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HomeMy Public PortalAbout9663-9665 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION ; CE 876(1 1-84) MISCELLANEOUS A P P L I C AT I O N • I,sure,bo 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.Q. Policy No." CompanyFOR APPLICANT TO FILL IN BUILDING c ADDRESS Certified copy is hereby furnished. DING 5 E L s -Tum y LOCALITY ADUILDRESS !1 Certified copy is filed with the county building inspection department. OCALITY 1 AS -R1`►1/�S NEAREST —RCNAS/'J CROSS ST. Date Applicant RAREST w� L,�*� DISTRICT NO. GROUP ITYPE PROCESSED BY 055 ST. H M Iv AVE:y 1CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this sI OF LOT EXISTING BLDG. O permit is issued,I shall not employ any person in any mannerLl i so as to become subject to the Workers' Compensation Laws. pwNER LLf S OCCUPANCY GROUP' 04 Date Applicant ODRESS �� E. LAS TUNAS �2. w NOTICE TO APPLICANT: If, after making this Certificate of CITY TEMPLE C ITvoL'(�(S� OCCUPANT LOAD y Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- ❑ with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl, deemed revoked. I I Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PER MI ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. of Exlrs nese and Professions Code,and my license is in full force and yR 1t I�#0 b)!_1t� �vL�. effect. 1L% /t 9 PARKING SPACES REq'D PROVIDED License Number Lic. Class r LIMITED TIME USE Contractor Date SiA I I H DATE DATE ❑ I am exempt from the licensing'requirements as I am a FROM: TO: licensed architect or a registered gm INSPECTOR'S gi professional engineer eer slzE of NO. OF SIG TORE acting in my professional capacity (Section 7051, Bile- EXISTING BLDG. STORIES mess and Professions Code). FINAL APPROVAL 01 Lic.or Reg.No. Date RESENT USE OF BUILDING comAurEws7'o E 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 p El 'I, as owner of the property, will do the work-and the SPACES PROVIDED �9 8 a 6 A structure is not intended or offered-for sale (Section # o o e o 8 8 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING o 0 0 0 0 0 o z I hereby affirm that there is a construction lending agency C'Q/l/J (,� cS7'O/P� 0� 7 0•=88 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, d hereby authorize representatives of this County to enter TOTAL FEE C15 10 U on the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION SCE 87b(11-84) M p�CELLANEOUS APPLICATION I hereby affirm. cat 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 ADDRESS Certified copy is hereby furnished. DRESILDINS v 1�G `4r / n� LOCALITY 'leAD Pit ElCertified copy is filed with the county building inspectionLOCALITY /� NEAREST department. -.Q rK ; CROSS ST. Date Applicant ;WAREST DISTRICT NO. G TYPE PRO SED BY CROSS ST. T. I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �V/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND OCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOTUSE 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. d 0 permit is issued,I shall not employ any person in any manner OWNER ex so as to become subject to the Workers' Compensation Laws. IL OCCUPANCY GROUP (/ ADDRESS 0. 7,124- Date Applicant TEL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY AIA&m`j t NO. Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ 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 PERMI ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. 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 SOF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGN TORE iness and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg..No. NIo. Date _ z i COI r HOME OWNER-BUILDER DECLARATION No. OFO EXISTING BUILDINGS 8 6 a�!A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's # 0 0 0 0 8 8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED � structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency co mp t4 TI-IZI for the performance of the work for which this permit is \ issued(Sec. 3097,Civ.Q. 1 \ Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 1 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 ereby authorize representatives of this County to enter TOTAL FEE u thea ave-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION or affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION re, 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 BUILDIENG ` AD OR SS Certified copy is hereby furnished.t- BUILDING q LOCALITY ADDRESS Dr, 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT I�Q' G OUP TYPE / PROC SED BY V CROSS ST. ('�/ CONST. l / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL lll///a YY COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP ;HIGHWAY STATE MAJOR SECOND LOCAL NO. �� j (CiR CL6) (This section need not be completed if the work involved TRACT Now NL OT S. 