7TY x �Certified copy is filed with the county building inspection LITY NEAREST department. Z,t �� r� CROSS ST. Date Applicant NEAREST .� / /` DISTRICT GR UP TYPE 1 PRO SSED BY CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SE OND LOCAL (This section need not be completed if the work involved TRACT NOW ONBLOT S USE ZONESPECIAL 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 Si E OF LOT EXISTING BLDG._ 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 / / OCCUPANCY GROUP o Date Applicant ADDRESS Z—t2S >r�" 1G c~s W NOTICE TO APPLICANT: If, after making this Certificate of CITY L/} NO. 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM] � (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 D PROVIDED. D • License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS ISTING BLDG, STORIES SIG ATURE iness and Professions Code). Aj Lic.or Reg;No. Date PRESENT USE OF BUILDING FINAL APPROVAL Eiz / HOME OWNER-BUILDER DECLARATION No. of EXI1'FSTING BUILDINGS }� ON LOT AND USE o O O;O 8 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- o'.0 0 0 • o o 27 ness and Professions Code): NO. PARKING I, as.owner of the property, will do the work and the SPACES PROVIDED Z structure is not intended or offered for sale (Section h 7044,Business and Professions Code). PROPOSED 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.C.). Lender's Name _ PROPOSED MAX. OCC. Lender's Address PERMIT FEE s I certify that I�iav/read this application and state that the `v above informa ons correct.I agree to comply with all County ISSUANCE FEE 0 ordinanc § a Sate laws elating to building construction, and herby t r.. e epre ntatives of this County to enter TOTAL FEE u t{e ab ve o erty for inspection urposes. P/ SEE REVERSE FOR EXPLANATORY LANGUAGE NJ S nature o er t Dae {� 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.) Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING1 /1 T ) LOCALITY ADDRESS H-1- ! n/ ❑ Certified copy is filed with the county building inspection NEAREST department. CALITY / / / �. CROSS ST. Date Applicant - NEAREST r'''� ( IL''' C•' 9_1Z Date DISTRIC_,T,N O. GRO TYP PROCES ED.BY CROSS ST. C O_iE �l R� . �VT]`U�joQ CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL BLOCK NO. DESCRIPTION LOT HIGHWY COMPENSATION INSURANCE NO. (Ci c E) STATE MAJOR SEC D LOCAL d 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.) vsE oLGB /I S E OF LOT EXISTIk (.. 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 OwrvER Q ER T so'as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUPlLLl AIL 9A DRESS79 ) a Date Applicant NOTICE,TO APPLICANT: If, after making this Certificate of CITY �� NO. — p6r 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 E3 No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION occuPwNcv INSPECTIONPanic DBVICeS ❑ I hereby affirm that I am licensed under provisions of ChapterSAFETY 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 PARKING. effect. SPACES REO'D D PROVIDED' D License Number Lic.Class LIMITED TIME USE Contractor ' Date DATE , DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S ,acting in my professional capacity (Section 7051, Bos- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ESENT USE OF BUILDING FINAL APPROVAL _ Lic.or Reg.No. DateRE 7A; L L2,A/ ISI- nl 1V CJ HOME OWNER-BUILDER DECLARATION IVO. of EXISTING BUILDINGS ON LOT AND USE 3 4 2 4�A; I hereby affirm that, I am exempt from the Contractor's License.Law for the following reason (Section 7031.5, Busi- # 88i. ness and Professions Code): NO. PARKING SPACES PROVIDED - • • a O •. • • 21 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 1 0 7"_ 8 5 7044, Business and Professions Code). PROPOSED USE.OF.BUILD ING .. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructionlending 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 V V I'certify that I have read this application and state that the- ISSUANCE FEE � It 11 above information is correct.I agree to comply with all County , ances and State laws relating to building construction, �/, lereby authorize representatives of th County to enter TOTAL:,FEE ; the ab entioned pro erty for,i spection purp es. . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P ittee l5ate WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION CE 875 I hCE 875(1' 1-84)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 / ADDRESS (/ F] Certified copy is hereby furnished. rC ,E ING TO LOCALITY ESS Certified copy is filed with the county building inspection ITY NEAREST department. CROSS ST. Date Applicant EAR 1 DISTRI T Ol G UP TYPE PRO 5E BY ST �` L `�� /I�/ NST. CERTIFICATE OF EXEMPTION FROM WORKERS' EGAL L COMPENSATION.INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rvo. ICIRCLE) 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 I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. �� o permit is issued, I shall not employ any person in any manneroWNE so as to become subject to the Workers' Compensation Laws. r OCCUPANCY GROUP• v o Date Applicant ADORES G 1 , 1 �.. CD NOTICE TO APPLICANT: If, after making this Certificate of Ir 1Qh q rTioL -Qg — 10� OCCUPANT LOAD 0- 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 SAFETY PERM/ ❑ (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 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- EXITING BLDG. STORIES S/ ATURE iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS r ON LOT AND USE Z O 8 a 7 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- # o 9,e 1. 8 8 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 • • 0 0 • • o'z 7044;Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING �r 5� I a 0 5:+-8 8 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See. 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 �� O ordinances and State laws relating to building construction, Ed hereby authorize rep entatives of this County to enter TOTAL FEE 1 on tI1 e-mention ro ert for inspection purposes. ,� k , 9 SEE REVERSE FORE PLANATORY LANGUAGE gnature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING LOCALITY I , ADDRESS - ❑ Certified copy is filed with the county building inspection bo NEAREST department. LQCALITY - �'i CROS_ ST. Date Applicant EAREST DISTRICT .TYPE lR0 SED BY - - CROSS ST. _ _ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS" LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK Mqp NICRwAY ru 0. 7/8�f>114nC.R C LE) STATE MAJOR SECOND LOCAL ll NO. OF BLDGS. (This section need not be completed if the work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0O by the permit is for one hundred dollars ($100) or less.) USE OF ' SIZE OF LOT EXISTING BLDG. cc 'I certify that in the performance of the work for which this P� 0 permit is issued, I shall not employ any person in any manner WNER F- so as to become'subject to the Workers' Compensation Laws. ' AIL ff J �,}/. s OCCUPANCY GROUP w I /� I ADDRESS �I, e.eVL�r! • '• - Imo. o. Date Applicant, ' tn. NOTICE TO APPLICANT: If, after making this Certificate of Cirri(' a '�1� NOI V 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. C1 No Spec. Knowl. El _ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION P, . DeVICOS El ; 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. PARKING effect' - - SPACES REO'D E= PROVIDED h License Number Lic.Class LIMITED TIME USE ,Contractor Date DATE DATE ' T : 1 I am exempt from the licensing requirements as I am a.. FROM: ❑ licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051,'Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ✓ FINAL APPROVAL S - SENT.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 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 a,913 2.6 A structure:is not intended or offered for sale (Section 7044, Business and Professions Code). OPOSED USE OF BUILDING - I CONSTRUCTION LENDING AGENCY 0 0 0 0 0 0 I hereby affirm that there is a construction lending agency for the performance of the work.for wAich this permit is Q 3,Q 1 —84 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 ordin S laws relating to building construction, TOTAL FEE a hereby aut orize ese tatives o his County to enter pon the ab -ment' ned ope y inspec • n purpo S. SEE REVERSE FOR EXPLANATORY LANGUAGE 17 Si nature of Per ittee ate WORKERS'COMPENSATION DECLARATION 76 44 (2-80)'- MI SC E L LA N EO U S APPLICATION I hereby affirm that I have a.certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Worker