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HomeMy Public PortalAbout9658-9660 LAS TUNAS DR_Miscellaneous__ WO ,)=KERS' DECLARATION 76M444 �• • CE 875(11-84) MISCELLANEOUS APPLICATION I hereby 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. Company FOR APPLICANT TO FILL IN BUILDING JA DRESS Certified copy is hereby furnished. BUILDIN ADORES LAI Certified copy is filed with the county building inspection LOCALITY L _ NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. rmUdd AS A VE �^•)O "J C10T. - - — �' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ,/�(/a oL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) 1 usE OF SIZE OF LOT A�P o)C• I ©O EXISTING BLDG:^5 l✓ a 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 e, Cf{IA(7 so as to become subject to the Workers' Compensation Laws. �7 OCCUPANCY GROUP a � MAIL p o, EGX l3O AD DRESS�.r 1 r/ ~ Date Applicant i j ILLI T ISE NOTICE TO APPLICANT: If, after making this Certificate of CITY I �-o iGI.rNO. $IFS —030 OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- El comply with such provisions or this permit shall be TRAILER USE ❑ , GEOLOGY INSPECTION No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (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 //��,,,�,� � }� �I effect. Nv, i,.�t/d? PARKING RRQ'D PROVIDED I SPACES J License Number Lic. Class o�` LIMITED TIME UR' Contractor Date DATE DATE FROM: TO: Ty��� El am exempt from the licensing requirements as I am a INsPECTOIf' 1/93 licensed architect or a registered professional engineer SIZE OF NO. OF + r� SIG ATu acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES 1 7775 • iness and Professions Code). �'1 FINAL APPROVAL • ��/.],r�J PRESENT USE OF BUILDING ( 1 F Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �glvl e ON LOT AND USE I hereby affirm that I am exempt from the Contractors l` 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 'PACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). PROPOSED USE OF BUILDING IAL ' 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.). � ,40 Lender's Name ) ' 4C��""``A PROPOSED MAX. OCC. ' Lender's Address •Q• I certify that I have read this application and stately, 76' PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State lawsrelating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the abov -inentioned proanty for inspectio urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ` ' WORKERS'COMPENSATION DECLARATION 176M444 MISCELLANEOUS A P P L I C AT I O N +' CE 875(11-84) I herebylafcertficat 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.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS L Certified copy is hereby furnished. BUILDING LOCALITY Soy ADDRESS Certified copy is filed with the county building inspection LOCALITY M' NEAREST department. -_;— 7 CROSS ST. Date Applicant NEAREST I-` DISTRICT}y0. GRP TYPE R CESSED BY CROSS ST. S Y CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. "�p.aC� BLOCK M HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT .�S.� NOW ON LOT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOTO. 0�7 ` EXISTING BLDG. g�G I certify that in the performance of the work for which this ti I� o permit is issued, I shall not employ any person in any manner OWNER �5_2so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY� GROUP o Date PP LLApplicant ADDRESS X % " NOTICE TO APPLICANT: If, after making this Certificate of cIrYX Tmo EL. OCCUPANT LOAD Exemption,' you should become subject to the Workers' -- Compensation provisions of the Labor Code,you must forth- APPLICATION FOR E IT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION77 No Spec. Knowl. E] deemed revoked. Pari, Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEM BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- . OF exits ness and Professions Code,and my license is in full force and effect. A PARKIN SPACE REq'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor DateD ATE DATE El / 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 SIGNATURE iness and Professions Code). FINAL APPROVAL - fJ Lic.or Reg.No. Date PRESENT USE OF BUILDING 91 F HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILD GS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 01001]-1313111 1/13/0' 33- License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 7g!6 1 PM 4:28 I, as owner of the property, will do the work and the SPACES PROV , structure is not intended or offered for sale (Section IDE 7044,Business and Professions Code). // PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name —�� �-- V PROPOSED MAX. OGC. Lender's Addresses �� ���— §Q;A a -I certify that I have read this application anes%;�h�RE R M I T FEE 06) 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. SEE REVERSE FOR EXPLANATORY LANGUAGE N 2E=;g /--->.I 3 Signatu a of Permittee ate WOI,KERS'COMPENSATION