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Home My Public Portal About9620 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 I SC E L LA N EO U S APPLICATION ^ d 1 � CE 875 (11-84) r � I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ,UI 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 Certified copy is hereby furnished. Bu1LDING /�Q — S �. LOCALITY ADDRESS F� 0 Certified copy is filed with the county building inspection LOCALITY _ _ ••� NEAREST department. CROSS ST. Date Applicant NEAREST Q ��v v p D I G �TY E �'�� PR ES BY CROSS ST. < C NST. IJ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP N16 RW AY ND. (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 COND TIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance f the work for which this o permit is issued, I shall not emplo any person in any manner OWNER-OF�L�I• /� ;1j G so as to become subject to the W rkers' Compensation Laws. MAIL OCCUPANCY GR UP o ADDRESS C-' Date Applicant �DS '0 OS ' w NOTICE TO APPLICANT: If, ter making this Certificate of CITY l NOL (fj�I /3 OCCUPANT AAD N Exemption, you should bec me subject to the Workers' Compensation provisions of t e Labor Code, you must forth- APPLICATION FOR EXIT HAIR�DWA E: with comply with such pro isions or this permit shall be TRAILER USE GEOLOGY INSPECTION El No Sp c. Knowl. deemed revoked. LICENSED CONTR CTORS DECLARATION OCCUPANCY INSPECTION Panic evices I hereby affirm that I am Ii ensedunder provisions ofChapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Sectio 7000) of Division 3 of the Busi- NO, OF EXITS ness and Professions Code, nd my license is in full force and /�aY � effect. I J PARKING REQ'D PROVIDED SPACES License Number Lic. Class �P.G' ' LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt fro the licensing requirements as I am a licensed architec or a registered professional engineer slzE OF NO. OF INSPECTORS acting in my p ofessional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG NATUR iness and Profe ions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOM/rthe NER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ;8 E ON LOT AND USE I hereby affiat I am exempt from the Contractor's License Law following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING l J .00-0'C !' 27��=1 SPACES PROVIDED El 1, as owner of the property, will do the work and the -Icis;_, �, Al 9*--33 structure is not intended or offered for sale (Section X. 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 /I issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address �S 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 upo t11e abo G tioped property for inspection purposes. n SEE REVERSE FOR EXPLANATORY LANGUAGE Signiture of Permittee Date ' WORKERS'COMPENSATION DECLARATION 76M444 n� /► �� p p APPLICATION��I CE 875 (11-84) u�u C Uf A A I hereby affirm that I have a certificate of consent to c self COUNTY ®F 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 Q ADDRESS Certified copy is hereby furnished. BUILDING C 5 C( ( LOCALITY DDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEARESTI r // l p DIST�IICT N G UP TYPE 1PR CES E BY CROSS ST. TM��G �/(� I�D, -'(� ^ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY Ho. (cIR CLE) STATE MAJOR SECOND LOCAL NO. OF BLD S. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. (/ d I certify that in the performance of the work for which this (holi C3 permit is issued, I shall not employ any person in any manner OWNER 7, Z ID 151IG MTCAae4 M. 7_10In75/1 - so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a Date Applicant ADDRESS ( jS AVE E!Q3 NOTICE TO APPLICANT: If, after making this Certificate of CITY Oa To� OCCUPANT LOAD a 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. Know]. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices E I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT EJ (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 �I effect. REo'D I PROVIDED SPACES J License Number Lie. Class _ rmA Co of u(/ (a 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: o. INSP CTOR's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE inessand Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL �� Lie.or Reg.No. Date �7 ��.� 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- QQQ]:!—�� 0/ S/u' ness and Professions Code): NO. PARKING I 1°3:50I, as owner of the property, will do the work and the SPACES PROVIDED �t8 F77 1 M 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 agencyL S� O 11 {fo/'� T 7� for the performance of the work for which this permit is I LD issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address D0 if J L� !ri PERMIT FEE "Y} I certify that I have read this application and state that the t 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 0� u on the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date low—,- WORKERS'COMPENSATION DECLARATION CE 875 (11-84) -� M I SC E L _A 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 Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). t Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING ADDRESS 74119 L-4.s -row _ a u LOCALITY FCertified copy is filed with the county building inspectionLOCALITY �� NEAREST department. cRoss sr. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CRO T. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rvo. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work InvolV d TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or I s.). USE OF SIZE OF LOT EXISTING BLDG. Y I certify that in the performance of the work for whic t 's o permit is issued, I shall not employ any person n any m n owNER so as to become subject to the Workers' Compensation aws. MAIL v p�,(/ ` T OCCUPANCY GROUP o ADDRESSq610 S Ty/T 3 V� ~ Date Applicant w NOTICE TO APPLICANT: If, after making this Certificate of Y'N11 g 64T NOI. 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 TRAILERUSE GE Y INSPECTION ❑ No Spec. Knowl. deemed revoked. �` "a-------- LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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. JP....NG SPACES REQ'D 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 I S PNATURE acting in my professional capacity (Section 7051, Bits- EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING S'YG�t FINAL APPROVAL / Lie.or Reg.No. DateteT L HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS FIS• "- ON LOT AND USE MD 5._ 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 t SPACES PROVIDED I��_I[, '-I Et II_j y;f F;f 0 I, as owner of the property, will do the work and the 09 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINGTJ2 I YS 4 I hereby affirm that there is a construction lending agenc 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 Q 11 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, ancyhereby authorize representatives of this County to enter TOTAL FEE n the above-mentioned property fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig u of Permittee Date `� WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO p S APPLICATION P �I CE 875 I hereby affirm that i have a certificate of consent to self COUNTY OF LO 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 �� vO � Certified co is herebyfurnished. BUILDING f copy ADDRESS \1p LOCALITY ff EJ Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. OUP TYPE P O ESSED BY CROSS ST. ��` Yj Q Q CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL i o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this SIZE of Lor EXISTING BLDG. � permit is issued, I shall not employ any perso any manner OWNER •`y�, so as to become subject to the We ers' Co nsa ' Laws. MAIL ( OCCUPANCY GROUP ,` o ADDRESS Date —J Applicant NOTICE TO APPLICANT: If, iter making t Certificate of CITY NO.TE �`� %�J 1 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 USEGEOLOGY 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 PERMITLIST 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 SPACES LIMITED TIME USE Contractor Date DATE DATE DI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. S�N Sg STORIES 1 SIGNATURE iness and Professions Code). FINAL APPROVAL / Lie.or Reg.No. Date PRESENT USE OF BUILDING ` HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS p � ON LOT AND USE I hereby affirm that I am exempt from the Contractor's �i. 00 001—CAU 1? 2/17/931 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING °x'.62 PN 4:317 F1I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County toe ter TOTAL FEE upon the above-mentioned property for inspection pure s. 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 certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LJ insure, or a certificate of Workers' rs'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. a ILDING /1 ti/ '81V LOCALITY ADDRESS f�/J tV �---•z Certified copy is filed with the county building inspection '= CITV NEAREST department. LO ALITY L e CROSS ST. _ Date Applicant NEAREST C FH1 ) DISTRICT NO. ROUP YPE SED BY CROSS ST. PV/ S CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGMw AY STATE MAJOR SECOND LOCAL NO. OF BLDGS. N.O. ® (CIRCLE) 0- (This section need not be completed if the work involved TRACT NOW ON LOT 11 SE ZONE SP CIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) _ 0 USE OF SIZE OF LOT EXISTING BLDG. ,r I certify that in the performance of the work for which this t permit is issued, I shall not employ any person in any manner WNER I C l� so as to become subject to the Workers' Compensation Laws. "DRESS OCCUPANCY GROUP U LU Date Applicant ) CL TEL. !'J OCCUPANT LOAD i z NOTICE TO APPLICANT: If, after making this Certificate of No. J J 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 E] GEOLOGY INSPECTION N ❑ deemed revoked. O Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITf (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 