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HomeMy Public PortalAbout9237 LOWER AZUSA RD_Miscellaneous__ WQRKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I laffirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insureure,,., o 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 BADDRUILDIN ESG � S Certified copy is hereby furnished. BDORIESG z 3 �Ow w�� J LOCALITY 1 ADDRESS N6. Certified copy is filed with the county building inspection ALOCALITY NEAREST (� department. CROSS ST. i� Date Applicant NEARESTDISTRGROUj' ITYPItJ PRO ESSED BY CROSS ST. T m 'h g , Q ICT O. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' Y COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL 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. O 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 Z3 L 111,- a .A v Date Applicant LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY T M (ll �,L �Q /� Q No OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions 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 SPACES License Number Lic. Class I. LIMITED TIME USE Contractor Date 1J Q U •w` DATE DATE I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF FROM: io: INSPECTOR'S acting hi my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). 0, FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS NCO CO FEE ON LOT AND USE ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 4967 1 PIN 1:01 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name `! J PROPOSED MAX. OCC. 11"—J� Lender's Address, OQ �' 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 TdTAL.FEE up n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per ittee Date WORKERS'COMPENSATION DECLARATION CE 875(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 drtified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUDRESSILDING AD5 Certified copy is hereby furnished. 0113UILDING y ADDRESS 9237 Lowe �7 Azusa Road Uni Lo LOCALITY 17) Certified copy is filed with the county building inspection LOCALITY NEAREST department. NV CROSS ST. Date Applicant NEAREST DISTRICT G TYPE PROCESSED BY CROSS ST.EI1 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. HLO CK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECAD 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 I certify that in the performance of the work for which this SIZE OF Lor EXISTING BLDG, O permit is issued, I shall not employ any person in any manner V OWNS =' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a ADDRESS 4Ci -P Date Applicant NOTICE TO APPLICANT: If,after making this Certificate of CITY fEL. _ OCCUPANT LOAD 0- Exemption, you should become subject to the Workers' ArradAPPLICATION 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 Eldeemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO 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 RRQ'D D PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor Date D ATE DATE I am exempt from the licensing requirements as I am a FROM: To: licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- iness BLDG.and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date l C Z&- 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- 8 5 1.9 A ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED � 0� # o - 88 structure is not intended or offered for sale (Section o 0 o a o 0 0 1 N 7044,Business and Professions Code). 1 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 206-87 I hereby affirm that there is a construction lending agency 1 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 u nt above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PermAtel Date 14. WORKERS'COMPENSATION DECLARATION 76M444 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.Q. Policy No. Company FOR APPLICANT TO FILL INBUILDING wonREss ❑ 3 dwE2 fires ��. O .�� Certified copy is hereby furnished. UILDING LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection LOCALITY /� NEAREST department. T 6,W P� a t 917 ed CROSS ST. Z Date Applicant EAREST •T �]/ DISTRICT NO, GROUP TYPE P OC SSED BY Pp CROSS ST. en 1,7(✓d • y"� per- CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL. ✓ v COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MA.P (CIRCLE) `.,j_�MIC NW AY STATE MAJOR SECOND LOC L NO �f(J NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESP ZE OF LOT EXISTING BLDG. CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF �7 �_ v q 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 ifOWNER G(/i We?OVl /4 0 Q so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP B—Y o f- Date ADRESS Applicant / E` oN `S�1-p w NOTICE TO APPLICANT: If, after making this Certificate of cITY COVfAlN.L P - (,�6o-Z OCCUPANT LOAD Exemption, you should become subject to the Workers' — Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know[. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION znk 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 Busl� NO. OF EXITS ness and Professions Code,and my license is in full force an1� y/� effect. JS /V/I/r" �CW J / PARKING REO'D PROVIDED License Number Lic. Class u SPACES O.� S• 30Efir N Ave, At LIMITED TIME USE Contractor Date �` DATA DATE ❑ I am exempt from the licensing requirements as I am a .�TI'v C I & ?177 licensed architect or a registered professional engineer SIZE OF NO.o PROM: To. INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S1,961ATURra iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED i structure is not intended or offered for sale (Section 25 0 4 3 A 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 0 0 0 0 $ 0 0 0 0 0 0 0 0 I hereby affirm that there is a construction lending agency 0 8. 18-88 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 1 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 repr 7tyspe ounty to enter TOTAL FEE up the abov a tigne pr ion purposes. �jSE� ERSE I'OR EXPLANATORY LANGUAGE (rJ 1 , D Signature of Permitteeto ,WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I Hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). BUILDING Policy No. Company FOR APPLICANT TO FI LL IN fe 7 ADDRESS / / FCrJ C-= Certified copy is hereby furnished. .DDR INC 9237 Lower Azusa Rd. Unit o G L: ADDRESS LO CA LIT DCertified copy is filed with the county building inspection LOCALITY NEAREST department. Tmple rilty CROSS ST. GROUP Date Applicant NEAREST DISTRICT NO TYPE PROCESSED BY CROSS ST. EC COgSq. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �f 10927 V '" " COMPENSATION INSURANCE DESCRIPTION N BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL QQ���� TT��oC. 0758280 NO. OF BLDGS. (This section need not be completed if the work involved Y A`CTL O O NOW ON LOT OneUSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) SIZE OF LOT _8506-218--_ use of nus ria I certify that in the performance of the work for which this EXISTING BLDG.Warehou eo_19 C:) permit is issued, I shall not employ any person in any manner OWNER Temple City Industrial Park so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL Date Applicant LTJ ADDRESS 177 L+L• . Front Street NOTICE TO APPLICANT: If, after making this Certificate of CITY Covina, CA 91723 No` ' 818./915-6027 OCCUPANT LOAD y Exemption, you should become subject to the Workers' a Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONXI 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 REO'D O PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE' _ Contractor Date DATD DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 29,.877 sq. ft. STORIES One SIGN TUBE - iness and Professions Code). - _ PRESENT USE OF BUILDING Industrial & FINAL APPROVAL ��Z2.-� Lic.or Reg.No. Date Warehouse HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE One 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 �tAs� I, as owner of the property, will do the work and the SPACES PROVIDED ' �^ structure is not intended or offered for sale (Section IIIIYYYY �1t• 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSEDp USE OF BUILDING acx,I--, Qedr I Hereby affirm that there is a construction lending agency -b k-rc 'e "SG 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 ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-me tioned property for inspection purposes. SEEREVERSE FOR EXPLANATORY LANGUAGE Signature oLpftmittee Dave WOR KS'COhIPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATI®N 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 ADDRESS Certified copy is hereby furnished. Bu1LDiNG _�/ ADDRES 923 / L'I wex Azusa PC,. �' LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEARESTDISTRICT NO. I GROUP TYPE PROCESSED BY CROSS ST. �ti1r --r �� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL 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. d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner DWNER' b"�V\ Moran Pro t C. so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o Date Applicant ADDRESS) 177 E Front St. °- NOTICE TO APPLICANT: If, after making this Certificate of CITY Covina CA TEL' 915 6027 OCCUPANT LOAD No. - vJ Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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 Q effect. N �� PARKING REQ'D PROVIDED SPACES License Number Lie. Class Da Zhong Upholstpry LIMITED TIME USE Contractor Date DATE DATE EI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF fT-PGNATU ECTOR'acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF HUILDINC�. Lie.or Reg.No. Date UPHOLSTERY HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS / ON LOT AND USE I hereby affirm that I am exempt from the Contractor's rl_I;I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING SPACES PROVIDED Two �"C I J. I n 44 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN I hereby affirm that there is a construction lending agency i for the performance of tete work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address REKNIT FEE I certify thaf 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-mentned property for msp ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE V/ Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate 'of consent Insur Insurance, or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN ADDRESS BUILDING 2vS '� Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS 3 �o(,(1eR�?.cls�r R�� Z L Certified copy is filed with the county building in spectio NEAREST LOCALITY department. TeM Le- rQty 11 C1 9D CROSS ST. Date Applicant NEAREST w DISTRICT �Ulii�� TYPE .�� P CESSED BY CROSS ST. L CI KI `r ,/' '` CONST, i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �+J ✓ 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 (5100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this r Co permit is issued, I shall not employ any person in any manner OWNER `-' so as to become subject to the Workers' Compensation Laws. MAIL ° '•,p OCCUPANCY GROUP o ADRESS I EI , 197- U ~ Date Applicant D ¢�/�dll/j• ILI NOTICE TO APPLICANT: If, after making this Certificate of CITYCaw TOl. OCCUPANT LOAD Exemption, you should become subject to the Workers' ro5r "111 9 Dm�d�_ 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 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. VANE DEN-sug* PARKING REQ'D PROVIDED SPACES License Number Lic. Class ' -C Wi" LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer NSPECTOR'S SIZE OF NO. OF IGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I iness and Professions Code). r FINAL APPROVAL PRESENT USE OF BUILDINGST-UR ,e /I Lic.or Reg.No. Date /, 4 L HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ND USE ir 0 �1�2111 ON LOT AI hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- 0090—Z1/189 ness and Professions Code): NO. PARKING °•Z I, as owner of the property, will do the work and the SPACES PROVIDED �7�'(�0 �• All Q�+°�4 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING Ge 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 0 b 0 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, n OTT— and hereby authorize representatives of this County to enter TOTAL FEE OC up n the above-menned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS:COMPENSATION DECLARATION 76M444 CE 875(11-84) MISCELLANEOUS APPLICATION {� I laffirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LI insureure,, oroi a certificate of Workers'Compensation insurance,e,or a certified copy thereof(Sec.3800,Lab.C.). BUILDING 112 Policy No. Company FOR APPLICANT TO FILL IN ADDRESS , o 1 Certified copy is hereby furnished. Bu1LD1NG LOCALITY rim ADDRESSZI : Les6� Certified copy is filed with the county building inspection LOCALITYNEAREST department. Temple City CROSS ST. Date Applicant NEAREST DISTRICT NO. G OUP TYPE PROCESSED BY CROSS ST. Encinita Ave. /1 ,/ �] CONST•. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL PQrr� of 10927 ---- ,d 6� . e¢ V COMPENSATION INSURANCE DESCRIPTION LO O. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL ee oc. 0 5 2 0NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT 99069RNOW ON LOT One 1USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of tits work for which this SIZE OF LOT699987 EXIST1N1nduatrial & agr t1�e permit is issued, I shall not employ any person in any manner OWNER VLrT2� park o so as to become subject to the Workers' Compensation Laws. Tem le Cit Indu MAIL 17 OCCUPANCY GROUP Date Applicant ADDRESS C� ES TEL. 1,_I NOTICE TO APPLICANT: If, after making this Certificate of clrr Covina, CA 91723�D' 818. .1 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 sliall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. 0 deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONgg 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. OMwiPARKING REq'D PROVIDED License Number Lic. Class SPACES LIMITED TIME USE 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 INSPECTOR'S EXISTING BLDG. STORIES SIGNATURE acting in my professional capacity (Section 7051, Bus 29 877 S . ft. 01 iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Industrial & Lic.or Reg.No. Date Warehouse .y HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS , l ON LOT AND USEOne 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): SNO. PARKING PACES PROVIDED Three , ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency Furniture Upholstery Shop 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 upon the above-mentioned propert for in ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Alt A • Signature of Permittge Date WORKERS'COMPENSATION DECLARATION 76 7E 87s(11-84) MISCELLANEOUS A P P L I C A T I O N 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 ADDRESS Certified copy is hereby furnished. BUILDING t,rli{£ LOCALITY ADORES q'Z3 ( Lower- Agus pet, DCertified copy is filed with the county building inspection LOCALITY t ik / ( 91 ft NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' DESCRIPTION LEGAL L COMPENSATION INSURANCE OT NO. BLOCK NAP 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. d I certify that in the performance of the work for which this � o permit is issued, I shall not employ any person in any manner OWNER4 ��L\ E� Lir C( INOVSZ� L 1f-• C.:0 so as to become subject to the Workers' Compensation Laws. MAIL p� �J OCCUPANCY GROUP o Date Applicant ADORES , E FI viU� S 1 V TEL . NOTICE TO APPLICANT: If, after making this Certificate of c1TY O 04 A,O ,���Z3 NO. (sl S) 91S'—61-27 OCCUPANT LOAD N °- 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 ❑ ❑ El 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 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 and1 effect. D'� PARKING SPACES REq'D D PROVIDED D License Number Lic. Class AOL EIJ_(F_K ff-k S9-S. LIMITED TIME USE Contractor Date DATE DATE FI 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, Blas- EXISTING BLDG. STORIES IGNATUR iness and Professions Code). Lic.or Reg.No. Date e 1 N�r S N e PRESENT USE OF BUILDING FINAL APPROVAL ' 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 structure is not intended or offered for sale (Section 7044,Business and Professions Code). /� PROPOSED USE OF BUILDING {-�61t.1E-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(Sec. 3097,Civ.Q. r'i Lender's Name F� I . m PROPOSED MAX. OCC:•) I Lender's Address I certify that I have read this application and state that the PERMIT FEE ' I 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 _J upon the above-mentioned property for inpkection purposes. ~r' 9 9a SEE REVERSE FOR EXPLANATORY LANGUAGE 3 1.s r Signature of ermittee Date i�I 1-+ WORKERS'COniPENSATION DECLARATION CE 875 (11-134) I SC E L)LAN E®U S 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. •- a Policy No. Company FOR APPLICANT TO FILL IN BUILDINT.j pD ORES Certified copy is hereby furnished. I� BUILDING •1 1, LOCALIl' /\ ADDRESS I— c V �i Certified copy is filed with the county building inspectionNEAREST LOCALITY E C department. ceoss sr. Date Applicant NEAREST DISTRICT NO. GROUP TYPE ROCESSED BY CROSS 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 SIZE OF LOT EXISTING BLDG. .i— I certify that in the performance of the work for which this !!! (/ o permit is issued, I shall not employ any person in any mannerV+ OWNER so as to become subject to the Workers' Compensation Laws. /� MAIL OCCUPANCY GROUP ® o Date ADDRESS Applicant p� LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. 