DECLARATION 75M444 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 BUILDING ADDRESS Certified copy is hereby furnished. p.....N-y .DRE55 Cf [ I �,� LOCALITY C I DCertified copy is filed with the county building inspection LOCALITY , NEAREST Q ti department. / L G/' CROSS ST. Q� f Date ApplicantNEAREST /� DISTRICT NO. GROUP TYPE R SS PED BY CROSS ST. L `"� ^2 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I V COMPENSATION INSURANCE DESCRIPTION LOT NO. .LOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (This section need not be completed if the work involved TRACT �6 NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) /X �� USE oP 4 �- I � SIZE OF LOT EXISTING BLDG. (� I certify that in the performance of the work for which this e / C� permit is issued, I shall not employ any person in any manner OWNER 5Z /� �/v =' ro as to become subject to the Workers' Compensation Laws. MAIL O / OCCUPANCY GROUP a ADDRESS ' C(11 GL• (rlL r- Date Applicant LvIJ NOTICE TO APPLICANT: If,'after making this Certificate of CITY f) No� �g9'�3l 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. ❑ E] No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ '(LIST ITEMS-BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as.1 am a FROM: TOI licensed architect or a registered professional engineerSIZE OR NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 9AGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING /- �• Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS _ ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING EJI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). ;.:'•- CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING _Itr I'hereby affirm that there is a construction lending agency Al�� I !J for the performance of the work for which this permit is y bl issued(Sec. 3097,Civ.C.), I l Lender's Name PROPOSED MAX. OCC. Lender's Address � I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE on the above-mentioned property for inspection purposes. C `� SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Ignatu of Permittee Date WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION r 'CE CE 87.5 875(11-84) I htieby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION• insure .or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING /� ADDRESS �(/�(p O Certified copy is hereby furnished. k BUILDING \ — 0 LOCALITY � 4 ADDRESS V'�7 DCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST ,^A �/ ! DIST RI N GROUP TYPE P ESSED BY CROSS ST. �Y v`� (/� ^'� (/�� VIAAAA D� /J CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LeGaLp+ VVV COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLD6S. NO. (CIRCLE) (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.) is of SIZE OF LOT EXISTING BLDG. / a 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 X OWNER CM-157C) ela"M . so as to become subject to the Workers' Compensation Laws. MAIL /tom OCCUPANCY GROUP o XADORES ,O. 3 3 Date Applicant IU NOTICE TO APPLICANT: If,after making this Certificate of clrY NO- OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- ❑ with -comply with such provisions Or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic 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- ness and Professions Code,and my license is in full force and J�� / effect. x Tr rW V� PARKING REQ•D PROVIDED SPACES License Number Lic. Class kupAs LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as 1 am a FROM: O: licensed architect or a registered professional engineer SIZE OFNO. OF INSSGECTORE acting in my professional capacity (Section 7051, Bds- EXISTING BLDG. STORIES iness and Professions Code). x FINAL APPROVAL 7 PRESENT USE OF BUILDING !/G f C� Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS d ON LOT AND USE �•1•` I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi �' _-n� _�' I i'•-(-_ =•'-- %� ness and Professions Code): No. PARKING SPACES 7 e SPACES PROVIDED T Ai'i'7 '•!t r•�' 1 ElI, as owner of the property, will do the work and the y 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 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 inspec ion purposes. `-` SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Perm t W a e WORKERS'COMPENSATION DECLARATION CE 8; 54(,,_84) MISCELLANEOUS APPLICATION I hereby affirm that IfWo 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.Q. LDING ADDRESS Policy No. Company FOR APPLICANT TO FILL IN BUI Certified copy is hereby furnished. Bu1LDISS r J ) LOCALITY / AOOR ESS l.1 J (,;de de e it..cL_.