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HomeMy Public PortalAbout5915-5927 OAK AVE_Miscellaneous__ WORKERS COMPENSATION DECLARATION CE 875(11 84) M I SC E L LA N EO U S APPLICATION CE 875 I hereby a cert 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 fy ADDRES ElCertified copy is hereby furnished ILDiN6 g f Ii ADDR 688 A l` LOCALITY Certified copy Is filed with the county building inspection OCALITY NEAREST department ig, CR088 ST Date Applicant NEAREST DISTRIC NO GROUP TYPE P 886D BY CROSS ST /D �J ^n CONST /� CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATIC MAJOR SECOND LOCAL NO OF BLOGS NO (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT U86 ZONE SPECIAL CONDITIONP by the permit Is for one hundred dollars ($100) or less) USE of ® 1 I certify that m the performance of the work for which this 8126 OF LOT EXISTING BLDG G v' permit is Issued I shall not employ any person m any manner ownICR eC.� so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP Q�j� c Date Applicant ADDRESS `� NOTICE TO APPLICANT If after making this Certificate of CITYNOL 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 BICLOw) 9 (commencing with Section 7000)of Division 3 of the Busy NO OF EXITS ness and Professions Code and my license is in full force and effect0'0 PARKING RQ D PROVIDED SRKIN License Number Lie Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM To licensed architect or a registered professional engineer SIza of No of 0 INSPECTOR a acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL ��rQ� Lie or Reg No Date PRESENT USE OR BUILDING ` 42!J__ HOME OWNER BUILDER DECLARATION NO OF s iITI BUILDINGS O FEE ON LOT AND USE I hereby affirm that I am exempt from the Contractors d License Law for the following reason (Section 70315 Busi ness and Professions Code) NO PARKING I as owner of the property will do the work and the $PACKS PROVIDED t� 4496 1 AM 9 3? 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 file 4-'1 fled Lo for the performance of the work for which this permit is CeAt Issued(Sec 3097 Cry C) jCa rd-i Lender s Name PROPOSICD MAX OCC Lender s Address PERMIT FEE pA�o0 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 represent es of this County to enter TOTAL FEE �O upon the abo o p rt r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE vnature o P imrtts Date aWORK#RS COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent nc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION mom or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab CUILDIN) Policy No Company FOR APPLICANT TO FILL IN BDDR8S6 ". y� ADDRESS Certified copy is hereby furnishedLOCALIT ADDRESS BUILDING Certified copy is filed with the county building inspection LOCALITY NBARBST department C. ST Date Applicant NEAREST DISTRICT NOj OUP TYPE CESSED BY CR088 ST � �D�/ CONS CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL a COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL O OF BLDGS NO (CIRCLE) N (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 or I certify that in the performance of the work for which this SIZE OF LOT EXISTING SLOG permit is issued I shall not employ any person in arty manner OWNER ?,&U(`4,0 o so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP c ADDR68arim Date Applicant Ld NOTICE TO APPLICANT If after making this Certificate of CIT NOL OCCUPANT LOAD Exemption you should become subject to the Workers all 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 ❑ ❑ ❑ No Spec Knowl deemed revoked I LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI 9 (commencing with Section 7000)of Division 3 of the Busy NO LIST ITEMS BELOW NO OP EXITS ness and Professions Code and my license is m full force and � � �. l� S effect PARKING REQ D PROVIDED SPACES License Number Lic Class LIMITED TIME USE Contractor Date DATE OATS I am exempt from the licensing requirements as I am a FROM To licensed architect or a registered professional engineer SIZE OF No OF INSPECT s acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGN B mess and Professions Code) Lic or Reg No Date PRESENT Y8B OF BVILDI FINAL APPROVAL Qom) HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS ON LOT AND U86 I hereby affirm that I am exempt from the Contractors Le 0000_0001 3}17/91t License Law for the following reason (Section 70315 Bun .&0� ness and Professions Code) NO PARKING - I as owner of the property will do the work and the SPACES PROVIDED 4't(34 1 PM 12 U1 structure is not intended or offered for sale (Section 7044 Busmeps and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OP BVILDI 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 FE6 above information is correct I agree to comply with all County ISSUANCE FEE rordmances and State laws relating to building construction and hereby authorize representatives of this County to enter TOTAL FEE upon the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS COMPENSATION DECLARATION cE eie(� 8a) M I SC E L LA N E U S A P P L I C A T I O N I�hereby affirm cert 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 certii 4copy thereof(Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING / ADDRESS Certified copy is hereby furnished JWILD INADDRESG 59N-7 f�MPL - X11 / O LOCALITY Ceertartiedecopy n filed with the county building inspection ALITY k VE U NEARBBT ir p CROSS ST Date Applicant NEAREST DISTRICT NO 1JOUP TYPE CUSSED BY CROSS ST LAS ' UN AS - -� CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCED68CRIPTION LOT NO BLOCK MAP HIGHWAYNo OF STATE MAJOR SECOND LOCAL No ICIRCL61 (This section need not be completed if the work involved TRACT NOW ON LOTS USB ZONE BPE CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG permit is issued I shall not employ any person in any manner OWNER A y so as to become subject to the Workers Compensation Laws [ Jp� OCCUPANCY GROUP OC MAIL zV •V Data Applicant ADDRESS making I G rvi Ory TEL W',a0 Il E��Z I t; OCCUPANT LOAD d NOTICE TO APPLICANT If after mak this Certificate of circ No rn Exemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE Z Compensation provisions of the Labor Code you must forth with comply with such provisions or this permit shall be ❑ ❑ No Spec Knowl deemed revoked TRAILER USE GEOLOGY INSPECTION 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 Durston 3 of the Bust NO OF EXITS a ness and Professions Code,and my license is in full force and PARKING effect SPACES RBQ D PROVIDED ( 1 04-AL C N iE 2 License Number Lic China LIMITED TIME USE Contractor Date DATE DATR F1I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF PROM io iNSPB CTOR S acting m my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL Lic or Reg No Date PRESENT USB OF BUILDING Of HOME OWNER BUILDER DECLARATION NO of EXISTING BUILDINGS D ON LOT AND USB I hereby affirm that I am exempt from the Contractor s ! License Law for the following reason (Section 70315 Bust /// 00110-OMI 5/2.0/5+t ness and Professions Code) NO PARKING ':P10 1 GMiI'■S+S I as owner of the property will do the work and the SPACES PROVIDED h71J7 1 ft�ED42 structure is not intended or offered for sale (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affum that there is a construction lending agency for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s Address PERMIT FEE I certify that I have read this application and state that the above information n correct I agree to comply with all County ISSUANCE FEB ordman and State laws relating to building constriction and here authorize representatives of this County to enter Torwi.FEE upon the ove men ned p party for inspection firpops SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Jute WORx tS COMPENSATION DECLARATION CE 875(11 64) M I SC E LLAN EO U S APPLICATION ..- CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING D SAFETY DIVISION insure+ or 'fl a cap icate of Workers Compensation Insurance or a certified copy thereof(Sec 3800,Lab C) �— / Policy No Company FOR APPLICANT TO FILL IN BAUILDING DDR688 Certified copy n hereby furnishedBDDRsss 5919—B Oak Avenue LOCALITY C Iendceco copy is filed with the county building inspection LOCALITY Tele City,CA 91780 CROSS BTAir P Date Applicant OJOARIST Las Tunas and Oak Avenue DISTRIgg T N GROUP TYPE 688KD BY R088 ST �ji 8 CONST 1 l CERTIFICATE OF EXEMPTION FROM WORKERS LKowL 4 a COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK NOPHIGHWAY OR BLD68 (CIRCLE) STATE MAJOR SECOND LOCAL NO (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) USK of I certify that m the performance of the work for which this SIZE of EXISTING BLDG C3 permit is Issued I shall not employ any person In any manner O King—Nang Chen C3 y so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP c Donnas 404 E Las Tunas Dr #205 L. W Date Applicant NOTICE TO APPLICANT If after making this Certificate of CITY San Gabriel NO 818-309-1240 OCCUPANT LOAD a Exemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE z Compensation provisions of the Labor Code you must forth with comply with such provisions oI this permit shall be TRAILER USK[:] 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 Busy No of EXITS ness and Professions Code and my license is in full force and , effect PARKING REp D = PROVID BD SPACES License Number Lic Class CNM OSTAL CENTER LIMITED TIME USE Contractor Date DATE DATE I am exempt from the hcensmg requirements as I am a FROM To hoensed architect or a registered professional engineer slzK OF No OF elLMINSPECTOR S wruRE acting m my professional capacity (Section 7051 Bus EXISTING BLDG sroRlEs mess and Professions Code) FINAL APPROVAL S /� Llc or Reg No Date RESENT USE OF BUILDING N/A 7 HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS 0,331 4/►�ip{�li1 ON LOT AND USK 6,96 1 AM -7�tyf I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Busy ness and Professions Code) NO PARKING I as owner of the property will do the work and the SPACES PROVIDED O structure is not intended or offered for sale (Section 7044 Business and Professions Code) JPW R 0P086D U86 OBUILDING Retail Stores CONSTRUCTION LENDING AGENCY n I hereby affirm that there is a construction lending agency Private Mailing Service 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 J?5 upon the above me red roperty fo irlspectro pu oses r 9 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat WORKERS COMPENSATION DECLARATION 75M444 M ISC E LLA N EOU S APPLICATION rt I hereby a cethat 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 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 ' LOCALITY ADDRESS Certified copy is filed with the county building inspection OCALITY NEAREST department CROSS Sr Date Applicant NEAREST DISTRICT NO6 OUP TYPE P CBSBED BY CROSS ST O� �J CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL /� COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK NO HIGHWAY(CIRCLE) STATE MAJOR SECOND LOCAL NO OP BLOGB (Thu 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 ($100) or less) _ USE of I certify that m the performance of the work for which this SI 6 OP LOT EXISTING BLDG c permit is Issued I shall not employ any person in any manner 6OWNER Mtn—T so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP c ADORE 88 �� t--� Date Applicant o k �� ul G NOTICE TO APPLICANT If after making this Cerfflcatg of CITY T (,,i No 818 1�t �D0OCCUPANT LOAD Exemption you should become subject to the Workers IppLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you must forth with comply with such provisions or this permit shall be ❑ ❑ No Spec Knowl deemed revoked TRAILER Y86 GEOLOGY INSPECTION LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$( 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 Busy No of ExlrB ness and Professions Code and my license is in full force and ,. /` S S r effect U-Ir PARKING REG D PROVIDED L 1 J License Number Lic class Rin SPACES 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 OP INSPECTOR S acting m my professional capacity (Section 7051 Bus EXISTING BLDG STORIES SIGMA RB mess and Professions Code) PRESENT Y86 OR BUILDING n/a_ _ 1 FINAL APPROVAL F Lic or Reg No Date V G � HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS n J � ON LOT AND USE ("i�/ x4 0001 10/27/C- I hereby affirm that I am exempt from the Contractors `i11 License Law for the following reason (Section 70315, Bun ,\ ..220 1 FM12C'u 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 IPROPOSICD USE OF BUILDING I hereby affirm that there n a construction lending agency 40 for the performance of the work for wluch this pernut is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s Address My PERMIT FEB VV I certify that I have read this application and state that the above Information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction and hereby authorize representatives of this County to enter TOTAL FEE upon the above mentioned property for inspection purposes L co 1, SEE REVERSE FOR EXPLANATORY LANGUAGE 'Aligtura of Permittee Ibati WORKERS COMPENSATION DECLARATION CE 875(1 1 sa) MISCELLANEOUS APPLICATION I here affirm that 1 have a certificate of consent tself COUNTY OF LOS ANGELES - PUILDING AND SAFETY DIVISION insure a certificate of Workers Compensation Insurance e or a czrtifie copy thereof(Sec 3800 Lab C) Policy No ti Company , FOR APPLICANT TO FILL IN 9ULDNADDRESS Certified copy Is hereby furnished BuAVE OAK IS LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department CROSS ST of Date Applicant NEAREST LAS TUNAS DR DISTRICT NO G OUP TYPE BSSBD BY CROSS ST �DV CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL No OP BLDGS NO (CIN CLE) (This section need not be completed if thb 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 m the performance of the work for which this size oR Lor EXISTING BLDG permit is Issued I shall not employ any person in any manner OWNER so as to become subject to the Workers Compensation Laws MAIL CCUPANCY UP c Date Applicant ADDRESS qa 5 9 2 OAK AVE S NOTICE TO APPLICANT If after making this Certificate of clrY NO 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 USKGEOLOGY INSPECTION ❑ deemed revoked ❑ ❑ No Spec Known 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 Buse- No OF EXITS mess and Professions Code,and my license is in full force and effect PARKING It D PROVIDED SPACES License Number Lic Class LIMITED TIME USE Contractor Date DATE OATS 13 I am exempt from the licensing requirements as I am a FROM To licensed architect or a registered professional engineer size of No of INSP S acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SI u mess and Professions Code) FINAL APPROVAL Lie or Reg No Date PRESENT USK OR BUILOlN6 �7 HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS O ,�j� 146 FEEI ON LOT AND USE I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Bust �' 00W—M17 '*/I�q ness and Professions Code) NO PARKING riI as owner of the property will do the work and the SPACES PROVIDED *909 1 A111169 structure is not intended or offered for sale (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOS u86 OP BUILDING 1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s Address I certify that I have read this application and state that the PERMIT FEE above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction and hereby authorize representatives of this County to enter TOTAL.FEE uponIng= erty for inspection purposes SEE REVERSE OR EXPLANATORY LANGUAGE O3-71-941 Signature of Permittee Date WORKERS COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION {� CE 875 LI I heteby iffam 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 BDDR688UILDING A FiCertified copy is hereby furnished BVILDING LOCALITY ADDR688 DCertified copy is filed with the county building inspection OCALITY NBARBST department CROSS ST Date Applicant