1� 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 0 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 O PROVIDED D 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES NO F TORE NO. OF inessand Professions Code). „ FINAL APPROVAL 1l PRESENT USE OF BUILDING _�� Lic.or Reg.No. Date , , l ■Y�/ _ J L �J •\� J'i IliU� -r1 j'}'icy HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE ///iiI IIA{1 y��] 9� • 49901 F 1 3:26I hereby affirm that I am exempt from the Contractor's V �e 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 agencyILA- 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 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 cons tion, „\ and 9theab uthoriz entatives of this C n e r TOTAL FEE ,�U up ve-me toned pr erty fo rpose SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1,-WbRKERS'COMPENSATION DECLARATION CE 8754(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.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING // y'/ / /( ADDRESS Q7J 1 Y� II ILL�C. Certified copy is hereby furnished. AunR.SS a37 4OWER A-ZU-" Rel. u1/r 0LOCALITY Certified copy is filed with the county building inspectionCALITY C;4 NEAREST department. rEM/I.& CROSS ST. Date Applicant OFNSAREST /� ,J DIST CT NO/// GR TYPE PROCES ED BY CROSS ST. (.� C/T $I J(r/ • /I OU CONST.. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J (jI VVV COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECO LOCAL NO. OF BLOCS. (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 (5100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of file work for which this CD permit is issued, I shall not employ any person in any manner OWNER QR /jQd � �. so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP , o Date Applicant ADDRESS // "OvT / • NOTICE TO APPLICANT: If, after making this Certificate of ITY eel///1,3 91 , ITvo�B/1 9/f d d a- OCCUPANT LOAD Exemption, you should become subject to the Workers' — Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE ❑ GEO06Y 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 PER ❑ (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 D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date D ATH DATE 0 I am exempt from the licensing requirements as I am a FROM. TO: licensed architect or a registered professional engineer SIZE OFNO.OF IN CTOR acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). r Lic.or Reg.No. Date Nd �rii({�j PRESENT USE OF BUILDING FINAL APPROVAL . _QP HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's d 951- CA License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING yI O O O O S 8 I, as owner of the property, will do the work and the 9-- SPACES PROVIDED 0 0 0 0 0 0 o N structure is not intended or offered for sale (Section � 7044,Business and Professions Code). 0 0 0 v—818 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 PERMIT FEE ( JI 1 certify that I have read this application and state that the �J10 A above information is correct.I agree to comply with all County ISSUANCE FEE IA I ordinances and State laws relating to building construction, I d hereby autiorize representatives of this County to enter TOTAL FEE u on the abov entioned property for inspection purposes. /9 a � SEE REVERSE FOR EXPLANATORY LANGUAGE 7inture of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirms that I have a certificate of consent to self insure, o: a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �J a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING /� ADDRESS L !/wCv�] P�CZI�iLJ L �Q Certified copy is hereby furnished. A .R E s s 9 +.�� /749,1'2./. Ir�..f�i 1!� - GG LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. !re—'o/r_C, CROSS ST. Date Applicant NEAREST /AJ_•y DISTRICT NO. GROUP TYPENST. P ESSED BY CROSS CO LEGAL ST. , C /V '•d !* r� (J CERTIFICATE OF EXEMPTION FROM WORKERS' / 6• _ CY_7 COMPENSATION INSURANCE DESCRIPTION e-IT NO. ;17 BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO.OF BLDGS. (This section need not be completed if the work involved TRACT' ` G NOW ON LOT �� USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) (S USE OF(,3'Are a sC. SIZE OF LOT �}.P• EXISTING BLDG. ��� I certify that in the performance of the work for which this o permit is issued, I sluill not employ any person in any manner OWNER/e..� /F C;'; erS;r,cj Kt/` °-' so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL o •�7 -� Date ADDRESS Applicant /� NOTICE TO APPLICANT: If,after making this Certificate of CITY L.L-) :1�� ���•jr7.;I3 No. �l$-�/S-�o0a7 OCCUPANT LOAD °- Exemption, you should become subject to the Workers' a Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such pIOvlslons or this permit sliall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO 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. PARKINGREQ�D O PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a PROM? TOI licensed architect or a registered professional engineer SIZE of NO. OFINSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES IDJ. 41140 F,_I A T U R E iness and Professions Code). J . .,.ro�r+�S?�:a/�G!�e.��•3� FINAL APP OVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING ` HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS p V O 1. _ _-- -M ON LOT AND USE X` � iI{. a 1 s. .. 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 'PACES PROVIDED `r4Ta 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 C r 2,_ eS 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 d State laws relating to building construction, and liereb uthorize r sent�es this County toenter TOTAL FEE upon the ve men on ropnspection purposes. �/.3 ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PVrmittee Date 'WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M �SC E L LA N E®U S A P P U C A T I O N I liety y affirm that I Have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION u a certified copy thereof(Sec.3800,Lab.Q. 09 Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING �W ADDRESS Certified copy is hereby furnished. BUILDtNG LOCALITY Certified copy is filed with the county building inspection ADDRESS 9237 Lower Azusa R. Unit LOCALITY NEAREST department. Temple City CROSS ST. IF Date Applicant NEAREST DISTRI Nf OUP TYPE P CESSED BY CROSS ST. En C ' 7 _-LCONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL g�rNOOf 10927 --- Q COMPENSATION INSURANCE DESCRIPTION BLOCK MAP HIGHWAY See Do C. 07582-80 No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This Section need not be completed if the work involved TRACT 850628 NOW ON LOT a USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) (� USE OFlndustrial & SIZE OF LOT 62,987 EXISTING BLDG. oma.. I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner OWNERTpinplp s� so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP . o ADDRESS 1 8 Date Applicant TEL. W NOTICE TO APPLICANT: If, after making this Certificate of CITY Covina, CA 91]23 NO 818 915-602 OCCUPANT LOAD On 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 Eldeemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices E] -n FEE 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 Busl- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. SPACES REO'D Logo License Number Lic. Class s - 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 EXISTING BLDG. STORIES SIGNATURE acting in my professional capacity (Section 7051, Bus- 29,877 S ft iness and Professions Code). PRESENT USE OF BUILDING Industrial & FINAL APPROVAL _ Lic.or Reg.No. Date ' Warehouse i HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (-1 ON LOT ANIOne U 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 1 1 E1, as owner of the property, will do the work and the SPACES PROVIDEDTwo 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 for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC.TWO Lender's Address I certify that 1 have read this appli tiond state that the PERMIT FEE above information is correct.I agr to copfly with all County ISSUANCE FEE ordinances and St to laws re IJlg to uilding construction, and lielab a ize ,;a s tative of this County to enter TOTAL FEE upon. a ab enti` oper for inspection purposes. �i SEE REVERSE FOR EXPLANATORY LANGUAGE ./ 1/25/91 Si f er ee Date 1.•AIe�- anueloS WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insureor a certificatd of workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ CeItified Copy 1S hereby fllImSlled. ADDRESS .lam) � .rRA LOCALITY DCertified copy is filed with the county building inspection LOCALITYa NEAREST department. � q t-1 Oc> CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. O f , CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLC) 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 this permit is issued, I shall not employ any person in any manner OWNER , y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o Dated ( Applicant l ADDRESS 3� p w TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this C rtificate of clrY No. g 5jCn Exemption, you should become subject to Workers' _ Compensation provisions of the Labor Code,you must forth- APPL ATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ ❑ ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY IN SPECTIONIn- Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT r❑ (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 {�/1 �/�U ` effect. 1 'v`y t e PARKING RSQ'D PROVIDED SPACES License Number Lic. Class cz Lac) LIMITED TIME USE Contractor Date DATE DATE PROM: 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 Y�)A, IGNATURE iness and Professions Code). PRESENT USE OF BUILDING `/•� /1_ FINAL APPROVAL Lic.or Reg.No. Date �7L C.�� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUIL GS [";� FE 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 coon_ou'r 7/u/r e 0 1, as owner of the property, will do the work and the 'PACES PROVIDED 1 structure is not intended or offered for sale (Section 7044,Business and Professions Code). Ir CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency 6 f for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. n Lender's Name O PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that 1 have read this application and state that the _ above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State 1 ws relating to building construction, and hereby a rite presentatives of this County to enter TOTAL FEE 4 on the abo - ent' ed pr perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE It Sign o ermittee Date RtO1tVjtS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereV affirm that I have a certificate of consent to self insure,•.or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION u a certified copy thereof(Sec.3800,Lab.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDINGADDRESS 7 1 •,1nWL & )"I , - Certified copy is hereby furnished. BUILDING CJJ 31 ADDRESS S LOCALITY , 9 ElCertified copy is filed with the county building inspectionLOCALITY NEAREST department. Q Q1 1' CROSS ST. Yv_le Date Applicant EAREST p DISTRICT O. GIII QU TYPE PROCE�SSE BY CROSS ST. f_)14C i N i TAS syse f� /I �1 NST. Ei CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL f COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAF HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND-LOCAL. NO. OF BLDGS. (This his 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 S ZE 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 4 OWNER y so as to become subject to the Workers' Compensation Laws. AIL S , OCCUPANCY GROUP o DDRESS U Date Applicant rEL. OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of � CITYAP � No. N N 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 USEGEOLOGY 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 PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq'O PROVIDED SPACES 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 OF NO. CF I SP CTOR acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI MATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date `i RESENT USE OF BUILDING e a I P U HOME OWNER-BUILDER DECLARATION No. OF EXISTING Bu LDINGS 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- oo ness and Professions Code): NO. PARKING 0 0 0 0 I, as owner of the property, will do the work and the SPACES PROVIDED 0 1, 12-87 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY yPROPOSED USE OF BUILDING C S JE I hereby affirm that there is a construction lending agency f- for the performance of the work for whichthis permit is issued(Sec.3097,Civ.Q. Lender's Name Y PROPOSED MAX. OCC. Lender's Address PERMIT FEE DO 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 Ov po he above-menti d pe for inspection purposes. ` l SEE REVERSE FOR EXPLANATORY LANGUAGE 114 itlu Signature 6T Mnittee date I ;YORKEkS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N I hereby affirm that I have a certificate of consent tself CE 875(11-84)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. BUILDI Policy No. Company FOR APPLICANT TO FILL IN Gq2,3? 'ha S ADDRENS M Certified copy is hereby furnished. wnoRs GEsI LMrsk IA2%3 00 IT L LOCALITY 7 L 0 Certified copy is filed with the county building inspection LOCALITYNEAREST department. _Tf_MP LC ONv CROSS ST. Date Applicant 49AREST ,�^G� ' 7/�� DISTRICT N1 G gy CONST. / PRO SED BY GROSS ST. ,�1 �� ` • Ute{ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP J / I°"'"A� CSTATE MAJOR SE ND LOCAL IRLE NO. OF BLO GS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZV SPECIAL CONDITIONS by the permit is for one hundred dollars (SI00) or less.) USE OF // OI certify that in the performance of the work for which this IZE OF LOT EXISTING BLDG. permit is issued, I shall not employ any person in any manner OWNER_T9MQ,CCkTI �°�tAU�a2I c' so as to become subject to the Workers' Compensation Laws. MAIL14 rEL OCCUPANCY GROUP o {i�+ ADDRESS 5 m A ��`d1���.tiJ ®p, V Date Applicant a La OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY Qy(��-�/� �'jA No. �- �7(f res Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIOPanic Devices N I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMG ❑ (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 ❑ 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 IGNATU R; iness and Professions Code). FINAL APPROVAL �;1 Lic.or Reg.No. Date 1 PRESENT USE OF BUILDING VJOVJT— 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 ElI, as owner of the property, will do the work and the SPACES PROVIDED # - 088 structure is not intended or offered for sale (Section D D a a o D G z 7044,Business and Professions Code). 011 1 (116-87 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency E0%\ a.06F �� LL jld0 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 a 00 l� 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 1\ti ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE u o ie above-mentioned pert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 14Si gnaturee of Permittee UDate WORKEITS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C AT I O N {� L1 I Hereby affirm that,I have a certificate of consent tself CE 875(11-84)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 BpODRESsUILDING j��?,6 Certified copy is hereby furnished. x BUILDING ,!� ADDRESS ) 4205-4fED- LOCALITY DCertified copy is filed with the county building inspection LOCALITY (� '•,t CROSS ST. department. i NEARESTr2 L Date Applicant NEARESTY DISTRICT NO. GROUP TYPE PRO ESSED BY CROSS ST. �'� �{Gt ��v CONST. 1/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL W-T o��aT 7 _ o J? 'e_a l� COMPENSATION INSURANCE DESCRIPTION ,COT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL � . DNaC NO. (CIRCLE) �, l7'7S •'S NO. OF LOT S� USE ZONE SPECIAL CONDITIONS (This section need not be completed if the work involved TRACT , NOW ON LOT by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner X OWNER C N so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL E�Z O ADDRESS ~ Date Applicant Z hOty Zv iT NOTICE TO APPLICANT: If,after making this Certificate of CITY a L NOL G ( OCCUPANT LOAD Exemption, you should become subject to the Workers' APPL CATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- El comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and ����)� effect. Vf `^�7/w PARKINGREQ' PROVIDED I SPACES JJ License Number Lic. Class _ ,�'- �+T— ` d gTi:t1 J c r K LIMITED TIME USE Contractor Date DATE DATE FROM: TO: EJI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE of G� M•/�J ff� NO.OF AA INSPECTOR'S g p EXISTING BLD G.� / ( ^r/ STORIES(Jd'�f� SIGNATURE acting in my professional capacity (Section 7051, Bus- , iness and Professions Code). ,.