✓ �.... _�, _-! _ . Certified copy is filed with the county building inspection LOCALITY / � NEAREST department. ��� _L� [!, �• caoss sr. Date Applicant NEAREST DISTRICT NO. GROUP TYPECESSED BY CROSS ST. CONST CERTIFICATE OF EXEMPTION FROM WORKERS' - � p COMPENSATION INSURANCE I DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. OF HLOGS. STATE MAJOR SECOND LOCAL NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. permit is issued,I shall not employ any person in any manner OWNER - d y so as to become subject to the Workers' Compensation Laws. MAIL u- OCCUPANCY GROUP �- o AD DR tJ Date Applicant TEL. O_ OCCUPANT LOAD. NOTICE TO APPLICANT: If, after making this Certificate of CITY No. e�iJ 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. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices Eli 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 �J SPACES REq'D D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date O ATE DATE I am exempt from the licensing requirements as I am a licensed architect or a registered profbssional engineer SIZE OF NO. OF FROM: To. INSPECTOR'S acting in my professional capacity (Section 7051, BIIS EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Of 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 /�11 yl l #_i- !tE_11 11"25 5 License Law for the following reason (Section 7031.5, Busi- 7' 7-7 1 Pr; � L�._ ness and Professions Code): NO. PARKING = = i?I :I:•`_3 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE �60 upon the above-mentionedproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE AMJLA W Signature ermittee Date •WARKERS'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':k.certificate of Workers'Compensation Insurance,e,or a certified popy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BAUILDING t DDRESS FiCertified copy is hereby furnished. UILDING a �`e.ra, ADDRESS /� N R LOCALITY • ElCertified copy is filed with the county building inspection 1 I { NEAREST � department. LOCALITY �m 1 r Cr 1 I 1 hl+ ei— CROSS ST. Date ApplicantAREST � � `1 DIST#ItRICT NO GROUP TYPE 1/ P OC E SSED BY�f CERTIFICATE OF EXEMPTION FROM WORKERS' ceoss ST. Lu/�S VFf, LEGAL NO. (CIRCLE) L—F�Li�.�CCGg COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIO ) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT �j� NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of / SIZE OF LOT LamEXISTING BLDG. C�— 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 owNEp - C E3 � so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP o i 3 U Date DDRESS Applicant NOTICE TO APPLICANT: If, after making this Certificate of tITY e bio. g�. 6 r-O' OCCUPANT LOAD °- Exemption, you should become subject to the Workers' y Compensation provisions of the Labor Code APPLICATION FOR EXIT HARDWARE: z p p ,you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION 11deemed 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. PARKING SPACES REQ'D D PROVIDED f I License Number Lic. Class LIMITED TIME USE Contractor Date VATIC DATE ❑ I am exempt from the licensing requirements as I am a PROM. TO. licensed architect or a registered professional engineer Slz OF NO. OR i INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EX15TI�NG BLDG. STORIES SIGNATURE inessand Professions Code). AJAi .5 1 4a& Qse FINAL APPROVAL , �� RESENT USE OF BUILDING L Sc (/ Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS NECE 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- j j1i ;_; 4i1 j .} 4 J`;i ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED ?55 I Int i•!L_ structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING N � A Nm f � GiL 4CO— 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.).C-I 1& C_y C"-Ervu Lender's Name I# U C PROPOSED MAX. OCC. / Lender's Address (Sam LLre PERMIT FEE I certify that'I hive read this application and s 4 above information is correct.I agree to comply with all County ISSUANCE FEE l� ordinances and State laws relating to building construction, ^�1' and hereby authorize representatives of this County to enter TOTAL FEE Od 1 upon the above-mentionedpro rtor Inspection purposes. !/ SEE REVERSE FOR EXPLANATORY LANGUAGE AJ[, Signature of-JPer-mittee Date WORKERS'COM1fYENSATiON 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. AILlILD INC �{y 1-195, £ �S �' LOCALITY ADDRESS , 3 L ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY tti C CROSS ST. L� Date Applicant AREST �G 1 L DISTRICT NO. RO P TYPE PROCE ED BY 10 CROSS ST. �.�L4((_ 6V CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 8 `/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY �- NO. (CIRCLE) STATE MAJOR SEGO LOCAL d 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 (5100) or less.) USE OF 7 SIZE OF LOT EXISTING BLDG. C� Cr I certify that in the performance of the work for which this 0 permit is issued, 1 shall not employ any person in any manner wi 5.1;9"AJP" U so as to becomi subject to the.Workers' Compensation Laws. OCCUPANCY GROUP LLI ADDRESS / Date Applicant / er NOTICE TO APPLICANT: If, after making this Certificate of Iry - No� �a�(� --�+��ci' OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- RCl 0;A-) APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION NO Spec. KnOWi. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT V (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 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 S GNATURE iness and Professions Code). ) ESENT USE OF BUILDING FINAL APPROVAL Lic,or Reg.No. Date �, 7 ! - NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION 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 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 fcir sale (Section 02 4 9 0.4 A 7044, Business and Professions Code). oPOSED USE OF BUILDING # 0 0 0 0 CONSTRUCTION LENDING AGENCY t / O ! I 0 0 0 0 0 0 o z I hereby affirm that there is a construction lending agency l f'1 (� for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). o&26 _86 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 represent tives of this County to enter upon the above-me ti ne pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gigAnture of Permittee D to �/ We 'KERS'COMPENSATION DECLARATION CE 87 a MISCELLANEOUS APPLICATION �1' CE 875 (11-84) I hereby'4lf`cert that I have a certificate of consent tc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or EL certified copy thereof(Sec.3800,Lab.Q. �f� Policy No. Company FOR APPLICANT TO FILL IN BUILDING �� ADDRESS Certified copy is hereby furnished. BUILDING ��� S ADDRESS `, LOCALITY Certified copy is filed with the county building inspection LOCALITY �' NEAREST department. . CROSS ST. Date Applicant NEAREST ��� DISTRICT GRO PEE PRO ESSED6BY CROSS ST. �/�'yS/ � CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL r �� ^� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NA - HIGHLE; ASTATE MAJOR SECOND LOCAL NO. OF SLOGS. , (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred'dollars ($100) or less.) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. 8' permit is issued,I shall not employ any person in any manner OWNER o so as to become subject to the W rkers' Compen o LawMAIL OCCUPANCY GROUP cC Date Applicant ADDRESS S-44r� A 5 . - TEL. OCCUPANT LOAD NOTILai CE TO PLICANT: I ter making this Certificate of CITY No. Exemption, you should be me 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 ❑ (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions C de,and my license is in full force and effect. SPACES REQ'D PROVIDED License Number 'Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO' licensed architect or a registered professional engineer SIZE OFNO. OF INSPFCTOR's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. ��(/�/ STOR IEs / SIGNATURE iness and Professions Code). PRESENT USE OF BUILDFINAL APPROVAL L LIC.Or Reg.NO. Date t - I !I J!-�y/ ,// ��f• (� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS Ins !J1 ON LOT AND USE I hereby affirm that I am exempt from the Co ractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1 U I, as owner of the property, will do the work and the SPACES PROVIDED l structure is not intended or offered for sale (Section 7044,Business and Professions Code). PROPOSED USE OF BUILDING �J CONSTRUCTION LENDING AGENCY �� 1, 2 7 34.3 A I hereby affirm that there is a construction lendin agency f for the performance of the work for which this permit is S $} c 0 0 o 8 8 issued(Sec.3097,Civ.Q. Lender's Name o 0 o D o 0 o M Lender's Address G PROPOSED MAX. OCC, 0 [ 2 6 8 7 I certify that I have read this application and state that the PERMIT FEE G V 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 3 upon the abo -mention d pro ins property for ion purposes. ' Z / SEE REVERSE FOR EXPLANATORY LANGUAGE . >gnature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 8754(11-B4) 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.Q. BUILDING Policy No. Company FOR APPLICANT TO FI LL.IN ADDRESS Certified copy is hereby furnished. ILDING LOCALITY w ADDRESS Certified copy is filed with the county building inspection OCALITY NEAREST department. JR cROSs ST. /� Date ApplicantDISTRICT O. tup PTYPE P SEED HY C�ACROSS ST. •� �J CONST/ / �I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL /��ry COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK rMi O (CIRCLE)-A-to, .1 O HIGHWAY STATE MAJOR SEC D LOCAL NO. OF HLD 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 /r EXISTING BLDG. o permit is issued,I shall not employ any person in any manner OWNER G so as to become subject to the Workers' Compensation Laws. �ADDRwllESS © _ OCCUPANCY GROUPEEK o �' - Date Applicant LI.I TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of ITY No. ZI i�,�e 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 D I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. of EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'D D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES Sic, ATURE inessand Professions Code). FINAL APPROVAL G�/ Lic.or Reg.No. Date RESENT USE OF BUILDING Z•.