NEAREST DISTRICT pNO GROUP TYPB CUSSED BY CRO88 ST �YCONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK NO HIGH WAY STATE MAJOR SECOND LOCAL "aw OF HLD68 (This section need not be completed if the work involved TRACTON LOT U86 ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) oP SIZE OR LOTTI LD6 I certify that in the performance of the work for which this permit is issued I shall not employ any person in airy manner OWNER so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP a c ADDRESS ~ Date Applicant uvJ NOTICE TO APPLICANT If after making this Certificate ofCITY No` OCCUPANT LOAD Exemption you should become subject to the Workers ppLtCATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you must forth with comply with such provisions or this permit shall be TRAILER USE[] 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 Buw NO OF EXITS ness and Professions Code and my hcense is in full force and effect PARKING SPACES ARKIN REQ D PROVIDED License Number Lic Class Amy LIMITED TIME USE Contractor Date DATE DATE PROM To I am exempt from the licensing requirements as I am a licensed architect oI a registered professional engineer SIZE OF NO OR INSPECTOR 8 acting m my professional capacity (Section 7051 Bus EXISTING BLDG BTORICS 919rATURN mess and Professions Code) FINAL APPROVAL Lic or Reg No Date RESENT USE OF BUILDING Ae,-,r HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS ON LOT AND USE 10 I hereby affirm that I am exempt from the Contractor s (I l 10/20/97 . License Law for the following reason (Section 70315 Bun i Q�.,1 ness and Professions Code) NO PARKING 2298 1 AM 9:31 ElI as owner of the property will do the work and the SPACES PROVIDED structure n not intended or offered for We (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED U86 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 t I certify that I have read this application and state that the PERMIT FEE CV 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 QD upon the above mentioned prop rty for inspection purposes �r 0� � SE$REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS COMPENSATION DECLARATION 76M4" I N EO U S APPLICATION CE 976(11 94) 1 hereba .that I have certificate of consent tself COUNTY OF LOS BUILDING AND SAFETY DIVISION insure or or a certificate of Workers rs Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) ` Policy No Company FOR APPLICANT TO FILL IN BUILDINGR ���� e/7 ADD688 �,e Certified copy n hereby furnished X AD DR B 88 BV ILDING 5 LOCALITY department copy is filed with the county building inspection LOCALITY Q NSAREST 01 CROSS BT Date Applicant NEAREST DISTRICT NQ O V TYPE CE88ED BY CROSS ST J/ V� CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL '�/ COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK NAP HIGHWAY STATE MAJOR SECOND LOCAL NO OF BLDGS NO ICIRCLE (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONN 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 my manner OWNER n %I so as to become subject to the Workers Compensation Laws OCCUPANCY GROUP ® OZ MAIL � Date Applicant ADDRESS C3 ` e~.s NOTICE TO APPLICANT If,after making this Certificate of CITY G TEL Qjp 3�9�/ p OCCUPANT LOAD H Exemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE z Compensation provisions of the Labor Code you must forth with comply with such provisions oI 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 9 (commencing with Section 7000)of Division 3 of the Busy SAFETY PERMIT❑ (CTBT!TENS BELOW NO OF EXITS ness and Professions Code and my license is in full force and //�� effect "? SPACBS REO D = PROVIDED License Number Lic Class (� ' �� LIMITED TIME USE Contractor Date DATE DATE 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 8 acting in my professional capacity (Section 7051 Bus EXISTING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL Lic or Reg No Data PRESENT USE OF BUILDING l� HOME OWNER BUILDER DECLARATION No OF EXISTING p 1` ON LOT AND USK '�� =_W01 b/ 9/9.I 1 hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Bust $� 0183 1 PM 12:5b ness and Professions Code) NO PARKING I as owner of the property will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency /Q��-� Ste°'?//C 4e!;- for the performance of the work for which this permit n /" ��/Y! 4 S`� issued(Sec 3097 Civ C) Lender s Name glwPR PERMIT FEE Lender s Address 00 PROPOSED MAX OCC I certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction and hereby authorize representatives of this County to enter TOTAL FEE upon the above mentioned property for inspection purposes V x SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 7 WORKERS COMPENSATION DECLARATION CE 87512 80) 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 APPLICANTTO FILL IN BUILDIN ! ADDRB . ❑ Certified copy is hereby furnished UILDING t�h[+ N iLOCALITY 40 ADD-DIN V/ ❑ Certified copy Is filed with the county building inspection NEAREST department LOCALITY �� / ! CROSS ST Date Applicant ARBST FFh++ r'a.r DISTRIC NO O OYP TYPE P O SSBD BY CROSS STLAS OP CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL a COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL d N OF SLOGS NO (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USB ZONE SPECIAL CONDITIONS V 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 t permit is issued I shall not employ any person in any manner BRIER t so as to become subject to the Workers Compensation Laws ARESS AI / �� ( V OCCUPANCY GROUP a W N Date Applicant n NOTICE TO APPLICANT If after making this Certificate of CITY `/ 4-,0L � ,SSD Z 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 Panic Devices E]LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi ness and Professions Code and my license is in full force andPARKING 01 effect SPACES RES D PROVIDED License Number Lic Class jam LIMITED TIME USE Contractor Date �/ DATE OAT E ❑ 1 am exempt from the licensing equlrements 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 !O"Q STORIES i SIGNATURE mesa and Professions Code) r PRESENT USE OF BUILDING Ah X-CFINAL APPROVAL �Z Lic or Reg No Date LIP 111 449� HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS ON LOT AND USE ` I hereby affirm that I am exempt from the Contractors D 0 � License Law for the following reason (Section 7031 5 Busi Q� �t�}i Iness and Professions Code) NO PARK PING ED �u ❑ I as owner of the property will do the work and the ij AM 7-1. structure is not Intended or offered for sale (Section I /� 7044 Business and Professions Code) �! PROPOSED U86 OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender a Name PROPOSED MAX OCC Lender s Address PERMIT FEE IR- 1 O I certify that I have read this application and state that the ISSUANCE FEE above Information is correct I agree to comply with all County ordinances and State laws relating to building construction TOTAL FEE 7`d Q and hereby authorize representatives of this County to enter u9w the above me to pr petty for inspection poses SEE REVERSE FOR EXPLANATORY LANGUAGE OA Pt/ D9-o3-t / Signatur of Perini tee Date WORKERS COMPENSATION DECLARATION 7eM444 MISCELLANEOUS A PPLI CATI O N CE 875(11 84) I u rebo affirm that I have a certificate of consent to c self , COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a cert>fjcate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) Policy No Compan91120! aMC FOR APPLICANT TO FILL IN ADDRESS ADDR688 Certified copy is hereby furnished OO A BAD DR 688U .92 ILDING LOCALITY Certified copy is filed with the call ty building inspection LOCALITY �y NNARKST / w^ `�-�,/w� O� M�L+� V` CROSS ST (A.i , "9 Date • �'Apphcant NEAREST DISTRICT NO GROUP TYPE P C688BD BY CERTIFICATE OF EXEMPTION FROM WORKERS ceoss BT L.A.S� 1MW0 r D d colvar v LEGAL O COMPENSATION INSURANCE ONSCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO (CIRCLE) 71. O OR BLD68 (This section need not be completed if the work involved TRACT `t OW ON LOT I USN ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or low) USE oP I certify that m SIZE OF LOT XISTING BLDG the performance of the work for which this � permit Is Issued I shall not employ any person in any manner OWNER 90 y so as to become subject to the Workers Compensation Lawsa m MAIL OCCUPANCY GROUP c DateApplicant ADDRESS U NOTICE TO APPLICANT If after making this Certificate of CITY No OCCUPANT LOAD 0- Exemption, you should become subject to the Workers APPLICATION FOR EXIT HARDWARE z Compensation provisions of the Labor Code you must forth with deemed corempply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAPNTY PERMIT LIST ITEMS BELOW 9 (commencing with Section 7000)of Division 3 of the Busy ❑ NO OF EXITS ness and Professions Code and my license is in full force and effect PARKING PROVIDED ���.