� � FINAL APPROVAL Lic.or Reg.No. Date e A J� PRESENT USE OF BUILDING 1Fj4/ r7 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUIL INGS+ ON LOT AND USE 1 hereby affirm that I am exempt from the Contractor's II License Law for the following reason (Section 7031.5, Busi- ( 1V ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the `'PAGES PROVIDED - structure is not intended or offered for sale (Section 7044,Businoss 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 re resentatives of this County to enter TOTAL FEE ov upon the aboy6-ment' eu�x ! ro. erty£yor inspection purposes. / ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate ..WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) M IRSCELLANEOUS 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 FI LL IN ADDRESS 3 —� Certified copy is hereby furnished. BUILDING , I �� ADDRESS 9237 Lower Azusa Road LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. Teml2le City CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP IT//Y��••P��E••��— OC SSED BY CROSS ST. Enc'nit Avenue ,O� 17--21coN CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL or.o of +� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK 0. P> Y/� pe E) STATE MAJOR SECOND LO L 075 � NO. OF BLDGS. (This section need not be completed if Uie work involved �$ee Doc.85D p RACT NOW ON L07 One USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE of warehouse I certify that in the performance of the work for which this SIZE OF Lor 64,000 sq.f x1srING BLDG. industrial/4 o permit is issued, I shall not employ any person in any manner OWNER subject to the Workers' Compensation Laws. Temple Cit Industrial Park so as to become subJ P MAIL OCCUPANCY GROUP Date Applicant ADDRESS 177E. Front St. Lt1 NOTICE TO APPLICANT: If, after making this Certificate of CITY rA No- RIR—91s— OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION 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 pp'' � effect. v (I/1�V� PARKING REQ D PROVIDED SPACES License Number Lic. Class Q 4 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 111E OF NO. OF INSPECTOR'S EXISTING BLOC. 29 $77 $ ft. STORIES one SIGNATURE acting in my professional capacity (Section 7051, Bus- , Q iness and Professions Code). PRESENT USE OF BUILDING warehouse industrial FINAL APPROVAL Lic.or Reg.No. Date 109�f_lpz HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGSON LOT AND USE one I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- warehouse/industrial , ness and Professions Code): NO. PARKING .... .-" • 0 I, as owner of the property, will do the work and the SPACES PROVIDED three ._•._ - _ structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING reconditioning & I Hereby affirm that there is a construction lending agency wholesale distribution of automobile for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). parts. Lender's Name PROPOSED MAX. OCG. Lender's Address I certify that have read this application and state that the PERMIT FEE above infor, tion is correct.I agree to comply with all County ISSUANCE FEE ordinances ,And State relating to building construction, and h re authoriz repr ntatives of this County to enter TOTAL.FEE upon bove-me Toned perty for inspection purposes. lG SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) M I S E LA N EO 5 APPLICATION I hereby affirm that I have a certificate of consent to selfCOUN'IX OF LOS ANGELES a. BUILDING AND SAFETY DIVISION insure. or a certificate of Workers'Compensation Insurance,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. BUILDINGoC 7 � -- / _I LOCALITY ADDRESS (�7 Certified copy is filed with the county building inspection LOCALITY CROSS sr .T department. Date Applicant NEAREST DISTRICT NO. 6 UP TYPE 15AVOCESSED BY CROSS ST. -21 —21CONST.// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (/ v �/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCKMAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLDGS. 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.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which thiso permit is issued, I shall not employ any person in any manner OWNER - k f'�S/� so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP �� a ADDR 1- Date Applicant LULL NOTICE TO APPLICANT: If, after making this Certificate of CITY _rloLOCCUPANT 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 E] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. o- & III PARKING REO'D PROVIDED License Number Lic. Class SPACES LIMITED TIME USE 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES _ SIGNATURE iness and Professions Code). -' FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING 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 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 ,�y 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 prdinances and State laws relating to building construction, and hereby authorize repr s rues of this County to enter TOTAL FEE 6U up�41 ntio rty for inspect' n purposes. r , SEE REVERSE FOR EXPLANATORY LANGUAGE u rmrttee Date WORKERS'COMPENSATION DECLARATION 76M444 M I SC E L LA N E®U S APPLICATION o I herebaffirm that I have a certificate of consent tself CE 875(11-84)COUN'T'Y OF LOS ANGELES BUILDING AND SAFE'T'Y DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a pertified copy thereof(Sec.3800,Lab.Q. Pblicy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. UIL ADRESS DING 123? [Ow Ez LOCALITY Certified copy is filed with the county building inspection -NEAREST department. V / /v CROSS ST. Date Applicant ZEAREST DISTRICT NO. I GROUP ITYPE PROCESSED BY CROSS ST. EN r OS COC I Al NST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK 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 SE OF LOT EXISTING BLDG, d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner owNER� j�i-;'. �.$7r �:.r v� c-1 so as to become subject to the Workers' Compensation Laws. MAIL �- OCCUPANCY GROUP o Date Applicant DR ESSi 7� � � r�pv� S�T �vNOTICE TO APPLICANT: If, after making this Certificate of�kA Y Cpff;nfcl C.-9/•7.,23 NOL�I -��� d�/ OCCUPANT LOAD °- Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. fIL/D/ PARKING REq D PROVIDED License Number Lic. Class rJ J� SPA CES ZD LIMITED TIME USE Contractor Date 7• `Oe DATE DATE ElI am exempt from the licensing requirements as I am a FROM? TO: licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). eFINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING U/fie A// HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING El I, as owner of the property, will do the work and the SPACES PROVIDED # 0 0 0 0 8 8 structure is not intended or offered for sale (Section y D D o D o O D U) 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY NWO PROPOSED USE OF BUILDING �J/j(,� . �$FL o(� 07. 12-88 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 AddressD 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 u n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE PPCF►, (o'— !�—91 Signature of Permittee Date ,YORKERS'COMPENSATION DECLARATION CE 875(11-84) 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 a certified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDINGSS ADORE / Certified copy is hereby furnished. UILDINGLOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection OCALITY F NEAREST department. CROSS ST. Date Applicant EAREST DIS'�rrCT GR TYP PRO SS D BY CROSS ST. �1 S CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J t COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SE NO 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.) I USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which thiso _ permit is issued, I shall not employ any person in any manner OWNER U1 1A 4 14M so as to become subject to the Workers' Compensation Laws. MAIL r J OCCUPANCY GROUP / a Date Applicant A DRESS 1776 '`ow -5_- TELOCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY 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 deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REq•D D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE DI am exempt from the licensing requirements as I am a FROM: TOC licensed architect or a registered professional engineer SIZE OFNO.OF INSPE oR s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES IG TORE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANI I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED .5-9 4 0.4 A structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ' # O O O O $8 I hereby affirm that there is a construction lending agency o D 0 0 0.0 0 for the performance of the work for which this permit is 0 IL ] 8-88 issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE O I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE Q n the above-mentioned property inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE p or Signature of CPA Date ��/_ • WORKrR$'C0MPENSATION DECLARATION CE 875(17-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BU1LbING 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. uILDING c� �j7 Leer u cr• �- LOCALITY 1 DDRESS 0 Certified copy is filed with the coun building inspection I LOCALITY y p NEAREST department. - ��; r � /f�f g� 'ROSS ST. Date Applicant NEAREST DISTRIC Nq9�' OUP TYPE CESSED BY CROSS ST. EJq�I�JQ (/ it � CONST. CERTIFICATE OF EXEMPTION ROM WORKERS' LEGAL o COMPENSATION IN RANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STA MAJOR SECOND LOCAL NO. OF NO. (CIRCLE) (This Section need not be comp] ted if the work involved TRACT NOW ON LOT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hun ed dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performan of the work for which this permit is issued,I shall not em oy any person in any manner .WN.R y so as to become subject to th Workers' Compensation Laws. MAIL / OCCUPANCY GROUP _�— 0 ADDRESS�' y.3 WOW P%11k S� V Date /Code, a I„ r¢L. OCCUPANT LOA D- NOTICE TO APPf, after making this Certificate of CITY --j {% No. (pda.'1 C/, Exemption, youecome subject to the Workers' z Compensation prof the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply witrovisions or this permit shall be TRAILaR USE GEOLOGY INSPECTION❑ No Spec, owl. deemed revoked. ,./�, Panic De ces LICENSEACTORS DECLARATION OCCUPANCY INSPE CTIO NIRIL I hereby affirm thlicensed under provisions of Chapter SAFETY PERMIT T� (LIST ITEMS BELOW) 9 (commencing wn 7000) of Division 3 of the Busi NO. OF XITS nese and Professioand my license is in full force and effect. (�( effect. 6 e7-CAx5jk�- AMA( 262,1%1PARKING R D SPACES PROVIDED �_ I J License Number Lic. Class LIMITED TIME USE Contractor Date D ATC DATE I am exe t from the licensing requirements as I am a licensed chitect or a registered professional engineer SIZE OF No. OF PROM: ro: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessan rofessionsCode). none, FINAL APPROVAL PRESENT USE OR BUILDING 77 Lic.or Reg. o. Date H ME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS I hereby affirm that I am exempt from the Contractor's ON LOT AND USE License aw for the following reason (Section 7031.5, Busi- ness usi 6/16/97, ness an Professions Code): SNO. PARKINGPACES PROVIDED � C297 �'11 —:*7 I, as owner of the property, will do the work and the s ucture is not intended or offered for sale (Section 044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I I reby affirm that there is a construction lending agency fo the performance of the work for which this permit is is ued(Sec.3097,Civ.Q. ender's Name PROPOSED MAX. OCC. ender's Address I certify that I have read this application and state that the PERMIT FEE O 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. n -1_„ � / � SEE REVERSE FOR EXPLANATORY LANGUAGE U I Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I Hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation insurance,e,or' a certified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING pDDRE55 Certified copy is hereby furnished. AUILDI e� Tq LOCALITY Certified copy is filed with the county building inspection OCALITYNEAREST department. �� L' iiz CA O cRoss ST. Date Applicant AREST DISTRICT 7KGL�OUPTYPE PROCE ED BY CRO55 ST. CONST/CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECON LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPEC IAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF IZE OF LOT EXISTING BLDG._ d I certify that in the performance of the work for which thiso permit is issued, I shall not employ any person in any manner OWNER DRESS so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP 0 MAIL r Date Applicant •O. O O NOTICE TO APPLICANT: If,after making this Certificate of clry C J - 7 To NO � ' —q S— Oa OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM( E] (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 effect. PARKING REq'D O PROVIDED E SPACES ..JJ 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- (STING BLDG. STORIES SIG ATURE iness and Professions Code). PRESENT USE OF BUILDING 3k�t� �' i FINAL APPROVAL Lic.or Reg.No. Date U a C CLAJr 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, Basi- A 0 1 8.7 A ness and Professions Code): NO. PARKING I. as owner of the property, will do the work and the SPACES PROVIDED # 0 0 0 0 $$ structure is not intended or offered for sale (Section 7044,Business and Professions Code). 0 0 0 0 0 0 0 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 07, 14-88 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 V above information is correct.I agree to comply with all County ISSUANCE FEE v ordinances and State laws relating to building construction, O [ind hereby authorize representatives of this County to enter TOTAL FEE �\ po lie above-mention property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign r of P ttee at Gam' fVORKER�S'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION I herra rthat I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,, o or a cecertt ificate of Workers'Compensation Insurance, e,or a certified 1copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. UDDILDRESS ING pi .2, -7 L ON, i/� LOCALITY A02, Certified copy is filed with the county building inspection OCALITY CROSS sr.T department. Date Applicant NEAREST DISTRICT NO. OUP TYPE CESSED BY CROSS ST. ���� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ONL OT S . USE zDNEr 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 f40.� n C:) permit is issued, I shall not employ any person in any manner OWNUR so as to become subject to the Workers' Compensation Laws. MAIL � G OCCUPANCY GROUP o 1— Date Applicant ADORE f S� 1221 W T.I. NOTICE TO APPLICANT: If,after making this Certificate of CITY n� `��7Z� NO . 5—�,C �� OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPQCTION❑ 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 �to� ceve-z' PARKING effect. SPACES REQ O O PROVIDED C' I J ,., II-- License Number Lic. Class - e L� �� + LIMITED TIME USE 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 OFNO. OF sPECTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLD 6. STORIES SI URE iness and Professions Code). PRESENT USE OF BUILDING �� FINAL APPROVAL Lic.or Reg.No. Date 1y HOME OWNER-BUILDER DECLARATION NO. OF•EXISTING BUILDINGS ON L'OT AND USE `I I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING µ+ SPACES PROVIDED I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section - r 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address d-O 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 I TOTAL.FEE uppn the above-mentioned property for insp�ecttion purposes. 9- SEE REVERSE FOR EXPLANATORY LANGUAGE .451giiature of ee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) RISC:ELLANEOUS APPLICATION I laffirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insureure,, o 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. X ABUILDING DDRESS q LOCAL. _ �„�. & Certified copy is filed with the county building inspection LOCALITY C '�� NEAREST d artment. X _CROSSsr. Date. Applicant NEAREST �(�/' �! DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. _ '/� v(i N���S i �yl�( CONST. CE IFICATE OF EXEMPTION FROM WORKERS' LEGAL I/CJ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLD GS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. ��/ I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner X OWNER y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP OZ Date Applicant X ADDRESS 3 W NOTICE TO APPLICANT: If,after making this Certificate of �( CITY ,G', Ivo OCCUPANT LOAD L. z Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know[. deemed revoked. OCCUPANCY INSPECTION ❑ Panic Devices LICENSED CONTRACTORS DECLARATION 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 X effect. PARKING REQ'D D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE OATH El FROM: TO: )NSP R'S I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OR NO. OF SI NA RE acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES iness and Professions Code). ` PRESENT USE OF BUILDING FINAL APPROVAL / Lic.or Reg.No. Date l HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS t^ O 2 ' "�`� �� ON LOT AND USE /I D' I hereby affirm that I am exempt from the Contractor's 1'/( License Law for the following reason (Section 7031.5, Busi- 1]I_rl�l�-1�1�(j1 8/12/92 ness and Professions Code): NO. PARKING Q 992 — I, as owner of the property, will do the work and the SPACES PROVIDED 49 � 1 PM 3-'26 structure 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 an State laws relay uilding construction, and hereby au r' a pre Ives oft 's County to enter TOTAL FEE upon the abov ti pro erty for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa e o rml ee to WORKERS'COMPENSATION DECLARATION CE 8754(11-84) M I SC E L LA N EGU S APPLICATION I hereby affirmthat 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. PolicyNo.