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Home My Public Portal About9654-9656 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76CE 8;54(11.84) MISCELLANEOUS APPLICATION I hereby affirm that i have a certificate of consent tself COUNTY OF LOS ANGELES- BUILDING AND SAFETY DIVISION insure, o= p-Eertificate of Workers'Compensation Insurance, e,or a certified co y thereof(Sec.3800,Lab.Q. PolicyNo. Company BUILDING FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. LD �� ' T C DORESSING LOCALITY ❑ Certified copy is filed with the county building inspectionNEAREST department. LOCALITY CROSS ST. Date Applicant &REST I Al J DISTRICT NO ROUP TYPE P. CESSED BY ROSS ST. 3 /'�n� "� CON B'r� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J/ !/ y COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. OF NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOW ONLOT TS. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.). USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this z/_ y permit is issued,I shall not employ any person in any manner owN so as to become subject to the Workers' Compensation Laws... MAIL ADDRESS i3 OCCUPANCY GROUP, ® C ) Date Applicant NOTICE TO APPLICANT: If, after making this Certificate ofITYo .ted OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions oI this permit shall be TRAILER 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) 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. Oi" �yl�/p7�//GJS' PARKING REq'D PROVIDED /I SPACES License Number Lic. Class S c � LIMITED TIME USE Contractor Date dne D ATE DATE ❑ I am exempt from the licensing requirements as I am a C/ licensed architect or a registered professional engineer SIZE OF NO. OP FROM: To: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date RESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION Pld. OF EXISTING BUILDINGS MCI 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 (Elji3,!??—l €.j) ! ❑ I, as owner of the property, will do the work and the SPACES PROVIDED �".7pri - structure is not intended or offered for sale (Section r`~' c i- 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING (� I hereby affirm that there is a construction )ending agency I V for the performance of the work for which this permit is +� issued(Sec. 3097,Civ.Q. n �D Lender's Name �J PROPOSED MAX. OCC. / b Lender's Address Y1J ' PERMIT FEE .d 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 here y authorize representatives of this County o enter TOTAL FEE `�O upon above-mentio d property for insp�ion p ?ses. !� � SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re ermittee Date I ' WORKERS'COMPENSATION DECLARATION 176M444 MISCELLANEOUS APPLICATION •eg ••. °•441.:• Cc 875(2-80) I hereby affirm that I have a certificate of consent nc ,or ( COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or I a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company. BUILDING �� rq� ❑ FOR APPLICANT TO FILL IN PDD N. .(.(� Certified copy is hereby furnished. BUILDING -6 LOCALITY ❑ ADDRESS qC Certified copy is filed with the county building inspection LOCALITY NEAREST de rtme t. (� 0 CROSS ST. Date Applicant l. 0 � � - NEAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. V�-% ! ry �_ CONST. //• L CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d (/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL (L NO. OF BLOGS. O '(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 EX's TINGTI 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 OWNERC -Z rV U so as to become subject to the Workers' Compensation Laws. i OCCUPANCY GROUP W Date Applicant ADDRESS tl t� �� l� N NOTICE TO APPLICANT: If, after making this Certificate of CITY {�� No� {� Q Q .J 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❑ I No Spec. Knowl. ❑ deemed revoked. Panic D8VIC8S ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION g 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.c SPACES ' REO'D O PROVIDED O License Number 1 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 J ) NO. OF INS CTO R'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 1 STORIES r� SI TORE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL IBJ `'JS iw `(� J iI;p Lic.or Reg.No. Date I r - L ' HOME OWNER-BUILDER DECLARATION NO.OF E I ON LOT AND USE USESTING BUILDINGS _ z� �lF li�jl I"(fC, l I hereby affirm that. I am exempt from the Contractor's Yl,:l,-tf,C License Law for the following reason (Section 7031.5, Busi- I �' %� NO. PARKING U� Ir- !