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Home My Public Portal About9629-9633 LAS TUNAS DR_Miscellaneous__ 76M444-DOS 75 12-54 MISCELLANEOUS APPLICATION 1 DIVISION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER BUILDING ADDRESS 47wa CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST OWNER Kemsl eys` Kiddie Ka rnive l CROSS ST.MAIL - ADDRESS 1055 Irving Ave• DISTRICT O. GROUP I TYPE CONST. CITY Glendale 1. No'Ci-3—n2 TE TEL. N MA ER SH WY YES N CONTRACTORSame NO. USEZONE SPECIAL CONDITIONS ADDRE S ._.r LEGAL DESCRIPTION I LOT NO. BLOCK BUILDING - EXIST. YARD HWY STREET ME I _ TRACT jj I NO. OF BLDGS. _SETBACK WIDTH NOW ON LOT FRONT I USEO SIZE OF LOT EXISTING BLDG. SIDE �x APPLICATION FOR P L INSPECTION RECORD OCCUPANCY INSPECTION SAFETY PERMIT X - TRAILER USE LIMITED TIME USE ........................I...._._......»...,_......_-.............................._...........................I_.................._.......... ........................1..._..-..........................................................................................I................».................. DATE DATE 5��- _ FROM: 2-27- . TO: '�-� -Lr�— USEOF STRUCTURES OR DEVICES .....................I..................................................................................................I.................................... No 5 Eli Ferris Wheel ........................I..................................................................................................I.................................... . Tilt-A-Whirl � ........................I............................................................................................._...I..................................... Rolo-plane, L .............i..................................................................................................I.................................... . Merry-go-round , fsrx a j r—pl anp .......................I........._.....................................................................................I.........................._........ Chair=o prune, c-r ride ................_-J......._..........._........................................................................I................_.................. APPROVALS I INSPECTION FOR DATE I INSPECTOR'S SIGNATURE _ OCCUPANCY AS OCCUPANCY APPROVAL I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC.LOAD APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES TRAILER USE AND STATE LAWS REGULATING BUILDING CgN .JC STRUC- TION. � A 'I n IM SAFETY PERMIT SIGNATURE OF PERMITTEE TEMPORARY _ STRUCTURE APPROVED ADDRESS 1055 Iry-in Ave TEMPORARY STRUCTURE REMOVED FINAL APPROVAL WILLIAM J. FOX, COUNTY ENGINEER VALIDATION � 2 5 1 15� FcR 17 7 Abi 1 1 .00 BY BY PUTY DEPUTY 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 ceftified copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS S ❑ Certified copy is hereby furnished. ObUILDING LOCALITY ❑ S Certified copy is filed with the county building inspection ADDRESS NEAREST department. LOCALITY /JJ/jl/ CROSS ST. /r1 Date AS EST EAEST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS CONST(� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VI `/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY >- NO. (CIRCLE) STATE MAJOR SECOND LOCAL tl NO. OF SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE FPECIAL CONDITIONS O by the permit is for one hundred dollars (SI00) or less.) USE OF SIZE OF LOT EXISTING BLDG. tr 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 so as to become subject to the Workers' Compensation Laws. OCCU All P A N C Y GROUPoffllz��] W ADDRESS M Date Applicant Z L. NOTICE TO APPLICANT: If, after making this Certificate of CITY No. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. NO Spec. Knowl. ❑ ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic D2VICe5 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. a SPACES REO'D I PROVIDED 6f License Number Lie.Class I T J LIMITED TIME USE Contractor Date DATE DATE ❑ FROM: I am exempt from the licensing requirements as I am a TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SLQP A T U R E iness and Professions Code). C� it FINAL APPROVAL PRESENT USE OF BUILDING Lie.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- '_("`J_I' .-: -- ness and Professions Code): No. PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o !' 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 J U4 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 �v and her thoriz reptesentatives of this County to enter v' up e a ve- ery�iy,7�Pd pr pe y for inspectio= purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Date 1 i• t WORKERS'COMPENSATION DECLARATION FE 875(11-84) M ISCELLANEOU8 APPLICATION I I hereby affirm that I have a certificate of consent to self ' COUNTY OF LOS ANGELES : BUILDING AND SAFETY DIVISION insureor a certificate of Workers'Compensation Insurance,or i a certified copy thereof(Sec.3800,Lab.C.): i Policy No. Company FOR APPLICANT TO FILL IN Bl {LDING �/ ADDRESS Certified copy is hereby furnished. % nooRess I, ' � S^®�� LOCALITY i } Certified copy is filed with the county building inspection X LOCALITY NEAREST I department. & 7 .14Oss ST. TYPE / Date EApplicant NAREST DiS CONST.