PARKING. effect' SPACES REO'D E= PROVIDED LJcense 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 /1 SIGNATURE iness and Professions Code). ESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date J� lfL NO.OF AXIS U G BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE 1 1 1.7 R I hereby affirm that, I am exempt from the Contractor's 0 0 0 0 88 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 0 0 0 0 0 0 0 SPACES PROVIDED �C I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section J�,_1 0—8/4 7044, Business and Professions Code). ROPOSED 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 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 ;p 2e ve-mentioned property for inspecti purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE AL_r �. '-4g'naturtfof 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 SAFE'T'Y DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING 9 LOCALITY ADDRESS A ❑ Certified copy is filed with the county building inspectionNEAREST L.department. LOCALITY CROSS ST. Date Applicant AP6AREST DISTRICT NO. GR P PE ESSED BY CROSS ST. t;l CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL - 12 Q .4 don COMPENSATION INSURANCE DESCRIPTION LOT No. B ocK MAP Rw Av } NO. _ STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved NO. CO BL T'S. USE ZONE: P CIAL CONDITIONS d P TRACT NOW ON LOT Q by the permit is for one hundred dollars ($100) or less.) USE OF U SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this0 permit is issued, I shall not employ any person in any manner NER so as to become subject to the Workers' Compensation Laws. IL `' OCCUPANCY GROUP (> ADDRESS 'Ina tL CL Date Applicant (n TEL. �" OCCUPANT LOAD Z NOTICE TO APPLICANT: If, after making this Certificate of Iry rvo. 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. ❑ 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) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- nem and Professions Code, and my license is in full force and PARKING effect' SPACES REO'D E= PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE Iness and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION 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 '0021 R )' SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # o oro 0 88 7044, Business and Professions Code). 11!5-POSED USE OF BUILDING O o 0 0 0 0 o z CONSTRUCTION LENDING AGENCY03.2,7_8 4 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 WORKERS'COMPENSATION DECLARATION ! CE 875(11-84) M 0 SC E L L A N EO U S APPLICATION 1 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 certif ed copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING `` ADDRESS ljJg�.� ❑ Certified Copy is hereby furnished. X ADDRESS ,J LOCALITY I 0 Certified copy is filed with the county building inspection LOCALIT h(Z� NEAREST department. CROSS ST. Date Applicant NEAREST DIST T NQ. ROUP TYPE R CESSED BY CROSS ST. off/ �q CONST. I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL TI Y COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK Mwr HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLDGS. NO. (CIRCLE) (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. I certify that in the performance of the work for which thiso permit is issued, I shall not employ any person in any manner x OWNER CO 1�r-�:S F4_� so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP a MAIL r- Date ADDRApplicant x ESS u`JI NOTICE TO APPLICANT: If, after making this Certificate of)( CITY` Ci�O`a� No� OCCUPANT LOAD Exemption, you should become subject to the Workers'/ APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth El comply with such provisions oI this permit shall be TRAILER USE deemed revoked. [J GEOLOGY INSPECTION EJ No Spec. Know]. 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. !` Cy I / AV PARKING REq D PROVIDED SPACES License Number Lic. Class C' �"' LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a INSPECT ORIS licensed architect or a registered professional engineer SIZE OF NO. OF SIGN RE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). a FINAL APPROVAL PRESENT USE OF BUILDING -(` Lic.or Reg.No. Date 7 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS y}'O 1/ rt _ ON LOT AND USE U I I hereby affirm that I am exempt from the Contractor's1�rf/ License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING SPACES PROVIDED .71 I, as owner of the property, will do the work and the i _ i`''1 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY x PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency1'<�- 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 ,U I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL. FEE 1UV upon the abo e-ment'oned opertor inspection urposes. L3] SEE REVERSE FOR EXPLANATORY LANGUAGE Signat e of Permittee ate WORKERS'COMPENSATION DECLARATION CE 875(11-84) M ISCELLANE®US APPLICATION I hereby 