s'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) Policy No. Company FOR APPLICANTTO FILL IN BUILDING . ADDRESS ❑ Certified copy is hereby furnished. BUILDING /❑ r LOCALITY ADDRESS t./ J Certified copy,is filed with the county building inspection L + ✓ LOCALITY �� NEAREST �) department. fid: @� - CROSS ST. 7,e; Date Applicant NEAREST ITS DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. C 6 ( o� CO NST , CERTIFICATE OF EXEMPTION•FROM WORKERS' LEGAL �/ COMPENSATION INSURANCE DEscRIPr1ON LOT"No. BLOCK MAP HIGHWAY NO. I '007 (CIRCLE) STATE.MAJOR SECOND LOCAL } NO. OF BLDGS. (This section need not be completed if the WOIIc 1nVOIVed TRACT - NOW ON LOT � USE ZONE SPECIAL CONDITIONS a by the permit is for one hundred dollars ($100) or less.) NO of U 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 v OWNER so as to become subject to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP V ADDRESS p5 SUI s— w Date Applicant l _ U) L, / el-44, TEL. / OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of l✓ CITY C I — � Flo _ 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 lam licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EX"ITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. - PARKING REO'D E= PROVIDED SPACES �J bLicense Number Lic.Class LIMITED TIME USE . Contractor. 'Date DATE DATE FROM: To: e ❑ 1 am exempt from the licensing requirements as I am a licensed architect'*or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my'professional capacity,(Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Profes sions Code). PRESENT USE OF BUILDING V FINAL APPROVAL Lic.or Reg.No. Date ZtS^�(� EXIS ING HOME OWNER-BUILDER DECLARATION ON AND USE NO. OF AND USE BUILDINGS - ,. . 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 r SPACES PROVIDED z.3 0,k 4 A ❑ I, as owner of the property, will do the work'and the I structure is not intended or offered for sale (Section # o}e e e 8 S 7044, Business and Professions Code). ✓ 'PROPOSED USE OF BUILDING 0 O O'O 0 0 0 12 CONSTRUCTION LENDING AGENCY �• + I hereby affirm that there is a construction lending agency /9 / �. �� -212 3:—8.2 for the performance of. the work for which this permit is p / + issued (Sec. 3097,Civ.C.). fJ AILS I 46� Lender's Name PROPOSED MAX'. OCC. Lender's Address PERMIT FEE I,certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances.and State laws relating to building construction, and hereby authorize representatives of.this County to enter. TOTAL FEE upon the above-mentioned proper y for inspection purposes- SEE REVERSE F& EXPLANATORY LANGUAGE Signature of Permittee Date ' \`°RI:ERS t:°MPENSaTI°N DECLARATION CE 875 i i-aa) M ISCELLANEOUS APPLICATION �t3 : 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 iSec. 3800.Lab.C.I. Policy No. _Company FOR APPLICANT TO F!LL IN BUILDING ❑ ADDRESS , Certified copy is hereby' furnished. BUILDING //� ��s F � r AD OR ESS Com! LOCALITY I Certified copy is tiled with die counn buildinL inspection LOCALITYNEAREST department. Temple City CROSS ST. Date applicant NEAREST `i \ DISTRICT GR P TYPE CESSED BY CROSS ST. \ \M 1.Q \_ \ CONS i CERTIFICATE OF EXEMPTION FROM'.\ORRERS LEGAL �� COMPENSATION INSURANCE- 0 ESCR IPT;ON LOT NO. BLOCK nAA cRw Av ' rr 0. (clRCLe) STATE MAJOR SECOND LOCAL ' NO. OF BLDGS. (This section need not be completed if the \l"ork Involved {-RAC" NO:v ON LOT USE "'_ONE SPECIAL CONDITIONS by the permit is for one hundred dollars iSl(101 or less.) >— iusE OF { i I SITE OF LOT EXISTING BLDG. I certifv that in the ncr o-mance of :he ori: _'Or cLieh :his Luptzr It permit is issued. 1 shall not employan} ne:sen fa any manner OWNER 2Dw C� so as to become subiect to the `Yorkers' Compensation Lsws. OCCUPANCY ROUP = �7 1 Date_1f" �__ y\pnlicantfl))GSC Co�locftb�tt .J N�"�ADDREss y�� fV�ul�S �)' _ NOTICE TO APPLICANT: I?. :user makim_ ::us I ertLricatr If CITY��L �e -40. 