// P SEED BY GR P -EROSS ST. !/ IVV/ i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' HIGHWAY COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK N9P (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This section need not be completed if the work involved ( TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) I USE OF 1 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 %I OWNER d I ~ so as to become subject to the Workers' Compensation Laws. I _ :NAIL / y/J I OCCUPANCY GROUP _ ADDRESS Date DllCant �• p- % / TEL. NOTICE TO APPLICANT: If,after making this Certificate of i crr � /� No. OCCUPANT LOAD - Exemption, you should become subject to the WorkersAP CATION FOR (EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- i with comply \Vltll such pIOYISlOnS OL [1115 permit shall be TRAILER USE n GEOLOGY INSPECTION ❑ No Spec. Know(. E deemed revoked. ^ I OCCUPANCY INSPECTION Panic Devices ❑ N LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT C] (LIST ITEMS BELOW i 9 (commencine with Section 7000) of Division 3 of the Busi 1; I NO. OF EXITS ness and Professions Code,and my license is in full force and effect. + PARKING REO'D PROVIDED SPPCES o License Number Lic. Class i LIMITED TIME USE LL y Contractor Date DATE GATE ZP M: TO: I am exempt from the licensing requirements as 1 am a INSPECTOR'S m ! licensed architect or a registered professional engineer SIZE OF NO.OF 1 SIGNATURE Z acting In m} professional capacity (Section 7051. Bus- E EXISTING BLDG. STORIES ; a iness and Professions Code). I FIINAL APPROVAL �+ I PRESENT USE OF BUILDING Ito ;� v Lic.or Reg.No. Date s t HOME OWNER-BUILDER DECLARATION � NO. OF EXISTING BUILDINGS f ON LOT AND USE y Fk-I.fj6y�k :lii�' II;•,; I hereby affirm that I am exempt from the Contractor's License Law for the following reason tSection 7031.5, Busi- ness and Professions Code): i NO. PARKING I, as owner of the property, will do the work and the sracss PROVIDED structure is not intended or offered for sale (Section '+ 7044,Business and Professions Code). S PROPOSED USE OF BUILDING �,— ' CONSTRUCTION LENDING AGENCY i i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is li issued(Sec.3097,Civ.C.). i Lender's Name '1 PROPOSED MAX.OCC. Lender's Address I 25.00 { I certify that I have read this application and state that the PERMIT FEE above information is correct.1 agree to comply with all County I ISSUANCE FEE ordinances and Slate laws relating to building cons—tion, •.)tiW. hereby au ize representatives of this County to enter I TOTAL FEE 25°00 ' tl a e- d property for inspection purposes. 1 y SEE REVERSE FOR EXPLANATORY LANGUAGE X g ° ` I• • e of°urm:ttee Date � t -V.!OF.KERS'COMPENSATION DECLARATION 76M444 MISCE.LLANEOU' APPLICATION 20-0063DPW 12/90 I hereby affirm that I have a certificate of consent to se!f COUNTY OF LOS ANGELES � BUILDING AND SAFETY DIVISION insure.or a certifieute of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800. Lab.C.) – — Policy Na Company FOR APPLICANT TO FILL IN (BUILDING 8 G ADDRESS 4 ADDRESS ❑ Certified copy is hereby furnished. 1 G1[(.$ ��• .� I LOCALITY r ❑ Certified copy is filed with the county building inspection CIT Q'� ` ZIP / I NEAREST I department. r / CROSS ST. lop Date Applicant 61ZE OF 110T .r" NO.OF BLDGS.NOW ON LOT i DISTRI' rLo.n. GR TYPE P SSED BY a tvl7 OOy CONST. JIr CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT !7 ✓ BLOCK LOT NO. ! , 1 I COMPENSATION INSURANCE MAP HIGHWAY NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL 1 VSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) Cl I certifv that in the performance of the work for which this OWNER/ LLI TEL C� permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. ADDRES , 147 1 OCCUPANCY GROUP t I Date Applicant CITY7 ZIP 7�.0 NOTICE TO APPLICANT: If. atter making this Certificate I OCCUPANT LOAD of Exemption, YOU should become subject to the Workers' AOPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: 1 comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Know(. ❑ revoked. OCCUPANCY INSPECTION LICENSED CONTRACTORS DECLARATION ❑ Panic Devices ❑ I hereby affirm that 1 um licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS 3 and Professions Code.and my license is in full force and effec!. 1 I PARKING• REQ'D PROVIDED s License Number Lic. Class gel SPACES Contractor Date L LIMITED TIME USE _ DATE DATE ElI am exempt from the licensing requirements as I am 'a FROM: TO: licensed architect or a registered professional enginee! (NSP TOR'S acting in my professional capacity(Section 7051. Businesk SIZE OF NO.OF SI TURF and Professions Code). I EXISTING BLDG. STORIES PRESENT,USE OF BUILDING ^ FINAL APPROVAL Lic.or Reg. Na Date I � HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's Licens1 ) Law for the following reason (Section 7031.5. Business ancI Professions Code): NO.PARKING ❑ !1, as owner of the property, will do the work and the SPACES PROVIDED , structure is not intended or offered for sale(Section 7044. PROPOSED USE OF BUILDING Business and Professions Code). t i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued i (Sec. 3097, Civ.C.). PROPOSED