`'� Hess and Professions Code): SPACES PROVIDL ED InI, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). PROPOSED USE of BUILDING CONSTRUCTION LENDING AGENCY � ul I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is \ issuedSec. 3097, Lender's Name- � C _ � PROPOSED MAX. OCC. Lender's Address PERMIT FEE 6 49 • I certify that I have read this application and state that the Vr above information is correct.I agree to comply with all County I I ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize re rese atives of this County to enter upon t above-me do d pr ,erty for inspec 'on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SI at re of Permittee Date WORKERS'COMPENSATION DECLARATION .CE 875(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 copy thereof(Sec. 3800,Lab.C.). _ Policy No. Company FOR APPLICANT TO FILL IN kRF_ / (� Certified copy is hereby furnished. BUILDING �rl !�,r TUNAS S DORESS 544 L FICertified copy is filed with the county building inspection v L CALITY Tdepartment. T.Date Applicant NEAREST T NO. TYPECROSS ST. -G CONSTCERTIFICATE OF EXEMPTION FROM WORKERS' LEGALCOMPENSATION INSURANCE DESCRIPTION LOT NO. ✓ �L/ BLOCK — (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOW ON LOT NO. OF S. E SP CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF • I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. o permit is issued, I shall not employ any person in any mannerOWNER IV (' L ® SP so as to become subject to the Workers' Compensation Laws. MnneEss 7Fl1 S /}f/ OCCUPANCY GROUP F Date Applicant � r� LCL+ TEL' OCCUPANT LOAD O NOTICE TO APPLICANT: If, after making this Certificate of CITY /��0D/A q(OC+ No. !�'�$ �n Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE [:] GEOLOGY INSPECTION ❑ ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE OATS FROM: TO: F] I am exempt from the licensing requirements as I am a licensed architect of a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXI TING BLDG. STORIES S GNATURE iness and Professions Code). /RESENT /� USE OF BUILDING FINAL APPROVAL .��y[1 A Lie.or Reg.No. Date (�((� lJ RNAAfR6 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSIn ON LOT AND USE O O O O O O O Z I hereby affirm that I am exempt from the Contractor's .11.05-86 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 0 I, as owner of the property, will do the work and'the SPACES PROVIDED 1 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING U ' I hereby affirm that there is a construction lending agency o RN I Off 9- 1 fr$ � tia jUS. 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 ounty to enter TOTAL.FEE upo •the abov mentionedp/rop/ert�yf�or insp tion purposes. :�% d A f SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date j WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS 7644 aarIA4 Certified copy is hereby furnished. BUILDING �' ,'� LOCALITY ADDRESS Jv Certified copy is filed with the county building inspection LOCALITY , NEAREST department. f �� ceoss sT. Date Applicant NEAREST / DISTF�k GRAUP TYPE PR ESSED BY CROSS ST. �(_ CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP J^ HIGHWAY Ho.�^^� (CI.C LE) STATE MAJOR S OND LOCAL NO. OF BLDGS. (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 SIZE OF LOT E [STING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ an A�� p p y y person in any manner OWNER �s e/� �� S� so as to become subject to the Workers' Compensation Laws. MAIL j OCCUPANCY GROUPc>_ ADDRESS D 0 / `�� J/� �J / ZI (D Date Applicant t; NOTICE TO APPLICANT: If, after making this Certificate of V CITY '9 rTvo� �� OCCUPANT LOAD N Exemption, you should become subject to the Workers' ? Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: With comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi- SAFETY PERMIT E] (LIST ITEMS BELOW NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REO'D PROVIDED 11 J 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING J 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 z7 e- 1, as owner of the property, will the work and the Ge d structure is not intended or offered SPACES PROVIDED R 6 9 3 7 A d for sale (Section 7044,Business and Professions Code). # • • • • 88 v PROPOSED 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 3� 0 Q,�9-8 7 issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 65 I certify that I have read this application and state that the V above information is correct.I agree to comply with all County ISSUANCE FEE C ordinances and State laws relating to building construction, Ilia and hereby authorize representatives of this County to enter TOTAL FEE upon lie above-mentioned property for in ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE z �,Signature of Permittedate . 