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Home My Public Portal About9650-9652 LAS TUNAS DR_Miscellaneous__ ( I WORKERS'COMPENSATION llECLARA11UlV20-0063DPW12/90 M1bIL; ,L.LAIC h0Ub AFFLIUAI 1C.,li� 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 , ( j I a certified copy thereof(Sed.3800, Lab.C.)• d Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified copy.is hereby:furnishedL S MA/As ��, ' . X LOCALITY { I I ❑ �Cerrtiaffied c py is filed with the county building inspection CITY � �� /� ZIP�i��O NEAREST ' 1 s CROSS ST. Date `- Applicant SIZE OF LOT NO.OF BLDG.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' CONST. TRACT BLOCK LOT NO. I COMPENSATION INSURANCE MAPOHIGHWAY - N . (CIRCLE) STATE MAJOR SECOND LOCAL. (This section need not be completed if the work Involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I rer TEL NO. i I certify that in the performance.of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compenstition Laws. ADDRESS s • OCCUPANCY GROUP r � ( I Date 6 n1.Applicant CITY4/ ZIP o0 NOTICE T APPLICANT: If, after ma ' g this Certificate OCCUPANT LOAD of Exemption, you should become subj t 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. [� Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Ii I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW)g NO.OF EXITS t I 9(commencing with Section 7000)of Division 3 of the Business ame o tr<s ess and Professions Code,and my license is in full force and effect. LNbLie Class PARKING• REq'D � PROVIDED License Y O � � SPACES ' { I I Contractor Date LIMITED TIME USE i ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered FROM: TO: € g professional engineer acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. OO�j° jr STORIES ,q SIGNATURE, Lic. or Reg.Na Date PRESENT USE OF BUILDING FINAL APPROVAL t -o UI / � ' HOME OWNER-BUILDER DECLARATION No.OF EXISTING BUILDINGS ON LOT AND USE �• I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and { I 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 7044.1 PROPOSED USE OF BUILDING Business and Professions Code). I � — Ldp✓i9 I CONSTRUCTION LENDING AGENCY --VA j I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued t I i (Sec. 3097,Civ.C.). PROPOSED MAX.OCG j Lender's Name APPLICANT JERWr) TEL NO. 109 ld </• o Lender's Address A60RESS I certify that I have read this application and state that the 1423 iv-DgA=— leo 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. TOTAL FEE •. X SEE REVERSE FOR EXPLANATORY LANGUAGE- ,I , Signature of Permittee Date WORKERS'C'OMPENSAIION DECLARATION , /bM•tad 20-0U63DPW I2'9U MISCELLANEOUS--APPLICATION " � N \ -'— - 1 hereby affirm that I have a certificate or consent iX.II' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers'Compensation Insurance•% a certified copy thereof(Sec.3800• Lah C.) I Policy No. Company I FOR APPLICANT TO FILL IN BUILDING ® I DING A D SS ADDRESS Certified copy is hereby furnished. ., ' " Certified co ) b p LOCALITY copy is filed with the count building ins ection CIT *C" NEAREST .� department. CROSS ST. Date. Applicant SIZE OF LOT NO.OF BLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. (' C'ERTIFICKIT OF EXEMPTION FROM WORKI:Iti' TRACT BLOCK LOT NO. COMPENSATION INSURANCE MAP HIGHWAY l NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This Section need n01 1)C completed If Illi' work- III fol Vld ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS 1 by the permit is for one hundred dollars Ir 100) or,less.) (' R , r.• t TEL NO. 1 certify that in the performance of the work I(Ir which this „ , t I permit is issued. I shall not employ any person in any manner RDRE�M _ ('' so as to become subject to the Workers' Compensation La\vs. - 1� _', -w - - OCCUPANCY GROUP , Date __-. Applicant IP NOTICE TO APPLICANT: If, after milking this C'ertVicate / OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.you must forthwith i comply With such provisions or this permit shall be llfemCd TRAILER USE❑ GEOLOGY INSPECTION❑ I i revoked. p No Spec.Knowl. ❑ OCCUPANCY INSPECTIONIK Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of C'llapter SAFETY PERMIT❑ (LIST ITEMS BELOW( 9(commencing with Section 7000)of Division 3 of the Bu;;iness NO.OF EXITS aI and Professions Code.and my license is in full lime.old effect. ,1A �� l\2.tNrFSS PARKING• REQ•O PROVIDED `• I License Number Lie. ('lass X .. SPACES ! I Contractor Dale ----- -- T LIMITED TIME USE I DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO: flicensed architect or a registered professional engineer 'acting in m)' professional