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. PARKING I I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section z 6 3 7,5 A 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING # O O O 0'3"0 I hereby affirm that there is a construction lending agency D o D•D'D D D for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). 0 1,21 -87 Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize represe atives of this County to enter TOTAL FEE upg 'the ab Ve-mentioned yp;o .erty ori spect'on pgses. g SEE REVERSE FOR EXPLANATORY LANGUAGEIIA AAA I S nature of ermittee Date WORKERS'COMPENSATION DECLARATION CE 875 I (2-80) M I SC E L LA N EO U t APPLICATION I 4rpby af`.im that I have certificate of consent to self ; COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) I Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Cl" Certified copy is hereby furnished. BUILDING D LOCALITY ESS E-1Certifiedcopy is•filed with the county building inspection ADDR LOCALITY NEARE department. e CROSSST ST. Date Applicant' NEAREST DISTRICT,NO. IT TYPE PROCES D BY CROSS ST. CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL fJ DESCRIPTION LOT NO. BLOCK �+D�.t j ,/w COMPENSATION INSURANCE MAP J jfJ(C/ IGMWAV } No. (CIRCLE) STATE MAJOR SECON LOCAL NO. OF BLDGS. LL (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 i SIZE OF LOT EXISTING BLDG. 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 of /*� r n I— so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP W /yj_7� Date Applicant J ADDRESS 50 Y.�h� lam' N NOTICE TO APPLICANT: If, after making this Certificate of eIT-v 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 USEGEOLOGY INSPECTION deemed revoked. 110 No Spec. Knowl. ❑❑ N UP OCCACY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ 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 effect. PARKING I SPACES REQ'D O PROVIDED D License Number Lic.Class LIMITED TIME USE (Contractor Date DATE DATE ❑ : J I am exempt from the licensing requirements as I am a: FROMTO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLD 6. STORIES GNATURtE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. DateBeAml%J / 0 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BU LDINGS ON LOT AND USE , O O O O 8-8 p ft V S I hereby affirm that- I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- 0 00 0 0 0•o z ness and Professions Code): NO.PARKING 0 4'1 6-85 SPACES PROVIDED I, as owner of the property, will do the work and.the structure is not intended or offered for sale (Section 7044, Business and'Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING-AGENCY ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE i I certify that I have read this application and state that the LL 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 u n the above- tinned property for inspection pur ose SEE REVERSE FOR EXPLANATORY LANGUAGE u, ignature of Permittee Date WORKERS'COMPENSATION DECLARATION I76M444 �A CE 875 (2-80) MISCELLANEOIJ A.0PLICATION {� I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES ••BUILQING AND SAFETY DIVISION �J insurg, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) I II1 Policy No.- Company FOR APPLICANT TO FILL IN BUILDING ❑ • ADDRESS Certified copy is hereby furnished. BUILDING 6Q �,9 t �+ LOCALITY DDRES A Certified copy is filed with the county building inspection � �-1 NEAREST department. LOCALITY /� C{ ` ++ r /� CROSS ST. Date Applicant NEAREST ` c L DIST T N GROUP TYPE P ESSED BY CROSS ST. ` /7� ONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL • �VV.•//J/ !!// DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE Ji MAP M STATE MAJOR SECOND L >_NO. OF BLDGS. Ng. (CIRCLEIRCLO)) OCAL d (This section need not be completed if the work involved TRACT r,,S61 NOW ON LOT USE ZONE PIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) y USE of SIZE OF LOT EXISTING BLDG. • kso Q_ I certify 'that iii the performance of the work for which this I I Q permit is issued, I shall not employ any person in any manner OWNER 64 40 OCCUPANCY GROUP so as to become subject to the Workers' Compensation Laws. mplL L) ADDRESI 3q,3 Ewi] tL Date Applicant , I Vft+ z NOTICE TO APPLICANT: If, after making this Certificate of CITY NOf� •G� 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 I TRAILER USE GEOLOGY INSPECTION I deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT W (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 i PARKING. effect. SPACES ' RE60 PROVIDED License Number Lic.Class J LIMITED TIME USE Contractor Date DATE DATE ('� C.,, w, .