�� I 1 License Number � SPACES R6q D Lic Class � LIMITED TIME USE ContractorMIQ TSQA Date �6'•9Z �N1F�v (J�aJ�' Var DATE DATE I am exempt from the licensing requirements as I am a FROM TO licensed architect oI a registered professional engineer SIZE OR No oP INSPECTOR 8 acting in my professional capacity (Section 7051 Bus EXIBTING BLDG I STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL PR BSKNT U86 OF BUILDING COM Lic or Reg No Date1-7-31-q?, HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS 00'�a �-�� ON LOT AND USE vvp I hereby affirm that I am exempt from the Contractors 1 I License Law for the following reason (Section 7031 S Bun /y ness and Professions Code) NO PARKING 'V 0000-CMI " ,70/92 as owner of the property will do the work and the SPACES PROVIDED V 4204 1 FM 2 17 structure is not intended or offered for sale (Section i 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 I certify that I have read this application and state that the PERMIT FEE MW above information is Correct I agree to Comply with all County ISSUANCE FEE ordinances and State laws relatmg to building construction and hereby authorize repress atives of this County to enter TOTAL FEEdb upon the above m pro rty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE , Signatu of Permittee Date WORKF.$S COMPENSATION DECLARATION MISCELLANEOUS APPLICATION . . CE 876(11 84) I CE 875 hereby affirm that I have a certof consent tself COUNTY OF LOS ANGELES BXDING AND SAFETY DIVISION insure or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) BUILDING Policy No Company FOR APPLICANT TO FILL IN ADDRKS Certified copy is hereby furnished ADDRESS{7 VILDING /�' V LOCALITY Certified�pecopy is filed with the county building inspection OCALITY clgeosa sT Date Applicant NBARKST //�� � ,,y DISTRICT NO G O TYPE CKSBED By CR088 ST (�{/G I.�/, / AR—P CONST I CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL (J �/ COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO or BLDOS 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 _a I certify that in the performance of the work for which this SIZE OF LOT ��� EXISTING BLDG C2 permit is issued I shall not employ any person in any manner wNKR ..� 4 rte' so as to become subject to the Workers Compensation Laws MAIL qQUP®NCY GROUP �a c Date Applicant ADDRg88 ��11'' NOTICE TO APPLICANT If after making this Certificate of clry noL -j6 OCCUPANT LOAD Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth APPLI ATION FOR EXIT-HARDWARE with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked IH' No Spec Known LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Id Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Er (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Busy No OF EXITS ness and Professions Code and my license is in full force and Effect PARKING REG DPROVIDED License Number Lic Class SPACES 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 �l No of IN G TOR 8 acting in my professional capacity (Section 7051 Bus- EXISTING BLDG f STORIES SINATURg mess and Professions Code) FINAL APPROVAL Lic or Reg No Date PRESENT V86 OR BUILDING No F11--hr HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS . D ON LOT AND USE I hereby affim that I am exempt from the Contractors B la3 License Law for the following reason (Section 70315 BusiA GOOGl v 4/93 ness and Professions Code) NO PARKING O II JI� '7L'Q 48 F1I as owner of the property will do the work and the SPACES PROVIDED 4 `418 structure is not intended or offered for sale (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USK OF BUILDING I hereby affnm 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 abqve 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 a� upon the above menti-opedolmperty for inspection purposes SZEER VERSE FOR EXPLANATORY LANGUAGE Sngnat f Permittee Da WORKERS COMPENSATION DECLARATION 76M444 M I SC E LLAN EO U S APPLICATION CE 875(11 84) I hereby aff�rni 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 ceitified copy thereof(Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRB88 Certified copy is hereby furnishedUILDIN6 DDR 68 S LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department CROSS ST Date Applicant NEAREST DIST N G OUP TYPE CUSSED BY CROSS ST D� ��� CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL �i� COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY NO (elweLK) STATE MAJOR SECOND LOCAL No (This section need not be completed if the work involved TRACT NOWOON LOTS USEZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less) USK of I certify that m the performance of the work for wluch this SIZE OF LOT EXISTING BLDG permit is issued,I shall not employ any person m any manner OWNER f j!? y so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP y/f� c Date Applicant ADDRESS LGf W rsL OCCUPANT LOAD NOTICE TO APPLICANT If after making this Certificate of CITY �A �No H Exemption you should become subject to the Workers z Compensation provisions of the Labor Code you must forth APPLICATION FOR EXIT HARDWARE with comply with such provisions oI this permit shall be TRAILER USKGEOLOGY INSPECTION ❑ deemed revoked ❑ ❑ No Spec Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Busy SAFETY PERMIT❑ (LIST ITEMS aULow) NO OF EXITS ness and Professions Code and my license is m full force and . i effwRM o-E PARKING REO D PROVIDED 1 1 ` LL��JJ License Number Lic Class SPACES 68 LIMITED TIME USE Contractor Date DATK 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 INSP crGR s acting m my professional capacity (Section 7051 Bus EXISTING BLDG STORIES SI rugs mess and Professions Code) FINAL APPROVAL ` Lic or Reg No Date PR B86NT U86 OF BUILDING HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS &VV f. �' ON LOT AND US6 rr I hereby affirm that I am exempt from the Contractors � License Law for the following reason (Section 70315 Busi t' L V ness and Professions Code) NO PARKING 0000--IJ001 , 2 X74 I as owner of the property will do the work and the SPACES PROVIDED 41}J 1 PM12:7 structure is not intended or offered for sale (Section 12:7? 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OP 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 IN I certify that I have read thus 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 FSE 00 upon the above men(loned pmp rty for inspection pu pose s { SEE REVERSE F EXPLANATORY LANGUAGE S ture of mittee D e WORKERS COMPENSATION DECLARATION MISCELLANEOUS APPLICATION o. CE CE 875 876(11 84) I hereby affirm that I have a certificate of consent tself COUNTY OP 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 ,6?