6;V p - fj(, OCCUPANT LOAD -Exemption, you <itould become suinect ;o 'he \\'I,rke:s ` -- Compensation precisions of the Labor ode, you must forth- 1 aP°L!CATION OR _(!T HA rl;!a _F: I - } \l'ltl: cont-')iv \1"it it �Lllll ^LOyIsiIlns o' .11ls "er?nit shall be -RAIL.R 'JSE GEOLOGY :NSP_CT:CN = NO Spec. K:'O`:'!l, ! deemed:emked. LICENSED CONTRACTORS DECLARATION OCCJPANCY iNSPEC7ION:ffK Panic Dev;ces I hereby affirm :hat I am licensed under provisionsof Chaoter SAFETY PERMIT (LIST ITEMS BELOW) I 9 (comn;encinLwith Section 7000) of Division 3 of the Susi- NO. OF EXITS ness and Professions Codc. and n:y License is in toil force and � effect. ,� �i ARK I N G (' 5—CES RED O I PROVIDED License \umber Lic. Class - LIMITED TIME USE ti Contractor----- —--- — Uatc---------- DATE �A-1 I N i Z ❑ v�rn: rot lam exempt from the licensing reyuirentent. :u I am .t a ! licensed architect or a registered o-oiessional engineer SIZE OFI No. of 1 :NSPECTOR'S Z acting :n my nrct's�ional -....,,., .1t'.;;iO:i -Il;1, !ills- EXISTING SLOG. �70RES SIG TUR U RE _ --- iness anti l'rofessicns �FINdI APPROVAL E C oael. J PRESENT USE: OF BUILDING L;c.or Reg. N,. _ _ na[e_ HOME Ml NER-Ii LILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE –i i�!•i, __ -t, i l; ^:_�_ I hereby affirm that 1 gin exernpt from the Contractors } License Law for the following reason i Section -031. Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED 1, as olcner of the property. will do ?he work and the strucnlre is not intended or offered for ;ale iSecdon 1 704.1. liusincss and Professions Code). v A PROPOSED USE OF BUILDING .r2��)•� �Q CONSTRUCTION LENDING AGENCI I Hereby affirm that there is a construction lending a_gcncv TQ ny e_ 1 for the performance of [lie work for which this pernr.t is issued(Sec. 3097,Civ. C.). Lender's Name — PROPOSED MAX. OCC. Lender's address I I certify that l have read this application and state that the PERMIT FEE 25.00 above information is correct. I agree to comply 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 1 upon the above-mentioned property for inspection purposes. I �Wlq SEE REVERSE FOR EXPLANATORY LANGUAGE $ � I Sienature of Perinitt Date WORKERS' COMPENSAIION DECLARATION /DM 11-1 MISCELLANEOUS APPLICATION 1 20-006,10PW 12'90 hereby affirm that I have a certificate of con-sew !o sell' COUN'T`Y OF I.OS ANGEL-ES BUILDING AND SAFETY DIVISION Ij I insure,or a certificate of Workers'Compensation Instim;ice, or a certified copy thereof (Sec. 3800. Lab. C.) Policy No. .... Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS 44 ADDRESS ElCertified copy is hereby furnished. . C LOCALITY _� ❑ Certified copy is filed with the county building inspection CITY ZIP /�� j'�) NEAREST department. Q, C r I )17U V CROSS ST. Date Applicant • SIZE OF LOT I NO.OFLDG , .NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY ' ` G CONST. {. CERIII'ICA1L OIC E .XEMI'llON FROM W(>RKLI;;; TRACT BLOCK LOT NO �1 COMPENSATION INSURANCE MAP - HIGHWAY l.. • NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work iniol%cd ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS f�.. by the permit is for one hundred dollars 0+1111)1 o! less.) L OWNPR TEL NO. 1 1 certify that in the performance of the work for which thisI0Vt vl t. permit is issued, I shall not employ any person in any manner — � ADDRESS t{. so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP Y t.. Date__ Applicant CITY tPG� 7 NOTICE TO APPLICANT: If. after making this Certificate U� �' OCCUPANT LOAD of Exemption, you should become Subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: Comply With Such provisions or this permit Shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ NO Spec.Knowl. ❑ revoked. ��11 t I OCCUPANCY INSPECTIONS)/ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions(11 t.napler SAFETY PERMIT❑ (LIST ITEMS BELOW) 1 I 9(commencing with Section 7000)of Division 3 of the B:ISIness NO.OF.EXITS �f and Professions Code,and my license is in full force and effect. ►1 �j PARKING• 2 I License Number L.ic. (lass �/ – SPACES REQ'D ROVIDED P Contractor Date ----- - LIMITED TIME USE j 1 DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO: s'. I licensed architect or a registered professional er•ginecr actin ll m' professional i roessi naCa arl (Section 7051BiSI ZE ecton , Business OF OF INSPECTOR'S N0. l g Ip p EXIS TING BLDG. SiOR1ES� SIGNATURE and Professions Code). — LIC. Of Reg. No. _ Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARAHON NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the C'ontractor's License Law for the following reason (Section 7031.5, Busine,s and 1 Professions Code): NO.PARKING ! SPACES PROVIDED —� ❑ L as owner of the property. Till do tho e lrrk (l I l structure IS not intended orIlercd Ii)I ,sale (Scciior 0-)-f, PROPOSED USE OF BUILDING Business and Professions Code). I CONSTRUCTION LENDING AGENCY �� 1 hereby affirm that there is t construction lending agene) for w}n_ � ";7� ICV,,—CAVA S�tyi the performance of Ilii: work for which this permit is issued (Sec. 3097,Civ.C.). 