� p PROM: TO: I am exempt from the licensing requirements as I am a l `��'/_AF,/1 —' licensed architect-or a registered professional' engineer size OF NO. OF I INSP[;CTO R'S acting in my professional Capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ! PRESENT USEOF BUILDING ,) ILII FINAL APPROVAL Lic.or Reg.No. Date (�� 7 NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's g License Law for the following reason (Section 7031.5, Busi- Ir ti '019 5 ' x, Hess and Professions Code): NO. PARKING _ SPACES PROVIDED EJ 1, 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). I PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY N l I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,C' i Lender's Name_ PROPOSED MAX. OCC. I - Lender's Address pp� PERMIT FEE I certify that I have read this application ands t tpl�f t � above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, I TOTAL FEE and hereby authorize representatives of this County to enter I u on the above-mentioned property for in purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84)a MISCELLANEOUS APPLICATION CE 87 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.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING E--Q • ADDRESS �43 FlCertified copy is hereby furnished. ILDING ADDRESS LOCALITY ❑ Certified copy is filed with the county building inspectionLOCALITY NEAREST department. , CROSS ST. kallmm_o �}1✓(' Date Applicant CROSS ST. It OISTR�CT6`NO. GR CONST. ESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL //J/J/.• COMPENSATION INSURANCE DESCRIPTION LOT ft. o2 BLOCK MAP-6T7 Ivo. (CIRCLE) STATE MAJOR SECOND LOCAL U047-NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT ` USE Z SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) SE OF E 7�• I certify that in the performance of the work for which this OF LOTEXISTING BLDG. permit is issued, I shall not employ any person in any manner OWNER C O y so as to cc a subject to the Workers' Compensation Laws. AIL 'OCCUPANCY GROUP- -7i M A.)--ESS Date V Applicant 1— CD 'O LU NOTICE TO APPLICANT: If, afvter kig this Certificate of c,.ry ` ��� o� — OCCUPANT LOAD y 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 TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION � Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq'D D PROVIDED o SPACES 1�.1 License Numbed Lic. Class ( (/ LIMITED TIME USE Contractor J `torte 08 foidna DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OFNO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXI ING'BLDG, s STORIES sI ArueE iness and Professions Code). FINAL APPROVALf / 1114. R ,RESENT USE OF BUILDING / ./ Lic.or Reg.No. Date 0 DTX HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE f 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 PROVIn ED El I as owner of the property, will do the work and the a P P Y� � structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY RorosEn USE OF BUILDING I hereby affirm that there is a construction lending agency• T' for the performance of the work for which this permit is O issued(Sec.3097,Civ.C.). Lender's Name y 'l PROPOSED MAX. OCC. ^ I� �Vv Lender's Address \ 010 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 abn---r-ndoned prop,*r+v f.9r inspectionpu poses SEE REVERSE FOR EXPLANATORY LANGUAGE elon :Signa• ie ,ti Pec; asfserY-✓� Da e - WORKERS'COMPENSATION DECLARATION I 875 CE ((11-84) MISCELLANEOUS AP;PLICATION I hereby affirm that I have a certimpe of c,QInsur to self 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.Q. r _ Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING ` ,(•• +1 (( C 'T S ADDRES -�i 1,r1. �`. 4.11�3 '� lry LOCALITY Certified copy is filed with the county building inspection yLOCALITY NEAREST department. cROSs ST. Date ApplicantNEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' I LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP' HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) ; uSE OF SIZE OF LOT EXISTING BLDG. a I certify that in the performance of the work for which thiso permit 1S issued,I shall not employ any person in any manner OWNER ,' , r: i r i frl;(J so as to become subject to the Workers' Compensation Laws. MAIL (V OCCUPANCY GROUP o ASD D R El"l /• •T.A ('--i' �1 i— Date Applicant IAJ r-f t 1�1_lY':� ' ' TELtir.:c \ifl�— I'I—t! 1 OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY , , l = NoF-��I•. ; .,� 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 ❑ E] ❑ 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 No, of EXITS ness and Professions Code,and my license is in full force and effect. PARKING REWD PROVIDED SPACES License Number Lic. Class _ f\� (( ' q/ (1 J/��'[�'J LIMITED TIME USE Contractor Date �L /U L �`1 v T )"`v DATE DATE ' y^p� �+ ❑ I am exempt from the licensing requirements as I am a Q . C-- PROM: TOI licensed architect or a registered professional engineer SIZE OF NO. OF IECTOR'S acting in my professional capacity (Section 7051, Bus- EXSI NISTING BLDG. STORIES l ATURE iness and Professions Code). FINAL APPROVAL 1211 PR ESfi NT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's MO FEE 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 QQQQ—QQQ1 10/20/E9 structure is not intended or offered for sale (Section 7044,Business and Professions Code). 