MAX.OCC 1 Lender's Name ( APPLICANT(PAINT) TEL NO. Lender's Address I ADDRESS t 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.an� hereby authorize representativ of this County to enter upon ISSUANCE FEE the above-mentioned proper for inspection purp ses. �I TOTAL FEE � 1 ZlO-1 SEE REVERSE FOR EXPLANATORY LANGUAGE .I^ Sig cure of Pe tree Da r I WORKERS'COMPENSATION DECLARATION 78M444 CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 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 ADDRESS Certified copy is hereby furnished. BUILDING ADDRESS 3 LO�•ALITY 1 Certified copy is filed with the county building inspection LOCALITYTem le Cit NZ" sT. department. P Y Date Applicant NEAREST DISTRICT NO GROUP TY CON P ESSED BY CROSS ST. I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL CERTIFICATE COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NOP HIGHWAY CSTATE MAJOR SECOND LOCAL NO. OF BLOGS. (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 (S100) or less.) USE OF } 1 SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this k#JLUFI= as permit is issued,I shall not employ any person in any manner OWNER ` so as to become subject to the Workers' Compensation Laws. AtL OCCUPANCY GROUP c Mla. AD ORESs '� L 1 Date Applicant yI TEL' OCCUPANT LOAD - NOTICE TO APPLICANT: If,after malting this Certificate of X CITY` 1 .*_ Caig No. Exemption, you should become subject to the Workers' APPLICATI N FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall beTRAILER USE GEOLOGY INSPECTION _ NO Spec. KnOWI. El deemed revoked. — LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$$ FoniC Devices j 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 Bdsi- — NO. OF EXITS ness and Professions Code,and my license is in full force andr�I effect. �' PARKING REQ'O 1 1 PROVIDED ,f SPACES License Number Lic. Class LIMITED TIME USE Contractor Date I CATS OATE F qO M: TO: 1 am exempt from the licensing requirements as I am a I licensed architect or a registered professional engine: SIZE OF NO. OF INSPECTOR'S acting in my professional capacity 1See-ion 'Oa 1. Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING I 2--&V Lic.,or Reg.No. Date 1 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's fs-f ---�•— I License Law for the following reason (Section "031.5. Busi- 1;;116-0001 E1 ness and Professions Code): I NO PARKING PROVIDED �PARKING C 1, as owner of the property. will do the work and the SPA1�9 1 I'1 M 4=50I r structure is not intended or offered for sale (Section I 7044,Business and Professions Code). AGENCY PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENC 1 hereby affirm that there is a construction lending agency t 1 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. I Lender's Address ! 1 PERMIT FEE 25.00 , I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction. and hereby authorize representatives of this County to enter TOTAL FEE 25.00 t,si I upon the above-men ' ted property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �w O`? r12IF3foo Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 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 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 Certified copy is hereby furnished. BUILDING ADDRESS `� LOCALITY ADDRESS r Certified copy is filed with the county building inspection NEAREST department. LOCALITY ew o cRoss sT. Date Applicant EAREST ///� /r�/�t DISTRICT NO. GR UP rTYP PROCE55ED BY CROSS ST. V�ji/ G�� /'/� /y CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCKAP IGHWA Mv �-� STATE MAJOR SECOND LOCAL 7- This section need not be completed if the work involved NO. OF BLDGS. 1`t3I a2 USE ZONE 5 ECTAL CONDITIONS 0 0- (This TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) USE OF �L1JoR U in 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 NER IAI / w [/;; so as to become subject to the Workers'Compensation Laws. AIL OCCUPANCY GROUP V ADDRESS �_ w Date Applicant CL TEL V) NOTICE TO APPLICANT: If, after making this Certificate of CITY r NO. 2 2 —f�2.S OCCUPANT LOAD 2 Exemption, you should become subject to the Workers' AppLI6A ION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. NO Spec. Knowl. ❑ Panic Devices El CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OV Exlrs 9 (commencing with Section 7000)of Division 3 of the Busi- Ass 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 OFROM: 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). ESENT USE OF BUILDING �G' O � 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 J 3 69.5A License Law for the following reason (Section 7031.5, Busi- ness and Prdfessions Code): NO. PARKING SPACES PROVIDED :: • • •.