capacity (Section 71151, Business SIZE OF NO.OF INSPECTOR'S EXISTING BLDG. STORIES SIGNATURE I and Professions('ode). N PRESENT USE OF BUILDING FINAL APPROVAL . I Lie.or Reg. Na. . .. __.._._..... Date $�D,t,� . -1 I HOME OWNER-BUILDER DECLARAI70N -NO.OFr-xisrINGBUILDINGS ON LOT AND USE " I hereby affirm that I am exempt from the C'ontractor's Lic•Usti Law for the following reason (Section 7031.5• Business and l ; Professions Code): NO.PARKING iEl Las owner or the properly. will du the work and tileSPACES PROVIDED - --- structure is not intended or offered Illi sale(Section 704.1• PROPOSED USE OF BUILDING -- ----------- Business and Professions Code). I CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which [his permit is issued (Sec.3097,Civ.C.). PROPOSED MAX.OCC. Lender's Name __—_-___-_.._._.. ..._-. _- .-_j ... APPLICANT( INTI =L_M �' . X 14 Lender's Address . ._-.--.._ A RES9 I certify that I have read this application and state that the � above information is correct. 1 agree to comply with all C'utlnty I ordinances and State laws relating to building construction,and PERMIT FEE j hereby authorize representatives of this County to entertupon ISSUANCE FEE + the above-mentioned property for inspection purposes. ; U1• ` TOTAL FEE ' 10 I �( SEE REVERSE FOR EXPLANATORY LANGUAGE D ' ySignature of Permittee Date I I WORKERS'C'OMPENSA'ION DECLARATION \ eooc6:+l)PWi2au MISCELLANEOUS APPLICATION ' I hereby affirm that 1 have a certificate of consent d N.11. COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION •i� insure,or a certificate of Workers'Compensation Insurance.LhE a certified copy thereof(Sec.3800. Lab.C.) yj Policy No. Company FOR APPLICANT TO FILL IN BUILDING NBUILDING A DR S ADDRESS Do HCertified Certified copy is hereby furltislteLl. � � � LOCALITY copy is filed with the county building inspection CIT IP NEAREST `•� department. GROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. 1 CERTIIAC'ATE OF EXEMPTION 1:110M WORK1.16' TRACT BLOCKLOT NO. C ICIRCL NO. CIRCL �J COMPENSATION INSURANCE MAP AY EI STATE MAJOR SECOND LOCAL (This section need not be completed if the Work ill►ol%ed ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS r• by the permit is for one hundred dollars 0+100) or Ic%s.) (" t 1 certify that in the performance or the work lin• which this - TEL NO. ! I permit Is issued. I shall not employ any person in any normo:. _- so as to become subject to the Workers' Compensation Laws. ADDRE _ _ i_ OCCUPANCY GROUP tr, d. Date Applicant CI IP ' NOTICE TO APPLICANT. If. after making this C'ertVicate r OCCUPANT LOAD of Exemption, you should become subject to the Wvrkers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.you must forthwith comply with such pro:•isions or this permit shall be L(fented TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. ✓ I LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONS Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ ILIST ITEMS BELOW I a 9(commencing with Section 7000)of Division 3 of the Bu.,iness NO.OF EXITS and Professions Code,and my license is in full force and l31 N&SS PARKING License Number Llc.Class �/ SPACES REQ'D PROVIDED ' I I Contractor Date 7` T LIMITED TIME USE • I DATE DATE t El am exempt from the licensing requirements as I am FROM: TO: f i licensed architect or a registered professional engineer acting Ill my prolesslonal capacity (Section 7011. Business SIZE NG BLDG. NO.OF STORIES 'S GNATOURE and Proessions('ode). PRESENT USE OF BUILDING FINAL APPROVAL Lie or Reg Na Date ` I HOME OWNER-BUILDER DFULARAHON NO.OF cxisrINO BUILDINGS I ON LOT AND USE I hereby affirm that I ant exempt from the Contractor's License Law for the following reason (Section 7031.5. Business and Professions Code): NO.PARKING � ElLas Owner of the property. ►►ill du the a+n•k and thSPACES PROVIDED e - structure is not intended or offered Tal sale(Seel loll 704-1.4PROPOSED USE OF BUILDING I Business and Professions Code). �I I I CONSTRUCTION LENDING AGENCY i1 hereby affirm that there is it consu•uction Icnding;1901cy for the performance of the work for which this permit is issued ' { • I (Sec. 3097,Civ.C.). PROPOSED MAX.OCC. *•J I Lender's Name _.