—Company BUILDING ` p y FOR APPLICANT TO FILL IN ADDRESS �� J F1Certified copy is hereby furnished. 'suILDING 3 ) __&IC r, �aU$/9 dZCI�r LOCALITY tea. ADDRESS LCA ElCertified copy is filed with the county building inspection OCALITY . NEAREST department. TEM OJG CITY CCz j 1�7 a C CROSS ST. Date Applicant NEAREST /� DISTRICT NO. GROUP TYPE PR ESSED BY CROSS ST. ��JCi�yl ,f7vC Q� CONST. �` � CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLUGS. (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 ,12 C (�+ EXISTING LD G. 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 OWN 4 ee. �— r so as to become subject to the Wo ers' nsation Laws. MAIL --- OCCUPANCY GROUP o ADDRESS Date _Lk-_,11-Applicant Z31 ff TEL. NOTICE TO APPLICANT: If, after,making this Certificate of CITY No. dl� OCCUPANT LOAD Exemption, you should become subject to the Workers' ION FOR Compensation provisions of the Labor Code,you must forth � �� �/��1/.�=�oa7 EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 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. 14 O PARKING REWO PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a PROM. 7D. 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 inessandProfessionsCode). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING C4,r YePa r 5 AcP y ; HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE J' I hereby affirm that I am exempt from the Contractor's ,�f�(, 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 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 S e 111 S . 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 ordinances and State laws relating to building construction, and hereby authorize repre epptatives of this County to enter TOTAL FEE �S upon the abov enti foperty for inspection purposes. /3 rr' SEE REVERSE FOR EXPLANATORY LANGUAGE Tr !/ Ct Sit'nature o Permittee Date WORKERS'COb4PENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I ]ure, o affirm crt 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.'—Company4 p BUILDING / Q FOR APPLICANT TO FILL IN ADDRESS G O� G Certified copy is hereby furnished. ncoeesstt 3 �� � ;�, LOCALITY e17 ❑ Certified copy is filed with the county building inspection LOCALITY .may NEAREST iC department. U NC \ l�G'�1 r(j CROS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. i0 O 1.,X_ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LE 6AL d A COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK MAP HIGHWAY OF BLD 65. No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. (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. F permit is issued, I shall not employ any person in any manner OWNER 1� �J I y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP -� S S V Date ADDRES Applicant 1„ NOTICE TO APPLICANT: If,after making this Certificate of CIr 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 USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 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. !•Ar Ajlne6 PARKING REQ'D PROVIDED `y� Ke-NCA e—NC. L SPACES License Number Lic. Class rtL�S\ LIMITED TIME USE Contractor Date DATE OATa 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). WCC FINAL APPROVAL PRESENT USE OF BUILDING V / Lic.or Reg.No. Date �—_b 2's K �Cfti ` 1�1 — ET—r•. HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS )jI—� F 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 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 BUILDIN 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.). 1�i Lender's Name PROPOSED MAX. OCC. t Lender's Address I certify that I have read this application and state that the PERMIT FEE -5-- above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and Hereby authorize representatives of this County to enter TOTAL FEE S ` upon the above-mentioned property for inspection purposes. *' SEE REVERSE FOR EXPLANATORY LANGUAGE W ��Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION {� CE 875 I--I 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 FILL IN BUILDING ADDRESS Certified copy is hereby furnished. Bu1LDING //''I/ ,//11 LOCALITY yf' /}f/� � me Q {�+_) ADDRESS 6if ojl . , 1 L/\ � a y ilI Certified copy is filed with the county building inspection LOCALITYCJ h "i NEAREST ' department. �f fr e- C ceoss sr. ya C f y J qs Date Applicant NEAREST h}, DI TRI CCCyyy���OU TYPE P CES BY CROSS ST. ' C, S /� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL n COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SE CO D LOCAL NO. OF BLD GS. (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 OF SIZE OF LOT EXISTING BLDG. i I certify that in the performance of the work for which this Co permit is issued, I shall not employ any person in any manner OWNER ' C _ �rS �1tL 6i � m so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP OZ ADDRESS ���1 Sf U Date Applicant _ CL. NOTICE TO APPLICANT: If,after making this Certificate of CITY cipV Jy;y ITvoL�f �5/� OCCUPANT LOAD y Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO 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. To w/ PARKING REq D � PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date D ATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NoP .OF IERATUs acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I iness and Professions Code). PRESENT USE OF BUILDING ll�l1 FINAL APPROVAL j Lic.or Reg.No. Date (a �7�V V 11 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS B �E V/ 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. PARKINGSPACES PROVIDED 00,0101-00111000,0101-00111 /16/ " El I, as owner of the property, will do the work and the 22 ? Hl, 7: structure is not intended or offered for sale (Section 7044,Business and Professions Code). , CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ®rtil' J �E�10 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 0.1 I certify that I have read this application and state that the PERMIT FEE `lJ 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 —� u on the abme onedAfrop tv fox.inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE y 4 x Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I laffirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insureure,, o or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.C.). BUILDING Policy No. Company FOR APP LI CANT TOFILL.IN ADDRESS p(�J OWer- Z l' FICertified copy is hereby furnished. BUILDING Qr 2 Q LOCALITY ADDRESS DCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST _I �a�p��/I o / f DISTRICT NO. G OUP TYPE P CESS D BY CROSS ST.7� v�i� •`a yC'\' �I i CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL No. (CIRCLE) NO. OF SLOGS. (This section need not be completed if 4work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollarsl($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 mannerOWNER 0E- U U so as to become subject to the Workers' Compensation Laws. MAIL / , OCCUPANCY GROUP ADDRESS 17? fall 1L � Date Applicant L„ NOTICE TO APPLICANT: If,after making this Certificate of CITY V�• d-3 No" q(p — v5 OCCUPANT LOAD y Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ -GE OGY 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 Q-7_ SPACES REQ'D PROVIDED License Number Lic. Class ' OP L: ��/VVVV/ • f LIMITED TIME USE Contractor Date avtot 11A 0 DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a �• licensed architect or a registered professional engineer SIZE OF y NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG.5,D �7On STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 0 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� i11l-ijl�{3� 3/15/90 ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 9.540 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING (I� cry" It I hereby affirm that there is a construction lending agency r,>6Y11 ✓✓iS for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Plev Lender's Name PROPOSED MAX. OCC. Lender's Address �� �� l 1, 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 tatives of this County to enter TOTAL FEE pon the above-mentioned p rty for inspection urpo,es. SEE REVERSE FOR EXPLANATORY LANGUAGE !� O Signs e P Date WIIiRKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION I p�/reby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION in re, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING /Ja ADDRESS L.T Certified copy is hereby furnished. A1ILI ING 3 ` LOCALITY 1,4 DDRESS (� G UI 0 Certified copy is filed with the county building inspection LOCALITY TI C- L'� NEAREST department. CROSS ST. ez Date Applicant AREST /� DISTRICT NO. RQUP TYPE JJJ PROCESSED BY CROSS ST. `, CON CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v D COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SEC ND L CAL NO. (CIRCLE) NO. OF BLD GS. (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 , NS E OF LOT EXISTING BLDG. I certify that in the performance of the work for which this Co permit is issued, I shall not employ any person in any manner OWNER J7'O.C,,,d o�e�l��- `' so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP o Date Applicant ADDRESS/77 f/1p�,Jp �T ~ v Lu NOTICE TO APPLICANT: If, after making this Certificate of CITY[dae.V G� T DLS'f�lJ: 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 ❑ deemed revoked. ❑ _ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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 REWD D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE 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 SI NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING AjC.V ZVZD AA 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 12 Q5 A structure is not intended or offered for sale (Section 7044,Business and Professions Code). # 0 0 0 0 8 8 u3 PROPOSED USE OF BUILDING �{��"� `, 2� CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 1 ].L8-88 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 A^, PERMIT FEE a5i 00 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, fod hereby authorize representatives of this County to enter TOTAL FEE n the above-mentioned property for inspection purposes. I EE REVERSE FOR EXPLANATORY LANGUAGE gnature of PzrrgKee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) M �SC E L L¢ NEO SAPPLICATION P P L I C y T I O N I erebaffirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure o 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 ? •'C.. 1 ,5 FlCertified copy is hereby furnished. BUILDING � /,Ij� ADDRESS [tee LOCALITY IG Certified copy is filed with the county building inspection LOCALITNEAREST department. Cf-r 66 • 1290 CROSS ST. / Date Applicant NEAREST ! DISTRI O. GROUP CONST. / PROC SSED BY CROSS ST. S ✓✓✓ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP N GNWAY STATE MAJOR SECO LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL JqONDITIONS by the permit is for one hundred dollars ($100) or less.) uSE OF SIZE OF LOT /a • ^ . EXISTING BLDG. &:Orrff-Vya 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 / "G% /J� 'CD � so as to become subject to the Workers' Compensation Laws. MA / n OCCUPANCY GROUPFT C) ADDRESS s 7, &. s�• o• LL�Y G Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY //f/ TNO�' - 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 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 )AA\)I LIMITED AIME USE Contractor Date • _ /I l�! FROM: TO: DATE DATE ElI am exempt from the licensing requirements as I am a , JP7 VG licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGfiATURE iness and Professions Code). FINAL APPROVAL � "0 Lic.or Reg.No. Date PRESENT USE OF BUILDING V HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANO 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 CK'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). c 0 3 8,5 A CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency # 0 0 0 0 3 0 for the performance of the work for which this permit is I o o $Q 5 0 issued(Sec. 3097,,d�iv Lender's Name (t9�� PROPOSED MAX. OCC. O O 08 /�U,S O U Lender's Addresses �"7 sTl 1�� {. �— PERMIT FEE O a 08—S 8 I certify that I have read this application and state t tAe' above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize represeiktives of this County to enter TOTAL FEE upon the above-mentioned p erty for inspection purpo e. EE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of irmitte,` ate WORKERS'COMPENSATION DECLARATION CE 875(17-84) MISCELLANEOUS APPLICATION c I t e;eby a ea;n 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 110, FOR APPLICANT TO FILL IN BUILDING l5 / ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS Z Certified copy is filed with the county building inspection LOCALITYNEAREST department. M O(� (� cwoss sr. Date Applicant NEAREST DISTRICT N Gjjj���OU TYPE PROCE ED BY CROSS ST. I TA'S J CONST.p, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �� (J(() Y COMPENSATION INSURANCE DESCRIPTION LOT NO. it BLOCK MAP (CIRC nv STATE MAJOR SEC D LOCAL NO. (CIRCLH) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE E SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SYS OF LOT,,,�Pi EXISTING BLDG. a I certify that in the performance of the work for which this � �� � ,-;,--f'T,r wS'rr.. permit is issued, I shall not employ any person in any manner WNER P C . L7,. `.:I so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP G o Date Applicant DRESS 2'T - , Fr-c.+ - S I CD TEL. IJJ NOTICE TO APPLICANT: If, after making this Certificate of cITrCV V `,fes f('713 No. SII - c/S -(�e.2�] OCCUPANT LOAD z Exemption, you should become subject to the Workers' _ Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ E OGY INSPECTION E] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PER IT ❑ (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 OA TE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- 1STING BLDG. STORIES sl AruRE iness and Professions Code). Of '/� PRESENT USE OF BUILDING�,J «S"r#'.:� P. rl/' FINAL APPROVAL � Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANO USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- -P 9 2 5 7 A ness and Professions Code): NO. PARKING ❑ I SPACES PROVIDED # 0 0 0 0 3 0 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). o 0 0 0 0 0 0 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING'�� I.S; �. �� 328-88 0 1 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 r 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 the ove mentio property or inspection purposes. ` ,SEE REVERSE FOR EXPLANATORY LANGUAGE C .,e a O ature of Permitte Date WORKERS'COMPENSATION DECLARATION CE 876((11-84) MISCELLANE®US APPLICATION f . lr 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 3 ADDRESS v / D Certified copy is hereby furnished. wDOREss 9237 LOWER AZUSA RD. UNIT S. LOCALITY D Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO./ GROUP TYPECONST. PROCE SE BY CROSS ST. (/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL OY IGHWAY STATE MAJOR SECO LOCAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP H NO. OF SLOGS. 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 //��%% I certify that in the performance of the work for which this s E OF Lor ° EXISTING BLDG. // _ o permit is issued, I shall not employ any person in any manner OWNER AAAAS?1 �V C-' so as to become subject to the Workers' Compensation Laws. MAIL /Vw OCCUPANCY GROUP o Date Applicant ADDRESS 177 EAST FRONT DR. Pn_ RnX NOTICE TO APPLICANT: If,after making this Certificate of No`.' 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 USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY 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 O PROVIDED D 2 // �,/ SPACES License Number Lic. Class J O-Z 9/T V ST� 77 LIMITED TIME USE Contractor Date b,��• ' / / ( DATE DATE TO: I am exempt from the licensing requirements as I am a . INSPECTOR'S licensed architect or a registered professional engineer Slz F NO. OF acting in my professional capacity (Section 7051, Bus- E TING BLDG. STORIES S17RATURE iness and Professions Code). FINAL APPROVAL i PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANI I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED j}I structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ROPOSED 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. 1=6— Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this ap lication and state that the PERMIT FEE above information is correct.I re to comply with all County ISSUANCE FEE ordinances and State laws re ti to building construction, and hereby authorize represent ' es of this County to enter TOTAL FEE Va u on the above-mentioned prop t r inspection purposes SEE ERSE FOR EXPLANATORY LANGUAGE Signa ure o ermitte WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION {� ' CE 875 LI 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,pertified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APP LICANTTO FILL IN BUILDING ADDRESS Certified copy is hereby furnished, nooRess 27 Lpv� ��(s' D� LOCALITY T� � 23 wits Certified copy is filed with the county building inspection LOCALITY �PC NEAREST 1 department. CROSS ST. Date Applicant NEAREST DISTRICT Np GR , TYPE 1 'PRO C SSED BY CROSS ST. 57 N�_ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J/l//1X� ¢//J 'Y/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP NIG Nw Ar STATE MAJOR SEC D LOCAL NO. (CIRCUS) NO. OF BLDGS. (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 ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. } I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER 6/LLo /� I� cz so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS Af G f� Z3 Date Applicant LO NOTICE TO APPLICANT: If, after making this Certificate of CITY C pe6 Ivo .