7 �) Lender's Name _..._-_.__...—----- -. -.....-_-_ APPLICANT(PRINT( P POSE M AX TEL NO Lender's Address ",Y\ ADDRESS iI certify that I have read this application and state that the above information is correct. 1 agree to comply with all County PERMIT FEE J ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. �l TOTAL FEE !x oiq10 �p I SEE REVERSE FOR EXPLANATORY LANGUAGE aSignature of Permittee . �) "VJORKtRS'C'OMPENSATION DECI_ARAIION 20-0063DPwn veo MISCELLANEOUS APPLICATION + i :creby aiTirm that 1 have a certificate of consent to sclf COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION IIJ insure, or a certificate of Workers' Compensation Insurance. or l a certified copy thereof (Sec. 3800. Lab. C.) ` Policy No. Company. FOR APPLICANT TO FILL IN 13UILDING - X BUILDfVC,.A D E55 ADDRESS •i ❑ Certified copy is hereby furnished. , "i LOCALITY , ❑ Certified copy is filed with the county building inspection CITYZIP n NEAREST department. - I `s Cn --ST. Date_ Applicant _ SIZE OF LOT NO.OF BLDGS.NO ON LOT DISTRICT CESSED BY ' CERTIFICATE OF EXEMPTION FROM WORKERS' ! TRACT BLOCK LOT NO. COMPENSATION INSURANCE Mn cMwnr ; ; NO- iCIRCLEI STATE MAJOR SECOND LOCAL (This section need not be completed If the work involvedASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS -� j by the permit is for,one hundred dollars (S 100) or less.,) OWNER I certify that in the performance of the wort: for which thi'X property b Cjo TEL 0. [ permit is issued. I shall not employ any person in any m.ulncr so as to become subject to the Workers' Compensation Laws. ADDRiy OCCUPANCY GROUP X ma Date _ .Applicant _ _ CITY ZIP ` NOTICE TO APPLICANT: If. after making this Certificata 9 1 gc _ OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLI ATION 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.Know]. ❑ revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW, 9(commencing with Section 7000)of Division 3 01'the Business NO.OF EXITS I and Professions Code,and my license is in full force and effect. /�J PARKING P ' REqD ROVIDED License Number --------.- _--_-- SPACES LL��11 Lic. Class -. .-_ -- Contractor ___.__—_—___- Date __.-__..- .._.___.______- LIMITED TIME USE DATE DATE ❑ 1 am exempt from the licensing requirements as I am it FRCM: TO: licensed architect or a registered professional engineer 1 NO. ' acting Ill nn professional Ca pal'll)' (Section 7O5 I. Business SIZE OF EXISTING BLDG. STORIOF INSPECTORES S S TORE and Professions Code). ^' Lic. or Reg. No. Dale PRESENT USE OF BUILDING FINAL APPROVAL � /t ' HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS w\ ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License \0 Law for the following reason (Sec(ion 7031.5. Business and Professions Code): NO.PARKING ❑ [. as owner of the property. will du the work and [heySPACES PROVIDED , structure is not intended or offered for sale (Section 703• PROPOSED USE OF BUILDING I Business and Professions Code). Y-e— CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for F-b-c>Ck , VAyLAC theerformance of the work for which this permit is issued p p PROPOSED MAX.OCC. (Sec. 3097. Civ. C). , Lender's Name __..___-___ __ APPLI NT(PRINT TEL NO. y ria C _ Lender's Address __ ___--- AD RESS r 3v . ��?a Cv S3�—► `r..Q� �7 6 I certify that I have read this application and state that the j' above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and rl hereby authorize representatives of this County to enter upon -'F p p ISSUANCE FEE I• the above-mentioned property f(r inspection purposes. rl_,-I., TOTAL FEE X I V SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o, rmit.tee ale