'COMPENSATION DECLARATION CE 875(1 1-84) M I SC E L LA N E O U S APPLICATION hereby affirm that I have a certificate of consent to c 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. BooRess LOCALITY 7 ,C, d b Certified copy is filed with the county building inspection LOCALITY /7 / pJ� NEAREST / department. 1/T e� (� cRoss ST. Lf`J Date ApplicantNEAREST , — DIST RM T O GOO TYPES Z PROCESSED BY CROSS ST. (,,.(� I{1/,,� CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY RD. (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.) USESIZE OF LOEXISTING BLDG.OF T d 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 WNER e/� y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o "' Date ADDRESS I Applicant LU TELCL- ' NOTICE TO APPLICANT: If, after making this Certificate of CITY ,C 6 N0 . OCCUPANT LOAD Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION F619 EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEO OGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: O: 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 o S NATURE iness and Professions Code). FINAL APPROVAL „� PRESENT USE OF BUILDING rj Lic.or Reg.No. Date C HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS / 7 /p ON LOT AND USE -" I hereby affirm that I am exempt from the Contractor's / V �/ • 8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING � m /^ • • • • • • z SPACES PROVIDED [ L 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency JV for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). `I Lender's Name �,\ \ PROPOSED MAX. OCC. U Lender's Address I certify that I have read this application and state that the PERMIT FEE C2 510 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby thorize representatives of this County to enter TOTAL FEE ^ on the a o e-mentioned propert for inspection purposes. _ E REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(1 1-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. Policr✓No. Company FOR APP LI CANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. y/ BUILDING LOCALITY 1� ADDRESS nAM M, Certified copy is filed with the county building inspection LOCALITYr NEAREST department. 1i1( GT CROSS ST. Date Applicant NEAREST I DISTRICT NO. GROUP TYPE PROCESSED BY• CROSS ST. I� ✓1 C+t Y CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD GS. (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.) USE OF I certify that in the performance of the work for which this SIZE-OF LOT EXISTING BLDG. a permit is issued, I shall not employ any person in any mannerowHER y so as to become subject to the Workers' Compensation Laws. �y MAIL OCCUPANCY GROUP OC [(X. ADDRESS �� U Date Applicant `+i W NOTICE TO APPLICANT: If,after making this Certificate ofCITY ,Tvo`. jOC�Q OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be deemed Ievoked. TRAILER USE GEOLOGY INSPECTION 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. PARKAIM& SPACES ING REQ'D PROVIDED License Number Lic. Class L' LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF iNSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNAT E iness and Professions Code). t ,/ � PRESENT USE OF BUILDING FINAL APPROVAL V V Lie.or Reg.No. Date ,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- 09000-000i 3/ 5/90 ness and Professions Code): No. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 933264 Z PM 4=242 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 RgAl 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 670 above information is correct.I agree to comply with all County ISSUANCE FEE 9rdinances 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 r TG.I y �f, 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o mittee Date WORKERS'COMPENSATION DECLARATION CE 854(1 1-84) 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 FI LL IN BUILDING ADDRESS FICertified copy is hereby furnished. BUILDING �ls� LOCALITY ZG C? ADDRESS /V LLL ❑ Certified copy is filed with the county building inspection LOCALITY CROSST s . department. L� L C Date Applicant NEARESTDISTRIC NO G TYPE . CESSED Y CROSS ST. •? Lv • >/C CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` ' r ON COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR CO 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 I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. C) permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL �� OCCUPANCY GROUP o ADDRESS U Date Applicant Lis TE .