/ 27 Certified copy is hereby furnished BUILDING W. Aa aVF: LOCALITY ADDRBSS • Certified copy is filed with the county bmldmg spection ILOCALITY0M NEAREST departmentCROSS ST Date Applicant NEAREST w/. NeS DISTRICT NO GROUP TYPE P 6886D BY CROSS ST U0165 -2 CONST ", CERTIFICATE OF EXEMPTION FROM W RS Lsawl O' r COMPENSATION INSURAN DESCRIPTION Lor No BLOCK MAP HIGHWAY I7�, Ivo (eIRCt.e) STATE JOR SECOND LOCAL No OF('Phis section need not be completed if work involved TRACT NOW ON LOTS USE ZONE SPECIAL CONDITIONS by the permit is for one hundred do ($100) or less.) USE or I certify that in the performance of the ork for which this SIZE OR LOT EXISTING BLDG permit is issued I shall not employ any erson in any manner OWNER y so as to become subject to the Worker Compensation Laws IN • OCCUPANCY GROUP ADDR68 9 Y� c MAIL `� !J 04K A/�/ Date AppllCSnt • W NOTICE TO APPLICANT fn this Certificate of CIr M T-ON 0-40• 0 OCCUPANT LO a- Exemptton, you should bject to the Workers rn Compensation provisions oCode APPLICATION FOR EXIT HARDWARE z you must forth with comply with such por this permit shall be TRAILER USE❑ GEOLOGY INSPECTION❑ No Spee` InOW1 ❑ deemed revoked LICENSED CONTRECLARATION OCCUPANCY INSPECTION❑ Panic vices I hereby affirm that I am her provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) 9 (commencing with SectioDurston 3 of the Busi- . No P EXITS Hess and Professions Codense is in full force and eff� PARKING REQ D PROVIDED SPACES License Number Class LIMITED TIME USE Contractor Date PA4141 RA DATE DATE I am exempt fro the hcensing requirements as I am a licensed architect or a registered professional eitg<neer SIZE or No OR PROM To INSPECTOR 8 acting in my pr essional capacity (Section 7051 Bus- sic ila- EXISTING BLDG STORIES SIGNATURE men and Profe roCode) FINAL APPROVAL Lic or Reg No Date PRBBENT USB OF BUILDIN .. HOME O R BUILDER DECLARATIONNo OR EXISTING BUILDINGS FEE ON LOT AND USE � TJ I hereby affirm that I am exempt from the Contractors License Law fo the following reason (Section 70315 Bust 1 $/i�/Q� ness and Profe 118 Code) NO PARKING I as o of the property will do the work and the SPACES PROVIDED 4981 i 3:�b structu is not intended or offered for sale (Section 7044 stress and Professions Code) NSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby firm that there is a construction lending agency 1 IGi for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s Address I certify that I have read this application and state that the PERMIT FEE above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction and hereby authorize representatives of this County to enter TOTAL FEE upon the above mentioned property for inspection purposes /( e SEE REVERSE FOR EXPLANATORY LANGUAGE oor rfJ Signature of Permittee Date WORKERS COMPENSATION DECLARATION CE 8775((11 84) MISCELLANEOUS`APPLICATION er—A,,W4 hereby affirm that I have a Certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a certificate of Workers Compensation Insurance or a cerhiled copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN Bu1LDINo���� / woossss Certified copy is hereby furnished XX wooRsss ,� dQ CW cwLlrr Certified copy U filed with the county building inspection LOCALITY NEAREST department XX CROSS ST Date Applicant MEANS ST GQS dt Q$ ';STRICT®NO Goa coesr CEsseD Br CROCERTIFICATE OF EXEMPTION FROM WORKERS LEGAL �o COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK NOP HI e4E) STATE MAJOR SECOND LOCAL ��L NO OF SLOGS (This section need not be completed If the work involved TRACT NOW ON LOT USK ZONE SPECIAL CONDITIONS by the permit Is for one hundred dollars ($100) or IIEL) USE of SIZE OF LOT EXISTING BLDG ' I certify that m the performance of the work for which this permit is issued,I shall not employ any person In any mannelRX OwNER of buildin ' A so as to become subject to the Workers Compensation Lawa I - OCCUPANCY GROUP �C c ADORERS Q �.! Date- PP NOTICE TO APPLICANT If,after making this Certificate of CITY , Trio` OCCUPANT LOAD Exemption, you should become subject to the Workers Compensation provisions of the Labor Code you must fort>r /da APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE[3 GEOLOGY INSPECTION❑ No Spec Knowl deemed invoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT[ (LIST ITEMS BELOW) 9 (comencug with Section 7000)of Division 3 of the Busy No OF EXITS m ness and Professions Code and my license Is in hill force an*x Name of business PARKING effect SPACES REG D PROVIDED License Number LIC Class / reef LIMITED TIME USE Contractor Date DATE DATE PED..: TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR SIGNATURE acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES mess and Professions Code) FINAL APPROVAL LIc or Reg No Date PRESENT YSE OR BUILDING .�uG HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS r.ON LOT AND USE ` I hereby affirm that I am exempt from the Contractors �' / License Law for the following reason (Section 70315 Bust- and Pn)04 fessions Code) NO PARKING I' es owner of the property will do the work and the SPACES PROVIDED + s cture is not intended or offered for sale (Section t 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 ,o Issued(See 3097 Civ C) �..� Lender s Name PROPOSED MAX OCC Lender s Address & "n I certify that I have read this application and state that the PERMIT FEE r M above information is correct I agree to comply with all County ISSUANCE FSE PP7 . ordinances and State laws relating to building construction, 25 00 ''1 and hereby authorize representatives of this County to enter TOTAL.FEE -n ' upon the ve mentioned property for inspection purposes. " SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX 7� } Signature of ermlttee ate s _�+ WORKERS COMPENSATION DECLARATION i.� 78M444- MISCELLANEOUS APPLICATION ` ^„ , hereby affirm that I have a certificate of consent tsoli CE 878(11,84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a certificate of Workers Compensation insurance of a certified copy thereof(Sac 3800.Lab C) do Policy No Company FOR APPLICANT TO FILL IN BYILDIN6��� ADOR668 Certified copy n4 hereby furnished Bun.DING fid { cwLrrr XX ADDRBBB 0 Catl[W copy is filed with the county buffing inspectiondepartment s LOCALITY NEARCPOSST z Date Applicant NEAR T LQ,S (rt Q S ISTRICT 0 G our corlsT csssse BYCROSi CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL �� COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK No HIGHWAY (CIR LEI STATE MAJOR SECOND LOCAL NO OF BLOOD (This section need not be completed d the work lnvolved TRACT NOW ON LOT USE XON6 SPECIAL CONDITIONS by the permit M for one hundred dollars ($100) or less.) USK or I SIZE OF LOT EXISTING BLDG I certify that m the performance of the work for which this c permit is issued,I dhall not employ any lin In any manneRX OWNER of buildin so as to become subject to the Workers Compensation Laws. MAIL OCCUPANCY GROUP c ADDRESS p ^ �� Date ApphcantuJ NOTICE TO APPLICANT If after making this Certificate of CITY GJe s,e> no OCCUPANT LOAD Exemption you should become subject to the Workers Compensation provisions of the Labor Code,you must forth- /4W 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 DBVIces I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT[3LIST ITEMS BELOW) st a 9 (commencing with Section 7000)of Division 3 of the BuNo OF EXITS nese and Professions Code and my hcense Is in full force anx Name of business PARKING effect SPACES use D PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date OATS DATE I am exempt from the licensing requirements as I am a PROM Vol licensed architect or a registered professional engineer SDs OF No OF INSPECTOR s acting m my professuinal capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) Q FINAL APPROVAL Lic or Reg No Date PRESENT YSs OF BUILDING L HOME OWNER BUILDER DECLARATION No OP EXISTINO BUILDINGS o I hereby affirm that I am exempt from the Contractor s N Lor AND USE [1� .4 License Law for the following reason (Section 70315 Bust If.x„11 and Professions Code) NO PARKING as owner of the property will do the work and the SPACES PROVIDED cture is not intended or offered for sale (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY ( PROPOSED YOB OF BUILDING I hereby affirm that them is a construction lending agency for the performance of the work for which this