__ _. X APPLICANT UrT) I Lender's Address __. A RESS .JIB D6 I certify that I have read this application and state that the ffamd,G above information is correct. I agree to comply with all County PERMIT FEE I 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. �• ` TOTAL FEE !x ` SEE REVERSE FOR EXPLANATORY LANGUAGE I Signature of Permittee Date IL v I e t r WORKERS'COMPENSATION DECLARATION ; CE 875(2-80) MISCELLANEOUS APPLICATION CE 875 Thereby 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 BUILDING K"� ❑ FOR APPLICANT TO FILL IN ADDRESS V Certified copy is hereby furnished. BUILDING / LOCALITY ADDRESS J� Certified copy is filed with the county building inspection NEAREST department. LOCALIT-k CROSS ST. Date Applicant NEAREST DISTRIC N GROUP TYPE JPROE BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGALIZ . COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY } rvo.NO. F BLDGS. (CIRCLE) STATE MAJOR SEC O LOCAL d ' (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE of //p^/ SIZE OF LOT EXISTING BLDG. ( - .^ cc AA I certify that in the performance of the work for which this t �v/ Q permit is issued, I shall not employ any person in any manner OWNER r'A ��^ I L. t - (-- so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP W ADDRESS d Date Applicant ( U3 NOTICE TO APPLICANT: If,"after making this Certificate of CITY ( - I 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 PERMIT 1--I (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. SPACES REO'D O PROVIDED .� License Number Lic.Class LIMITED TIME USE Contractor Date I 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 tTUREiZ iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL — Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ,,. I SPACES PROVIDED ❑ I, as owner of the property, will do the work and the -structure is not intended or offered for sale (Section ;23366A 7044, Business and Professions Code). PROPOSED USE OF BUILDING � r J CONSTRUCTION LENDING AGENCY 7 # 088 , I hereby affirm that there is a construction lending agency D D o a o D D z for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. 1 1. 01 -85 I 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, f TOTAL FEE and hereby authorize representatives of this Co my to enter up o the above-mentio a pr ert for inspe gn� rpos . SEE REVERSE FOR EXPLANATORY LANGUAGE ignature Permittee Dae • 11 MARKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION eaffirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION k , y ure,ebor a certificate of Workers'Compensation Insurance,or ' a certified copy thereof(Sec.3800,Lab.C.) 1 Policy No. Company FOR APPLICANT TO FILL IN ADDRESS (({ �• /OS7ZCA.1 D2, ❑ Certified copy is hereby furnished. BUILDING 7tlS� y LOCALITY I r /11 ❑ DRESS J W 0, Certified copy is filed with the county building inspection J V NEAREST department. L ALITY CROSS ST. LVD � L Date Applicant NEAREST Q/J DISTRICT NO I GROUP ITYPE O PRC SSED BY CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �f V DESCRIPTION LOT NO. BLOCK MAr n NIGNwpv ND LOCAL STATE MAJOR SE COMPENSATION INSURANCE ND.15V_2 5V� A (CIRCLE) a NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT IUSE ZONE SP CIAL CONDITIONS V 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 Q permit is issued, I shall not employ any person in any manner J o4AWNER so as to become subject to the Workers' Compensation-Laws. MAIL �� +� OCCUPANCY GROUP lal �dLIiLLO lJI. " ADDRESS , L�' CL Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate ofclrY . ITv, —2012- OCCUPANT LOAD z Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- AP KATION FOR I EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ' GEOLOGY INSPECTION NO Spec. Knowl. ❑ deemed revoked. 11 Panic D2VIC@S ❑ LICENSED CONTRACTORS DECLARATION. OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) I 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 andLr ARK ING. effect. SPACES REO'D PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I ami a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO..OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). FINAL APPROVAL .SENT USE OF BUILDING n/ 7 Lic.or Reg.No. Date P&J n G/ HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby 'affirm that. I am exempt from the Contracto'r's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING , V SPACES PROVIDED , ❑ I, as owner of the property, will do the work and the R 2 5.6-9-A structure.,is not intended or offered for 'sale (Section_ # 0 0 o o 88 7044, Business and Professions Code). �l up-PeOSED USE OF BUILDING I •0 0 0 0 0 0 o In CONSTRUCTION La construction AGENCY Ly 9 •r . , � Q A /J � I 07.30,-85 I hereby affirm that there is a construction lending agen .