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 APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING 1ICJ 445 T/Axs P/,- LOCALITY ADDRESSYZ 0 Certified copy is filed with the county building inspection LOCALITY 7-M Lc Gj'T �'c7 NEAREST department. /� r / 7 cRoss sT. Date Applicant NEAREST DISTRICT NO. I GR U ITYPEST-V -- P CROSS ST. 5, e)j �6¢E SSED BY tM Lc' G/ f CDN CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP 2 / IGMWAY NOOF LOGS. No. /�_24 CIRCLE) STATE MAJOR SECOND LOCAL /[- . (This section need not be completed if the work involved TRACT b J NOW ONBLOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) �J USE OF C SIZE OF LOT $'�7 $' -jj• EXISTING BLDG. '� � I certify that in the performance of the work for which this T o permit is issued, I shall not employ any person in any manner OWNER 1141 Z, ZiO11113L/G so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS �[ Las /9L/os Date Applicant LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY ITvo� OCCUPANT LOAD � g RC,4DI% /�06 /�j�� 'i%/3 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 I hereby affirm that I am licensed under provisions of Chapter I 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 SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE F] I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FRo �: To: INSPECTORS acting in my professional gapacity (Section 7051,Bus- EXISTING BLDG. STORIES "SGNATURE 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 I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). 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 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 up n the above-mentioned property for inspection purposes. • SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date �\\ i WORKERS'COMPENSATION DECLARATION CE 875 1-84) M I SC E L LA N EO U'� APPLICATION _ CE 875 (. 4 ^,. I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS :ANGELES BUILDING :AND SAFETY DIVISION iri'sure, or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec. 3800, Lab. C.). Policy No. Company FOR APPLICANT TO FiL'_ IN BUILDING 9Gaa •i f•DOft ESS �i Certified copy is hereby furnished. f � ADDRESS d.Cl LOCALITY } Certified Copy is filed with the county building inspection LOCALITY I NEAREST � department. - Temple City ! :nROSS ST. dr Date Applicant NEARESTr=iS7RICT NO. GROUP YPE CES5ED BY CROSS ST.� iqlast ' ICONS'T]�' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL L co�' /4 moi' } - COMPENSATION INSURANCE 1 DESCRIPTION ILOT NO. (BLOCK i.+:AP HIGHW wY ^I=. (CIRCLE) STATE MAJOR SECOND LOCAL i NC. OF BLOGS. (This section need not be completed It the Work involved 7TRACT INC. CN LOT 3USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S 100) or less.) --4 USE OF SIZE OF LOT EXISTING BLDG. 1 I certify that in t}ne performance of the work- for which diis permit is issued. I shall not employ any person in any manner �i OWNER I so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP 1 I Date -applicant TU$ TEL. NOTICE TO APPLICANT: If, after making this Certificate of �C;T�/¢nC9��/$ NO. /2�_ _ i�/ OCCUPANT LOAD Exemption, you should become subject to the Workers' °LIC:=_ 4P, I ION Or': i :'C!T HARDbVP.P,F: Compensation provisions of the Labor Code, you altar forth- I } with comply with such provisions or this permit shall be RAILER USE JI GEOLOGY INSPECTION + c — t deemed revoked. — No „Pec. Kno.vi. I I I anDevices Pic Devi LICENSED CONTRACTORS DECLARATION i occuPaNCY :NSPEcroNgg L I hereby aftlIm that } am licensed under provisions Of Chapter ii SAFETY PERMIT ` !LIST ITEMS BELOW) m w I 9 (commencing with Section 7000) of Division 3 of the Busi- i NO. OF EXITS ness and Professions Code, and my license is in full force and jt� effect. I PA RK ING N _P.ACES `ft E0•D PROVIDED �. License Number Lic. Class LIMITED TIME USE 4 I Contractor Date ! DATE DATE UI ❑ FROM: TO: I am exempt from the incensing requirennents as I am a m ! licensed architect or a registered professional engineer SIZE CF No. OF INSPECTOR'S z acting in any professional canacity (Section 7051. Btis- EXISTING BLDG. )STORIES -_ SIGN"URE iness and Professions Code). / !F. J PRESENT USE OF BUILDING 4-6'a C NA'- APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLAR.aTION No. of EXISTING BUILDINGS ` ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 1I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I I, as owner of the property, will do the work and the SPACES PROVIDED structure is not untended or offered for sale (Section j 7044.Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency ` 1 for the performance of the work for which this permit is 12 N(� 6n �! 3 issued(Sec. 3097,Civ.C.). Lender's Name i CI PROPOSED MAX. OCC. I Lender's Address 'T'j PERMIT FEE 25.00 l 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 25.00 ; upon the above mentioned property for inspection purposes. (� SEE REVERSE FOR EXPLANATORY LANGUAGE , Ar s Signature of Permittee Date