� o- NOTICE TO APPLICANT: If,after making this Certificate of CITY No.L. OCCUPANT LOAD — —0 —0 Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION I Eldeemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and, effect. Of: PARKING REQ•D pROVID ED SPACES 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 FROM: io: INSPECT R•s acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES S NA RE iness and Professions Code). � PRESENT USE OF BUILDING FINAL APPROVAL Xt Lic.or Reg.No. Date / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANI 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 )" its-. 001 3/ /, 3 SPACES PROVIDEDer;ry ElI, as owner of the property, will do the work and the 9327 1 Phi 4: : structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX.OCC. Lender's Address r 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 ate aws relating to building construction, and herebau or iepr ntatives of this County to enter TOTAL FEE C'J p n th m tione roperty for inspectio pu oses. ! SEE REVERSE FOR EXPLANATORY LANGUAGE ' 2S i r ofpermittee Dat ti WORKERS'COMPENSATION DECLARATION 76M444 .rr CsE875 (2-80) MISCELLANEOUS APPLICATION {� I r reby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �J 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 LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection i NEAREST department. LOCALITY CROSS ST. � �- Date Applicant NEAREST DISTRIf�T JpI PPS, Gjjj��I OUP TYPE PROCS D BY CROSS ST. �(/ft Y ONST. a / '= ' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL . U V V COMPENSATION INSURANCE _ DESCRIPTION LOT NO. BLOCK MA HIGHWAY No. (CIRCLE) STATE MAJOR SECON LOCAL d NO. OF'BLDGS. O (This section'need-not be completed if the work involved TRACT NOW ON LOT USE ZONE SP CIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) /jl USE OF (v:A,. SIZE OF LOT EXISTING BLDG. (IC 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 _ F— so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP C] W ADDRESS y Date Applicant NOTICE TO APPLICANT: If; after making this Certificate of CITY ` N. 8 OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLI ATION 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 I OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY.PERMIT ❑ (LIST ITEMS BELOW) t ❑ NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the BUST- S ness and Professions Code, and my license is in full force and PARKING: effect' _ SPACES REQ'D PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE 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 I NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic,or Reg.No. Date n^ EXIS HOME OWNER-BUILDER DECLARATION ON LOT AND USE NO.OF AND USE LDINGS I hereby affirm that- I am exempt from the Contractor's 2 2 7 5 A 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 PROVIDED0 0 0 0 8.8 structure is not intended or offered for sale (Section i a o D 0 0 0,02 7044,Business and Professions Code). PROPOSED USE OF BUILDING ( q p8 p 0 U 1 V CONSTRUCTION LENDING AGENCY " I hereby affirm that there is a construction lending agency for the performanceof 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 i above information is correct.I agree to comply with all County ISSUANCE FEE ances and State aws reIt g to building construction, and reby authori re resent Ives this C my to nter TOTAL FEE upon a above- ntio o erty fo insp, ion Pur ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat Perttee Date � I WORKERS'COMPENSATION DECLARATION - 76M444 . CE 875 (2-80) MISCELLANEOUS APPLICATION I hy affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION. inure, , or a certificate of Workers' rs'Compensation Insurance,or � a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS VfAa`r/ Certified copy is hereby furnished. BUILD •f ING �—� LOCALITY bp ADDRESS �(' F-1. Certified copy is filed with the county building inspection 2 _ NEAREST �� department. LOCALITY '� ��i'�!'�fl ' CROSS ST. Date Applicant NEAREST f DISTRIC NO. GRQUP TYPE PROLES BY CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J ✓rM� 1LL�! COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP �) HIGHWAY _NO. �V® (CIRCLE) STATE MAJOR SE CON OCAL O NO. OF BLDGS. (This section 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 n SIZE OF LOT EXISTING BLDG. 0i/. cc 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 + �1�� (r"�. �• — U so as to become subject to the Workers' Compensation Laws. MAIL a ' OCCUPANCY GROUP W ADDRESS J'� " ' tL Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY ,+ — �' i oio� �•�, C� A � 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 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- El ness and Professions Code, and my license is in full force and t� effect. � uo � Ile SPACES PARKING REO'D E:= PROVIDED i License Number R Lic.Class ( T ' " . 