�� —��? OCCUPANT LOAD V Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth ❑ with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ )LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and ^ effect. PARKING SPACES REQ'D D PROVIDED 1�—J License Number Lic. Class LIMITED TIME USE Contractor Date DAYS DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATUREd iness t Reg. d Professions Code). /' FINAL APPROVAL -;l7 , / t/9� C Lic.or Reg.No. Date PRESENT USE OF BUILDING / (�f�� vt� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 8 5 2 0 A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's # o o o o F.$ License Law for the following reason (Section 7031.5, Busi- 0 0 0 0 0 0 0 cn ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 1206-87 structure is not intended or offered for sale (Section 7044,Business and Professions Code). �- PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY QEaLEP \ {1 I hereby affirm that there is a construction lending agency V 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 OO 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, n and hereby authorize representatives of this County to enter TOTAL.FEE of up the above-mentionA property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE -Z3—d'? Signature o Permittee Date .ERS'C'nk41'F,NSAT(ON DECLARATIONI CE 875(2-80) I� 0 SC E L LA N EO U S APPLICATION I y affirm that L have certificate of consent to self COUNTY OF ]LOS ANGELES BUILDING AND SAFETY DIVISION insu e, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company_ cofg ,I FOR APPLICANT TO FILL IN ADDRESS 7 Iff WC& Ue--k I JA ❑ Certified copy is hereby furnished. rRE LOCALITY ❑ 9237 Lower Azusa, Suite >4 *P-c I Certified copy is filed Nvith the county building inspection NEAREST department. Tem 1e C L t CROSS ST.Date Applicant DISTg1CT GR P TYPE PROC SED BY .Encini S '� CON T. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MwF HIGHWAY } NO. (CIRCLE) STATE MAJOR SECO LOCAL CL NO. OF BLDGS. (This section need not be completed if the work involved � TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars (SI00) or less.) ' V USE OF IZE OF LOT EXISTING BLDG. tr I certify that in the performance of the work for which this 10 permit is issued, I shall not employ any person in any manner I OWNER Temple CitU Zndusfrial P �/J 1-- so as to become subject to the Workers' Compensation Laws. 110-�;`R OCCUPANCY GROUP K/ WESSAf5 E. Huntin ton Drive (,� yDate Applicant TEL.NOTICE TO APPLICANT: If, atter making this Certificate ofITY Arcadia 91006 No. unknown OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION ` OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. SPACES REQ'D E=:= PROVIDED License Number Lie.Class LIMITED TIME USE Contractor Date r DATE DATE OFROM: TO: I am exempt from the licensing requirements as I am :1 licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus!- FISTING BLDG. STORIESNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL tt new industrial Lie.o: Reg.No: Date unit (M-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- 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 for sale (Section 7044,Business and Professions Code). PROPOSED USE OF BUILDING Warehouse and /// CONSTRUCTION LENDING AGENCY 97 89.2 A I hereby affirm that there is •r construction lending agency Off i Ce 1Kt If Al for the performance of the work for which this permit is # 0 0 0 0 8 8 I issued(Sec. 3097,Civ.C.). Ol� 0 0 0 0 0 0 0 Lender's Name PROPOSED MAX. OCG. 1 ` Lender's Address - PERMIT FEE , o9. 11 -87 I certify that I have read this application and state that the above information is correct.I agree to co ply with all County ISSUANCE FEE ordinances and ate laws relating to uilding constructign. TOTAL FEE and her rixe represent at' es f this County to enter on a -mentions o rt for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r 812787 nature of Permittee Date I IV WORI&ERS'COMPENSATION DECLARATION CE 875(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.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS A Certified copy is hereby furnished. BUILDING • ..� Z h _ ADDRESS 5 L,�j IIU LOCALITY ` DCertified copy is filed with the county building inspection LOCALITYCITY, C la (� NRoss sT. department. T Y_0 WL L Date Applicant ON9AREST DIST�J NO GRQ,Up TYPE PROCEP D BY CROSS ST. ` � ,L CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL D r� COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP NIG NW AY STATE MAJOR SES40 LOCAL NO. (CIRCLII) (This section need not be completed if the work involved TRACT �\ NO-OW F BLOCS.OW ON LOT USE ZO ESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE///OF LOT ,I 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 OWNER C hl l� li �t(. t so as to become subject to the Workers' Compensation Laws. MAIL v , OCCUPANCY GROUP ,/rte o Date Applicant ADDRESS Lti ,�{�� S)LI ISII �t}� ICJ rEL. OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate s' c1TY TEl*1lr'LE CIT C r� ND. �t fa ��4 -X Exemption, you should become subject , the Workers- APPLICATION FOR —SJ'/ EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE GE OGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'D PROVIDED SPACES License Number 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 of . , 7 STORIES SPECTORE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. r� 3�t T• STORIES IG NATURE NO iness and Professions Code). r4 I ���S FINAL APPROVAL A PRESENT USE OF BUILDING U Z Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS # a o 0 o 8 8 ON LOT AND USE I hereby affirm that I am exempt from the Contractor's o 0 0 o G 0 o Ln License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 0 9 p 9—8'7 ❑ 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). 14 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency :112C1AL Lk O for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name — I 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 1 ws relating to building construction, and hereby authorize epresentativesof this County to enter TOTAL FEE u on the aboveme oned property for in ction purp ses. — _ SEE REVERSE FOR EXPLANATORY LANGUAGE Sligliature of Permit Date „ 1 WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insuip, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). BUILDING Policy No. Company r FOR APPLICANT TO FI LL IN ADDRESS Certified copy is hereby furnished. J BUILDING ADDRESS , s �� LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST V - department. ��' ! CROSS ST. , Date Applicant NEAREST L //��/^ DISTRICT NO. ROUP TYPE PR�OC ESSED BY pp CROSS ST. EMC/ vE C� ,`, ��� CON$h'. /l./ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` 1t ;/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCL¢) STATE MAJOR SE OND LOCAL NO. OF BLDGS. (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 SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this n- s _ permit is issued,I shall not employ any person in any manner OWNER "V Je0P�?I G_5 y so as to become subject to the Workers' Compensation Laws. ly MA IL q-S �-_ HU/U' Il�s')'O� R a OCCUPANCY GROUP Z o Date Applicant L�LI �e�0! Q TEL ^ ` !7D OCCUPANT LOAD NOTICE TO APPLICANT: If after mak' this Certificate of CITY , 1 NO. d" 1 D 0- 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. Eldeemed 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 El I am exempt from the licensing requirements as I am a PROM: To: licensed architect or a registered professional engineer SIZE OF ©� NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. I rT STORIES ( SIGNATURE inessand Professions Code). FINAL APPROVAL .� PRESENT USE OF BUILDING Lic.or Reg.No. Date �I HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 7 5 'J R ON LOT AND USE G I hereby affirm that I am exempt from the Contractor's # o - 88 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED 0 0 0 0 0 0 0 Ln I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 0 7,27-87 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency OO G� N 1 sH 8`o for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name (i PROPOSED MAX. OCC. (r Lender's Address I certify that I have read this application and state that the PERMIT FEE ° ° ,�� Il 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 upon the above-mentioned property for inspection purposes. s� u4C /J . 7—/7, J,� SEE REVERSE FOR EXPLANATORY LANGUAGE p6 Sifnature of Permittee Date , WORKERS'COD4PENSATIONDECLARATION CE 8784(11-84) MISCELLANEOUS APPLICATION . 1 hereby affirm that 1 have a certificate of consent tself COUNTY OF LCIS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). ' - Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING C 3 ��i/• 2�S�. LOCALITY X31 ADDRESS i�T� ,O Certified copy is filed with the county building inspection LOCALITY / NEAREST department. XX (tel cnoss Sr. Date Applicant NEAREST DISTR ON, GR P TYPE ESSED BY CROSS ST. CONST. ell 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 SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued,1 shall not employ any person in any mannelkXl OWNER of building 209/v Td G• EZ::] L' so as to become subject to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP / G , n� �• Date ADDRESS Applicant t LL'I NOTICE TO APPLICANT: If, after making this Certificate of clrr 60 I/t/1e /-7:); NO. vJ� OCCUPANT LOAD D. Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices 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 anix effect. Name of business PARKING SPACES REWD PROVIDED /• License Number Lic. Class Q fo't�J� OfO LIMITED TIME USE Contractor Date DATE DATE PROM) TOI ❑ 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SI" UR iness and Professions Code). PRESENT USE OF BUILDING Ft L A tROVAL Lic.or Reg.No. Date 7 i HOME OWNER-1)1111.DER DECLARATION NO. OF EXISTING BUILDINGS A 1 hereby affirm that 1 am exempt from the Contractor's ON LOT NO 956 / 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). I CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ;rl =I -2;• issued(Sec.3097,Civ.Q. Lender's Name ► _' PROPOSED MAX.OCC. Lender's Address , t PERMIT FEE 1 certify that 1 Have read this application and state that the 25.00 r 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 25-001 upon t e above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGEXX XX ,.. Sienaturc af crmillcc Dale I I WORKERS'COMPENSATION DECLARATION 5 CC 875 5 875(11-84) M I CC E L LA N E O U S APPLICATION I hereby affirm that I have certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure, or a certificate of Workers'rs'Compensation Insurance,e,or I_ I a certified copy thereof(Sec.3800,Lab.C.). - Policy No. Company FOR APPLICANT TO FILL IN BUILDING & / r ADDRESS ❑ Certified copy is hereby furnished. pD DRESS � l V WCA LITY ► I Certified copy is filed with the county building inspection LOCALITY LQI 1 O NEAREST department. �, L "0.. ST. Date Applicant NEAREST A DISTRICT NO GRQUP TYPE CESSED BY CROSS ST. CONS . I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. NO.OF SLUGS. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT ruSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) 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 so as to become subject to the Workers* Compensation Laws. _ OCCUPANCY GROUP MAIL I E �� -5-j— _ ADDRESS \ EZ] I Date Applicant _ NOTICE TO APPLICANT: If,after making this Certificate of X CITY IDvz -A�, obvNOL 11--,3 OCCUPANT LOAD = Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- I with comply with such provisions OI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ O deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) i 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. fi PARKING REO D O PROVIDED O y SPACES License Number Lic. Class M LIMITED TIME USE Contractor Date DATE DATE N W I F-1I am exempt from the licensing requirements as I am a PROM: TO: 'm f licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S Z acting in my professional capacity (Section 7051, BUS EXISTING BLDG. STORIES S ATURE m mess and Professions Code). FINAL APPROVAL O PRESENT USE OF BUILDING H 0 U Lic.or Reg.No. Date � I . — � '1141 HOME OWNER-BUILDER DECLARATION NO. OF EX AND USE BUILDINGS �1. 1/ 10EI ON LOT AND USE yi 0021 1 PM � I hereby affirm that I am exempt from the Contractor's � I I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): I 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 OR BUILDING I hereby affirm that there is a construction lending agency vv-&A, ), I ) 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 I I certify that I have read this application and state that the PERMIT FEE 25.00 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 upon the a ye-mentio ed property for inspec. n p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r )M1 I Signature o Permittee ate WORKERS'COMPENSATION DECLARATION CE 8 7 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.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. p B ILDING LOCALITY .p ' A DRESS�2 �.�., Certified copy is filed with the county building inspect n CALITYNEAREST department. Tkw%Pig-> CROSS ST. Date Applicant EAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. O O S,( CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J �j/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO.OF BLOGS. (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. E) 1 D_ permit is issued,I shall not employ any person in any mann O NER of buildingo :J so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP °C 0 ADDRESS r" 5K] Date Applicant / . 7 V ` � uol NOTICE TO APPLICANT: If,after making this Certificate of CITY �L `C� ND. 8t8 332-Gie% 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❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION El 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 Bus' NO.OF EXITS ness and Professions Code,and my license is in full force a' ` effect. X ame of business c `� PARKING R6q•D PROVIDED License Number Lic. Class SPACES�� iti LIMITED TIME USE Contractor Date DATE DATE RROMC TOI 0 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG TURK % iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date 6�rry_?,Q, PRESENT USE OF BUILDING i 7 ell HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS .n © r'6 a - ON LOT AND USE 1� "t I hereby affirm that 1 am exempt from the Contractor's � ��• License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING 0,000-01,10i 5% 4/95 F1 I, as owner of the property, will do the work and the SPACES PROVIDED 0? 5 1rI structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OR 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 25.00 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, iereby authorize representatives of this County to enter TIT.L.FEE 25.00 upon a above-mentioned property fo i ectio urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX + XX Signature of Permit ee Dy to r 10 WORKERS'COMPENSATION DECLARATION ICE 875(11-84) MISCELLANEOUS APPLICATION- I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES B-UI :DING' ' 5AEL':TY DIVISION insure, or a certificate of Workers'Compensation Insurance,or _ - a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS / .J Certified copy is hereby furnished. lug-DFN� /, ( I A LOCALITY L X • -ADDR ESB ZJ' - er Lao_ •♦ IWt., 1. D Certified copy is filed with the county building inspection_. LOCALITY 41 NEAREST department. r�- i-eklL L_� q178C CROSS ST. Date Applicant NEAREST DIS�ICTNG UP TYPE PCESSED BY ROSS ST. � lam �'��•� � CONSTCERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL P1 ° (OR2'7 COMPENSATION INSURANCE _D SCRIPTION LOT NO. BLOCK — ^— MAP HIGHWAY STATE MAJOR SECOND LOCAL 1 NO. GC. OT SO NO.OF BLDGS (CIRCLE) (This section need not be completed if the work involved TRACT U 1� NOW ON LOT Af� USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE oP it In / SIZE OF LOT (y �, 8 7 EXISTING BLDG, t.,� Hv�J C I certify that in the performance of the work for which this L3 OWNER permit is issued,I shall not employ any person in any manneXX of building so as to become subject to the Workers'Compensation Laws. rJ// OCCUPANCY GROUP ADDRESS / / I � �C, MAIL Ei::J Date Applicant TEL. Lal NOTICE TO APPLICANT: If,after making this Certificate of CITY �'0Y`M'I C`-`x/74-'3 No. $l 91 SOCCUPANT LOAD N Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: l Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION Eldeemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I Hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Busi- NO. of EXITS El ness and Professions Code,and my license is in full force an4 effect. _ 1V3II18—af bllS iness PARKING REQ'D PROVIDED I I L_J License Number Lic. Class UK,S r -EIUZ�-IVlS� �NC SPACUS /7 LIMITED TIME USE Contractor Date C �) 0��V DATE DATE FROM- TO: ❑ 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF oy NO.OR c� IN SP croR s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG.�^ �J77 S STORIES V`•r�—, S ATURE iness and Professions Code). Q FINAL APPROVAL � r PRESENT USE OR BUILDING�j.�J`'V")iY'+T+7 jw,S2+^C Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OP EXISTING BUILDINGS,,.,., ON LOT AND USE Il�� 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 1, as owner of the property, will do the work and the SPACES PROVIDED -ate structure is not intended or offered for sale (Section 1 7044,Business and Professions Code). PROPOSED US6 OF BUILDING— CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency _ for the performance of the work for which this permit is I — issued(Sec.3097,Civ.Q. Lender's Name I I PROPOSED MAX.OCC. Lender's Address 25.00 -- ! 1 certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County I ISSUANCE FEE I ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 _• ugon_the above-irlentioned property for-inspc5tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ;X- Signature of Permittee Date WURKLRS'C'OMIILNSAIION DECLARATION 10-006 DPV/I.? ,u MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of' consent It, self COUNTY Of I.OS ANGIa.f5 BUILDING AND SAFETY DIVISION mI� I insure,or a certificate of Workers'C0111peatloll Insurance.or - I a certified copy thereor (Sec. 3800. Lab.C.) d Policy No. _• , Company FOR APPLICANT TO FILL IN BUILDING UlLDING ADDRESS AD.REss ❑ Certified copy is hereby furnished. Y =3Z �,\t ,2 (`\?_UCta•IP"�o O --- LOCALITY ❑ Certified copy is filed will)the colmly building in%p-,clion CITY Y ZIP - department. "C-tom �l ``LCA %_( NEAREST `\ CROSS ST. Date Applicant SIZE OF�DT NO.OF BLDGS.NNOW ON LOT DISTRICTN P TYPE oCESSED BY CERTIFICATE OF EXEMPTION FROM WORKI.RS .C� 1 �� v�•C' G CONST. L lV C'UMIJENSAI'IUN INSURANCE TRACT BLOCK LOT NONOAp. ICIRCLAr lJ NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This section heed not be L'ompie(e(! Ir the %%ork ill%01%Cd ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit i% for one hundred dollar% (14100) or lc%%.) 1) I certify that in the performance of the %%ork Iin• „hick this owN (� TEL No. v I permit is issued. I shall not emplo) all person in ❑ny manner _ ' so as tt become subject to tile Worke •' ('ompcn.alion 11,Y, A DRESS c. _ �.. OCCUPANCY GROUP r" \��!ta„►••- Z Date i �$,�p\App CITY ZIP Q - NOTIC TO APPLICANT: If. alter I,,.. lg this ('erwirate <iL� * OCCUPANT LOAD of Exemption, you should become subjeet to the Wt rkers' APPLICATION FOR Compensation provisions or the Labor Code.)tilt nmlst I"n•ulwith Ir--11 EXIT HARDWARE: 1 comply with SLICII provisions lir thi% permit sll:lll Ill.' lleellled TRAILER USE LJ GEOLOGY INSPECTION Ll No Spec.Knowl. ❑ I revoked. ' I.ICl:NSED CONTRACTORS I)FULAR M'I0N OCCUPANCY INSPECTION��••II ILII — Panic Devices ❑ 1 hereby Tilt Irin that I am licensed under pro,isions of Chapter SAFETY PERMIT F] I LIST ITEMS BELOW I 9(commencing with Section 7000)or Di%inion 3 of the BLV;iness NO.OF EXITS and Professions Code,and my license is in full force and effect. PARKING• REQ'D PROVIDED License Number Lic.('I:Itis C1' f' j SPACES I contractor Date — — — - --- --- — - LIMITED TIME USE i I DATE DATE _ I ❑ 1 am exempt from the licensing requirements iN I dill a FROM: TO: licensed architect or a registered professional engineer _ acting in Ill)' professional capaclt (Section 7051. Ittisines" SIZE OF `� i NO.OF ` INSPECTOR'S I i EXIS rING BLDG. 141r1PL�'t; �, STORIES 1 S TORE D '••- and Prol'cssiunsC'udcl. — ---••- Lic. or Reg. No. Date ly PRESENT USE OF BUILDING FINAL APPROVAL IIOME OWNER-IIIIILDER DECLAIM ION NO.OF I'XIS IING BUILDINGS O // N-LOT AND USE Vw�(S - / 1/ 1 hereby affirm that 1 am exempt from the C'ontractor's License - - 0 Law for the following reason (Section 7031.5. Business and Professions Code): NO.PARKING j– D✓��l ❑ � tNRC'`;L-�/Las owner of the properly. affil du ole %%ork anal tileSPACt_PROVIDED 1\rlb L. r — -- - - structure is not intended or olf'ered lin sale(Section 111.1.1. PR OPOSED USE OF BUILDING Business and Professions Code). ...' I C;7u, i I CONSTRUCTION LENDING AGENCY 1 hereby affinn that there is a consu•uction lending agency li,r - the performanCt! of the work for llhich this permit is issued PROPOSED MAX.OCC. l (Sec. 3097,Civ.C.). Lender's Name _ • - _. APPLICANT(PRINT) lTEL NO. )/ Lender's Address ADDRESS �. � I I certify that I have read this application and state that the �z;; ,� � ��• � 0(L-xd above information is correct. 1 agree to comply with all County PERMIT FEE I ordinances and State laws relating to building construction.and hereby authorize representatives of this Count)- to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. � TOTAL FEE — X Z 0 SI I Rl.\'LRSI: I-OR LXIILANAIORY L.ANGUAGIL- i9i 1• Ig lee Date • t _ — WORKERS'COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION 1 hereby affirm that I have a certificate of consent tself COUNTY OF LO ELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING 1r1 Cf A /,fit ADDRESS of Certified copy is hereby furnished. XX ADDRESS / 2q^" , A2,s4 LOCALIT ECertified copy is filed with the county building inspection LOCALITY � NEAREST department. 3CX a /e �' ` CROSS ST. Date Applicant 1 NEAREST r- I C �r� ��� DISTRICT GR UP CYPS ON P ESSED BY CROSS ST. L 1V Ux// IT CERTIFICATE OF EXEMPTION FROM WORKERS' ' LEGAL �r /O r/n4T COMPENSATION INSURANCE OR LOT NO. BLOCK [MAO HIGMWAr STATE MAJOR SECOND LOCAL ee.D&c- Ooto NO.OF BLDGS. RD' (CIRCLE) (This section need not be completed if the work involved TRACT04�g Now ON LOr Bnre uss ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I SIZE OF LOT gnn. �D a7 EXISTING BLDG.1 Z'C_ USE of T„r r I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any mannex OWNER of building � ,.,pis so as to become subject to the Workers Compensation Laws. MAIL / r/ OCCUPANCY GROUP a_ ADDRESS ( / L rdnl-r-S�rYC� I--- Da Date Applicant NOTICE TO APPLICANT: If,after makingthis Certificate of clTr e� TEL. Of�- OCCUPANT LOAD r°�y Cpm(1`nr>� C'a. /7 No, b Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter 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 anix effect. NSIIIe of business PARKING 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 FRuM• TO! licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. �9, -7-1 STORIES 8nf� SIGNATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OR BUILDING 6, HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ' ON L07 AND USE t%J 1 hereby affirm that I :int exempt from the Contractor's 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 SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 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 1 certify that I have read this application and state that the PERMIT FEE above information is correct.I agroeirrpomply with all County ISSUANCE FEE ordinances and State laws relating tO building construction, and hereby authorize representatfv of this County to enter TOTAL FEE 25.00 upon the Ove-mentioa pro X for inspection purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE I XX % e. � XX f�� (' `� Signature n erntittee ate ° CE' 4VOR:LRS'COMPLVSATIO\DECLaRaT10N 8i11-Sad MISCEL ANE-OUS APPLICATION �► I hereby affirm that I have a certificate of consent to self COUNTY OF LOSANGELES BUILDING AND Sr+FETY SIGN ,! insure, or a certificate of 14orkers Compensation Insurance.or i+,certified copy thereof(Sec. 3500,Lab.C.). JILDI Policy No. Company FOR APPLICANT TO FILL IN B13DREMS �� ,ODR � E] Cerr ied co is hereby furnished. BUILDING copy y fiXs- LOCALITY Certified copy is filed with the county building inspectionLOCALIT p NEAR EST department. X5: �[: p� ROSS ST. Date Applicant 1 NEAREST --� DISTRI ONO,- GR P ITY PE 052p.dercESSED BY cRO'SS ST. GGJJFF aapp co CERTIFICATE OF EXEMPTION FROM WORKERS' j LEGAL COMPENSATION INSURANCEi DESCRIPTION LOT NO. BLO CH �V 0. (CIRCLE) „IGhy•Y 37ATE MA"OR SECOND LOCAL I NO. OF BLOCS. (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 (SI00) or less.) usE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the T•vork for which this permit is issued. I shall not employ any person in any manned` OWNER of buildin so as to become subject to the Workers* Compensation Laws. MAIL 13 OCCUPANCY GROUP - ADDRESS Date —.—applicant — NOTICE TO APPLICANT: It', after making this Certificate of CITY NO. l OCCUPANT LOAD _ i Exemption. you should become subject to the Worker!,' APPLICA T ION FOR EXIT HARDWARE: - Compensation provisions of the Labor Code,you must fo-tl-I- with comply with such provisions or this permit `:1u111 be i-;ZAILER USE [ GEOLOGY INSPECTION rl I No Spec. Knowl. deemed:evoked. ( LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices her6l affirm that I am licensed under provisions of Chapter +— SAFETY PERMIT 1_ (LIST ITEMS BEI.O`.Y) 9 1comme:ic:nS "•till Section 0001 of Division 3 at :In, Bwzi- vo, OF EXITS ness and Pro:es:::•ne(:orie,and mr license is il: ::li! In:te .`rYy; Name business .�� ped_ 6,n 3 -ARXING r —I CIIeCt' 1 :CES REO'D L� PROVIDED II License tiurlther Lie. Class--_--.--_.—_ �_ I LIMITED TIME USE 1 _ 1 Contractor— Date __— '— O ATM .BATH ❑ I r'lyn M: TO: I ant exempt from the licensing requirements as 1 i;t+ t �___-� t•- licensed architect or a registered profe.:ional :n-,owe: I::=E OF i NO..Jr 1 INSPECTOR'S actiin m professional cap•icity fS:::o - !. ::!:• _XI5T:NG BLDG. ST CRIES l� SIGNATURE iness and Professions Code). ' rR[Sr NT USE OF BUILDING IF-INAL APPROVAL �� Lie.or Ree.No. Dala____—— �— -- I t HOME OWNER-BUILDER DECLARATIONrN1-CF EXISTING BUILDINGS •JN LJ-AND USE I hereby affirm that I am exempt from the Contracts License Law for the following reason (Section 7031.3. BuMV ness and Professions Code): N•], PAR HI NG $=ACES PROVIDED [. as owner of the property. ::ill do the work and the >--- — structure is not intended or offered for sale ISecticn j 7044.Business and Professions Code). L CONSTRUCTION LENDING AGENCY 1 PI FOPG SED USE OF BUILDING I hereby affirm that there is a construction lending agency I for the performance of tate work for which this permit is t ,- issued(Sec.3097,Civ.C.). Lender's Name — j PROPOSED MAX. dIG C. Lender's Address PERMIT FEE �00 .•a.� 1 certify that I have read this application and state that the ..� I 1 above information is correct.I agree tc comply with all County ISSUANCE FEE _ ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter i TOTAL FEE 25.00 upon tit ve-mentioned property for inspection purposes. , SEE REVERSE FOR EXPLANATORY LANGIJI XX XX 1zq X0 1 ' Si nature of Permittee at I , I bereby asirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFE'L'Y DIVISION II insure,or tI certificate of Workers'Compensation Insurance,or, ac I 11 a certified copy thereof(Sec.3800, Lab.Q Policy No. Company FOR APPLICANT TO FILL IN BUILDING J BUILDING ADDRESS ADDRESS ❑ Certified copy is hereby furnished. (,6VJ .&Z D0�L LOCALITY ❑ Certified copy is filed with the county building inspection CITY q ZIP department. (,� Gl l I �(� NEAREST CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICII1Jy9 GR�q{yP TYPE CESSED BY [400 sa.PT. f s ��.��770 CONST GE�•i� CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. COMPENSATION INSURANCE L MAP HIGHWAY NO. )CIRCLEoRCLE, 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 certify that in the performance of the work for which this OWNER TEL NO. Property MDQ PPIC permit is issued, 1 11 not employ any in any manner ADDRESS so as to become subject to the Workers'' Compensation ensation Laws. $ VI I OCCUPANCY GROUP Z � 11 I p Date Applicant CITY ZIP ,/ 'NOTICE TO APPLICANT: If, after making this Certificate OVZ �t 77v-4�0 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR EX T HARDWARE: Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed I TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ )LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business I— - -- - NO.OF EXITS and Professions Code.and my license is in full force and effect. _ _ � ,:�,i„__,• -;--_ .- >�� `,_ PARKING REO'D D PROVIDED License Number Lic. Class •I yZ _ f SPACES Contractor Date LIMITED TIME USE �' C� • DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer INSPECTOR'S acting in my professional capacity(Section 7051,Business SIZE N NO. SIGNATURE p EXISTING BLDG. STORRIES and Professions Code).— — LIC.Or Reg. No. _ Dale --_- PRESENT USE OF BUILDING FINAL APPROVAL t �� 3 HOME OWNER-BUILDER DECLARATION f NO.OF EXISTING BUILDINGS •�//, Lt-, ' l hereby affirm that 1 am exempt from the Contractor's License L( ON LOT AND USE v sia law for the following reason (Section 7031.5. Business and + A(AT 2A0 71 Ve AWS50y4eS � t Professions Code): NO.PARKING 1 /1 El 1. PROVIDED I,.as owner of the property, will do the work and the U1TJ structure is not intended or offered for sale(Section 7044X PROPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued _ (Sec 3097,Civ.C.). PROPOSED MAX.OCG Lender's Name _ APPLICANT fPFUNT) TEL NO. Lender's Address ADDRESS 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. LTOTAL FEE X SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date „'ORKL'IsS'C'OItIFENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS APPLICATION {� ' CE 875 L1 I Ilerreby affirm that 1 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. BUILDI Policy No. Company FOR APPLICANT TO FILL IN ADDRESS �?A 7 � �� 1 L �� Certified copy is hereby furnished. XX nnowess Jr L2rl -X, Q_V, � 61Ngr �, LOCALITY Certified copy is filed with the county building inspection LOCALITY - ' C NEAREST department. 3Ma CROSS ST. Date _Applicant NEAREST _ DISTRICT NO. GROUP TYPE P ESSED BY i CROSS ST. C/AJ(r / YC1 1/`IJ t01ti CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL tl2 QF"7-,2-7v (JO /rJ COMPENSATION INSURANCE DESCRIPTION L T NO. BLOCK NO1AAP (CIRCLE) CLE)HWAY STATE MAJOR SECOND LOCAL SGL ADC'. c9'75gIZE0 NO.OF SLOGS. ('fills 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 ($100) or less.) ' USE OF Xt-&us7Je/*e- SIZE OF LOT 62 EXISTING BLDG.(�, ,/ -+� 1 certify that in tOt he performance of the work for hich this c; permit is issued, I shall Irot employ any rson ' ny manneg OWNER of build / Jarvussk O- so os to become subject to life Wnrke Ct ensation Laws. }III MAIL r OCCUPANCY GROUP C: AD OR ESSP7 7 Le VT C: 1)a IC_�2/i�gs Applicant -- - LL Norm; 1'0 APPLICANT: If,a er making this Certificate of I CITr�y„V� C/e} �j�'/��� NO. �$/"�)9/,s- 6M7 OCCUPANT LOAD C/ 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 E] GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. ElI.hCE.NSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 1 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- i No. OF EXITS El ness and Professions Code,and my license is in full force arXi Name Of business PARKING effect. 10-5SPACES REO'D PROVIDED License Number — Lic. Class LIMITED TIME USE Contractor __-_- ___—Date I u-d C /�+-rDATE DATE p g q FROM! To: I Iry SPE CTOR'S 1 and exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF v� /�n NO.OR ?� �5 - s ru E acting in my professional capacity (Section 7051, Bus- EXISTING BLDG.a / 8� / ,�, STORIES�b iness and Professions Code). I Gor FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDINGiX«�� ( J HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS Ito 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 ^ ` El1, as owner of the property, will do the work and the SPACES PROVIDED oL structure is not intended or offered for sale (Section 7044,Business and professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OP BUILDING f� � 1 hereby affirirr that there is a construction lending agency 7-AA for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name__—_ PROPOSED MAX"OCC. I_endcr's Address-_-_________-- __ 25.00 I certify that 1 have read this application and state that the PERMIT FEE above informati�nape correct. 1 gree to comply with all County ISSUANCE FEE ordinances and la v, hating to building construction, Iilld hereby aute eselitatives of this County to enter TOTAL. FEE 25.QQ upontheabc ' red property for inspection purposes. ;SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX Z Cimr,liire of PrrnlifIer late j .WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION `hereby affirm that I have a certificate of consent 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. i Policy No. Company FOR APPLICANT TO FILL IN BUILADDRDING` � ESS G/ FiCertified copy is hereby furnished. eVILDING �'j� 1�„`e� A']u1�.t Roa LOCALITY ! A'C DR ESS ,J 11 WG A L 1. depafiedrtmcopynt. is filed with the county building inspectioII !f�LITY ��M 1E 0_1j1 I j NEARCROSsT. Date Applicant 'YC�,('' NEAREST DISTRICT NO. UP TYPE / CESSED BY CROSS ST. �MC I K)1 1 A r D y G OCONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MPF HIGHWAY STATE MAJOR SECOND LOCAL HO. (CIRCLE) NO. OF BLDGS. (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 SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued,I shall not employ any person in any man �NER of buildin UdWfi nc� . horar), `� so as to become subject to the Workers' Compensation Lai MAIL ^�T i _ f OCCUPANCY GROUP o ADDRESS I�'r EzSt {rOtlt S Ilf�,? ''- Date ApplicantTE uvI NOTICE TO APPLICANT: If,after making this Certificate of CITY l OUI-0-0 .CA QI -2 NOL(818)x{15- 60 23 OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. ❑OCCUPANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION 1 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 effect. lame of businessPPACES ARKING REq'D PROVIDED License Number Lic.Class k)E _ SW 1 E Ch Q Ar S PE C I A LI 5 T LIMITED TIME USE Contractor Date DATE ~' - DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional. capacity (Section 7051, Bus- EXISTING BLDG. STORIES ;.I:: I :.