• 88 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ° • • • • •'• z 7044, Business and Professions Code). OPOSED USE OF BUILDING n'7, CONSTRUCTION LENDING AGENCY � / I hereby affirm that there is a construction lending agency G 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 authorise representatives of this County to enter upon t ve-mentioned ro erty for inspection purposes. SEE REVERSE FOR EXPLANATORPYNGUACtE ignatUre of Per ttee Date WORKERS'COMPENSATION DECLARATION 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 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 BUIDLDREING lag ADSS 0 Certified copy is hereby furnished. BUILDING 8 LOCALITY /I ADDRESS ) /f/%tom// 0 Certified copy is filed with the county building inspection NEAREST i. jell department. LOCALITY It �� CROSS ST. Date ApplicantNEAREST / /J / DISTRICT NO. GR P TV PE OC SED BY CROSS ST. s Z (� (,��7 CONST, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP GNWAV NO. (CIRCLE) STATE MAJOR SECOND LOCAL a (This section need not be completed if the work involved NO. OF LOT USE ZONE SPECIAL CONDITIONS O P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) U USEOF SIZE OF LOT EXISTTING BLDG. G, o I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. LOOOMAIL OCCUPANCY GROUP w W Date Appllcan� ADDRESS 1j GjQ$ �jj/t/.� N TEL. Z NOTICE TO APPLICANT: If, after making this Certificate of-00, CITY �� (,/ NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLIC TION 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 PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- n7lss and Professions Code, and my license is in full force and PARKING. effect. SPACES REO'D O PROVIDED D L*ense 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 INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE IneSS and PfofeS510rIS Code). RESENT USE OF BUILDING '� �f' FINAL APPROVAL Lic.or Reg.No. Date 6 7,9 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS f ON LOT AND USE 0 S: I hereby affirm that I am exempt from the Contractor's �,;. 0 z License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING OSPACES 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). P POSED 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, and hereby authorize representatives of this County to enter TOTAL FEE upon tove-menti ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature omittee Date {' ! WORKERS'COMPENWON DECLARATION 7OM444DPw72' .MISCELLANEOUS' 'APPLICATION I hereby affirm that I have.a certificate bf consent to self COUNTY OF LOS ANGELES I = BUILDING AND SAFETY DIVISION i•Aftsure,or a certificate of:WdrkersI Compensation Insurance,or (� I ;a certified•copy thereof(Sed. 3800,Lab.C.). 1 , I Policy'No- Company FOR APPLICANT TO FILL.IN I BUILDING + : I ADDRESS BUILDING ADDRESS i I Certified copy.is.hereby:fumished �6 { S Tu N,4S /4 0 LOCALITY Certified copy is filed"with the county building inspection CITY ZIP' I NEAREST ! department TEI''LPLy C-ff V GSI- 17e CROSS ST. v: = Date Applicant SIZE OF LOT NO.O BLDGS.NOW ON LOT I DISTRICT NO. GROUP TYPE PROCESSED BY a I CONST. CERTIFICATE OF-EXEMPTION FROM WORKERS' TRACT BLOCKLOT NO. { V ( !COMPENSATION INSURANCE MAP HIGHWAY :y NO. !CIRCLE! STATE MAJOR SECOND LOCAL.. (This section need not be completed-if the work invbived ASSESSOR MAP BOOK PAGE PARCEL 4 USE ZONE �7ALCONDITIONS by the permit is for one hundred dollars ($100) or Mess.) I Q :., @r I TEL O. I certify that in the performance.of the work for which t ' p 1NI C 674 Z�7 41"7 a. permit is issued:I Shall not employ any person in any mann i so as to become subject to the Workers' Compensation Laws. ADOR SS OCCUPANCY GROUP Cn 4?7 LAS r,�NAS D� Z { i Date Applicant . _ CITY Tr ZIP /7 NOTICE TO APPLICANT: If; after making this Certificate D OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the4abor Code,you must forthwith comply with such provisions OC this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ NO Spec.Kr10WI. ❑ ' revoked. 1 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I I hereby affirm that I am licensed under provisions of Chlpter SAFETY PERMIT❑ (LIST ITEMS BELOW) t I 9(commencing with Section 7000)of Division 3 of the Bus ne NO.OF EXITS OuSlIIess and Professions Code,and my license is in full force and e e e ' PARKING• REO'D E= PROVIDED D License Number Lie Class tJ�T�A N SSI�i� .� d! SPACES I ! f I I Contractor Date N LIMITED TIME USE DATE DATE I ❑ I am_ exempt from the licensing requirements as I Int a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO.OF I INSPECTOR'S j•! acting in ray professional capacity(Section 7051,Business EX ISTING -ISTING BLDG. u Y STORIE§ SIGNATi1R l� and Professions Code).• Lie or Reg Na - Date I PRESENT USE OF BUILDING I FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE i I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Businessland ` A ( I Professions Code): NO.PARKING // /1 SPACES PROVIDED 'v ' i ❑ I, as owner of the property, will do the work and; t structure is not intended or offered for sale(Section�4 ROPOSED USE OF BUILDING i Business and Professions Code). I CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 1 the performance of the work for which this permit is issued ' (Sec.3097,CIV.Q. I PROPOSED MAX.OCC r ( I Lender's Name APPLICANT(FAINT) EL NO. /2REW a 62-6 2309 -12 Lender's Address ADDRESS ! I I certify that I have read this application and state that'the 05/ LAS 7i/NAS 'f} % TQM LE c/T f /7�o • above information is correct I agree to comply with all Co�nty PERMIT FEE ordinances and State laws'relating to building construction,and i hereby authorize rtpresentatives.of this County to enter upon ISSUANCE FEE ..46,', the above-mentioned property for inspection purposes. , ,! • i - { I''S'•' I �.. [GTOTAL FEE F. I' SEE REVERSE FOR EXPLANATORY LANGUAGE X ! ' d Signature or Permittee Date i .I 1L°URI:L'RS'COM PENSaTION DECLARATION 8 a CE 75 11 sal :S APPLICATIONMISCELLANEOI 1 11leby affirm that I have a certificate of consent to self COUNTY OF LOS .ANGELES BUILDING AND SAFETY DIVISION ' insure. or h certificate of Workers'Compensation Insurance. it a certified copy-thereof iSee.3800•Lab.C.1. — Policy No._—Company FOR APPLICANT TO FILL IN (BUILDING / / UJ 'ADDRESS C. Certified copy is hereby furnished. p BUILDING �y I / p A ADDRESS (� a J # LOCALITY 1 1 ❑ CeItified :opy is Fled with the county-building inspect;,-mi LOCALITY NEAREST department. Temple City ICRos5 ST. Date Appli antNEAREST � DISTRICT NO, GROUP TYPE ESSED BY • CROSS ST. - � I CER!'IFICATL••OF EXEMPTION FROM WORKERS' LEGAL CONS - CO\IPEMATION INSURANCE � CIES CPIPT:ON LOT N0. (BLOCK II MAY AIGNw AY NO., (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This section heed not Ile completed if the work invoked i-RAC-r NOW ON LOT 09E 'CONE SPECIAL CONDITIONS by the permit is for one hundred dollars 611101 or le;s.) 1IusE DFEXISTING BLDG. j SIDE OF LOT I ' 1 I 1 I certify that in :Ile perio:mance if :!le•.l•u;!; 'Ii:Which -h }F��r�� permit is issued. I illall :lot employ any pe-man :n am'manner X,OWNER 0/y1.�N%G /�d.CT£J`J�-p so as to become iuhiect -o the `�'or rs' t;:nae ion i.:rvs. NAIL OCCUPANCY GROUP _ n q I ADDRESS96 29 �j I DateS22�n� —9it •\pplica.. R D •.— -EL: - NOTICE TO APPLICANT: if. '.ct making :!lis CL—nu Bare :it XI CIT-'�� %y +lo. �/� 25��_��527 1 C)CCUP4N—!OdC Exemption. you ihould become ;ubiect :a she Wnrk•ri } aP L!CA i ICN( C)F _X17.4ARM%J'AF Compens.'llion rro:•itiions of rhe I_:►bot+.'.lde. you mus[ to�:h- r, •with conl(lly with .hill prll\•I\m,; or his •+ennir iharl,hl' -RAILER :OSE J GEOLOGY :NPPECTICYMo Soec S l�< ' deemedrevoked. — I . :io�vl. L� OCCUPANCY AN CY INSPE CTION� Panic Devises LICENSED CONTRACTORS DECL.-\R.aT1t)`:�• I' I hereby affirm :hat I am licensed uncle:prcvisions�.-&'haqter. — �� 1 C, SAFETY PERMIT LIST ITems BELOW) Illllllll[enl'IIlL +CI[h LIUPn 0001 4t DI\'Is1l1R � •+1 ale B{I U- NO. OF EXITS ncss and 1'•''+1'essiom Code. and my license ii in 'oil force Ind W ' effect. I; PARI SP%CESG REO 'D I I PR C`J ID ED License Number L.c. (-!as,— LIMITED TIME USE ii Contractor . ...._..-------__-_-- I+:Ire.—_-----._-.._...-.-.�.- OAre oA-E ❑ l am exempt t:om the ;Icensing requirement, as 1 aip .I licensed archirect or a re'_istered professional eneirif.er ;IZE OF Ir1sP crOR' actin_ in any prrits;iona!' :ar:wu: e: iva EXISTING SLOG. 3.0RIS3 S ATU iness and 1'rofessicn.Cade I. � — — 1 �j ' IrI 'RESENT USE OF BUILDING (FINAL APPROVAL [� qty i Lic. r Rea. No.. --- Da;o—_-- /J • I ijEJ 1 ILOML•' OWNER-I31•ILUER DECLARAI'ION III NO. OF EXISTING BUILDINGS ON LOT AND USE n P JC I hereby affirm that I am exempt from the Contrlctdrs / (� 1 License Law for the following reason I Section -1131.E. Busi- ness and Professions Coder: No. PARKING It ❑ 1• as owner of the property. will do e work :Ind 'rhe ]'PACES PROVIDED rh struc:urc is not intended or offered for isle (Section I 7044.BUShICSS:md Professions Code). V v A PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENC% I` I hereby affirm that there is a construction lending agency jL I 1 for the performance of the '.fork for which this permiis issued,(Sec. 3097,Civ.C.I. 'U DO D ✓% !7 Lender's Name.— -•— —_—._—. PROPOSED MAX. OCC. ` Lender's address ' ' 1 ! PERMIT FEE 25.00 I I certify that I have read this application and.state that he I above information is correct. I asree to comply with all Coll:tv ISSUANCE FEE j ordinances and State• laws relating to building construction. - i l and hereby authorize representatives of this County to eller TOTAL FEE 25.00 upon the mentioned prA erty for inspection purpose. _ SEE REVERSE FOR EXPLANATORY LANGUAGE tSignature of Permittee Date I •' WO :ERS'COMPENSATION DECLARATION I 768444 MISCELLANEOUS. APPLICATION ` CE 875 (2-80) I hereby a firm that I have a certificate of consent to self COUNTY OF LOS ANGELES SUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) I Policy No. Company l 3 FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS a�C Certified copy is hereby furnished. I UILDINSL9GG Lf r , 5�. LOCALITY A DRES1. E. WAS bR, ❑ Certified copy is filed with the county building inspection NEAREST department. G Loc LITY 1 G (� i gniza cRoss s _ Date Applicant AREsT a�D L� /1 ) DISTRICT NO. G UP TYPE P O SSED BY i ROSS ST. (`\1 C_� LV s I L.�L v. CONST. �f t CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK Mpp �}� H,GHyygy } No. 67b—� (clReLe) STATE MAJOR SECOND LOCAL (L NO. OF BLOGS. (T1ilS SCCtIOn need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE OF C_ , SIZE OF LOT EXISTING BLDG. l.. 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 L JM"NER 115 tj Q i U so as to become subject to the.Workers' Compensation Laws. L OCCUPANCY GROUP a rD RESS t f - �., 1.