pernut is _ z 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 Pse 1-� i-- M above Information is correct I agree to comply with all County ISSUANCE Pus m ordinances and State laws relating to buil construction and hereby authorize representatwes of this County to enter TOTAL.PEE 25.00 -71 4 ' upon the a vementioned property for inspection purposes. i XX ]CIC " SEE REVERSE FOR EXPLANATORY LANGUAGE r Signature of ermittee pate -� iv WORKERS COMPENSATION DECLARATION M ISCELLARE,OU "�►PPLICATION +► CE G4111- CE 8875(1784) 75 1 hereby 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 C) t Policy No (ompany FOR APPLICANT TO FILL IN eu1LDINaa�.7 ADDRESS 1-3 Certified copy is hereby furnished BUILDING ZG LocwLlrr XX DRESS Y Certified copy is filed with the county building Inspection LOCALITr Q NEwt1EST department 3M G' G� _`f D clloss ST Date Applicant NEAREST DISTRI'T NJoy9u° eons CESSED Br � CFRT[I KCROSS ST ATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION I OT NO BLOCK NOP `,IRC`U) STATE MAJOR SECOND LOCAL NO OF (This Section need not be completed if the work involved TRACT NOW ON LOTS USE ZONE SPECIAL CONDITIONS by the permit Is for one hundred dollars (5100) or less) USE OF SIZE OF LOT EXISTING BLDG 1 certify that in the performance of the work for which this C-1 permit is issued I shall not employ any person In any mannetx DWNER of building I-14 LIQ a+ 9s to become subject to the Workers Compensation Laws MAILOCCUPANCY GROUP ADDRESS C*MaNe W*L- E�:] Date— ApplicantuJ NOTICE TO APPLICANT If after making this Certificate of CITYno7.. OCCUPANT LOAD 13- 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 GEOLOOT INSPECTION❑ No Spec Knowl deemed revoked I ICCNSED(ON7 RACTORS DECLARATION OCCUPANCY INSPBCTtON Panic Devices I hereby affirm that 1 am licensed under provisions of Chapter SAPETY PERMIT[] (LIST ITEMS BELOW) a No OF Extrs 9 (commencing with Section 7000)of Division 3 of the Busi- ness ustness and Professions Code and my license is in full force an Name of business PwwKINa effect SPACES REO D = PROVIDED I (cense Number Lic Class OVb T#41� WMtZJIW4 C A-r LIMITED TIME USE (ontrctor Date DATE DATE PROM TO 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer 91290" No or 1 SSPEATURE acting in my professional capacity (Section 70SI Bus- EXISTING BLDG $TOR IRS iness and Professions Code) FINAL APPROVAL Lic or Reg No Date PR68ENT YS6 OF BUILDING v HOME OWNFR BUILDER DECLARATION No OF S OP EXISTING BUILDINGSI �I g ^ 1 hereby affirm that I am exempt from the Contractors ON LOT AND V86 oonn-noo 1 �1_4/1r I icense 1 aw for the follow Ing resson (Section 7031 S Bust 1893 1 AMO '1 t�` 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) CONST RUCTION 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 N•ime PR POSED MAX OOCC I ender s Address I certify tint I have read this application and state that the PERMIT FEB s, above Information is correU I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction 25-00 and hereby authorize representatives of this County to enter TOTAL.PEE s� upon the above mentioned pro erty for inspection purposes SEE REVERSE FOR XPLANATORY LANGUAGE XX �• ]CX t6 19mi mirt of I rrnrttic 11 rte %%ORkLRS COMPENSATION DECLARATION 7SM444 MISCELLANEOUS APPLICATION * • !� F WI hereby affirm that i have a certificate of consent to self CE 875(11 84) msure or a certdicateof Workers Compensation insurance or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION i a certified copy thereof(Sac 3800 Lab C) t ' Policy No Company FOR APPLICANT TO FILL IN BUILDING �i}`� woowsss //��✓ Certified copy is hereby furnished XX woowsss ,r Y.SD L� Loewurr Certtfled copy u filed with the county buddhig inspection LOCALITY CROSS ST ST department JIM t:woss Date Applic-int NEAREST DISTRI NO GROUP FPS CESseD BY CROSS ST ` G CONST (I R 111 i(ATE OF EXEMPTION CROM WORKERS LEGAL 'fid COMPENSATION INSURANCE OESCRIPTION LOT NO BLOCK NAP IININWAT No (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work Involved TRACT NOW ON LOTOF S USE ZONE s►e IAL CONDITIONS by the permit is for one hundred dollars ($100) or less) use OF 91 1 certify that in the performance of the work for which this 9aZE OF LOT EXISTING SLOG permit is issued I sh-ill not employ any person in any mannekX —En of building so -1s to bet otne sulletI to the Workers Compensation 1 awe MAIL OCCUPANCY GROUP r, ' Date_ applicaooae1111 • applicant A... NOTICE TO APPLICANT If after making this Certificate of CITY o0 6 TO OCCUPANT LOAD I%emption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE (ompensalion provisions of the Labor Code you most forth pith comply uith stiLli provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION 0 No Spec Knowl deemed rccoked i K I NSE D(ON I RA( TORS DECLARATION oceu►wN¢r INSPECTION Panic Devices 1 IIL rLb) affirm that I am licensed under provisions of Chapter SAFETY PERMIT[3iLIST ITEMS BELOW, 9 (commencing with Section 7000)of Division 3 of the Bust. NO of EXITS ness -ind Professions Code and my license is in full force a" *x Name of business PARKING REG D PROVIDED _ s.Aees I isunu NumbLr —_-- — — I is Class •ln� tAd t LIMITED TIME USE (ontr Ictor _ ___ Date DATE OATS OM TO I am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer 1112E OP NO OP INSPECTOR s acting in my professional capacity (Section 7051 Bus EXISTING BLDG srowlE11 111GNwruwE loess and 1 rofessiuns(ode) FINAL APPROVAL Z' 1 is or Reg No _— —_ _Date vwssewT Use OF BUILDING tea' IIOMi OWNCR BUILDER DELI ARATION NO OF EXISTING BUILDINGS ON LOT AND USE I htmb). iffirrit that 1 int exempt from the Contractors y fj I icense I-kw for the folho%Ing reason (Section 70315 Bust ness Ind Professions Lode) NO PARKING ri1 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) (ONS I RUC I ION l ENDING AGENCY PROPOSED use OF BUILDING I hcreb) affirm that there is a construction lending agency for the performance of the work for which this permit is 0 Q :t issued(Sec 3097 Civ C) i I ender s Name __-- pwo.oseo MAX Dec � 1 I ender s Address I certify taut I have read this application Ind state that the PERMIT P66 shove information is correLt 1 igree to comply with all County ISSUANCE FEE r • ordinances and State haus relating to budding construction -ind hereby authorize representatives of this County to enter TOTAL FEE 25.00 upon thea ve_mentioned property for mspeLtion purposes - i — - - - — SEE REVERSE FOR EXPLANATORY LANGUAGE XX � XX ` I WORKERS COMPENSATION DECLARATION _ CE 875(17 841 MISCELLANEOUS APPLICATION -- —- CE 875 �I I hereby affirm that I have a certificate of nconsentIncur to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a certificate of Workors Compensation Insurance or I a certified copy thereof(Sec 3800 Lab C) 992 Policy No Company FOR APPLICANT TO FILL IN aoowass 3 Certified copy is hereby furnishedUopase Z 3 RE mW� LOCALITY D t 1 dCertified ant is filed with the county budding mspectio g LOCALITY L-� 0-j. . R �-D NC:OSS ST Date /AppluCONST t NawRHST Dig TQM GR P TYPE EBSED BY //� 09 1 CERTIFICATE OF EXEMPTION FROM WORKERS CROSS ST LHGAL COMPENSATION INSLRANCE DESCRIPTION Lor NO BLOCK NAP NIONWAV (This (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOONBLOT S USE ZONs SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less) USK of SIZE OF LOT EXISTING BLDG b. I certify that m the pertoritiance of the work gLmlany hich 61 this permit is issued I shall not employ any person manner OWNERso as to become subject to the%4orkers Compn Laws 1 OCCUPANCY GROUP NAIL }A i Date APD11GtnL =ass o S C Af w G/` L 4U"b NOTICE TO APPLICANT If atter making this Certificate of CITY I /d 0D9z0 k1P—*(f ^6nW OCCUPANT LOAD = Exemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you must torch I with comply with sulh provisions or this Hermit ,hall be TRAILER USE n LONo Spec Knowl GEOLOGY INSPECTION ❑ deemed re%oked C n LICENSED CONTRACTORS DECL AltATION OCCUPANCY INSPECTION