-516IXTURE iness and Professions Code). FINAL.APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING �j HOME OWNER-BUILDER DECLARATION No.of EXISTING BUILDINGS ON LOT AND USE JI I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usiness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). 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 25.00 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 �upon he above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE .Jy�` �b Ia6I95 Signature of Permittee Date „'OItKL'1tS'1Q0DiPENri'11'lON UI.:C'LARA'I'lON CE 875(11.84) M ISCELLANEOUS APPLICATION CE 875 r I . I hereby affirm that I have a certificate of s conr: self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION tf in3''ure, or a certificate of Workers'Compensation Insurance, Insurancc e,or t r a certified copy thereof(Sec.3800,Lab.Q. BUILDING Policy No. Company _ FOR APPLICANT TO FILL IN />a? ADDRESS % J Certified copy is hereby furnished. BUILDINe C } .a LOCALITY�� XX ADDRESS ElCertifiedcopy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date_- Applicant _ __ NEAREST ��. DISTRICT NO GRQyP TYPE CESSED BY CROSS ST. �T CONST. CI?RTIFICAI'E OF EXEMPTION FROM WORKERS' LEGAL b/l (J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO.OF BLDGS. (Tills section heed 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 OF _A _ SIZE OF LOT EXISTING DG. VY�—� I certify that in the performance of the work for which this permit is issued, I slltlll not employ any person in any Inanne3EX OWNER Of building so as to become subject to the Workers Compensation Laws. MAIL r l�L' OCCUPANCY GROUP ; ADDRESS Dale—_ _ Applicant —_— TEL NOTICE TO APPLICANT: If, after making this Certificate of CITY - f NO.'c ori _(s 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 [his perllllt shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. ❑ LICENSED C'ON"1'IiAC'I'OIiS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I and licensed under provisions of Chapter .SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Basi- NO. OF EXITS ness and Professions Code.and Illy license is in full force all effect. Name of business PARKING SPACES REQ'D pROV1DE0 1 1 License Number ___ __ Lie Class—_—__ Ch \4DTLD T t-kcom 0th 1`z� LIMITED TIME USE Contractor--__ __-- Date_ -- DATE DATE ❑ 1 alit exempt from the licensing requirements as I am a i FROM: TO- licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting In Illy professional capacity (.Section 7051, tills- EXISTING BLDG. STORIES - SI ATURE inessand l'rofcssionsC'ode). FINAL APPROVAL �` ///��� PRESENT USE OF BUILDING �- 1•ic.or Reg.No. _ _ _ __ __— D;Ite—__ __ _ —_ IIDME'OWNI'R-1311ILDER DEICLARA I ION NO. OF EXISTING BUILDINGS — 0 �i ( ' ON LOT AND USE I�� I hereby affirm that 1 and exempt from the Contra;rtor's J License Law for the following reason I Scetion 7031.5, Busi- ness and Professions Code): NO. PARKING 1, as owner of the property• will do the work and the SPACES PROVIDED j structure is not intended or offered for sale (Section 7044,Businessand Professions Code). CONSTRUCTION LENDING AGENCY I PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this perrpit is 0, o issued(Sec.3097,Civ.C.). im Lender's Name—__ _ — --_ _ _-----!_— PROPOSED MAX. OCC. Lender's Address_—__--_--- ------ _— PERMIT FEE I certify that 1 have read this application and state thelr4t the25 - 00 I-` above Information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building conslru-Ition, andhercl au 1 rescntalivcs of this County tolenter TOTAL FEE 25-00 upon the abs 'one a ,r inspection purpo: —�J_ — -- -- � IQg SFF RFVERSE FOR EXPLANATORY LANGUAGE Xa XX X G �. nn; me of I'rtrnitlrr �•ttl I T i i I WORKERS'COMPENSATION DECLARATION i CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certimpe of consent to c self COUNTY OF LOS ANGELS . BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or � . i a certified copy thereof(Sec.3800,Lab.Q. i -1 . .1 . . fl u Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy Is hereby furnished. BUILDINa -f )OW �Q L) �!} /� VEIL LOCALITY ��� - _ �� F I ADDR N. �i L1JW yF• •+ "�•� ✓' 1 Certified copy is filed with the county building inspection LocALITY NEAR EST sT. department. -TGMP(C— C/T Date Applicant NEAREST r�r/J/f//tn_ �/� DIST No 6R0 TYPE CONST. CES9ED BY , CR089 ST. ��tl C/ /� YI �1 •L. (/y� 1 I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCKMAP HIGHWAY STATE MAJOR SECOND LOCAL NO.OF BLDG$, NG• (CIRCI.a) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE 8PB CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF 1 I I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. F permit is issued, I shall not employ any person in any manner wNER g-C •uj, . Mog&I p PErT1 5.1,ve ' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ® i DDRE88 �) S7 ,trr 57T ; Date Applicant rEL. p1,p y _ ' NOTICE TO APPLICANT: If, after making this Certificate of CITY &I INR 9/713 No• D/p- 1 '6017 OCCUPANT LOAD ; Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: • Compensation provisions of the Labor Code,you must forth- I ; with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION' Panic Devices ' i hereby affirm that I am licensed under provisions of Chapter (LIST ITEMS BELO SAFETY PERMIT ❑ W ' 1 ' 9 (commencing with Section 7000) of Division 3 of the Bust- NO.OF EXITS ness and Professions Code,and my license is in full force and R .�y�, y , i effect. — Q e O� VU SO 13W-P ISG ( . PARKING RKQ'D PROVIDED SPACES == LL��11 I I License Number Lic. Class LIMITED TIME USE j Contractor Date DAT¢ _il Y-. ;DiLTe DI am exempt from the licensing requirements as I am a i licensed architect or a registered profbssional engineer SIZE OF No.of FROM: To: INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE r.•. .-1 r.r..:i iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING I Lic.or Reg.No. Date - �'t ••• i flyro k6l e x I HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 1�• 1 hereby affirm that 1 am exempt from the Contractor's O i 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 SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY fVROPOSRO USE OF BUILDING I hereby affirm that there is a construction lending agency MO ('l for the performance of the work for which this permit is i I issued(Sec.3097,Civ.Q. Lender's Name I PROPOSED MAX.OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the CD above F•I andState lawsrelating to building information ot relatree tilding lwith constructon, ISSUANCE FEE ordinances and hereby a • orize representatives of this County to enter TOTAL FEEeD I i upon tlr b InenW nspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Date WORKERS'COMPENSATION DECLARATION ICE 875(11-841 MISCELLANEOUS APPLICATION I hereby affirm that 1 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.Q. i Policy No. Company FOR APPLICANT TO FILL IN BUILDINGDDRE89 9&g7 A Certified copy is Hereby furnished. BDILI "die ADDRDENSe S Z3 L,bV < LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. 3M. �. [ CROSS ST. Date Applicant NEAREST DISTRLCY NO. GR P TYPE-1 CESSED BY CROSS ST. JAI -AIIZ2� A O CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C/G �C. COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY i ND. OF SLOGS.O. ICIRCLE) STATE MAJOR SECOND LOCAL N (This section need not be completed if die work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE _ n SIZE OF LOT EXISTING OLDS. !/wG_ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manne3EX; owNER of building cIi as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS Z s U Date Applicant u, NOTICE TO APPLICANT: If,after making this Certificate of CITY(f TEL 992- �� 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. deenied revoked. OCCUPANCY INSPECTION ❑ Panic Devices I ICENSED CONTRACTORS DECLARATION I hereby affirm that I atm 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 a effect. X� Name of business PARKING (� SPACES REq•D D PROVIDfiD E- I License Number_._.____—.-_ Lic. Class LIMITED TIME USE J Contractor Dale DATE DATE I am exempt from the licensing requirements as I am a PROM? TOI licensed architect or a registered professional engineer , SIZE OF NO.OF INSPE CTO s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES T fi inessand Professions Code)' FINAL APPROVAL 110-41-1Lic.or Reg.No.— Date PRESENT USB OR BUILDING ..&,V I 110111E OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS n } ON LOT AND USE v� fil1l - lfitl� '{i IJ 7itr..-" I Hereby affirm that 1 am exempt from the Contractor's I A License Law for the following reason (Section 7031.5, Busi- � I t1i)1+ F 4A I, ness and Professions Code): NO. PARKING 1, 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 US6 OF BUILDING 1 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 9-5.00 1 certify that 1 have read this application and stale that tilt 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 I TOTAL FEE 25.00 rupon the above-mentioned property for inspection p ' urposes. XX XX p 6 SEE REVERSE FOR EXPLANATORY LANGUAGE ----- -- - - - -- -- I., WORKERS'COMPENSATION DECLARATION cE e75(t t-aa) I M I�CELLAIWEOUS APPLICATION I hereby affirm that I have a certificate of consent self COVUNTI!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. LOCALITY / t7 II LRHABUD5NG 6 Certified copy is filed with the county building inspection LOCALITY C crossT.s department. xx �` Date Applicant NEAREST DISTRICT NO. GROUP TYPE WCESSIED BY CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO.OF BLDGS. 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 ($100) or less.) uSE OF ,y SIZE OF LOT EXISTING BLDG. d I certify that in the—performance of the work for which this. o permit is issued,I shall not employ any person in any mannelkX oWNKR of building ,U% /�1 "a/Y? / so as to become subject to the Workers' Compensation Laws. bCCUPANCY GROUP MAIL ADDRESS /774 c. T��QaryT C °C B V Date Applicant Lu NOTICE TO APPLICANT: If,after making this Certificate of CITY eUr✓rti%� NOI.�'f� q%$'�UZ OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 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 Name of business PARKING �I effect. SPACES REQ D D PROVIDED �— I License Number Lie. Class © ® -=-e n...I e J �/J LIMITED TIME USE Contractor Date r ` DATE DATE FROM: TO' I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE.OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL A PROVAL %,1� Lie.or Reg.No. Date PRESENT USE OF BUILDING P HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 1/1✓� I hereby affirm that I am exempt from the Contractor's 1 License Law for the following reason (Section 7031.5, Busi- ness usiness and Professions Code): No. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING fk I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 1 W issued(Sec. 3097,Civ.Q. 'At Lender's Name PROPOSED MAX. OCC- Lender's Address ; ' I certify that I have rod this application and state that the PERMIT FEE 25.00 above information is c Efrect.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby author' representatives of this County to enter TOTAL FEE 25-00 ,,upon the above- , oned property for inspection purposes. I' , SEE REVERSE FOR EXPLANATORY LANGUAGE , XX / XX 12.. 0_ Signatuf Permittee Date WORKERS'COMPENSATION DECLARATION 20 00 3DPW12 /90 MISCELLANEOUS APPLICATION I hereby'affimt that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING•AND SAFETY DIVISION sinsure,or a cerrificate of.Wdrkers'Compensation Insurance,or - ,�: • ' a certified copy thereof(Sed.3800,Lab.C.)• Policy No Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS I Certified copy.is hereby:furnished. g Z Lev_*_Q_ A2kPSA LOCALITY Certified copy is filed with the county building inspection CITY I ZIP ! I I department. tit eur_- G�'C'�( CA "I\'j 86 cR ss sr. Date _Applicant SIZE OF LOT NO.OF BCDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY Q 1C CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. CONST. { , COMPENSATION INSURANCE / MAP HIGHWAY NO. (CIRCLET STATE MAJOR SECOND LOCAL.. (This section heed not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCELusE zoNE J=IALCONDITIONS 4rby the permit is for one hundred dollars (S100) or less.) I.certify that III the performance.of the work for which thiset � TEL N . ewt ILL permit is issued. I shall not employ any person in any manneril rL I so as to become subject to the Workers' Compensation Laws. ADDRESS OCCUPANCY GROUP Cr 3 c�'CK ll��ll Z ( i Date Applicant . CITY ZIP NOTICE TO APPLICANT: If; after making this Certificate ��1')0 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) ! I 9(commencing with Section 7000)of Division 3 of the Business Bus1ness NO.OF EXITS and Professions Code,and my license is in full force and effect. ' PARKING i License Number Lic.Class SPACES REQ'D E= PROVIDED { 1 I Contractor— Date LIMITED TIME USE I i ❑ I am exem-)t from the licensing requirements as I am aDATE DATE ' licensed architect or a registered professional engineer FROM: TO: acting in my professional capacity(Section 7051,Business SIZE OF 7 ra NO.OF ` INSPECTOR'S (` ! and Professions Code). EXISTING BLDG. 2 STORIES 1 SIGNATURE. Lic.or Reg.No. Date PRESENT USE OF BUILDING tQxFINAL APPROVAL ,p ' 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 ( ( Professions Code): s ACES PROVIDED J i ❑ O.PARKING 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 ani Professions Code). CONSTRUCTION LENDING AGENCY j 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.OCG Lender's Name_ AP (CANT r!'RWr TEL N Lender's Address ADDRESS t , I I certify that I have read this application and state that the &qk WJ&gcYK A,-f—&30W u4 IA- "(00 30 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 t: the above-mentio nedpr y for inspection purposes. s 'I TOTAL FEE . % 7 ` OZj SEE REVERSE FOR EXPLANATORY LANGUAGE I n of rmittee Date i , Nt=JRI:ERS'COMPENSATION DECLARATION 761w444 MISCELLANEOUS APPLICATION CE 875-1 1.841 J I hereby affirm that I have a certificate of consent to self . LSI insure. or a certificate of workers'Compensation Insurance."or 031UN- OF LOS .ANGELES BUILDING .AND SAFETY DIVISION a certified copy thereof ISec.3801).Lab.C.). Policy No. _Compan} FOR APPLICANT TO F! Bu 1LDING LL IN ADDRESS Certified cop}' is hereby furnished. g BUILDING ��� (J� LO CA LIT ADDRESS '1 1 O'Certlfled copy is tiled with the county building inspection LOCALITY NEAREST department. Temple City CROSS ST. Date .applicant NEAREST DISTRICT Nggq��� GR P TYPE��� OCESSED BY CROSS ST. /D (/ HW CONF CERTIFICATE OF EXEMPTION FROM WORKER!:' LEGAL � �1f a �01 IV COMPENSATION INSURANCE � DESCRIPTION LOT NO. 9LOCK t MAY HIGHWAY(CIR CLE' STATE MAJOR SECOND LOCAL NO. NO. OF SLOGS. (This section need not be completed If the :work involved -RACE NOW ON LOT USE ':ONESPECIAL CONDITIONS by the permit is for one hundred dollars IS100) or less.) USE OF I SIZE OF LOT EXISTING BLDG. I certify that in the performance of :he work io:-vhich -his ' permit is issued. 1 shall not employ:In>' ?e-.son :n am'r•annex OWNER 2f (& - el 9y WN so G so as to become subiect to the Worker-* l oinvensation La::•s' XINAI � OCCUPANCY GROUP Date Applicant ADDL RESS � , �� c2 NOTICE TO APPLICANT: If.after making :his Certi icate -it $I CITaif j� 04 �/rG_0.ia- 9/Si to 7 OCCUPeAN–LOAD Exemptio•1. you ihould become itibJect -o -he WC rkers' lompensnion orn:isions of the Labor Code. you trust tort h- 4PDL!CATICN °�F .X''4ARC!:!:11=c wall Comniy with iuch 7rovisi lni or Ill% •`ernlit ihlll be -RAILER :JSEGEOLOGY :NSPE CT:CN r I 1 =' deemed re%oked. — No Spec. K:ot�l• L�JJ N LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$ Panic Devices I hereby affirm :hat I am licensed under provisions of Cramer .� SAFETY PERMIT LIST ITEMS BELOW) I 9 tcommencina with Section 0001 of Division 3 :1I the Buri- NO. OF EXITS ness and Professions Code.and my license is in "till for:=and effect. [ PARKING REQ*0 PROVIDED y � SPq CES License Number Lic. Cla.iM ��' Ge LIMITED TIME USE c – LL y Contractor __ Date DATE DATE W H ❑ [ am exempt from the licensing requirements as I ant a CIO I licensed architect or a registered professional en Tineer SIZE OF .,o. of INSPE OR S Z acting in •nv professional mr•l::ir: 5&:.ion -11:1, Bus- EXISTING BLDG. STORIES sI URE VIneSS Jlld llrUtetiSll:nti(:ld6'.1. PRESENT USE OF BUILDING o FINAL APPROVAL Lie.or Ree. No Daw s I _ _ HOME OWNFR-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (F1't- - E I hereby affirm that 1 am exempt from the Contractor's ON LOT AND USVe �� License Law for the following reason 'Section -1131.5. Bu-;i- AAI Hess and Professions Code): NO. PARKING �I! 1, as owner of the property. will do the :work and the SPACES PROVIDED — struCture is not intended or offered for ::Ile (Section 704.1.Business and Professions Code). CONSTRUCTION LENDING AGENCY X PROPOSED USE OF BUILDING I hereby affirm that there is a construction lendine agenev ��$i� for the performance of the :work for which this rernlit is issued(Sec. 3097,Civ.C.). 