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. permit is issued,I shall not employ any person in any manner OWNER S� so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP -• o Date Applicant ADDRESS � r W T >N_411 OCCUPANT LOAD a- NOTICE TO APPLICANT: If,after making this Certificate of clrY No. y Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: a Compensation provisions of the Labor Code,you must forth- with comply with such provisions oI this permit shall be TRAILER USE [:] GEOLOGY INSPECTION Eldeemed 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 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 DATEC OA TE FROM. I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OP INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING ✓ Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXI TING ON LOT ANUSE B ILDI S I hereby affirm that I am exempt from the Contractor's 27210 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # — o o 88 ElI, as owner of the property, will do the work and the SPACES PROVIDED •o o 1 0 0 0 0 o z• structure is not intended or offered for sale (Section 7044,Business and Professions Code). 0615-87 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUIL N 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. �(J Lender's Name PROPOSED MAX. OCCLender's AddressI ertify that I have read this application and state that thePERMIT FEE bah 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 5,i u n t bov - entioned prope y`or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE —Sigifalure WP6mittee Date i WORKERS COMPENSATION DECLARATION 76M444 7� !-r CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm,that I have a certificate of consent to self I 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.). BUILDING �f /j Policy No. Company FOR APPLICANT TO FILL IN v u ADDRESS � Certified copy is hereby furnished. AnORES �� L�VI d( Yi LOCALITY g- El Certified copy is filed with the county building inspectionO ALIrY e ° NEAREST department. _al I CROSS ST. ; Date Applicant EAREST �I^ DISTRICTjjj OUP TYPE PR(. SSED BY CROSS ST. ` �T'�// ,�I CONST. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J(U (�/ 7Y/ COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR S COND 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.) us a OF S ZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER ICL VI C wam 0u 111) so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP ADDRESS r Date Applicant AIL D �1 n j IU NOTICE TO APPLICANT: If,after making this Certificate of CITY �I �yyl,i��-�� No•. lG�11 J��[ / I OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR /l? EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be E U TRAILER SGEOLOGY INSPECTION ❑ ❑ ❑ No Spec. Knowe. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices EJ 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 0 E:= PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: - TO: D I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer slzE of NO. OF INS P rOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL i 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 �8 9 Q 7 A 0 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section # o e o e 3 0 7044,Business and Professions Code). D 0 o D Io 0 0r13 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING� 0219-88 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is J Q issued(Sec. 3097,Civ.Q. Lender's Name -' PROPOSED MAX. QCG. � I> P� � 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 uthorize representatives of this County to enter TOTAL FEE u n`61 ve-mentioned p y r inspection purposes. / t !�,�`(� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date (� �� WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION .v 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�tgrtified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN ADDRESS . 1 FICertified copy is hereby furnished. BUILDING r ADDRESS , LOCALITYiYl Certified copy is filed with the county building inspection LOCALITY NEAREST department. '� CROSS ST. t%jvj'� Date-Applicant NEAREST �� DISTRICT G$OUl� TYPE / PRO S ED BY �..� CROSS ST. �Lt/I, l/ -t'.yr 5,F&VV .�J CONST j]// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL b (/ I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SEC O LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF �� SIZE OF LOT EXISTING HLD G. ' Zf 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 ..1 I OWNER =O so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS I Z5 Date Applicant ( 1.1 NOTICE TO APPLICANT: If, after making this Certificate of�9 CITYAft C%— TE OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION 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 E] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION(x Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq'D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a FROM. TO: licensed architect or a registered professional engineer SIZE OF NO.OF, I PE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES IGNATURE iness and Professions Code). , FINAL APPROVAL PRESENT USE OF BUILDING (f Lic.or Reg.No. Date i HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS z 6 8 9 7,A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's # G D,o.0 8.8 License Law for the following reason (Section 7031.5, Busi- ness usiness and Professions Code): NO. PARKING o D•G Doo•o a EJI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for We (Section 0 4,-2 4,-i&8 7 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 Wignature laws relating to building construction, represen ives of this County to enter TOTAL FEE CS.A boned pr9 A for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Permittee Date a WORKERS'COMPENSATION DECLARATION CE 875(11-81K 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 // r q� ADDRESS �I�J 4`l� � KS Certified copy is hereby furnished. ADDRESS L'ts7.s��LfrS /!.Ak4'S A9 LOCALITY Lar3 Certified copy is filed with the county building inspection LOCALITYCROSS$T department. '40, A"CG1 1 .C om? Date Applicant NEAREST �/�� D'ISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. /`/rW ST_ 0+D sJ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 'M o� v COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF ]SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF 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 G' }/v S�(/,J L1L.&I) !oH so as to become subject to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP Date Applicant ADDRESS 4.0- VIII wAt v,.LT 2i]kvx- U W TEL OCCUPANT LOAD �- NOTICE TO APPLICANT: If, after making this Certificate of CITY �JA- &4- NO.91f-44.7.the-s rn 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 I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D D PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 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 SIGN TURF iness and Professions Code). FINAL APPROVAL ����V9z PRESENT USE OF BUILDING Lic.or Reg.No. Date 65 ii z?9_r&/ic/ e �,10AI n/ HOME OWNER-BUILDER DECLARATION NO. OF EXI TING BUILDINGS 0 r �'=-•i ON LOT AND USE I hereby affirm that I am exempt from the Contractor's I-.rll License Law for the following reason (Section 7031.5, Busi ness and Professions Code): NO. PARKING SPACES PROVIDED ;r-•+�: •;I.�l-:;„C: I, as owner of the property, will do the work and the i 8113 s •.1 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 /i,✓ /fe�S/N�sS i for the performance of the work for which this permit is If issued(Sec. 3097,Civ.Q. Lender's Name , PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that 1 have read this application and state that the �Dp above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE iSEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date I WORKERS'COMPENSATION DECLARATION ICE 8754(11-a4) MISCELLANEOUS APPLICATION I hereby affinR,Jhat I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a cert:rlcate of Workers'Compensation Insurance,or a certifies copy thereof.(Sec.3800,Lab.C.). /` _ Policy No. ' ADDRESS J�Company FOR APPLICANT TO FILL IN BUILDING o3 /2AM( k Certified copy is hereby furnished. BUILDING / ( , [;� TUNf'� br. LO CALI7Y L RE CITY ADDRESS 1�v Certified copy is filed with the county building inspection LOCALITYNEAREST department. J-F(,J?Lir UTy GA 01(-76O cROSs ST. Date Applicant NEAREST DIST IC G U�TYPE P CES BY PP 6�1�U API -L G 5 CROSS•ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this 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 E3 Date Applicant / ____ _ � NOTICE TO APPLICANT: If, after making this Certificat of CITY R0�1+1+,t aD No�'l. OCCUPANT LOAD oral Exemption, you should become subject to the Wor ers' -- Compensation provisions of the Labor Code,you must f rth- APPLICATION FO EXIT HARDWARE: with comply with such provisions oI this permit sh be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of C apter SAFETY PERMIT ❑ (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of th Bus!- No. OF EXITS ness and Professions Code,and_ my licesp iglin gull for a and �NS- effect. (�1'/V /�` � %vV /I SPACPARK ESG Ra Wo PROVIDED License Number Lic. Class `0` i LIMITED TIME USE Contractor ate -7474- i Ar` DATE DATE I am exempt from the licens re uuelii� t as am a licensed architect or a registered professional engineer SIZE OF NO. OF PROM. TD. INSPECTOR'S SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES inessand Professions Code). +. ` FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING �Ia I�s ('t 0 2 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- ��}ry `I i{ ness and Professions Code): Nb. PARKING i.l00101-0001 .4 6190 I, as owner of the property, will do the work and the SPACES PROVIDED 8793 1 All 19:47 structure is not intended or offered for sale (Section 7044,Business and Professions Code). �j CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING WPri LS S d 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. � v Lender's Name 1� - V PROPOSED MAX.OCC. Lender's Address 5 LIU ' 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, d�} and hereby authorize representatives of this County to enter TOTAL FEE as upon the above-mentioned property for inspection purposes. 19 S T �) n SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee�- Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MI I SC E L LA N E O U S APPLICATION CE 875 I hereby,.•afcert 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,Wrtified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDINGDV ADRESS ❑ Certified copy is hereby furnished. BUILDING :EM E C; V ADDRESS 63 e r"v OCA LITY J ❑ Certified copy is filed with the county building inspection.J LOCALITYNEAREST department. + — CROSS ST. Date Applicant ` c NEAREST DISTRICT NA. GR-P TYPE / PRO SED BY V CROSS ST. U FFMA I/ N57/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL YYY COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SEC D LOCAL ( NO. OF BLD GS. NO. CIRCLE) (This Section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. l.� I certify that in the performance of the work for which this ��JJ o permit is issued, I shall not employ any person in any manner -4 OWNER O' - + j s44 `� so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o J ADDRESSr- Date Applicant p.O, 0 7 7 LLI NOTICE TO APPLICANT: If, after making this Certificate of CITYA-I#pMB&4 GA'Q,1 OA N0- i d _ 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ i 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. PARKING REQ'DD PROVID EO D 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 pp SIZE OF NO. OF INS ECTOR's acting in my professional capacity (Section 7051, BuS V EXISTING BLDG. WS0 S �� STORIES I S NATUR iness and Professions Code). PRESENT USE OF BUILDING � FINAL APPROVAL —ID 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. PARKING7 SPACES PROVIDED � 1 J.O I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # o o*o o 8 8 .7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY -"A PROPOSED USE OF BUILDING l�itS :NGTS 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 ` rj,Ov n I certify that I have read this application and state that the PERMIT FEE V� " above information is correct.I agree to comply with all County ISSUANCE FEE o o e o o D o z 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 Signature of ermittee ate c WbRKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L LA N EO U S APPLICATION � CE 875 I hereby affirm That I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FI LL IN BUILDING y, 1 //��,, t� ADDRESS 663 � ( N � �1 rl Certified copy is hereby furnished. AUILDIN Ea �•I1� (l( Dr `� LOCALITY Ck 1-V CA q 1396 -F� Certified copy is filed with the county building inspection LO LITY NEAREST department. L ceoss sr. Date Applicant EAREST e' DISTRICT.���tIODD OUP PE PR CE SED BY ROSS ST. ry/�F,..LLIA ` �( ` CONST, CERTIFICATE OF EXEMPTION FROM WORKERSLEGAL u COMPENSATION INSURANCE DESCRIPTION LOT NO. NO. OF BLDGBLOCK MAP (CIRCLE)HIGHWAY STATE MAJOR SEC D LOCAL Ro. cl$. (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 ($100) or less.) USE D ZE OF LOT EXISTING BLDG.F I certify that in the performance of the work for which this ` � o permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY ZZ Ai"i GROUP �j —,2/ a D DRESS !-•- Date Applicant `d 6 A, IAJ NOTICE TO APPLICANT: If,after making this Certificate of ' CITY NO. IOCCUPANT LOAD 1`I_� Ir z Exemption,• you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE El GEOLOGY INSPECTIONNo Spec. Know]. ❑ deemed revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices E I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO, of EXITS ness and Professions Code,and my license is in full force and effect, PARKING SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME U S E Contractor Date DATE DATE D I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer sI ofG NO. OF 0� I$SGECTURE acting in my professional capacity'(Section 7051, Bus- SE (STINBLDG. STORIES mess and Professions Code). \�• 1� FINAL APPROVAL ;PR ESENT USE OF BUILDING ` t' / Lic.or Reg.No. Date 6 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 IV AA= act ROPOSED USE OF BUILDING Qy� I hereby affirm that there is a construction lending agency A for the performance of the work for which this permit is ACCT°r issued(Sec. 3097,Civ.Q. MI CI FEE Lender's Name PROPOSED MAX. OCC. Lender's Address L-1 -y�.1 .I !4 PERMIT FEECQ_50 0U �[l0(�•-Dian(i S! !il/8 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 0297 AM 8:35 ordinances and State laws relating to building construction, O and hereby authorize representatives of this County tc enter TOTAL FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE &j-O 'Sygnature of Ilermittee Date 1131 WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or IL a certified copy thereof(Sec.3800,Lab.C.) ` Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS 6/1 ❑ Certified copy is hereby furnished. AUILDIN �, LOCALITY ❑ Certified copy is filed with the county building inspection Q / NEAREsr 10 department. LocALlry 7'�� / C(✓ C7,)� 6 CROSS ST. Date Applicant EAREST / ,/ DISTRICT NO. OUP PROCESSED BY CROSS ST. ST, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NO. (CIRCLE) STATE MAJOR SECOND LOCAL >_(� HIGHWAY NO. OF LDGS. a (This section need not be completed if the work involved TRACT NOW ON LOT USE ONE S CIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) U N USE OF SIZE OF LOT VD EXISTING BLDG. �/V cc certify that in the performance of the work for which this V 0 permit is issued, I shall not employ any person in any manner J,ATWNER R ) so as to become subject to the Workers' Compensation Laws. AIL Wl OCCUPANCY GROUP �� `U AO ADDRESS0. Date Applicant j TEL d�U� fn NOTICE TO APPLICANT: If, after making this Certificate of cirY — L No. �767j 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 d ❑ NO Spec. Knowl. deemed revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING effect. SPACES REO'D I I PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ I FROM: TO: 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). LY-WfSENT USE OF BUILDING FINAL APPROVAL Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE -F1 8 3,9 A I hereby affirm that I am exempt from the Contractor's • • • • 8 8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING • • • • • • • SPACES PROVIDED 2 ❑ I, as owner of the property, will do the work and the ) _8 3 structure is not intended or offered for sale (Section 7044, Business and Professions Code). oPosEO USE of BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency f 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 t correct. I agree tcomply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter .Q Jof— upon the above-m tioned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATO AGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.CJ. Policy No. Company FOR APPLICANT TO FILL IN BUILDING �(O103 ADDRESS (O Certified copy is hereby furnished. BADUILDRDENSIG J P. L- 1S U NfIr LOCALITY S v 6 Certified copy is filed with the county building inspection LOCALITY l qo NEAREST LOCALITY 1l� CRoss sT. Date Applicant NEAREST / '` `, yI� r�N/�/'I {`} DISTRIC33 NO. GROUP TYPE PR CESSED BY CROSS ST. 'l-NU 1` �=I' , ��� / \ ,('�D� -3 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY rvo. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPS CIAL 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 . C:) permit is issued, I shall not employ any person in any manner OWNER 0` 61111_,0111e �g . =' so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP �� o ADDRESS ,Lf 74- � Date Applicant uJ NOTICE TO APPLICANT: If, after making this Certificate of CITY PIL (l/( ( No. 6 OCCUPANT LOAD O_ 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 USEGEOLOGY 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 andK S ./�� effect. N PARKING REQ'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 SIGNATURE iness and Professions Code). pp / PRESENT USE OF BUILDING X ���,+cam w FINAL APPRQV�4„ - /] Lic.or Reg.No. Date - .W HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's0000_C 12/- 9., License Law for the following reason (Section 7031.5, Busi- =`. �M� ness and Professions Code): NO. PARKING V" "` 6767 1 FIM 4:418 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section �1 7044,Business and Professions Code). �r CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address / I certify that I have read this application and state that the PERMIT FEE ',above information is correct.I agree to comply with all County ISSUANCE FEE grdinances and State laws relating to building construction, 1.01 and hereby authorize representatives of this County to enter TOTAL FEE upon the above- entioned ty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SignaturkJof Permittee Date °�/ WORKERS'C'Ob11'ENSAIION DECLARATION '0-000. M15C:ELLANtVl,15 APPLIUAI 1UN 0-UUt�sDPW 12'UO 1 hereby affirm that I have a certifie;tc of consent (,I, self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I� insure,or a certificate of Workers'Compensation Insurance,or it certified copy thereof(Sec.3800. Lab.C.) J ::ilicy No. _ _• Company FOR APPLICANT TO FILL IN BUILDING BUILD G ADD ESS ADDREss ty� V 'v 2- 4C�I• • El Certified copy is.hereby furnished. (; /� L tw_ b XXVVE I LOCALITY ❑ Certified copy is filed with the county building inspection CITYo % ZIP NEAREST 6 '•J department. i t 9/7,;V CROSS ST. � Date Applicant SIZE OF LO NO.OF BLDGS.NOW ON LOT I DISTRICT NO. GROUP TYPE PROCESSED BY I. CERTIFIC'AIT 01' EXEMPTION FROM WORKLIt's TRACT, / t7 BLOCK LOT NO. CONST. `. COMPENSATION INSURANCE 1 MAP HIGHWAY I 1 NO. IGIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work ill"'OIYC111 ASSESSOR MAP BOOK PAGE PARCEL � USE ZONE SPECIAL CONDITIONS r" by the permit is for one hundred dollars (�IIOUI oil less.) I certify that in the performance of the work li,r wit 1 Iliti ow ER ^ t T L o. i permit is issued. I shall not employ any person in any n{anne I, so as to become subject to the Workers' Compensation'IL . APID ESQ OCCUPANCY GROUP ® tl l�./ rid• l�l.l=�- G*�-� I Date Applicant CIT, NOTICE TO APPLICANT: If, alter making this Certificate zlP�l.C.a 007 OCCUPANT LOAD of Exemption• you should become subject to the Whrkers' APPLICATION FOR Compensation provisions of the Labor Code.you must rorf,hwith EXIT HARDWARE: . I comply with such provisions or this permit shall be Llremed TRAILER USE GEOLOGY INSPECTION❑ revoked. y p No Spec.Knowl. ❑ OCCUPANCY INSPECTIONILII ' Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 3 I I hereby affirm that I .1m licensed under provisions of Chapter SAFETY PERMIT❑ ILIST ITEMS BELOW, 9(commencing with Section 7000)of Division 3 Of till'BgslneSS NO.OF EXITS and Professions Code,and my license is in full force and-,'effect. �� t3tNfi55 ' PARKING• REQ'D O PROVIDED D License Number Lie. Class SPACES Xl/�yNC' oG �'! _,___._• r LIMITED TIME USE I Contractor Date t ~ IDATE DATE ❑ I am exempt from the licensing requirements as 11 am a FROM: TO: t I licensed architect or a registered professional crlgineer acting Ill Illy professional capacity (Section 7051. 11as'illess SIZE OF NO.OF INSPECTOR'S and Professions C'ode). E%IS TING BLDG. STORIES SIGNATURE Lia or Reg. No. _._ _ . _ Date ) PRESENT USE OF BUILDING f,l6;9 V9AJ I FINAL APPROVAL ar •`•! i HOME OWNER-III.III.DER DFULARAHON I NO.OF uxisrING BUILDINGS t ON LOT AND USE hereby afTirn that I am exempt front the Contractor's License Law for the following reason (Section 7031.5. Business and I , Professions Code): ; NO.PARKING SPACES PROVIDED ❑ 1. as owner of the properly. will do the %%ork ;uid the - structure is not intended or ol'iVred 161 sane(SeelILII 7044. PROPOSED USE OF BUILDING Business and Professions Code). I CONSTRUCTION LENDING AGENCY i1 hereby affirm that there is a construction lending agency lin• the performance of the work for which this permit is Issued ! (Sec. 3097,Civ.C.). 1 PROPOSED MAX.OCC. Lenders Name ._........... ...-. _.. APPLIC9NT(FRINT) TE,L}�0. , X L£v.-A Lender's Address l ADDRESS I certify that I have read this•application and statetl�t the above information is correct. 1 agree to comply with all(�'ounty PERMIT FEE I ordinances and State laws relating to building construction.and j hereby authorize representatives Of this County to enterI upon ISSUANCE FEE the above-mentioned pro erty for inspection purposes. 1 �•. r TOTAL FEE o 1 - c :X I /T �_ SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Id - Signat re o r it ata v I .I I WORKERS'COMPENSATION DECLARATION 76M444 ICE 875(11-84) M ISCELLANEOUSAPPLICATION 'I hereby affirm that I have a certificate of consent to self , I COUNTY OF LOS :ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or r , �.• 1 a certified copy thereof(Sec.3800,Lab.Q. ` : Policy No. Company FOR APPLICANT TO FILL IN BUILDING AD &� DRESS ❑ Certified Copy IS hereby fUInlShed. II BUILDING �j F , � ASTU&f� oQ LOCALITY X�1� ADDRESS L.r1 �v Certified copy is filed with the county building inspection I LOCALITY "iEM per. Gi ry 9 rI O OSS GRST. department. SX Date Applicant NEAREST JJ�� (w/��� ( ( DISTRICT NO. GROUP TYPE P ESSED BY CROSS ST. �rC��P,n l j `�I,1 `��^^v .�� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v 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 permit is issued,I shall not employ any person in any manner, OWNER of building, Irl LIJ'ki'-6 S(-rl if so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP D'MAIL n ADDRESS P� O� t r- Date Applicant {��l w NOTICE TO APPLICANT: If,after making this Certificate of CITY 4'}A"RA NO. �D I6� OCCUPANT LOAD Exemption, you should become subject to the Workers' gppLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ 1 hereby affirm that I am licensed under provisionsof Chapter 1 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 an X ^ effect. Name of business PARKING REQ'D SPACES JJ�J PROVIDED �_ 1 J License Number Lic.Class -1 N IN LIMITED TIME USE Contractor Date I DATE DATE EJ1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer f slzE OF qo %a NO.OR PROM. TO. INSPECTOR'S 7 SIGNATURE , acting In my professional capacity (Section 7051, Bus- I; EXISTING BLDG. �' STORIES iness and Professions Code). ' Ap/ PRESENT USE OR BUILDING /� �t�W11 FID IAL APPROVAL Lic.or Reg.No. Date �} I IIOME.OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS v Wt I hereby affirm that I am exempt from the Contractor's ON LOT AND par. License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1, as owner of the property, will do the work and the ,I SPACES PROVIDED structure is not intended or offered for sale (Section I , 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY j PROPOSED USE OF BUILDING NIS 1 hereby affirm that there is a construction lending agency I .p for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name t 1 PROPOSED MAX.OCC. J Lender's Address Ti PERMIT FEE 1—� ;i 1 certify that I have read this application and state that the I above information is correct.I,agree to comply with all County I ISSUANCE FET, E :t! ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 1 t. upon the allpvezmet t" ed property for inspection purposes. XX XX ' ( SEE REVERSE FOR EXPLANATORY LANGUAGE Sig aturc of Perinittec Date WORKERS*COMPI:NSAI'ION DECLARATION :,��M�� 1 ; MISCELLANE061S APPLICATION sl hereby affirm that I have a certil'icale of ct .ent iy .ell' COUN11' OF ANGI-LI-S liIIILUING AND SAFETY DIVISION n insure,or a certificate o1' Workers'C'unlpen.ation Insurance.or I certified copy iherenl (Sec. 3800. lab. C.) s Policy No. , • Company �a AQ FOR APPLIGAN I TO FILL IN BUILDING BUILDJJJ)',pQDRES �- j ADDRESS ❑ Certified cop)' is hereby I'u rnishcd• �[ry� ( � ,�S �(�11�GS l'.� + LOCALITY ❑ Certified copy is filed with the county building hisli ICtion CITY.- ZIP department. , 1 C1 J NEAREST �� yv CROSS ST. Date _. Applicant SIZE OF LOT% NO.OF BLDG .NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY C'ERTIFICK111: OF EXEMPTION FROM 1VORKLR.t+ CONST. i �I C'UMPENSXHON INSURANCE ' Tr1ACT BLOCK LOT NO. NAP HIGHWAY t I NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This tiE•CI11111 need not be completed If IIIC \\(11'h i1111)I t'l"(I ASSESSOR MAP BOOK PAGE PARCEL t by Elle' permit is for 011e hundred dollars (S I(3()) 111' Ie%0 USE ZONE SPECIAL CONDITIONS III OWNER TEL NO. ) ,•� iI certify that in the performance of the work fur tthicf� this — �-- I---- - I�- i permit is issued. I shall not employ any person in any manner I ADDRESS so as to become subject to the Workers' C'ompen.atinn Ilatt•s. i OCCUPANCY GROUP i Dale Applicant CITY ZIP NOTICE TO APPLICANT: If. alter making this ('eriii'ieate _ OCCUPANT LOAD of Exemption, you should hCC0IIIC subject to tale W(trkers' APPLICATION FOR EXIT HARDWARE: C'ompensalion provisions of the Labor Code.you moil Ioriliwith comply with such prat ilio 1S or this pernlll SINIII he dtfelllCd TnAILER UIE D GEOLOGY INSPECT ION Ll NO Spec.Knowl. ❑ revoked. - p'7- OCCUPANCY INSPECTIONN I• Patric Devices ❑ ' LICENSED CONTRACTORS DECLARATIONII ^^ 1. 1 hereby affirm (flat 1 amlicensed antler provisions- (11 (II;11)ll'r SAFETY PERMIT IJ (LIST ITEMS BELOW I'' `L •� I 9(commencing with Section 7000)of Division 3 of the I3lISilless NO.OF EXITSEl and Prol'essions Code.and my license is in full li)rce and effect. I�IA1_lf c:r +i(-.tnilts`_'i i PARKING• REO•D PROVIDED License Number Lie.Class SPACES D LIMITED TIME USE IT Contractor Ua(r - - --- - --'- -- DATE DATE I ❑ I deet exempt Troll the licensing requirements its I�il111 a FROM: TO: licensed architect or a registered prulessional en lincer - • acting I11 111)' pl•(lf L•titiln11;11 L•ilpill'll) (tit'L'llnit 7(li(. Ittff,Sllll'ti. SIZEOF NO. )F INSPECTOR'S I• iI EX1srING BLUG. SI'ORIL.S SIGNATURE - and Professions ('ode). --------- --- PRESENT USE OF BUILDING Lie. or Reg. No. Dale I _ - :FINAL APPROVAL ( V i HOME OWNER-1311ILDER DIA LARAIION 1 NO.OF'l:XI51 ING BUILDINGS I r I I ON LOT AND USE I hereby affirm that I and cunlpt from the Contractor's License --- -- — Law for the following reason (Section 7031.5. l3usinesp and Professions Code):): NO.PARKING El 1. as owner ill' PROVIDED l' the,property. "ill d(, the 1%, -1, alltl the - -- ---�-- --- - -'•---'---- - structure is not intended or ul'lercd I'm sale (tieclion Itl•)•I. PROPOSED USE OF BUILDINGI & elm- a, hi- Mgt I Business and I rofessions ('ode). I br�"'�- i CONSI'RUCTION LENDING A(il:NCY 1 hereby al'11rnl that there is it cunslruction lendinp aeenl•t 1,411- tile performance of the work for which this permit'is issued - -------- I (Sec. 3097.Civ.C.). I PROPOSED MAX.OCC. Lender's Name ( APPLICA^r 1,I(MINI) I ) TEL NO. I x �.Il i t•�. 1111�. ti/s Lender's Address ADDRESS li I certify that I have read this application and stile this the above information is correct. I agree to Comply with all County PERMIT FEE I ordinances and Slate laws relating to building ennsiruclim.;Ind hereby authorize tives of this C'nunly to enlerl upon ISSUANCE FEE I the above-mention d operty Rlr inspection purposes. TOTAL FEE J V /� I SEE REVERSE FOR EXPLANATORY LANGUAGE i Si aturc of Pcnniucc Del(I 4 1 WORKERS'COMPENSATION DECLARATION S /6M444 MISCELLANEOUS APPLICATION 1 20-0063DPW12/90 rl •• I hereby'affirm that I have.a certificate bf consent to self COUNTY OF LOS- BUILDING.AND SAFETY DIVISION Ylhsure6 or a certificate of:Wdrkers'Compensation Insurance,or ;a certified copy thereof(Set 3800,Lab.C.) 1 - ` i Policy No. Company FOR APPLICANT TO FILL IN BUILDING ^. •�• BUILDING ADDRESS iADDRESS Certified copy.is:hereby; d X furnished. 9665 1. 2 LAS TUNAS DRIVE LOCALITY Certified copy is filed'with the county building inspection CITY zip I department TEMPLE CITY CA 91780 NEAREST, I CROSS ST. Date ' Applicant I SIZE OF LOT NO.OF BLOGS.NOW ON LOT DISTRICT NO. I GROUP TYPE PROCESSED BY CERTIFICATE OF-EXEMPTION FROM WORKERS' 2,748 1 CONST. o. TRACTBLOCK LOT NOV COMPENSATION INSURANCE .6561 MAP - HIGHWAY 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 ($100) or less.) _ g5g7 020 016 USE ZONE SPECIAL CONDITIONS ] i t� I.certify that in the performance.of the work for which)chis erlEer TEL No• I permit is issued'(•shall not employ'any person in any manner CHANG SUN SHIN1(626)445-758C i so as to become subject to the Workers' Compensation Laws. ADDRESS480 WALNUT AVE. I OCCUPANCY GROUP ' I Date Applicant . CITYl�► _ NOTICE TO APPLICANT: If; after making this Certificate ARCADIA ZIP CA 91007 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION,FOR Compensation provisions of the-(:tabor Code,you must forthwith EXIT HARDWARE: comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ revoked. No Spec.Know). ❑ ' ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION C$ Panic Devices ❑ ' I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) I 9(commencing with Section 7000)of Division 3 of the Busi'rtess :y NO.OF EXITS and Professions Code,and my license is in full force and effect. ., ame o Business KELLYMUSIK STUDIO � PARKING• REQ'D DPROVIDED License Number Lie Class SPACES I I Contractor Date i LIMITED TIME USE ! I ❑ I am exempt from the licensing requirements as I am a DATE DATE ' licensed architect or a registered FROM: TO: gi professional engineer acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S and Professions Code). IXISTING 13LDG.A-pprx. 1,000 S ft STORIES -7-(:77 SIGN TURF. Lit or Reg.No. •- Date PRESENT USE OF BUILDING FINAL APPROVAL i HOME OWNER-BUILDER DECLARATION NO.OFEXISTING 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, .Business and � Professions Code): I NO.PARCES PRov1DED i ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044_1 PROPOSED USE OF BUILDING Business and Professions Code). I PROVIDING, PRIVATE MUSIC LESSONS 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 (Sea 3097,Civ.C.). PROPOSED MAX.OCG Lender's Name APPLICANT(FRWT) TEL NO. KELLY KAUNG HUA CHEN (626)378•=777 Lender's Address ADDRESS I certify that I have read this application and state that the 2426 LENTA LANE ARC IA CA 91006 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 aboy mentioned property for inspection purposes. , --• s. 1 TOTAL FEE .• % /0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signafffre of Permittee Date i )