1' LIMITED TIME USE r / 'Contractor Date f`1 f� t•�e\ DATE DATE ❑ [FINAL ROM: 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 SI NATURE iness and Professions Code). APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date v�J / / V 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. PROVIDED 2 3 8. /7 A• ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # o D a D 3 0 7044, Business and Professions Code). PROPOSED USE OF BUILDING I O o $Q 5 p CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructiork lending agency o 0 0 8 Q 5 Q 5 U for the performance of the work•for which this permit is issued(Sec.3097,Civ.C.). me o7,03-85 O r$5 Lender's Na PROPOSED MAX. OCC. - Lender's Address PERMIT FEE I certify that I hav read this application and state that the above information correct.I gree to comply w' all County ISSUANCE FEE ordi nces and tate laws r ting to buil ' construction, and ler by au Oris t 'ves o is Codnty to enter TOTAL FEEXto Is upo t i n operty or inspectron pulposes� SEE REVERSE FOR EXPLANATORY LANGUAGE _y �� Si at a of P @ /Date .' WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N E O US APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or ; a ceitifieclxopy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ' J FICertified copy is hereby furnished. BUILDING . TUALAS LOCALITY ADDRESS J 0 Certified copy is filed with the county building inspection LOCALITY NEAEST department. COSS ST. Date Applicant NEARESTCDA)U DISTRICT NO. GROU YPE P SSED BY CROSS ST. /^ CONST. AkrCERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL '_J] (/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP �q / 1I1GMW AV no.`j//%007(CIRCLE) STATE MAJOR SECOND LOCAL r NO. OF SLOGS. (This section need not be completed if the work involved TRACT J ~� NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) SIZE OF LOT /Y / USE OF • x EXISTING BLDG. C— } I certify that in the performance of the work for which this c permit is issued,I shall not employ any person in any mannerOWNER = - so as to become subject to the Workers' Compensation Laws. OCC(JP,ANCY,•GROUP MAIL O ADDRESS O Date Applicant VVV NOTICE TO APPLICANT: If, after making this Certificate of CITY ( ` 1.113 0. 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 El GEOLOGY INSPECTION b. 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 D (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 RI-Q'D D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a O: licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. , b S STORIES sl NATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date , HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ' I— 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 -- SPACES PROVIDED 1, as owner of the property, will-do the work and the i, F1 structure is not intended or offered for sale (Section — 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF.BUILDING I Hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name / 7n� PROPOSED MAX. OCC. n /J Lender's Address OU 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 Ails County to enter TOTAL.FEE p p�n the above-mentioned perty for' I�ction pi poses. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION I CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of workers'Compensation Insurance,or . COUNTY OF LOS ANGELES ' BUILDING AND SAFETY DIVISION LLLIII a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company BUILDING '' FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. BUILDING PC. LOCALITY C ADDRESS lV Certified copy is filed with the county building inspection LOCALITYNEAREST department. CRoss ST. Date_Applicant NEARESTDISTRICT NO. GROU$ TYPE �/� PR ESSE BY CROSS ST. A y`.[ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J �Y/—' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OR 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 n ° ICD permit is issued,I shall not employ any person in any manner OWNER �T C. C%p O so as to become subject to the Workers' Compensation Laws. �� , ° OCCUPANCY GROUP �� a MAIL ` ~ Date Applicant ADDRESS 1 ` 3 IUa NOTICE TO APPLICANT: If, after making this Certificate of CITY k� No'�«� �� 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ❑ ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of the Busi- 11,1e. O NO. OR EXITS ness and Professions Code,and my license is in full force and effect. 