1 Lender's Name PROPOSED MAX. OCC. Lender's.address I certify that 1 have read this application and state that the PERMIT FEE 25.00 above information is correct •1. mply with all('011111y ISSUANCE FEE ordinances and State la ati t uildigg construction. ' It. and hereby Ize r pr ret Iv of this Co ty to enter TOTAL FEE 25.00 upon the, n I pr for inspe�jotfpurp .,es. SEE REVERSE FOR EXPLANATORY LANGU•NGE I Signature of Permittee ate { I WUKKJ:KJ I.VMYCI4JA1tU1,4 1JCl.LAKAl1VlV 20-0063DPW12/90 �Vr,L,I-.�lyl:,VUy 1Al"'rL.1L.1A1 1VN i I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES i = BUILDING•AND SAFETY DIVISION ' , I uiilsum or a cerhfreate of.Workers'Compensation Insurance,or - : ;,Y . I (� I a eertEFied copy thereof(Sed. 3800, Lab-C.) z•_. - !1!1111 1 Policy No.. Company FOR APPLICANT TO FILL IN 13UILDING -.' " •; B 1 G A RESS ADDRESS I El Certified copy,is hereby:furnished. X �p LOCALITY ❑ Certified copy is filedwith the county building inspection CITY ZIP NEAREST 1 department �� Ott MW X I / CROSS ST. Date ''• I'� Applicant stze of NO.QF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY I I CONST. a CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT 0, ( 1 COMPENSATION INSURANCE e MAP HIGHWAY (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE 'v PARCEL NO. tclRc�e, STATE MAJOR SECOND LOCAL.. O by the permit is for one hundred dollars ($100) or,less.) USE ZONE SPECIAL CONDITIONS [ I I.certify that in the performance.of the work for which this g le f e TEL NO. I le permit is issued:I"Shall not employ any person in any manner I so as to become subject to the Workers' Compensation{Laws. AD Ess OCCUPANCY GROUP ( I 1 Date Applicant . 1 CITY ZIP 1 NOTICE TO APPLICANT: If. after making this Certificate left se ptalad d OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the-f*6or Code.you must forthwith EXIT HARDWARE: comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ revoked No Spec.Know!. ❑ ' OCCUPANCY INSPECTION[31 Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) { 1 9(commencing with Section 7000)of Division 3 of the Business �e o Business NO.OF EXITS and Professions Code,and my license is in full force and effect. . PARKING• REWD E= PROVIDED License Number Lic.Class SPACES ' ( I I Contractor Date LIMITED TIME USE 1 ' ❑ 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). i EXISTING BLDG. STORIES SIGNATURE, i Lia or Reg.No. Date PRESENT use OF BUILDING FINAL APPROVAL ( 1 i HOME OWNER-BUILDER DECLARATION NO.OFEXISTING BUILDINGS ON LOT AND USE j I hereby affirm that I am-exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ( ° Professions Code): O.PARACES PROViDeD 1 El 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 CONSTRUCTION LENDING AGENCY f✓ f �" • 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.Q. PROPOSED MAX.OCG Lender's Name APPLI ANT(ENMr) TEL NO. Lender's Address AD RESS ( 1 i I certify that I have read this application and state that j the G � A w, k A/W above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws ielating to building construction,and -• hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. . I t• �� TOTAL FEE " 3 Z SEE REVERSE FOR EXPLANATORY LANGUAGE rc Signature of Permittee Date ' WOPrKZRS'COMPENSATION DECLARATION 0-046( 20-0063DPW12/90 MISCELLANEOUS APPLICATION [ I hereby affirm that I have a certificate of consent to self "COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Ij insure•or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800• Lah C.) , Policy No. Company _____ _ FOR APPLICANT TO FILL IN UR BUI}�W�ING ADDRESS ❑ Certified copy is hereby furnished. —l2� LO frp/ Az sI., QC/ *P— ❑ Certified copy is riled with the county building inspection CITY zIP department. .— ` ( elf Z�� Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT GR P TYPE CESSED BY CONS CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. COMPENSATION INSURANCE MAP HIGHWAY I NO. ,CIRCLE. STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS I" by the permit is for one hundred dollars ($100) or less.) I � I certify that in the performance of the work far which this OWNER TEL NO. j I permit is issued, I shall not employ any person in any manner c •� yNt9?r2tn ate(-+�f�, t t so as to become subject to the Workers' Compensation LawsADDRESS . ire OCCUPANCY GROUP f�aa",r -.—I lz:::] I. _ Date Applicant_ CITY ZIP NOTICE TO APPLICANT: If. after making this Certificate l Aw, 1 91 M OCCUPANT LOAD i of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forthwith i comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ I revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices ❑ I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT El (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS and Professions Code•and my license is in full force and effect. KING• REWD D PROVIDED D License Number Lic.Class -- sPAces 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 S ISTIN STORIES INSPECTOR'S and Professions Code). EXISTING BLDG. STORIES S TORE Lic.or Reg. No. Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS }� ��:i r_ _ :;.; •.;;'. I ON LOT AND USE I r'�/ w� r I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): NO.PARKING 191 � 1, as owner of the property will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 704 PROPOSED USE OF BUILDING I Business and Professions Code). r I CONSTRUCTION LENDING AGENCY iI hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued I (Sec. 3097,Civ.Q. PROPOSED MAX.OCC. Lender's Name APPLICANT(PRINT) TEL NO. Lender's Address ADDRESS 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 I grdinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE tke above-mentioned property for inspection purposes. i TOTAL FEE �_ ILI ,-�7 SEE REVERSE FOR EXPLANATORY LANGUAGE -X' --Signature rmittee Date *I . I WORKERS'COMPENSATION DECLARATION CE 875 11 7.841 MISCELLANEOUS APPLICATION ` CE 875 [ hereby affirm that 1 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 ISec.3800.Lab.C.I. ; h 7 Policy No. Company FOR APPLICANT TO FILL IN aUILDIN_LDORES ��/ Certified copy is hereby furnished. BUILDING �1 LOCALITY + ADDRESS �/3 VETE ,� 1 r � Certified copy is filed with the county building inspection LOCALITY NEAREST 10, department. Temple City CROSS ST. Date—Applicant NEAREST DISTR ICTDN GRO TYPE CESSED BY CROSS ST. / CONST. I CERTIFICATE OF EXEMPTION FROM'CORKERS' LEGAL � MAP HIGHWAY COMPENSATION INSURANCE ; DESCRIPTION LOT NO. BLOCK (No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not Ile completed If the (fork Involved TRACT NOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (SI001 or less.) USEof ( SIZE OF LOT EXISTING BLDG. I certify that in the performance of :lie nark for which :Itis permit is issued. I shall not employ any -?e-.son :n any manner X1 OWNER so as to become subject to the!Corkers' Cimpensation Laws. OCCUPANCY GROUP MAIL i Date :applicant ADDRESS i 0 TG_ p_ - NOTICE TO APPLICANT: If, after making :his Cert�icare of $I CITY C� 2 "OL 6�6 S_ 602 OCCUP4N—LOAD Exemption, you iliould become subiect :o :he Wnrkers II//APDLICATICN COR EXIT HARC!�!ARE Compensation provisions of the Labor Cade. you mast forth- I with comply with ;uch provisions I,,- :his :+ermit shall be TRAILER USE � GEOLOGY :NSPECTION � NO Soec. \notvl. deemed te%nked. ❑ N • LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$$ Panic Devices I Hereby affirm :hat I am licensed under provisions of Chapter SAFETY PERMIT '� (LIST ITEMS WOW) 9 (commencine with Section '000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and me license is in full force and effect. ING y SPACES REO�D O PROVIDED License Number Lic. Class LIMITED TIME USE In Contractor Date DATE DATE W Z I am exempt from the licensing reouirements as I am .I To: m I licensed architect or a registered professional engineer SIZE OF yo. of INSPECTOR'S z acting In m) professional :aracit. $e:ttoll 0 1. BITS- EXISTING BLDG. STORIES SI NATURE 9iness -qq 11 A��— and I'rofessicns Cadet. �D J r O PR ESEYT USE OF BUILDING FINAL APPROVAL 18 Lie.or Reg.No. Date HOME OWNER-BUILDER DEGLARATION NO. OF EXISTING BUILDINGS O ON LOT AND USE 11 N 1 W-Aff—E-lel/ 4/99 I hereby affirm that I am exempt from the Contractor's 1=11`{ y;4 j1 ( License Law for the followingca4�°��I reason (Section -031.5. Busi- I�' ��A V ness and Professions Code): NO. PARKING 1, as owner of the property. will do the work and the SPACES PROVIDED structure is not intended or offered for stile (Section 1 7044.Business and Professions Code). CONSTRUC-11ON LENDING AGENCY X 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 I certify that I have read this application and state that the PERMIT FEE 25,00 above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, P and Hereby author' preserltatives of this County to enter TOTAL FEE . 25.00 1 upon the ab v entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE )$nature of Permittee Da(e „ s F' WORKERS"COMPENSATION DECLARATION 'E 8754(17.84) MISCELLANEOUS APPLICATION I 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 I FOR APPLICANT TO FILL IN BUILDING " �. ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS ''G� (Aj 9!Z 1 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DIS �� GRO P ...STY/,001 O ST� ESSED BY CROSS ST. ITYPE 1 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK No. (GGIRCLEI STATE MAJOR SECOND LOCAL NO. OF (This section need not be completed if the work involved TRACT NOW ON LOT BLOGS. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USE OF SIZE OF LOT EXISTING BLDG. 9/l I �'I �'•• I certify that in the performance of the work for which this /y� permit is issued.I shall not employ any person in any manner OWNER [.0 � f so as to become subject to the Workers' Compensation Laws. MS(/AIL p OCCUPANCY GROUP I ADDRES %V. e , Date Applicant Ila{ TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of � CITY- Y/i� 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 I, GEOLOGY INSPECTION 1 No Spec. Knowl. El deemed revoked. Y LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW a 1 9 (commencing with Section 7000) of Division 3 of the Bus- NO. OF EXITS ness and Professions Code.and my license is in full force and effect. PARKING REO•D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date n DATE DATE .i PROM: TOI n 1 ❑ 1 am exempt from the licensing requirements as I am a I licensed architect or a registered professional engineer INSPECTOR•5 SIZE OF NO. OF NATURE acting in my professional capacity ISection 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL Y,I PRESENT USE OF BUILDING c ` V Lic.or Rea.No. Date eee,,, - IIk HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS PP�� ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor's , �� ,/► ���� I License Law for the following reason ISection 7031.5. Busi- ness and Professions Code): NO. PARKING 0 1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale ISection i 7044•Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency 1 for the performance of the work for which this permit is issued(Sec. 3097.Civ.C.). Lender's.Fame PROPOSED MAX. OCC. Lender's Address /� I I certify that I have read this application and state that the PERMIT FEE pC W above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, Cb uponand hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE • Sisn the� ermit:ce Date ` WORKERS'COMPENSATION DECLARATION 7snn444 M ISCELLANEOIIS APPLICATION - I affirm that I have a certificate of consent tself CE 875(11.84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ' insuresure,, o or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.Q. o • ' Policy No. Company FOR APPLICANT TO FILL IN BUILDI AOURESSss Certified copy is hereby furnished. A8U LDIN DDRESS A L 31 �+12.J` AZ V, LOCALITY 6 Certified copy is filed with the county building inspectiLOCALITY NEAREST n department. C-Stl CROSS ST. Date Applicant NEAREST DISTRICT NO. CTP TYPE P ESSED BY CROSS ST. !! /p'CCONST! (:F:R'1'II'ICATE OF EXEMPTION FROM WORKERS' LEGAL - COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO.OF BLDGS. No. (CIRCLE) (TMs 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 . \ C 1 certify that in the performance of the work for which t SIZE OF LOT EXISTING BLDGC-1La permit is issued, I shall not employ any person in any mann X OWNER Of buildin so as to become subject to the Workers Compensation Law. AIL OCCUPANCY GROUP L^-) ADDRESS r r' Date Applicant � I LL NOTICE TO APPLICANT: If,after making this Certificate of CITY rTio $1 �S_ ^L OCCUPANT LOAD N Exemption, you should become subject , the Workers- APPLICATION FOR EXIT HARDWARE: Compensation provisions of file 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 1 ICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of CI qXName SAFETY PERMIT❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Bu NO.OF EXITS ness and Professions Code,and my license is in full force a effect. of business PARKING SPACES REQ D � PROVIDED License Number-- —. — Lic. Class �1 LIMITED TIME USE JJ Contractor— _ Date DATE DATE El1 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 /J PRESENT USE OP BUILDING 1��7i'!�'.Lr�q�u•'• --'— Lic.or Reg.No.- _—___ — Date 110111E OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND U86 —(I}Ij,l ie)3 �:i+••ir I hereby affirm that 1 ant exempt from the Contractor's 9206 ; 4;,! v ., 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 SPACES PROVIDED structure is not intended or offered for sale (Section NT VYf 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 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 1 certify that 1 have read [his application and state that the PERMIT FEE above information is correct. 1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, s and llc by autho ize representatives of this County to enter TOTAL FEE 25.00 up o t le.hove-In tinned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE X XX 1,06411,1(o 1 I WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS CE 875 111-841 I hereby affirm that i have a certificate of consent to c self COUNTY OF LOS ANGELES 5RE Vg TY 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 Certified copy is hereby furnished. BUILDINGoq'1„'+y L VS LOCALITY i Certified copy is tiled withwith%tie count} building inspectionIOri ADDRESS LOCALITY /+ /� NEAREST department. Temple City `� l CROS. ST. Date Applicant NEAREST DISTRI T NOw� GR P TYPE OC ESSED BY CROSS ST. j V\C\_ `��{ • (/Jp/1!/�/// CON 1 CERTIFICATE Of EXEMPTiO` FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. iBLOCK (MAP HIGHWAY SID. (CIRCLE) STATE MAJOR SECOND LOCAL 1 NO. OF BLDGS. (This section need not be completed If the %vork involved' TRACT NOW ON LOT USE ;ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) EXIST of t 1, SIZE OF LOT I BLDG. I certify that in the performance of :lie work 'o.which :his permit is issued. I shall not employ any person in any manner owNER �riU� �d�l�V\ so as to become subject :o the t%'orkers Compensation L:111'S. 5\, AIL . �TRcOCCUPANC'! 3ROUPADDRESS \ V"`Date Applicant `^ /�NOTICE' 'TO APPLIC ANT: If.af,cr makitr_ :!tis CortitiCarr ,ft $jIT��Ov�Y 1 � or,, t moo. (P-L& 91 �O Z OCCUP4N—LOAC Exemption. you mould become sui)iect :o :lie Workers* ICI � —' Compensation provisions of the Labor Code. %ou mast forth APD ICA. + ?F =X+T H.4RC4�1AFE VV �I I 1 with COMDiy %vith ;uch provisions or :his -ermit ,hail be _RAILER USE ❑ GEOLOGY INSPECTION _ No ScIec. I\go%.vI. U deemed reinked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$$ Panic Dev�res n I Hereby affirm :hat I am licensed under provisions of Citamet a SAFETY PERMIT ITEM .1S BELOW):Vi t 9 (commencine with Section ?000) of Division 3 o LIST the BUST- NO. OF EXITS ness and Prnfessionc Code.and my license is in 'ttil force and /J 1 effect. /GJ !Y/, PARKING S.P 4 C E 5 REO'O I I PROVIDED y License Number Lie. Class o LIMITED TIME USE y Contractor Date DATE DATE W Z c 97 M: TO: 1 ani exempt from the licensing requirements as I am .r licensed architect or a registered professional engineer ;IZE OF No. DF IN G CTOR E z acting 'n 'n}• professional :arazit�: Sez:ion -1151. Bus- EXISTING BLDG. S-ORIES SIGNATURE o inessand P-ofessicnsCade l. FINAL APPROVAL PRESENT USE OF BUILDING L Lie.or Reg. No. Dax X 1 - HOME OWNER-BUILDER DECLARAMN NO. OF EXISTING BUILDINGS C Q ON LOT AND USE ` I hereby affirm that 1 am exempt from the Contractor'% 1 License Law for the following reason (Section 7031.5. Busi•. Bess and Professions Code): NO. PARKING 1, as owner of the property, will do the work and the SPACES PROVIDED SMICnlre is not intended or offered for sale (Section 1 7041.Business and Professions Code). CONSTRUCTiON LENDING.AGENCY X PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending : enc% 1 for the performance Of the work for which this permit is f IM issued(See. 3097.Civ.C.). ;_tiiL�l z Lender's Name 'Tn C, PROPOSED MAX. OCG. I Lenders Address C.) PERMIT FEE 25.00 C') 11 I certify that I have read this application and state that the I._,. Mabove information is correct.1 aeree to comply with all County ISSUANCE FEE I_. ordinances and St a lases relating to building construction. 1T1 and hereby at[tho a representatives of this County to enter TOTAL FEE 25.00 t+J f upon the above-m tioned property for inspection purposes. �'.. SEE REVERSE FOR EXPLANATORY LANGUAGE =�I. I ( 9 er}�urg of Permittee Date � rE t 9 1