� �Date Applicant `M1J_NOTICE TO APPLICANT: If, after making this Certificate ofY 1� M LE C I QAR17 Q NOL OCCUPANT LOAD Exemption, you should become subject to•'the Workers' APP (CATION 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 ❑ o Spec. Knowl. El ClCldeemed revoked. I El ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION' Panic Devices I hereby affirm that I am licensed under provisions of Chapter 'I SAFETY PERMIT ❑ (LIST ITEMS BELOW) I NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- �. El ness and Professions Code, and my license is in full force and PARKING: effect. SPACES REq'D PROVIDED License Number Lic.Class \ I LIMITED TIME USE I Contractor Date DATE DATE ' FRAM: TO: F1I am exempt from the licensing requirements as I am licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus-' EXISTING BLDG. STORIES I SI NATURE iness and Professions Code). p SENT USE OF BUILDING — _ FIAL APPROVAL Lic.or Reg.No. Date �.c I N HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS i ON LOT AND USE I 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 ❑ 1, as owner of the property, will do the work and the I I structure is not intended or offered for sale (Section j 7044, Business and Professions Code). i OPOSED USE OF BUILDING 1� *573 A CONSTRUCTION LENDING AGENCY I 4 # 0 0 0 0 8 1. Y; I hereby affirm that, there is a construction lending agency � �^� 0 0 0 0 0 0 o z for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 1. Lender's Name Q 2 2':-$b PROPOSED MAX. OCC. Lender's AddressFE PERMIT E • I . 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, I TOTAL FEE h and hereby authorize representatives of this County to enter C r ./ upo th ve-mentioned propert for inspect: n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE (b ign tore of Pe DAte I WORKERS'COMPENSATION DECLARATION 176M444 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'pcertified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING z ADDRESS J C. ❑ Certified copy is hereby furnished. BUILDING /� .�/��f,y y LOCALITY -' e. _ ADDRESS 3/ f�IJ / *Pjr ®I�V '� ❑ Certified copy is filed with the county building inspection ` NEAREST department. LacALlry 7em. h C CROSS ST. Date Applicant NEAREST �`' DISTRICT Pp ROUP TYPE PROLE SED BYk.. CROSS ST. /L m /e- g1t� �10 �J_ CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Y COMPENSATION INSURANCEIN DESCRIPTION LOT NO. BLOCK MAP d a NIGNww- } No. (CIRCLE) STATE MAJOR SECOND LOCAL t1 NO. OF BLD GS. (This section need not be completed if the work involved TRACT I; NOW ON LOT USE ZONE SPECIAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) NSE OF /�1 U SIZE-OF LOT EXISTING BLDG. lj l It I certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner OWNER l�v7ih/Gt S so`as to become subject to the Workers' Compensation Laws. MAIL ` Jn /J�J.� q OCCUPANCY GROUP E. U LU ADDRESS ?�r �•i� �v�J�/f a. Date Applicant nn // /� U) NOTICE TO APPLICANT: If, after making this Certificate of j CITY � /[ L/T• o-ioL 7S%% 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 I TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ 11 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- El ness and Professions Code, and my license is in full force and PARKING PROVIDED . r'- effect. REQ'D � SP.AC ES I� License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE F1FROM: 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). 1 PRESENT USE OF BUILDING �j I'I'NAL APPROVAL 1 Lic.or Reg.No. Date— HOME ate HOME OWNER-BUILDER DECLARATION j NO. OF EXISTING BUILDINGS I ON LOT AND USE i 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): I NO.PARKING SPACES PROVIDED ❑ I, as.owner of the property, will do the work and the structure is not intended or offered for sale (Section -20 3 8.9 A 7044, Business and Professions Code). PROPOSED USE OF BUILDING t ' # eeDD88 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency D D o D o D D z for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 0717-81 Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE �{ IJr at I have read this applicat' i and state that the amation is or c I agree to o ply with all CountyISSUANCE FEEoandgSt 1 ws lating o uilding COnsirUCiIOR, TOTAL FEEaauthor e r Pres nta i s f this County to enter iv uove- olio ed prop fpyinspect ion purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE 11,31tl Signature of Permittee D to 7 ;WO KERS'COMPENSATION DECLARATION CE 875 M I SC E L LA N EO U S' A P P L I C AT I O N ►,.�� .' CE 875(17-84) I sure bo'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.Q. _ Policy No. Company FOR APPLICANT TO FILL IN BUILDING J ADDRESS FICertified copy is hereby furnished. BUILDING ` 3 r LOCALITY ADDRESS J 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. cRoSS ST. Date Applicant NEAREST ^ DISTRICT NO. G}iOU� CONST., / PMJSS ED BY CROSS ST* `, "J^l�l/Jy! SIV/1_/t!:{/.-� VVV CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I ` COMPENSATION INSURANCE DESCRIPTION I LOT NO. ` BLOCK MAP HIGHWAY No. ' O�,�,�( (eIR CLE) STATE MAJOR SE•OND LOCAL NO. OF BLDG S. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) US OF nil �\ 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 mann-f'--y OWNER WAIM so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP 2` o ADDRESS r �/ w Date Applicant C� TELa NOTICE TO APPLICANT: If, after making this Certificate of CITY � L No.' OCCUPANT LOAD :187' '7� �5 Exemption, you should become subject to the Workers' gppLICATION 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 El with revoked. El No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (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 Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INS NATURE TOR E acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. a STORIES 5 GATUR , i � iness and Professions Code). /—v PRESENT USE OF BUILDING Lie.or Reg.No. Date ) S FINAL APPROVAL � � I .� f 04-- HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 17 /I 4. ON LOT AND USE Z / 2 2 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- # e o o o 8 8 ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED o 0 0 0 o e o z structure is not intended or offered for sale (Section 7044,Business and Professions Code). O t'i 15-87 CONSTRUCTION LENDING AGENCY -13 PROPOSED USE OF BUILDING 6 f I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX.•OCC. Lender's Address • I certify that I have read this application and state that the PERMIT FEE MJ �Q 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 ,QQ upon the above-mentioned property for inspection purposes. `/�!S 7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION 75M444 CE 875(11-84) M ISCELL;ANEOUS(, APPLICATION I hereby..affiYm '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 any therebt(Sec.3800,Lab.Q. Policy No. - Company FOR APPLICANT TO FILL IN BUILDING �•�� ADORES / L•-��J '47Lsf. � FiCertified copy is hereby furnished. ILDING 31 ',' C LOCALITY DD ARESS Certified copy is filed with the county building inspection ALITYNEAREST department. G CROS s ST. Date Applicant NEAREST DISTRICT N GROUP TYPH CESSED BY CROSS GA �w. •� /� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VVWW��++ ?w+' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF a I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. shall o permit is issued,I not employ any person in any manner OWNER )C N ieu —1` � S' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS ~ O F- Date Applicant TEL. c7� v� •� ul NOTICE TO APPLICANT: If,after making this Certificate of CITY G No. �O �' � ( OCCUPANT LOAD y Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: z Compensation provisions of the Labor Code,you must forth- with comply with such provisions of 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 PARKING effect. SPACES RBq D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a PROM: O: licensed architect or a registered professional engineer SIZE OF STORIES SIGN INSPECTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STRE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date —Z HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS VU /I ON LOT AND USE Q -VT License I hereby affirm that I am exempt from the Contractor's D { fj i;(chili-0101 f 1 5/ License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 5- I.F AM ElI, 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 B ILDING I hereby affirm that there is a construction lending agency Q S for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this a licati tate that the D above information is co o comply wit all County ISSUANCE FEE ordinances and S awe ting to buildi onstruction, ,,and rize sentatives of ' County to enter TOTAL FEE 00 up abov a 'oned rt y inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature gMeermitte / e KER5'COMPENSATION DECLARATION . CE 875(11-84) MISCELLANEOUS APPLICATION affirm that I have a certificate 'of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION r a ertificate,of Workers'Compensation Insurance,or a cert .cLg thereof(Sec.3800,Lab.Q. . Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. ncnREss /� V /qs LOCALITY Certified copy is filed with the county building inspection LOCALITYNEAREST department. CROSS ST. Date Applicant NEARESTDISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) u3E OF d I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG.b o permit is issued,I shall not employ any person in any manner OWNER1 ,� b L.i9+20 S� so as to become subject to the Workers Compensation Laws. OCCUPANCY GROUP Date Applicant ADDI REs*- - _7_f-/ S 41eff Lo~val rEL• r OCCUPANT LOAD o_ NOTICE TO APPLICANT: If,after making this Certificate of CITY C ? NO Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICA ION FOR EXIT HARDWARE: —' with comply with such provisions or this permit shall. be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPE CTIO 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. �'livl PARKING REQ'D PROVIDED License Number Lic. Class SPACES Contractor Date d/SrJ Gs .Q IJe�s DATLIMITED TIME USE DATE ❑ I am exempt from the licensing requirements as I am a PROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OR INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). �� FINAL APPROVAL Lic.or Reg.No. Date r PRESENT USE OF BUILDING 1:fz �Lm� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �` O FEE 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 ,, El I, as owner of the property, will do the work and the SPACES PROVIDED 3518 11112;10 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING &ADA[ I hereby affirm that there is a