LZ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PHRMIT[3 (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Busi- NO of EXITS Hess and Professions Code and my license is in cull force and effect PARKING RBO D PROVIDED � SPACES II��JJ X I License Number Lic Class 9 LIMITED TIME USE is Contractor Date DATE OATS W PROM 'O I am exempt trorn he licensing equirements as I am a m i licensed architect or a registered orotessional engineer SIZK of ND of INSPECTOR s SIGNATURE 7 acting in m% prote%uonal =at,u% lSet,tion -0-i I Bus EXISTING BLDG STORIES mess and ProtessiunsCode) FINAL APPROVAL v LIC or Reg No Date PRESENT USB OF BUILDING HOME OWNER BLILDER DECLARATION No OF EXISTING BUILDINGS AL 1/Q � UOU � r1/9 ON LOT AND USE I herebv affirm that i am exempt from the Contractor s �r � ISI Lilense Law for the folio%%mg reason iSection 7031 _ Bust ness and Professions Code) NO PARKING I as owner of he propertv will do the vork and the SPACES PROVIDED structure is not intended or otfe ed tut sale i Section I 1044 Business and Protessions Codel PROPOSED USE OF BUILDING n ' CONSTRLCTIOV LENDING AGENCY I hereb) affirm that there is a construction lenduig agency (Zt V —& -�� -TI, Orth ( for the performance of the work for %hicli this permit is { issued(Sec 3097 Civ C) Lender s Name PROPOSBO MAX OCC Lender s Address 25.00 I certify that I have read this application and state that the PERMIT FEE abol.e mformauon is correct I agree to comply%ith all County ISSUANCE FEH ordinances and State lads relating to building construction ( d hereby authorize representatives of this County to enter TOTAL FEE 25.00 u on the above mentioned property for inspection purposes % �`C�- g Z- SEE REVERSE FOR EXPLANATORY LANGUAGE a D-tte Signature of v.m tt UnRI.CRS CO)IPENIS.ITION DCCL►RMON 76M444 MISCELLANEOUS APPLICATION =� I CE 875 11 1 841 /-� I hereby affirm Leri that 1 have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a Lertificate of Workers Compensation Insurance or , �1 a certified copy thereof(Sec.3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN loo�ss eJ�v '444e � Certified lop* u hereby furnished BUILDING rC a coo DR sss 21 LIAF.• LOCALITY ! Certified copy is fled with the county building inspection g LOCALITY T� NEAREST department CROSS ST Date applicant NEAREST OISTRI T rfi I WP lywcasquo BY CROSS ST I CERTIFIC GTE OF EXEMPTION FROM%%ORkERS LEGAL O COMPENSATION INSLRk%CE 265CRIPTION LOT VO BLOCK 4AP HIGMMAr OF 1116005 NO ICINCL81 STATE MAJOR SECOND LOCAL NO (Tills section need not he completed If the work Involved TRACT Now ON Lor US6 Zama SPECIAL CONDITIONS by the permit Is for lne hundred lollars ISIQQI or lets) I use of I ergf% Kiat in he Der urTiant.c it he ,ort or %huh his SIZE OF LOT EYtSTING BLDG permit is Issued I shall -lot•mplov an% pe on n env manner X owNgR gIhp. C ;dn1 so as to become ublec o the toners Comoe-isatton Laws RAIL OCCLPANCY GROUP X AOORESS 6b -lipi Date 1orllt.ant 4267 NOTICE TO APPLIC %%,T If atter mak,n_ his.,e-tilit ate titg CI- JAvo- � OCCUPANT LOAD Exemption Lou should become subject o the %orkers APPLICATION FOR E(IT HARCwARE Compensation pro%lsions at he Laoor Code ou -nust forth i pith lomph lith I h p n%ib Vns r i is e nin hall bo- -RAIL-R JSB 1 GEOLOGY INSPSL-ON X10 Spec Knowl G deems d re%aked ' ' OCCJP4VC INSPECTION rZ Panic Devices LICENSED 10\TRaCTORS DELL tR%TIO\ 01 1 liereb% affirm that I -m licensed under provisions of Lhaoter a 2 I 9 it.otnmencute with Section 70001 of Dnisfon a of he Busi- SAFETY PERMIT = LIST trams 66LOwl NO OF EXITS ti ness and Professions Code and mV Iltense is in ull orce ind e►feLt PARKING REG D D PROVIDED A SPACES License Numbe L L Ciao% LIMITED TIME USE a aCtlntrat.or D1tl DArs DA re <.qN D I im a Lnipt rum h% hkensmit euuue nuts % I _i 1 a m I lit.enxd arLhlteL or 1 exiuer%d -irnie%slonal n_nom_ Izs of vo of INsase-ON = actin. m "1% orotelslonal .aDaL t bel loll i l BIIC =`CIS- Yo BLZI4 i To C. NATO 6 lneuand P oteuiuns(-odel FINAL APPROVAL �� •4BSE IT Jse OR SUILDIYa41 3 Li;. or RLL N, _ _ _ D iiL _ = I HOME OUNER BLILDCR DECL aR%rim Yo OR EXISTINGBUILDINGS 0 AI ON LOT AND JSE 41' I hereb% aftlrm hat i Im exempt -nm Ise Cuntrat.tor s j LiLense Lau for he %llutm_ a-ison bel ton "0-1 Bu%I ness and Professions t ode) NO PARKING 1 as rnner it he Dropertt till do ht. lora and he PACNS •ROvlD60 struc ure is lot intended or otte Ld it ale SeLnon i 7044 Bu%iness ind Protesnons l Act v a PROPOSED J86 OF BUILDING COh)TRLCTIO\ l LVDI\(, %61\t 1 i I hereb% affirm that here is a lomtruLtion ILnding agent.% n OG Z 1 for the performanLe of the work for whiLh this permit is issued iSec 309- Gu t i Lender►Name _ PROPOSED MAX OCC LLndt.r s \ddress r m ! I Lertifv that I Ita%e read this application and state hat the PERMIT REE 5• abo%e information is lorrect I agree to Lomph with all Count% ISSUANCE FEE orduunces and State laws relating to budding construLtfon 3` ind 1lcrehv authorize representatnes of this Count% to enter TOTAL FEE 25.00 i+ t I upo t ab mentiont.d pm Ertl for inspeLtion purposes Gap. % ) E SEE REN ERSE COR EXPLANATORY LANGUAGE c n WORkERb L01tIPENbAlI0N ULLLAKAIIUN ,DM444 M ISCELLANEO o t he>'eba certificate that I have a certificate of consent tself CE 875(11 84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION PIAGATION Isere or a certificate of Workers Compensation Insurance or certified copy thereof(Sec 3800 Lab C) olicy No Company FOR APPLICANT TO FILL IN BUILDING a�V ADDRESS Certified copy is hereby furnishedAoeRass J ezJr ORAA LOCALITY 1 Certifie opy is filed with the count) building mspectio OCALITY 7`— � ,^ NEAR EST departmentLC ewoss sr late Applicant NEAREST DISTRIC NO GR P TYPE asset BY CROSS ST he /j CONST CERTIFICATE OF EXEMPTION FROM iVORkERS LEGAL v �/ COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK No ICIRC AY STATE MAJOR SECOND LOCAL NO OF BLDGS NO (GIRCLS) This Section need not be completed if the pork involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS y the permit is for one hundred dollars (SI00) or less.) USE of I. certify that in the performance of the wort. for which the SIZE OF LOT EXISTING BLDG ... ermit is issued I shall not employ any person in any manner OWNER 0 as to become subject to the 1%orkers Compensation Laws MAILv� O OCCU W GRO P Late ADDRESS Applicant x 40710E TO APPLICANT If after making this Certificate of elTr r/yPtZ- Cl T y NoL gi ao OCCUPANT LOAD xemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE ompensation provisions of the Labor Code 'ou must forth ( a ith comply with such provisions or this permit shall be TRAILER USE O GEOLOGY INSPECTION[] No Spec Knowl teemed revoked Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION hereby affirm that i am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) + (commencing w ith Section 7000)of Division 3 of the Busy NO OF EXITS toss and Professions Code and my licence is in full force and ffectPPACfiB ARKING REO D PROVIDED S icense Number Lic Class LIMITED TIME USE ontractor Date DATE DAYS I am e%empt from the licensing requirements as I am a FROM TO INSPCC OR S licensed architect or a registered professional engineer SIZE OFNO OF acting m my professional Capacitor (Section 70*i1 Bus EXISTING BLDG STORIES slG ..�uR mess and Professions Cod") .