1J5 PARKING SPACES REWO PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM? O: 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 OR 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- 00001]—+01301 4/17/90 ness and Professions Code): NO. PARKING I, as owner of the property,.will do the work and the SPACES PROVIDED I ('11 z • ;il { structure is not intended or offered for sale (Section 1 aa i 7044,Business and Professions Code). PROPOSED USE OF BUILDING lC e Auk CONSTRUCTION LENDING AGENCY rN I hereby affirm that there is a construction lending'agency 'y for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name T PROPOSED MAX. OCC. ^ I Lender's Address � ►Un\U 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 IS]1EA.C. E \ ordinances and State laws relating to building construction, and hereby thorize representatives of this County to enter T _ upon the ove-mentioned property for inspection purposes. S)EE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I 1. WORKERS'C'OMPENSATION DECLARATION . T„20A.14.Maaa 1UPWIG/00 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to sell' COUNTY OF LOS ANGELES 6UII_DING AND SAFETY DIVISION Il insure,or a certificate of Workers'Compensation Insurance. or y a Certified copy thereof(Sec.3800. Lab.C.) r _ Policy Na�N �j3,CompanyN elz-.Ml p� j ___ r FOR APPLICANT TO FILL IN BUILD NG I 1 Xcrl L ING A.13DRESS ADDRrSS (p� IUl Certified copy is hereby furnished.7H�rA4MR - B IrJ LOCALITY u Certified copy is filed with the county building inspection CIT \ ZIP NEA�}EST department. ��{ CROSS ST. Date___ Applicant_ _ _ SIZE OF LOTI z NO.OF BLDGS.NOW ON LOT DISTRICT NG UP TYPE P SSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' ,Q ' CONST. ” COMPENSATION INSURANCE TRACT • BLOCK LOT NO. NAP N,cMwAY yY t NO. ,CIRCLE, STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZINE SPECIAL CONDITIONS -� by the permit is for one hundred dollars (S 100) or less.) OWNERTEL NO. f I certil'y that in the performance of the work for which this property ' — ((p>6)3a —O�j O� permit is issued. I shall not employ any person in any manner so as to become subject to rile Workers' Compensation LawsX ^mail (>On I3 OCCUPANCY GROUP Date Applicant.____ _ CITYZIP NOTICE TO APPLICANT: If. after making this C-ertificatd; -50WN tl Q,' 1 OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.you must forthwith comply With such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ revoked. No Spec.Knowl. ❑ LICENSED CONTRACTORS DECLARATIONOCCUPANCY 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 Business No.of EXITS and Professions Code.and my license is in full force and effect. r License Number _-_—.- __---- Lic. Class .PARKING• REq'D � PROVIDED SPACES J Contractor _____.___.____.— Date _ __..___ ___. ___ LIMITED TIME USE ❑ DATE I am exempt from the licensing requirements as I tint :I FROMDATE: TO: licensed architect or it registered professional engineer INSPECTOR'S acting in m3 professional capacity(Section 7051. Business SIZE OF NO.OF and Professions Code). EXISTING BLDG. STORIES SIGNATURE LIC. or Reg. No.___ ._ _ - Date - PRESENT USE OF BUILDING FINAL APPROVAL S HOME OWNER-BUILDER UEC'LAIZAI'IUN NO.OF EXISTING BUILDINGS , ON LOT AND USE Q/ 1 hereby affirm that 1 am exempt from the Contractor's License O Law for the following reason (Section 7031.5. Business and Professions Code): NO.PARKING V O e El 1. as owner of the property, will do the work and thrX SPACES PROVIDED structure is not intended or offered for sale(Section 70.34• PROPOSED USE OF BUILDING I Business and Professions Code). CONSTRUCTION LENDING AGENCY 0 LO 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 CC.Lende!S Name ____.____..__.— APPLICANT iPRINT) TEL NO. I Lender's AddressADDRESS I certify that I have read this application and state that the above information is correct. 1 agree to comply with all County I PERMIT FEE ordinances and State laws relating to building construction.and f hereby gutliorize representatives of this County to enter upon I ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE X ly 0� SEE REVERSE FOR EXPLANATORY LANGUAGE I WORKERS'COMPENSATION DECLARATION 76cE 8 . (11-84) MISCELLANEOUS APPLICATION .. 1 hereby affirm that I lmamre 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 BUILDINDG ADRESS •T Certified copy is hereby furnished. BuuDING XX p6 �S Dy, L� LOCALITY 40 Ress �_C112& Certified copy is filed with the county building inspection LOCALITY NEARESr department. 3M a .sass Sr. Date Applicant NEAREST DISTRICT NO. G OUP TYPE • CESSED BY p CROSS ST. �D G CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Q COMPENSATION INSURANCE DESCRIPTION ILOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved. TRACT NOW ON LOT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE DP I certify that in the performance of the work for which this SIZE OF LOT/IEXISTING BLDG. c permit is issued, I shall not employ any person in any manneiSEX p'WNER of buif ding w as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP l! c ADDRESS or r , Date— Applicant t3 13 3 NOTICE TO APPLICANT: if, after making this Certificate of CITY S'Ayr I ��L 07(7 NE"121 �3 —03x3 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 ❑ No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION ❑ Panic Devices LICENSED CONTRACTORS DECLARATION 1 Imcreby 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 anX ^ erfect. Name- of business PARKING REQ'D PROVIDED I�.J SPACES JJ License Number Lic. Class DIA11,161 LIMITED TIME USE Contractor— Date GATE DATE PROM) TOI El 1 am exempt from the licensing requirements as I am a licensed architect-or a registered professional engineer SIZE OF NO.OF / I SIPf�ATURE acting in my professional capacity (Section 7051, Bus- ' EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL L Lic.or Reg.No. Date PRESENT USE OR BUILDING p„Z� l(� ( HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS 1blp ON LOT AND USE 1 hereby affirm that I am exempt from the Contractor's %17 HO FEF_ - License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING 1, as owner of (lie property, will do the work and the 'SPACES PROVIDED III (I_(a � 9/'L2/91"- structure is not intended or offered for sale (Sectiong` 7044,Business and Professions Code). 2435 1' fi t� (� r.-� CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN6 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 I PROPOSED MAX SOC C. Lender's Address_. 1 certify that I have read this application and state that the PERMIT FEE 25.00 above information is cnrrect.I agree to comply with all County ISSUANCE FEE ordinances and Stale laws relating to building construction, OJT mind I creby am horize representatives of this County to enter TOTAL FEE 25.UU r# 1 01111, ,I -nmcutioned operty to r' pection purposesSEE REVERSE FOR EXPLANATORY LANGUAGE XX �(,vL X n�% I Cinll•IIIIrr 'PV111011r11 Im,ie WORKERS'COMPENSATION DECLARATION 70M443DPVV'.a�so 1�i/IISCE,L.L.AINEOU5 APPL-'ICATION 1 . r. I hereby affirm that I have a certificate bf consent to self COUNTY OF LOS-ANGELES BUILDING:AND SAFETY DIVISION jure,or a certificate of.Workers'Compensation Insurance,or a certified copy thereof(Set~3800, Lah C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING • • BUILD Iy�AD RESADDRESS ❑ Certified copy.is.hereby:furnished. S �(� eVe P m tDCALITY ' ❑ Certified copy is filed with the county building inspection CITY zIP NEAREST ' I department. ® CROSS ST. I Date j= Applicant SIZ OF NO BCDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT No. V 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 (s 100) or less.) O I.certify that in the performance.of the work for which this ey er TE No. �j permit is issued:I shall not employ any person in any manner F 66Qii11 SS so as to become subject to the Workers' Compensation Laws [AD a p m /p, % �r� OCCUPANCY GROUP Date Applicant . CITY V Q J� ZIP 1 NOTICE TO APPLICANT: If. after making this Certificate OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLI ATION 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. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[$ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) 1 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS l and Professions Code,and my license is in full force and effect. ame 6t Bustuess _ PARKING• REQ'D PROVIDED � License Number Lic.Class � � SPACES ' I I Contractor Date LIMITED TIME USE ! DATE DATE i ❑ I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer acting in my professional capacity(Section 7051,Business SIZE OF FENT ® INSPECTOR'S 1 and Professions Code). EXISTING BLDG. ®� 3TORIE§ yJ SIGNATURE. LiC or Reg Na - Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO'OF EXISTING BUILDINGS �L 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 7.044,1 PROPOSED USE OF BUILDINGS p 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 APPLIC rertwr) T L NO AC Lender's Address ADDREs J a y�0�o� I certify that I have read this application and state that the LrSc 1 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 FEEthe above-mentioned property for inspection purposesTAL FEE g !s SEE REVERSE FOR EXPLANATORY LANGUAGE Isnatu rmittee ate