�J r�-f TQC ,dam- for the performance of the work for which this I p permit his issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE f l I certify that I have read this application and state that the ISSUANCE FEE v / above information is correct.I agree to comply with all County ordinances and State laws relating to building construction, TOTAL FEE V and hereby authorize representatives of this County to enter upon the above-mentioned property for Inspec Ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLICATION CE 875 (2-80) eie, o affirm that I have a certificate of consent nc 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. BUILai NG LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY V CROSS ST. Date Applicant EAREST f� DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. �V�{ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY >_ No. (CIRCLE) STATE MAJOR SECOND LOCAL 0. NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOTUSE ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE OF SI E OF LOT EXISTING BLDG. W 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 OWNERPC 1 G U so as to become subject to the Workers'Compensation Laws. OCCUPANCY GROUP AIL LU io ADDRESS iIS9 �D N Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY ITuo� OCCUPANT LOAD Exemption, you should become subject 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 ❑ Cl No Spec. Knowl. deemed revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (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 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 §AGNATURE iness and Professions Code). FINAL APPROVAL 090O.-ENT USE OF BUILDINGAil /' Lic.or Reg.No. Date a• /GL �C� HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's A 0 8 3.9 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # 0 0 0 0 8 8 SPACES PROVIDED ❑ I, as owner of the property, will do the work and the o D o 0 0 0 o z structure is not intended or offered for sale (Section 7044,Business and Professions Code). OPOSED USE OF BUILDING I Q09-84 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 Q� and hereby authorize representatives of this County to enter upon 1 above- enti ned operty for inspection urpos SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perm ee Date W� CE 87 I CE 87RKERS'COMPENSATION DECLARATION a5 (11-84) MISCELLANEOUS 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 dopy thereof(Sec.3800,Lab.C.). i BUILDING ell e Policy No. Company FOR APPLICANT TO FI LL IN ADDRESS ❑ Certified copy is hereby furnished. ILDING LOCALITY /C� ADDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. cRoss sT. Date Applicant NEAREST ' CS. GROUP TYPE PROCESSED BY OSS ST. DISTRICT N / % CONST.�� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP NIGNwav STATE MAJOR SECOND LOCAL NO. (CIRCLE)NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. �� / I certify that in the performance of the work for which this A , o permit is issued, I shall not employ any person in any manner I WNER oq C, =' so as to become subject to the Workers' Compensation Laws. MAIL D OCCUPANCY GROUP o DDRESS La b Date Applicant I„ NOTICE TO APPLICANT: If, after making this Certificate of TYoL' � J�l OCCUPANT LOAD Exemption, you should become subject to the Workers' _ Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS ness and Professions Code,and my license is in full force and ^�y eeqq .( / G s effect. /�A�E e� "An-'I' /�//�✓s. PARKING Rrm Wo PROVIDED SPACES License Number Lic. Class A1Z5k-&T&VS LIMITED TIME USE Contractor Date -1171 DATE DATE I am exempt from the licensing requirements as I am a _ licensed architect or a registered professional engineer SIZE OF NO. OF EcroR s FROM: TO:}L,��} �gx:� acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES '! 3_ {I" �F:31 c ORI mess and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date64 VA OU _ //• c i { HOMEOWNER-BUILDER DECLARATION No. OF EXISTING BUILIbINGS 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 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). J 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. OCG. Lender's Address I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL.FEE upon the above-mentioned property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE oe Sign re of Permittee ��Dat, WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I�CELLAN EOUS APPLICATION I hereby affirm that I have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or,�cel irate of Workers'Compensation Insurance,or a certified v�y tlg&eeof(Sec.3800,Lab.Q. Policy No. Company 1 FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is hereby furnished. Aucees9 L Lr'i� (-11`I ISS i,�I. ! LOCALITY -�' ❑ Certified copy is filed with the county building inspection 10RESY r NEAREST department. '^ ^�''^ �`„� j '� t• I CROSS ST. Date Applicant NEAREST DISTRIS,T NO. FPROUP TYPE PROLE ED BY CROSS ST. / CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP ` HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLD GS. ��!! NO. Ja- (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPE IAL 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 1S issued,I shall not employ any person In any manner OWNER N so as to become subject to the Workers' Compensation Laws. — OCCUPANCY.GROUPIV ' y3 Date .Applicant ADDRESS \^� � 1•:s` il f 1 `ti \•. 6~7 _ LSI NOTICE TO APPLICANT: If after mak' this Certificate of CITY TOL** I OCCUPANT LOAD °- Exemption, you should become subject to the Workers' ,� ' � �� Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be TRAILER 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 AFETY PERMIT ❑ (LIST ITEMS BELOW) ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- 9 NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REO'DD PROVIDED SPACES O License Number Lic. Class ) LIMITED TIME USE Contractor Date t I=.-.I 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 SIG"TURE iness and Professions Code). ' ESENT USE OF BUILDING FINAL APPROVAL�� / Lic.or Reg.No. Date (/ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSA 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 ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 4507 1 AM10:05 structure is not intended or offered for sale (Section 7044,Business and Professions Code). 00, CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency -e In for the performance, of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name r� PROPOSED MAX. OCC. V 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 St a laws relating to building construction, and hereby auth iZe representatives of this County to enter TOTAL.FEE 05, +u n the ove- entioi mperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �' nature of Permittee Date WORKERS'COMPENSATION DECLARATION I CE 875(11-84) MISCELLANEOUS APPLICATION I ,hereby affirm that I have a certificate' consent tself' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure., or a certificate of Workers'Compensation on Insurancc e,or; a certified copy thereof(Sec.3800,Lab.Q. , Policy No. Company FOR APPLICANT TO FILL IN BUILDING n ADDRESS y`j- ❑ Certified copy is hereby furnished. NJ AnnRess oil.� LOCALITY L C ❑ Certified copy is filed with the county building inspection LOCALITY Y NEAREST department. )CROSS ST. TYP PRO IE SED BY Date Applicant EAREST (: �/L C DISTRICT NO. G i CROSS ST. 4\4 /moi rJ CONST. ✓ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SEC LOCAL 'NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. 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 S , j y so as to bdcome subject to the Workers' Compensation Laws. AIL r� OCCUPANCY GROUP r o ADDRESS rrQ� U V F Date Applicant V CEL. a NOTICE TO APPLICANT: If,after making this Certificate of CITY SW C,,,� 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 oI 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 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 PROVIDED SPACES License Number Lie. 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 INSP CTOR'S acting in my professional capacity (Section 7051, Bus- 2XISTING BLDG. STORIES SI NATURE iness and Professions Code). l� ` PRESENT USE OF BUILDING I�''�� li � d- 1NAL 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 License Law for the following reason (Section 7031.5, Busi- ness usiness 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). A 7.7 9..2.A CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ' •0 0 0 0 $$z I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 08.31 -87 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 eoole odinance nd State laws relati to building construction,and here y authorize re resentat' esofthiS County to enter TOTALFEEN,pTn the o entioned p per or insp ctioni u ose. �.^) SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Permit a Date WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have 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 ADDRESS Ah Certified copy is hereby furnished. LDING es q J_ �� L ±J� 01? LOCALITY ADDRESS 1l� of rl C. Certified copy is filed with the county building inspection NEAREST department. OCALITY 'T t=/'1 I_ C�TCROSS ST. _ Date Applicant EAREST 1 G.r �r +�, DISTRICT NO. GROUP TYPE PROC ED BY CROSS ST. �Ar� L{,��. ice`✓ ��/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL f YJr COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP IGRWAY STATE MAJOR SECOND LOCAL NO. O;Z �J (CIRCLE) (This section need not be completed if the work involved NO. OF LOT USE z NEFEIIAL CONDITIONS d l P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) U USE OF SIZE OF LOT EXISTING BLDG. /� ^ I certify that in the performance of the work for which this .J permit is issued, I shall not employ any person in any manner WNER M A ' `+"I so as to become subject to the Workers' Compensation Laws. AILOCCUPANCY GROUP ADDRESS 115 S H1�Rv,� W Date Applicant 5A� M�� TEL.) OCCUPANT OCCUPANT LOAD Z NOTICE TO APPLICANT: If, after makingthis Certificate of clrY J J 1 NO. ! _ Exemption, yod 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 E] 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 (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 PROVIDED LIicense Number Lic.Class LIMITED TIME USE *�Mtractor 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). ENT USE OF BUILDING C FINAL APPROVAL O ' _ 1 Lic.or Reg.No. Date VVV VVV z369, 3A 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 O I, as owner of the property, will do the work and the 7 15—83 structure is not intended or offered for sale (Section 7044, Business and Professions Code). &>-S-- USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency Cw' 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 here au 'ze representatives of this County to enter upon a bove- n1liAed property for inspecti purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r 3- Si n• ure of Permittee Date WORKERS'COMPENSATION DECLARATION E 875 (2-801 CMISCELLANEOUS APPLICATION CE 875 I hereby affirm that•I'have 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 ADDRESS ❑ 01< IV Certified copy is hereby furnished. uILDING❑ Y DRSSS //� LOCALITY Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PRO SS�D AY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 2� / COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP ]I NIGH WAY NO. �oV� (CIRCLE) STATE MAJOR SECOND LOCAL Q. (This section need not be completed if the work involved TIRACT NO. OF BLDGS.NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF �i�l U OF LOT • D EXISTING BLDG. I certify that in the performance of the work for which this 1 t U permit is issued, I shall not employ any person in any manner NER(J" fJ 7,fj so as to become subject to the Workers' Compensation Laws. IL l / �!. -�, / OCCUPANCY GROUP Q U / J J nt ,O/✓ ✓ CJ to ADDRESS LU Date Applicant TELt/7 NOTICE TO APPLICANT: If, after making this Certificate of TTY ' NO.. i OCCUPANT LOAD z Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE[] GEOLOGY INSPECTION NO Spec. Knowl. ❑ deemed revoked. Panic DBVICOS ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (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 . effect. PARKING SPACES REO'D O PROVIDED D License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FRDM TO: INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL I��►.yJ( rL_ Lic.or Reg.No. Date V o P i✓f /lid,! 3l91fjiYefAl HOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the -Contractor's 4 1 5 3 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING O ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section • • • • • • •SPACES PROVIDED # • • • • 4 z 7044, Business and Professions Code). ROPDSED USE OF BUILDING 0223—8 1 CONSTRUCTION LENDING AGENCY /G 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 PERMIT FEE I ;ertify 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 nd her tithorize representatives of this County to enter ion ab v - enti ed p r for inspec llo�n purposes. SEE REVERSE FORE PLANATORY LANGUAGE �J L=, �gnatu of ermittee Date WORKERS'COMPENSATION DECLARATION E 875 (2-80) CMISCELLANEOUS 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.) PolicyNo. Com any UI1.-.IN P FOR APPLICANT TO FILL IN ADOss .J ❑ Certified copy is hereby furnished. do^BUILDING • LOCALITY DDRESS ElCertified copy is filed with the county building inspection / r NEAREST /007 department. LOCALITY �� ." CROSS ST. Date Applicant NEAREST IDISTRICT O. GR P TYPE PRO SSED BY CROSS ST. `Q CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK AP HIGHWAY STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved NO. OF BLDGS. . (CIRCLE) P TRACT NOW ON LOT E ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) of less.) U USE OF �{ SIZE OF LOT EXI WiG BLDG. .� I certify that in the performance of the work for which this •= VVVCr O permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. IL � y�� OCCUPANCY GROUP I ��,i(I--��J�I U D DRE �� UJ Applicant � NOTICE TO APPLICANT: If, after making this Certificate of TY'/ TrioWIJ OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION NO Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION Panic D@VICE$ EJ INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (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 License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: MI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF N TR'S acting In my professional capacity (Section 7051, Bus- XISTING BLDG. / STORIES SIGNATURE mE _ //Y mess and Professions Code). RSENT USE OF BUILDING !)) C .49 / FINAL APPROVAL �J- 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 9'8 5 4,6 A structure is not intended or offered for sale (Section 7044, Business and Professions Code). P }*} p o 8 ROPOSED USE OF BUILDING tF • • � • O CONSTRUCTION LENDING AGENCY A/� � • • • • • • • z' I hereby affirm that there is a construction lending agency �i for the performance of the work for which this permit is 12 23-82 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 O qig.nat10.f5Pk.r,__.,above- etioned property f or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /ittee '7•'— Date `l 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 ADDRESS ❑ Certified copy is hereby furnished. BUILDINGLOCALITY ` ' ❑ ADDRESS . Certified copy is filed with the county building inspection l NEAREST department. LOCALITY J.� CROSS ST. Date Applicant AREST / DISTRICT NO. GROUP TYPE PR SSED BY CROSS ST. R' `� CONST' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 43 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP SRN AY d NO. L� (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved NO. OF LOT USE ZONE SP CIAL CONDITIONS P TRACT NOW ON LOT 0 by the permit is for one hundred dollars ($100) or less.) U USE OF SIZE OF LOT EXISTING BLDG. (� I certify that in the performance of the work for which this r O permit is issued, I shall not employ any person in any manner OWNER H so as to become subject to the Workers' Compensation Laws. AIL }''' / p OCCUPANCY GROUP I /s�� W ADDRESS/7VJ L/ a Date Applicant n n to NOTICE TO APPLICANT: If, after making this Certificate of CITY05;9 // 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 E] GEOLOGY INSPECTION NO Spec. Know[. ❑ deemed revoked. Panic DOVIC@S ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (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. REq'D PROVIDED SPACES i4icense 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). FINAL APPROVAL RESENT USE OF BUILDING Lic.or Reg.No. Date1 T /4/ O' r �. 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 El 1, as owner of the property, will do the work and the 1.8 P. structure is not intended or offered for sale (Section 7044, Business and Professions Code). ){' • • • • ' ROPOSED USE OF BUILDING � CONSTRUCTION LENDING AGENCY • • 0 0 0 • • L l / /(� L n 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 5.1 Q— 4 issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that 1 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 building7construction, TOTAL FEE and hereby authorize representativ of this u ty to enter upo the above-mee,n�Atio d r er for on rp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE vI Signature of ermittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.) Policy No. CompanFOR APPLICANTBUILDING Ga y TO FILL IN ADDRESS ❑ Certified copy is hereby furnished. euILDING LOCALITY ADDRESS %S6 �� ❑ Certified copy is filed with the county building inspection DEAREST department. LOCALITY `T�G CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TV PE PROC SED BV CROSS ST.j4aVke C L > / �� CONST./ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /Y V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY a NO. o67 (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work. involved NO. OF BL T USE ZONE SPECIAL CONDITIONS 0 P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) V USE OF SIZE OF LOT EXISTING BLDG. C cc I certify that in the performance of the work for which this Q permit is issued, I shall not employ any person in any manner OWNER V U so as to become subject to the Workers' Compensation Laws. MAIL 1 OCCUPANCY GROUP �� W ADDRESS Date ApplicanttJS!SL: Z TEL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITU No. 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 DeVIC@S ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (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 TO: DATE F1FROM: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional Capacity (Section 7051, Bus- EXISTING BLDG. STORIES , SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL, Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EON LOT ANXISTING BUILDINGS D 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 0 2 9,Jr A SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # 0 0 0 • 8 8 7044, Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 7, �'.0—8 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. 1 agree to comply with all County ISSUANCE FEE `- ordinances and State laws relating to building construction, TOTAL FEE v7'� and hereby authorize representatives of this County to enter D upon.�the above-mentioned property for inspection purposes. SEE REVERSE 1 OK EXPLANATORY LANGUAGE Sign re of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensatiti on insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.) C 7 Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. / BUILDING I LOCALITY ADDRESS Certified copy is filed with the county building inspection n NEAREST r department. ocaurY l C� CROSS ST. Date Applicant NEAREST /j / DISTRICT NO GROUP TYPE PROC SSED BY CROSS ST.i/i• G !'��y �� CONST. i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J Q V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP R,�Hy,Ay STATE MAJOR SECOND LOCAL 9L NO. �(J (CIRCLE) (This section need not be completed if the work involved NO. OF LOT USE ZONE SPECIAL CONDITIONS 0 P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) USE OF C 0 SIZE OF LOT EXISTING BLDG. Lr 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 OWNERMAN so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP �,—� 0 ADDRESS S6 /N^� W Date Applicant N NOTICE TO APPLICANT: If, after making this Certificate of CITY ' NOL 3 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 USEGEOLOGY 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- ness and Professions Code, and my license is in full force and PARKING REO'D E== PROVIDE. SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ElFROM' 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). L PRESENT USE OF BUILDING FINAL APPROVAL ,t—;t_ 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 El [, as owner of the property, will do the work and the SPACES PROVIDED 9 2 9 4,0 A' structure is not intended or offered for sale (Section 7044, Business and Professions Code). # • • • • 8 8 'PROPOSED USE OF BUILDING - � I CONSTRUCTION LENDING AGENCY • • • • • • • I hereby affirm that there is a construction lending agency 0212-8 2 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 s /, C, upon the Bove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /- Signat o rmit ef Date �i WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800, Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING �•D 1, LOCALITY d ADDRESS Certified copy is filed with the county building inspection NEAREST department. 'LOCALITY �� >(� L CROSS ST. Date Applicant AREST �L.T DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. 1 G� JI CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL / COMPENSATION INSURANCE DESCRIPTION .., BLOCK M P -HIGHWAY } rvo. ��j (CIRCLE) STATE MAJOR SECOND LOCAL Q. (This section need not be completed if the work involved NO. OF BLDGS. USE ZONE sP CIAL CONDITIONS P TRACT NOW ON LOT �./ by the permit is for one hundred dollars ($100) or less.) U USE OF NG BLDG. I certify that in the performance of the work for which this SIZE OF LOT EXISTITI _�. 2-rO permit is issued, I shall not employ any person in any manner WNER P P Y Y� 0 so as to become subject to the Workers' Compensation Laws. ADDRESS All _ �, OCCUPANCY GROUP � LU Date Applicant r I to TEL. NOTICE TO APPLICANT: If, after making this Certificate of TY ')No. 3 OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- nes4 and Professions Code, and my license is in full force and effect. PARKING.SPACES REO'O PROVIDED Lidense Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM. ro. INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL SENT USE OF BUILDING c�c Ck Lic.or Reg.No. Date 1 ((( HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 9 `] j 0 A ON LOT AND USE n • (` 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 • • • • • • • In SPACES PROVIDED 1 I, as owner of the property, will do the work and the O J_ 4 structure is not intended or offered for sale (Section 7044, Business and Professions Code). 4.151�POSED USE OF BUILDING l CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). Lender's Name 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 ab ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date