6326 1 PM 20-30 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency NLA 1 U sMV1GC! for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name (� PROPOSED MAX. OCG. Lender's Address PERMIT FEE t \ �� 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 95 r boon the above-mentioned property for inspection purposes. +9 SEE REVERSE FOR EXPLANATORY LANGUAGE i ature of Per e' Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 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 BUILDING ADDRESS FICertified copy is hereby furnished. ILDING LOCALITY DDRESS FCertified copy is filed with the county building inspection OC AL IT-1 NEAREST department. CROSS ST. Date ApplicantAREST ITY PE PROCESSED BY CROSS DISTRICT NO. GROUP ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF VSE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER LLI so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP LL DDRESS Date Applicant t TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of Iry No. Exemption, you should become subject to the Workers' VAPPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- E] ❑ with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION No Spec. Knowl. 1-7 deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING REQ'D PROVIDED SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR IU R : acting in my professional capacity (Section 7051, Bus- EXIS ING BLDG. STORIES SIGNAT' iness and.Professions Code). IN .SENT USE OF BUILDING FINAL APPROVAL Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law 'for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY 1— OPOSED USE OF BUIIyb ING 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 above-mentioned property for inspection purposes. SEE REVERSE FOR 16XPLANATORY LANGUAGE Signature of Permittee Date WORKERS'C:UMY MULUN UCI.LAKAIIUIV 2o-ooesDPW1P/sD ldll�<.C,1LLHl�l1C.��J� Hrll—l..Il�.�''11 1iJ11L , I hereby'affilm that I have a certificate bf consent to self COUNTY OF LOS ANGELES - BUILDING•AND SAFETY DIVISION • ulnsurl;or a certifiheteo f(Sed 800CLah C.jation Insurance,or s, a Certified copy ' CompanyFOR APPLICANT TO FILL IN BUILDING I Policy NakBUILDING ADDRESS ADDRESS ❑ Certified copy.is hereby;furnished. $ o �� W�� PI ° LOCALITY ❑ Certified ifan� py is filed with the county building inspection CITY�� ZIP dK a -7 190 NEAREST, CROSS ST. } ' Date *' Applicant SIZE OF LOT NO.OF BLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY . CONST. O CER1TFIt_ATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LAT NO. COMPENSATION INSURANCE MAP (CIRCLnr (� N4. (CINCLC) 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.) �r er TEL NO. L certify that in the performance.of the work for which this APA I0 permit is issued'I shall not empADDRES loy'any person in any manner S D. I so as to become subject to the Workers' Compensation Laws. ® e OCCUPANCY GROUP E:aE of Date Applicant , CITY ZIP_q17glr NOTICE TO APPLICANT: If.' after making this Certificate OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the-Lalior 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) NO.OF EXITS 9(commencing with Section 7000)of Division 3 of the Business �e uslIIess and Professions Code.and my license is in full force and effect. PARKING• REQ'D D PROVIDED D License Number Lia Class® ��a SPACES 0 I Contractor Date LIMITED TIME USE I DATE DATE ❑ 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 NO.OF INSPECTOR'S and PIOfeSS10RS Code). EXISTING BLDG. STORIE6 SIGNATURE, No. - Date PRESENT USE OF BUILDING FINAL APPROVAL Lia or.Reg HOME OWNER-BUMDER 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 SPACES PROVIDED i ❑ I, as owner.of the property will do the work and .,— structure is not intended or offered for sale(Section 7044,1 PROPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY _ ..... iI-hereby affirm that there is a construction lending agency for the erformance of the work for which this permit is issued (Seap3097,ay.C.). PROPOSED MAX.OCG Lender's Name APPLICA ® ) TEL N9. i Lender's Address ADD ESS j I certify that I have read this application and state that the °- ° gad ® ° 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 g SEE REVERSE FOR EXPLANATORY LANGUAGE- Signature of Permittee Date C 1 WORKERS'COMPENSATION DECLARATION za oOesoPtrir:ziso MISCELLANEOUS APPLICATION ' I hereby affirm that I have a certificate of consent to self COUNTY OF LOS' ANGELES BUILDING AND SAFETY DIVISION 6Ii ;ii>isure,or a certificate of Workers'Compensation Insurance,or y Ll a certified copy thereof(Sei 3800, Lah C.)