construction lending agency - I� for the performance of the work for which this permit is v issued(Sec.3097,Civ.C.). Lender's Name I'1 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 th)riz LeFrese tives of this County to enter TOTAL.FEEpon th v n io p rt q�nspectio purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu V Permittee Date WORKERS'COMPENSATION DECLARATION 75M444 M I SC E L LA N E O U APPLICATION -hereby affirm that I have a certificate of consent tself CE 875 (1 1 84)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 FILL IN BUILDING AL'DRESS ❑ Certified copy is hereby furnished. A BU ILDINGL /� /t� T/ L� LOCALITY , /J ADDRESS RL/�l////// (r�) ,tel/ {/ /� <T(� I ❑ Certified copy is filed with the county building inspection LOCALITY /�A�7-6-H P& /i / JT NEAREST department. ( f( V{/ c I CROSS ST. Date Applicant NEAREST �4 to y ! /��l/ DISTRICT NO. GRQQQ///��P TY P6 CESSED BY CROSS ST. C /''ff C. [_ ( •J D ? CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP (CIR LU) STATE MAJOR SECOND LOCAL NC. (CIRCLE) NO. OF SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars (SI00) or less.) USE OF i SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this �f permit is issued, I shall not employ any person in any manner g pyyNER so as to become subject to the Workers' Compensation Laws. g MAIL DRu v �+'-4OCUPANCY GROUP o Date ADESS &- applicant ^ G q _ NOTICE TO APPLICANT: If,after making this Certificate of � CITI�G d / �-o,ypL OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth 1 with comply with such provisions oI this permit shall be TRAILER USE f-1 GEOLOGY INSPECTION I No Spec. Knowl. deemed revoked. J Panic Devices r LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION fS I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) L 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 T� r effect. / G c t �� Si RCESG REO•D PROVIDED y 1� License Number Lic. Class LIMITED TIME USE N Contractor Date PATE OA TE W I am exempt from *he licensing ^equirements as I am a ! licensed architect or a registered vrofessional eneineer 31ZE OF NO. OF NSPECTORS SIGNATURE 9 - Z acting in my professional capacity (Section 7051. Bus- EXISTING BLDG. STORIES iness and Professions Code). I FINAL APPROVAL 1 _l U 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 I L License Law for the following reason tSection 7,031.:. Busi- ness and Professions Code): NO. PARKING Q I, as owner of the property, will do the work and the SPACES PROVIDED J d�'� structure is not intended or offered for ;ale I Section 1 7044.Business and Professions Code). _ I PROPOSED USE OF BUILDING SC CONSTRUCTION LENDING AGENCY I lieteby 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 25.00 ( I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all Count\' ISSUANCE FEE t ordinances and State laws relating to building construction, •''' and hereby authorize representatives of this County to enter TOTAL FEE 25.00 L upon th7 above-mentioned pro erty for inspection purposes. / EE REVERSE FOR EXPLANATORY LANGUAGE mature of D_.rnit Date 76M444 )MISCELLANEOUS APPLICATION WORKERS' COMPENSATION DECLARATION 20-0063DPW:2/90 I I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I :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 BUILDING-DDRESS .— ADDRESS El Certified copy.is hereby:furnished. x LIS�� LOCALITY ❑ Certified copy is filed with the county building inspection CITY ZIP NEAREST ' department ) C�i CROSS ST. Date " Applicant SIZE OF -0T I NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY C CONST. r 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.) S !k�erty er TEL NO. i i I certify that in the performance.of the work for which this 70 1—\\ ; � �UR-TC Pk1 �F I- 0`y U I permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. ADOREss Y u k-} OCCUPANCY GROUP ( Date Applicant � zLe NOTICE TO APPLICANT: If, after making this CertificatelF �� < « 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. ❑ 1 revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E:J Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) �.� e , 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS and Professions Code,and my license is in full force and effect.19 game ot Busluess PARKING• REO'D O PROVIDED D License Number Lic. ClassSPACES .s' t I i Contractor Date _ LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE I � FROM: TO: licensed architect or a registered professional engineer acting in my professional capacity (Section 7051,Business SIZE OF NT-.OF INSPECTOR'S SIGNATURE. EXISTING BLDG. { I STORIES and Professions Code). Lic. Or Reg. NO. - D81e PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS 4-1 ON LOT AND USE - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and { Professions Code): No.PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING 0 F C Business and Professions Code). { I 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. Lender's Name APPLICANT(PRINT) TEL NO.. Lender's Address ADDRESS. t I t 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 authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. A\ TOTAL FEE - X � O-: � , r u `" ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate