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Home My Public Portal About10455 LOWER AZUSA RD_Miscellaneous__ 7GM444-CE #8754-67 M-ISCELLANEOUS APPLICATION COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS lei1-1'51 ' Ao4)ez az Js/4 - BUILDING AND SAFETY DIVISION -� JOHN A. LAMBIE. COUNTY ENGINEER LOCALITY / e/ft J.0 Jr„ CL/ COLEMAN W. JENKINS, SUPT. OF BUILDING NEAREST _`r�rk// CROSS ST. IJ /�'✓ FOR APPLICANT TO FILL IN DISTRICT NO. IGROUP TYPE PR CESSY CONST. BUILDING �fHIGHWAY ADDRESS QL./� S Q(,Q�e/Z ✓a Z.Gds' NO. CJ f L) (CIIRCLE) STATE MAJOR ECON LOCAL LOCALITY USE ZONE SPECIAL CONDITIONS CROSS ST.NEARESToL A ♦ T2— LEGAL /�.,� REQUIRED YARD HWY STREET NAME EXIST. ^�/A- SETBACK WIDTH DESCRIPTION BLOCK _ FRONT NO. P.L. I _ -e y OF BLDGS. / Cv-{J TRACT 3 Z 'LS NOW ON LOT ( /i DE USE OF P SIZE OF LOT EXISTING BLDG. OWNER 2Td Le- 1 i MAIL - 1' ADDRESS 7 r 7-e- • � � �% %ZIJ! 17 V ♦ � '' 11 ^ TEL. CITY 9 ix) ,�j� i N0. CL APP CATION FOR v OCCUPANCY - D��s I .0 `, O INSPECTION SAFETY PERMIT ^ TRAILER USE _ a USE OF STRUCTURES OR DEVICES N okua LIMITED TIME USE DATE DATE FROM: T0: APPROVALS DATE INSPECTOR'S SIGNATURE OCCUPANCY APPROVAL I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC. LOAD APPLICATION AND STATE THAT THE ABOVE IS COR- RECT AND AGREE TO COMPLY WITH ALL COUNTY TRAILER USE ORDINANCES AND STATE WS REGULATING SUC WORK AS INDICATED EO SIGNATURE OF SAFETY PERMIT PERMITTEE TEMPORARY `� STRUCTURE APPROVED ADDRESS !� TEMPORARY %/nQ � _ STRUCTURE REMOVED FEE `C' FINAL APPROVAL APPLICATION VALIDATION 'J JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER (NOT A PERMIT) cK. M.0. CASH PERMIT VALIDATION CK. M.0. CASH clAIJ, 4477 APR 3022 D 15.00N 76M444-CE #8754-67 MISCELLANEOUS APPCICATIO�7 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY I ENGINEER B UI esNs BUILDING AND SAFETY DIVISION v JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W. JENKINS, SUPT. OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN DISTRyCT N G -UPYPE P o S BY .5-r'ONST. BUILDING j^ MAP HIGHWAY ADDRESS Gf NO. 0 (CIRCLE) STATE MAJOR SECON LOCAL LOCALITY USE ZONE SPECIAL CONDITIONS NEAREST i CROSS S i. LEGAL REQUIRED YARD HWY STREET NAME EXIST. DESCRIPTION LOT NO. BLOCK SETBACK WIDTH �t"`A L� NO. OF BLDG S. o P.L.FRONT _ `.Y/L rJ� e' TRACT NOW ON LOT SIDE � USE OF P.L. �5 SIZE OF LOT EXISTING BLDG. OWNER MAIL fo ADDRESS _ CITY NO -' Q G` l'7 f�+� of'•P/1..."A d APPLI ATION FOR C..') OCCUPANCY INSPECTION [/ SAFETY PERMIT 0 V W TRAILER USE d N Z USE OF STRUCTURES OR DEVICES LIMITED TIME USE DATE DATE FROM: TO: INSPECTOR'S APPROVALS DATE SIG ATURE OCCUPANCY APPROVAL I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC. LOAD e� APPLICATION AND STATE THAT THE ABOVE IS COR- RECT AND AGREE TO COMPLY WITH ALL COUNTY TRAILER USE n (J ORDINANCES AND STATE LAWS RE U!LAA/J,TII,N�G SUCH y WORK AS E O AT�D�IE ON. a V p"' SIGNATURE OF l/�iV/ SAFETY PERMIT PERMITTEE TEMPORARY O STRUCTURE APPROVED v ADDRESS TEMPORARY t / STRUCTURE REMOVED F E E FINAL APPROVAL APPLICATION VALIDATION JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER (NOT A PERMIT) CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 1 09U0 2, 22 D 15.00; 7.pT ONM4p -C.E #8754-67 MISCELLANEOUS APPLICATI COUNTY OF LOS ANGELES 5 ''DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION ?- JOHN A. LAMBIE, COUNTY ENGINEER LOCALITY COLEMAN W. JENKINS, SUPT. OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE PROCESS D BY i og /=--2 CONST.� i3 r— BUILDIN G "� _ ADDRES U- [! Sy � Q' S NO.P2o / d (CIRCLE) STATE MAJOR SECOND LOCAL LOCALITY W USE ZONE SPECIAL CONDITIONS NEAREST C Z CROSS ST. LEGAL J _ REQUIRED YARD HWY STREET NAME EXIST. DESCRIPTION I LOT NO. / S BLOCK SETBACK WIDTH FRONT L,0Q J42f/S/� ea NO. OF BLDGS. P.L. TRACT 7 NOW ON LOT SIDE / SIZE OF LOT/0 $ J EXIUSE O IN . BLDV=C- P L. IS e OWNER t MAIL ADDRESSlzz CITY ' d/ NO. CD APPLICATION FOR =c v OCCUPANCY _ � '' 0 INSPECTION SAFETY PERMITU I— _ W TRAILER USE 0- Cor)N USE OF STRUCTURES OR DEVICES Z LIMITED TIME USE DATE DATE FROM: TO: APPROVALS DATE INSPECTOR'S SIGNATURE OCCUPANCY APPROVAL I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GROUP OCC. LOAD APPLICATION AND STATE THAT THE ABOVE IS COR- RECT AND AGREE TOCOMPLY WIT ALL COUNTY TRAILER USE ORDINANCES AND STATE LAWS R G LATING SUCH WORK AS INDICATED EREO SIGNATURE OF SAFETY PERMIT PERMITTEE Gov' TEMPORARY STRUCTURE APPROVED ADDRESS TEMPORARY STRUCTURE REMOVED FEE FINAL FINAL APPROVALz 7- _ [� APPLICATION VALIDATIOJ—,l JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER (NOT A PERMIT) `/' CK. M.0. CASH PERMIT VALIDATION CK. M.0. CASH l;;Ka 1 8 1 21%16 s-012 2 2 B 1 5.0 0; i WORKERS'COMPENSATION DECLARATION CE 875 -(11-131 MISCELLANEOUS APPLICATION CE 875 4), 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.). BUILDING Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. wDOREss LOCALITY L 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date ApplicantAREST DISTRICT NO. GROUP TYPE PROCESSED BY ROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO, (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this 4t I permit is issued, I shall not employ any person in any manner w R y so as to become subject to the Workers' Compensation Laws. MAIL - OCCUPANCY GROUP — o D .DRESS rl� I C~3 Date Applicant LU NOTICE TO,APPLICANT: If, after making this Certificate of CITY J L' -�9 OCCUPANT LOAD 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 SPACES REQ'D PROVIDED License Number Lic. Class �� LIMITED TIME USE. . Contractor Date DATE ;., DATE a ' �'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 - SIG uRE iness and Professions Code). i-fFINAL APPROVAL RESENT 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 =sl =('_ 1 ^)!a 7t 231 72 License Law for the following reason (Section 7031.5, Busi :`' (/ /�0 _ k, ;n I ness and Professions Code): y0. PARKING s: I�� Y` 5,i--,9 t ' =`'`° ,,SPACES PROVIDED � � I, as owner of the property, will do the work and the t,. structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY A, PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency ow 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 1 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances an State laws relating to building construction, �j�aD and hereby ane representati of this County to enter TOTAL. FEE OJ upon the a(-.4 e entio d ro for inspection purposes. �� / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit,*e f/ Date WORKERS'COMPENSATION DECLARATION CE 8° 54(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3809,hab. PolicyNo1Z-O206Compan; & C'� � �S ``� FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING((/ (yA (� ADDRESS`� ,O \ � o lt.l�t v��c, �Vl LOCALITY Certified copy is filed with the county building inspe LOC ALIT-Te depart C` NEAREST a (�� CROSS ST. Date 2 Applicant ^^"^" NEAREST DISTRICT NO. I GROUP TYPE PROCESSED By CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM W LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY NO. F BLD 65. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER AAAA y so as to become subject to the Workers' Compensation Laws. ADORES cc ^j�A)e OCCUPANCY GROUP a= 0 Date Applicant w NOTICE TO APPLICANT: If, after making this Certificate of CITY � Yv�O l/�_ NOL 5 —� OCCUPANT LOAD r'- 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 USEG OLOGY INSPECTION ❑ ElE] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION occuawNcv INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT E] (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 D License Number Lic. Class NLW� 1 �J N\� V CT • `� G SPACES Contractor Date C�Do DATE LIMITED TIME USE DATE ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF ` FROM: TO: I. SPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES J 11 A GNATURE iness and Professions Code). Lic.or Reg.No. Date PRESENT USE OF BUILDIN U RCf FINAL APPROVAL � hal SCoQL 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, Busi- ness and Professions Code): NO. PARKING 'C. O 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 QV I hereby affirm that there is a construction lending agency t— S Q) L for the ,performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Z Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE P,""..i I certify that I have read this application and state that the I.rI above information is correct.I agree to comply with all County ISSUANCE FEE I i ordinances and State laws relating to building construction, I ) and hereby authorize representatives of this County to enter TOTAL FEE uFtpn the above-mentioned pro ert or• ection purposey. SEE REVERSE FOR EXPLANATORY LANGUAGE X> 0 l�Y-�1-1`i5 \ L r-� h•.3 �tu,� re Permittee Date e= :n WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L LA N E O U S APPLICATION 1--1 CE 875 1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insureyr�f a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BADuaDING C DRESS ..! Certified copy is hereby furnished. ILDESING ADD S I® Jrs L o fit/e r Z ! f f LOCALITY WJ El Certified copy is filed with the county building inspection cALITY C!T n I �� NEAREST department. PLS C CRoss ST. i Date Applicant -REST >J ^ DISTRICT NC}. G�O 11P TYPE L/ PRO ED/BY CROSS ST. AK,9�h1 A r�n L IJ I/Iro/ /-()/� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (� COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP. HIGHWAY rvD. (CIRCLE) 'STATE MAJOR SECON LOCAL NO. OF BLDG$. (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 SIZ DLEXISTING BLDG.OF F OT d I certify that in the performance of the work for which this _ CD AIL permit is issued, I shall not employ any person in any manner OWNER 00�� r M lU�Z �v y so as to become subject to the Workers' Compensation Laws. / r OCCUPANCY GROUP � ADDRESS^ O �s L� Z,u� r3 Date Applicant TEL C-3 OCCUPANT LOAD 0.- NOTICE TO APPLICANT: If, after making this Certificate of CITY �i1�1 S LC C/7 No. Ll 4 L-1— 33 3 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 INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Rr Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT E] 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 D SPACES License Number Lie. 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL. APPROVAL RESENT USE OF BUILDING Lic.or Reg.No. 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 0 I, as owner of the property, will do the work and the SPACES PROVIDED # O • a • 8 8 structure is not intended or offered for sale (Section 7044,Business and Professions Code). �.o o ® o • • z CONSTRUCTION LENDING AGENCY 0PosED USE of BUILDING OFF/CC I hereby affirm that there is a construction lending agency 0 Sl 5-86 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, d hereby authorize representatives of this County to enter TOTAL FEE on the above-mentioned property for inspectionpurposes. // 8^ $6 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pe tee VV if Date WORKERS'COMPENSATION DECLARATION CE$4 5412 80) MISCELLANEOUS Bi ®�p I ,4'® T I N 1 hereby affirm-thati have a certificate of consent to self COUNTY GL' LOS ANGELES BUgb�LDINGILA�N�D SAFETY ODIVISION insure, or a certificate of Workers'Compensation Insurance,or . a certified copy thereof(Sec. 3800,,Lab.C.) Policy No. Company FOR APPLICANTTO FILL IN❑ ADDBUILDRESSING Certified copy is hereby furnished. ILDING pp LOCALITY ❑ Certified copy is filed with the county building inspectionA NEAREST department. CALITY 7 �J1, (L CROSS ST. Date Applicant AREST ,lj� j / J_, DISTRICT NO. GROUP TYPE PR ESSED BY CROSS ST. `'/ ` /j CONST: - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO: BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. 13- (This section need not be completed if the work involved TRACT NOW ON LOT. USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) USE OF V 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 wNER S' 1,�iN 'J� �y F- so as to become subject to the Workers' Compensation Laws. /y �7 1 ( OCCUPANCY GROUP f�/� 4, 11XIL ADDRESS m C"A/ 1 S - �,�'�� w CL Date Applicant g g� TEL. a � 8 OCCUPANT LOAD _. NOTICE TO APPLICANT: If, after,makin this Certificate of clrY �r �/ /�IC-,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 Shallbe 'TRAILER USE GEOLOGY INSPECTION ENo Spec. Knows. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 0 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 REQ'D PROVIDED License Number Lic.Class LIMITED TIME USE II��JJ Contractor Date DATE O AT S El - _ FROM: - TO: lam exempt from the licensing requirements as I am a licensed architect' or a 'registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date 47 Lo Z-0-ot 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 Z"b`9 3, A - SPACES PROVIDED ❑ 1, as owner of the.property, will do the work and the #Io 0 0 0 $8 structure is not intended or offered for sale (Section 7044, Business and Professions Code). a to OPOSED USE OF BUILDING - O O O O O.O O Z I [ e CONSTRUCTION LENDING AGENCY /► Q,-1 '8 8 2 I hereby,affirm that there .is a construction lending agency < V Y for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address_ - PERMIT FEE I.certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE' and hereby authorize representatives of this County to enter upon the b e-ment' ned prop ty for inspect �io'n urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SI ature of ermittee Date"h�`� L/� RKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I he y affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ins e, 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 A D D R E SS ❑ Certified copy is hereby furnished. UORess ��"► ��) LOCALITY �� U ❑ Certified copy is filed with the county building inspection NEAREST department. - LOCALITY CROSS ST. Date Applicant NEAREST 'DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE MAF d HIGHWAY NO, / (CIRCLE) STATE MAJOR SECOND LOCAL d � NO. OF BLDGS. USE ZONE SPECIAL CONDITIONS O (This section need not be completed if the work involved TRACT 3 S Now ON LOT V by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. C Cr I certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner WNER f�)G14lbe d;eC�f,g L� 0 so as to become subject to the Workers' Compensation Laws. MAIL ��} /�� OCCUPANCY GROUP W Date Applicant DORESS 24/4 DRi' / AOM f N w w A,1,4 TEL. z. NOTICE TO APPLICANT: If, after making this Certificate of ITY /"L,iIV, 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 Ei GEOLOGY INSPECTION❑ NO Spec. KnOWI. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) rvo. OF Exlrs ❑ 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 O PROVIDED O 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- FJXISTING BLDG. STORIES. SIGNATURE iness and Professions Code). ) 75 f)?A)& FINAL APPROVAL v ESENT USE OF BUILDING r_ '�7/�L! r'1 Lic.or Reg.No. Date— f'e'1/4t DlR M/M CCa!/SMS HOME OWNER-BUILDER DECLARATION No. of EXISTING BUILDINGS ON LOT AND USE , I'hereby affirm that• I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED /I aCJ 5 C Z If A I, as owner of.the property, will do the work and the 4 �J structure is not intended or offered for sale (Section # o'o 4o o 4 0. 7044, Business and Professions Code). ROPOSED USE OF BUILDING ��/y//ac (A - .tel .o o�0 0 0 0 o z CONSTRUCTION LENDING AGENCY ��.� I hereby affirm that there is a construction lending agency 3,27-81 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 U/ I certify that I have read this application and state that the above information is correct..I agree to comply with all County ISSUANCE FEE , ordinances and State laws relating to building construction,- TOTAL FEE and hereby auth rize representatives of this County to enter po t e abov boned p operty for inspect purpo 2s. SEE REVERSE FOR EXPLANATORY LANGUAGE 4 Signatur of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 It 1-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGEL-CC , BUILDING AND SAFETY DIVISION unsure, or a certificate of Workers'Compensation Insurance,or R a certified copy thereof(Sec. 3800,Lab.C.). Policy No. BUILDIHG Company FOR APPLICANT TO FILL IN ADDRDDR Ea:Is O FICertified copy is hereby furnished. BUILDING rtlkh �p�y- LOCALITY - XX ADDRESS 1� Az- ,, 1 - _ 0 Certified copy is filed with the county building inspection LOCALITYp- �\, NEAREST department. ][y; iJV �Q. CROSS ST. Date Applicant NEAREST CROSS ST. DISTR CT NQS GR P TYPE CE ED BY n CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL [.�(J !1!/ I COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP RIGRWAY OF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NONO.W ON LOT USE LONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I USE OF SIZE OF LOT EXISTING BLDG. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mannekX OWNER of building C-� t--- so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP Date Applicant ADDRESS L�LGi✓�CJ c .,,G' _ 4 TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. CJ 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 (1 GEOLOGY INSPECTIONE] No Spec. Knowl. deenned revoked. ❑ OCCUPANCY INSPECTION I] Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT 1] (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 anJX effect. Name of business PARKING (� j REq'D 1 1 PROVIDED License Number_`___--_, Lic. Class �� Se SPACES LIMITED TIME USE L��J Contractor Date DATE DATE ElI am exempt From the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO.OF INSP E CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessand Professions Code)' FINAL APPROVAL g_Z3�j PRESENT USE OF BUILDING 4Q Lic.or Reg.No.__ _ _ Date IIOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 1 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 tile 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 04 _., . • _ 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 FEE00 li certify that I have read this application and state that the 25, ' above information is correct. 1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, - and hereby authorize representatives of this County to enter TOTAL FEE 25.00 upon the above-menti hned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX R'OKKERS'CO(\IPENSATION DECLARATION CE 875 (11-84) ►- MISCELLANEOUS APPLICATION CE 875 �'' I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insute, or a certificate of Workers'Compensation Insurance,or a certified cop rt�hereof(Sec. 3800 Lab.C.). Policy No."VF—CompanyS7 .rs FOR APPLICANT TO FILL IN BUILDING ADDRESS �� Certifibd co is hereby furnished. DRESS ; S� � �� copy y XX ADDRESS � LOCAL[ G=G Certified copy is filed with the county building inspection LOCALITY t., rA� r A (� NEAREST depa toren . (� �' ` ] I .TS U — CROSS ST. Date it JpA Iicant v J NEAREST x DISTRICT NO. GROUP TYPE �/ CESSED BY Pp CROSS ST. �v`��" CONST.// CTR'l II ICATE OF EXEMPTION FROM WORKER LEGAL 116 �j COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MRP HIC Hw AY Ho. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (?Ills 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 slzE of Lor EXISTING BLOC. O- cnnit is issued, I shall not employ an person in an manne e � L1� p' P y y P Y }{]{ OWNER of building -' so as to become subject to the Workers' Compensation Laws. I�^�f/� q OCCUPANCY GROUP R' MAIL �/ \4 ^ I�!� `I•'I CJ ADDRESS -+ Date _ Applicant 41 NOTICE TO APPLICANT: If, after making this Certificate of clrr \Qy\V�� 2fQ\Z No� 0.4 �>�O�1 C,� OCCUPANT LOAD �� Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth— with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION Panic Devices El CONTRACTORS DECLARATION I hereby affirm that 1 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 an*X effect. Name of business PARKING REp D I PROVIDED 1 I SPACES License Number — Lic. Class _ �C..1��A\Gd�� ,�1VV�\�2_ 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 1 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL u=' PRESENT USE OF BUILDING kl;," Lic.or Reg. No.__ ____—._ -- Date HOME'OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 1 i. 4-i ON LOT AND USE - I hereby affirm that I ani exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING O El1, 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 U36 OF BUILDING 1 hereby affirm that there is a construction lending agency for file performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name_ PROPOSED MAX. OCC. Lender's Address._____________-- _ 25.00 I certify that I have read this application and state that the PERMIT FEE above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25- 00 up the bove-mentioned property for inspection purposes. l > � SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX WORKERS" (0NIPENSNI ION DIJ LARAI]()N M1bL;LLL_A1*4r_UUt> I hereby affirm that I I)ikNC a CCI ldiCiIIC 01 C01F,C111 10 ,L'11 COL)N'I'Y OF I.OS /\NGI--I..F-.S BUILDING AND SAFETY DIVISION II icate of Workers' Compensation 111milalw,% or a certified copy thereof (See. 38017. Lah. j Policy No. Company FOR APPLICANT TO FILL IN E'jILDING BUI ING ADD E55 hwt-L, Ce ADDRESS ❑ Certified Cot)) is IIClChV IIIIIIISIICII FOCALITY ❑ Certified copy is filed wall the Cotlill% building Ci ZIP I NEAREST department. ca 17/ 710 GROSS ST. Date Applicant SIZE OF L T NO.OF EILDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. ER111:1CAll Of-' EXENIVIJON I RIM \VORKLIZ'S COMPLNSAHON INSURAM 1. TRACT _ BLOCK LOT NO. HIGHWAY L_ No. iCIRCLE) STATE MAJOR SECOND LOCAL (This section need not be compleled if file Work ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (.-,100) or IL!-,,%.) I certify that Ili the performance III' Ilic \wik 10i Mii,l) 1111." OWNER TEL NO. permit is issued. I shall not cnipl(\ an) I'Clsoll III ;illy nufflicl so as to become SUbject to the Worker' ( ollI)CII,iltioll t;,\,s ADDRESS OCCUPANCY GROUP ® rF, Applicant CITY ZIP NOTICE TO APPLICANT: If. after making this Uemji\aie OCCUPANT LOAD of Exemption, you Should become SUbjec[ to the Woj..<crs' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor('ode.you must f0l I Ilwil 11 comply with such provisions or thii PCI-Illit siliIII hC LiCCIIICLI TRAILER USE LJ GEOLOGY INSPECTION U No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTIONK Panic Devices ❑ LICENSED CONTRACTORS DFULAR-AlION I hereby affirm that I am licensed Under PrOViSiOnS of' (hill)[Cl SAFETY PERMIT LIST ITEMS BELOW I Yi 9(commencing with Section 7000)of DiN ision 3 of Ilse Business NO.OF EXITS and Professions Code,and my license is in full force and ellect. I=ARKING REQ'D ';PACES License Number Lic. Clils; LIMITED TIME USE Contractor Dille DATE DATE El I am exempt from the licensing requirements, its I i'lli it FROM: TO: licensed architect or it registered professional engineer acting Ili my professional capacil) (Sccnon 7(h I. IN sincss SIZE of NO.OF INSPECTOR'S Exts FIND BLOC. sroRILs SIGNATURE and Prolessions (ode). Lie. or Reg. No. Dille PRESENT USE OF BUILDING FINAL APPROVAL c, I IONI L OWNER-BUILDER DIA LARAHON No.OF CXISI ING BUILDINGS ON-1-01 AND USE I hereby affirm that I iiiii cwnipt IIt)IIj tile("1111 Law for the following reason (Section 7031J). Business and Professions Code): NO.PARKING SPACES PROVIDED El I. it, 0\,icr of, the \oii ti,. the \\,,I k Jild IIli S Business and Professions Co"i IIIICIIIIC 1'�' not Intended 01* IICII�kl fol Sale ()CCI I0II 1011. P $ ROPOSED USE OF HIIILDINI, C). CONSTRUCTION LENDING AGENCY I herchy affirm that IIICI-C is it C011SHUCti011 ICIldilig J!'C110 1,11 the performance of (lie \\oik I'm \Nllicll [Itis I)CIII'lit 'is ISSUCLI ----------- (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. Lender's Name APPLrANT(PRINT) j( I TK.,NO. rK4 24, :jjrr 201) 4 IF- Lender's Address ADDR-SI& I certify that I have read this application and stale thi;- 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 Count)' to enter IT'"' ISSUANCE FEE property[he above menu lu°(I for inspection purposes. TOTAL FEE SEF REVERSE FOR EXPLANATORY LANGUAGE 0 I Signature of Permittee Da lc