• ( I Policy No Company FOR APPLICANT TO--FILL BUILDING B LDING AD ESS ADDRESS El Certified copy.is hereby:furnished. $ ADDRESS LOCALITY I ❑ Certified copy is filed with the county building inspection Cer zIP I department O ! NEAREST CROSS ST. CESSED BY Date ` Applicant SIZE OF T NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROS CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' ( I COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY • NO. (CIRCLET 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 I certify that in the performance,of the work for which this ^��rty r �� TE"O' �c` /r I permit is issued. I shall not employ any person in any manner �P T! � U. I so as to become subject to the Workers' Compensation Laws. AD p _I 'JOq 5-)'ZZZ? OCCUPANCY GROUP a I Date Applicant CITY �GzIP 91173 NOTICE TO APPLICANT: If, after making this Certificate ` OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: ( comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ ' revoked. 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 •=� t 1 9(commencing with Section 7000)of Division 3 of the Business a e c1 tnsazmess and Professions Code,and my license is in full force and effect. PARKING• REWD PROVIDED License Number Lic.Class SPACES E= ( 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 professional engineer FROM: To: acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. STORIES SIGNATURE. Lic or Reg.No Date PRESENT USE OF BUILDING FINAL APPROVAL 23 03• 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 1 I Professions Code): NO.PARKING i ElI, as owner of the property, will do the work and theSPACES PROVIDED structure is not intended or offered for sale(Section 7044,19 PROPOSED USE OF BUILDING Business and Professions Code). 1 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 ' 1 (Sec. 3097,Civ.Q. PROPOSED MAX.OCC. Lender's Name ICANT(PRINT) TEL NO. Lender's Address AMRESS ( i I certify that I have read this application and state that the above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE Z SEE REVERSE FOR EXPLANATORY LANGUAGE Signature or Permittee Date WORKERS'COMPENSATION DECLARATION, 2o-ooe3DPW-- - M125 ELLANEVV� APPLlC:ATIUN I hereby affirm that I have.a certificate bf consent to self COUNTY OF LWANGELES BUILDING.AND SAFETY DIVISION !•vinsure,or a certificate of;Wiirlers'Compensation Insurance,or 'i,; ! 'A certified copy thereof(Seg. 3800, Lab.C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING '' •;• BUILDING ADDR SS s ADDRESS u Certified copy.is ( � LOCA Certified copy is filed with the county building inspection CITX_ i ' 1 LZI b I NEAREST department �-c �AC1 , CR . .. ' Date %' `= Applicant I SIZE OF Larl U NO.OF BCDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF•EXEMPTION FROM WORKERS' s coNsr. I TRACT BLOCK LOT NO, I 1 .. .. ,COMPENSATION INSURANCE . MAP - HIGHWAY I • 1 NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL ! by the permit is for one hundred dollars ($100) or less.) ` USE ZONE SPECIAL CONDITIONS s, I.certify that in the performance.of the work for which this 31 �ty ere,,A f .TEL NO. 0 .G G ! permit is issued;I'bje not employ any person in any manner ! so as to become subject to the Workers' Compensation Laws. ADDRESS � .��•� OCCUPANCY GROUP , ( I Date Applicant CITY �� I�� ZI CA � NOTICE TO APPLICANT: If.' after making this Certificate OCCUPANT LOAD of Exemption• you should become subject to the Workers' APPLICATION FOR Compensation provisions of the-Labor Code.you must forthwith EXIT HARDWARE: comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ t 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) g f I I 9(commencing with Section 7000)of Division 3 of the Business game o usiness No.of EXITS and Professions Code,and my license is in full force andjeffect. .. PARKING• REQ'D O PROVIDEDco D s License Number Lie Classu v a SPACES l I I Contractor Date i LIMITED TIME USE c i ❑ I am exempt from the licensing requirements as I am a FROM: DATE TO. DATE licensed architect or a registered professional engineer �+ acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S ' and Professions Code). ( EXISTING BLDG. STORIES SIGNATURE. Lie or Reg No - Date ! PRESENT USE OF BUILDING. FINAL APPROVAL SO L ' 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 ( I Professions Code): NO.PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044,3 PROPOSED USE OF BUILDING Business and Professions Code). 1 1i (�'l LC> "Lo CONSTRUCTION LENDING AGENCY ;( i' • I-hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ' (Sec 3097,CIV.C.). PROPOSED MAX.OCC Lender's Name APPLICANT(PRINT) L Lender's Address ADDRESS V i I j I certify that I have read this application and state that the above information is correct I agree to comply with all County PERMIT FEE ! ordinances and State laws Yelating to building construction,and .. i hereby authorize representatives.of this County to enter upon ISSUANCE FEE . r•{ the above-mentioned property for inspection purposes "' !! -► :s.'1 ! I TOTAL FEE ! I •` ! % ,d let (7�ib2 SEE REVERSE FOR EXPLANATORY LANGUAGE L , Signature of Permittee Date I