�Qrgg PRESENT USE OF BUILDING FINAL APPROVAL 7 ry is or Reg No Date HOME OI%NER BL ILDER DECL4RATI0^ No OF EXISTINGBUILDINGS g hereb% affirm that I am exON LOT AND USE exempt from the Contractors E: tense � tense Law for the follon ing reason (Section 7031 a Bust �f�� less and Professions Code) NO PARKING 'r yn I as owner of the propl.ri) will do thl wort. Ind the SPACES PROVIDED 11 structure is not intended or offered tot salt. (Sttmon 7044 Business and Professions Code) CONSTRUCTIO\ LE\TD1NC AGE\C1 PROPOSED Use OF BUILDING herebm affirm that there is a construction lendinL acenci or the performance of tilt. pork for Much till' pLrmn I% ,sued(Sec 3097 Cn C) ender s Name PROPOSED MAX OCC ender s Address PERMIT FEE 0 certify that I have read this application and state that the ibove information is correct I agree to oomph with all County ISSUANCE FEE Irdmanees and State laws relating to building construction ,Ind hereby authorize representatives of this Countm to enter TOTAL FEE p�j� Cs Ipgn the above mentioned pro ert}1or inspection purpowb SLE REVERSL I QR CXPLANATORI LANGUAGE N ,Signatilie of Permittee Date i WORKERS COMPENSATION DECLARATION 76M°44 MISCELLANEOUS APPLICATION I hereby affirm that 1 have a certificate of mor to self CE 875 Ill 841 COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION l insure or a Le;trficate of Workers Compensation InsuInsuranme or I P� a cert*tcopy thereof(Sec 3800 Lab C I d901111 OD Polw% No Company FOR APPLICANT TO FILL IN BUILDING owess r ao riCertified copv is hereb% furnished BUILDING 1 Ir Op� eJl� LOCALITY ADDRESS J 1 /�� I rCertified copv is tiled with the mount,. buddma Inspection LOCALITY Temple Cit eieeoss sT department P Y Date Apphmnt NEAREST DISTRICT NO GR P TYP ESSED BY CROSS ST '�� CONS i CERTIFICATE OF EXEMPTION FROM %ORKERS LEGAL /E� COMPENSATION I\SLRA\CE DESCRIPTION I LOT NO BLOCK I MAP HIGHWAY I No (CIRCLE) STATE MAJOR SECOND LOCAL NO OR SLOGS (This section need not he completed if the cork involved -RAC- NOW ON LOT VSE TOMB SPECIAL CONDITIONS by the permit is for one hundred dollars 4S1001 or legs) USE OF I SIZE OR LOT EXISTING BLDG ( ti I certify that in thL ppmrtormanme of she a)ri. u ihfich his =_ permit is issued I Miall not emplos am oe son n an% manner owNER C141A US so as to become subject to the 1%orkers Compensation Laws OCCUPANCY GROUP ACC.ESS 0 Ba eo.r8 E;K] I Date ►pplicant = NOTICC f() ►PPLIC%NT It at er-nakm_ Iris C.ruit ate tit CITY SAd MMIAP 09 VI/,NOL OCCUPANT LOAD Exemption sou should become suDiect o thL Unrke s APDLICATICN DOR a-Xr 4ARDINAPE Compensation proLisions of he Labor erode %ou must forth I with comon. with such pro%isons Lr bib -+ermit shall be RAILER USE 13 GEOLOGY NSPECTION deemed Lsoked — No Spec Kyo vl LKENSCDCONTRACTORS DECLARATION occUPaneY INSPEC"ION Panic Devices I hereby atfirm hat I am licensed under provisions of Chapter SAFETY PERMIT .^J LIST ITEMS BELOW) a I 9 1commenLlne with Section "000) of Dntslon o of the Busi• No OF EXITS ness and P otessions Code and m% license is in full force and etfemt PARKING REO O PROVID BD �� N SPCCBS License \umber L c Class o LIMITED TIME USE LL Contractor Date DATE DA T6 3 l am exempt from the litensma requirements as I am a FgOM TO I I licensed architect or a registered professional envineer IZE of No oR INSPECTOR s 2 aLtina In 'ni protLs%tonal avaot� $e ion ,a I Bus ERISTING BLDG SORIE SI NATURE °m FINAL APPROVAL iness and r' otessicns Code Q PRESENT USE OF BUILDING Z G. Lic or Ret; \o Date x I O HOME O►1vi R BLILUER DECLAR LTIUh NoOP EXISTING BUILDINGS �0 ON LOT AND USB I herebv af`irm that I am exempt from the Contramtor s 1 License Law for the following reason i Section -oil a Busi nets and P otessions Code) No PARKING I as -)caner of the propert% will do the work and the SPACES PROVIDED stns ure is not intended or offered for sale (Section I I 7044 Business and Professions Code) CONSTRLCTION LENDING AGF\Cl PROPOSED USE OR BUILDING I hereb% affirm that there is a constriction lendinE laencv 8&ANtr %% 1 for the performance of the work for which this permit is issued(Sem 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s Address I 1 certif) that I have read this application and state that the REKNIT FEE 25.00 above information is morrect I agree to compl) with all County ISSUANCE FEE t'iln ordinanLes and State laws relating to budding construLtion and hereby authorize representatives of this County to enter TOTAL FEE 25.00 (� I upon thL Ibo%L mentiontd pro ty for mspemtion purpose~ r SLC RLVERSC COR EXPLANATORY LANGU►GC I Sigitature of Permittee D to i AOR(.ERS COMPENSATION DECLARATION CE 875 111 841 M ISCEttANEOUS APPLICATION CE 875 Afterebiv affirm that I have a certificate of consent to self yi COUNTY OF LOS ANGELES 13UILD[NG 4WD SAFETY DIVISION sun or a Lertiticate of Workers Compensation Insurance or D�;I • a certified copy thereot iSec 3800 Lab C► og Policy No Compan3 FOR APPLICANT TO FILL IN ADDRESS �l ADDRESS or Certified copv is hereb, furnishedu'LOINGS L] C �• LOCALIT ADDRESI 1 I Certified er rtieed copv a filed with the Lounrt buildine mspectio LOCALITY Temple C�ty q( NEAREST CROSS ST Date AppliLant NEAREST DISTRICT N GROUP TYPE P ESSED BY CROSS ST �•'�� CONS i CERTIFICATE OF L\EMPTIO\ FROM %ORLERS LEGAL ' . CO%IPENS AT1ON INSLR k\CL DESCRIPTION LOT NO (BLOCK (MAP NIG C E) STATE MAJOR SECOND LOCAL I NO IOIRCLCI NO OF BLOCS (This section need not be completed if the cork involved "RAC" NOW ON LOT USE LONB SPECIAL CONDITIONS by the permit is for one hundred dollar, iS1001 or less) USE OF i SIZfi OF LOT EXISTING BLDG I � I certifv that m the oLrtormance of lie w)rk or ,lith his _— permit is issued I shall not employ lni oe son nan% manner OWNER � (A LZ� 4r I� — so as to become subject to the Rorker, Compensation Law, MAIL OCCUPANC't GROUP I Date %pplicant ADDRESS O NOTICL TO kPPLIC INT It .0 er-nakm_ Itis(Lrt.tiLare if IT r Q NOL OCCUPAN—LOAD Exemption ,ou ,hould become ,uoiect o the Anrke s APOLICA—ICN e:)R EXIT HARDIVAPE Compensation pro%isions of he Labor i.ode ,ou *rust torch 1 aith compty with suLh props ons Lr hi, ^ermat ,hall be RAILER USE El GEOLOGY NSPECTION deemed rooked No Soec Kqoivl LKENSLDCONTRXLTORS DECLARATIO\ OCCUPANCY INSPEC-ION3nC Panic Devices 1 hereb, affirm hat I am licensed unde provisions of Chapter SAFETY PERMIT .^.. (LIST ITEMS BELOW) I 9 icommenLing with Section "0001 of Dnision o at the Busi- NO OF EXITS ness and P otessions Code and ml license is in full force and etfec PARKING SPGCfiS REO O O PROVIDED N cLicense \umber L c Class LIMITED TIME USE LL I� Contractor Date DATE DATE W F40M TO ZZ I am exempt from the ltiLnsine reautrement, u 1 am i m I ' licensed architLct or 1 maistered protevuonal envineer IME OF No of INSPECTOR s Z acting in n, protissional araat S ion "it 1 Bits ._"..TING BLDG •-oRI SWrATURE m )mess and P otessicns Code► PRESENT USE OF BUILDING FINAL APPROVAL Lac or Ree No D1,L RE 1 HOME 01%NCR BLILDER DECLAR MON No OF EXISTING BUILDINGS �G tJtJ—tJtJ�l 6/ .fir A �1 1 +. 77 I hereby affirm that I am exempt from LOT AND USE m the ContraLtor s 11'V I 4154 1 F� 4•�4 1 License Law for the following reason ISei tion "031 a Bust ness and P ofessions Code) NO PARKING I as -)weer of the propertv wall do the work and the SPACES PROVIDED strut ure is not intended or offered for sale fSeLtion 1� 1 7044 Business and Professions Code) v LOASTRLCTION LENDING AGF\Cl g PROPOSED USE OF BUILDING 1 hereby affirm that there is a Lonstruction Iendina a¢encv N bte�•�v 1 for the performance of the work for which this permit as issued i SeL 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s %ddre,s I 1 certify that I have read this application and state that the PERMIT FEE 2S.00 above information is Lorect I agree to comply with all County ISSUANCE FEE �• ordinances and State laws relating to building construLtion and hereby authorize representatives of this County to enter TOTAL FEE 25.010 1 upon tht.abo%e mentioned property for inspection purposes SEL REVERSE FOR EXPLANATORY LANGU 1GE �i Uf r'til/ A f Signature of Pernrtte Date t 1 WORKERS COMPENSATION DECLARATION 20�0003DPWi2,90 MISCELLANEOUS APPLICATION I I hereby affuin that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION riiaBnm of a certificate of Workers Compensation Insurance,or ( 1 a eertified copy thereof(Sec.3800 Lab.Q Pbhcy Na CompanyFOR APPLICANT TO FILL IN BUILDINGBUILDI ADDRESS ADDRESS ® Certified copy is hereby furnished X r6f IS' LOCALITY iiSiL d copy is filed with the county budding inspection CITY ` ZIP,, 9`,� eNAARREST depST Date r Applicant SIZE OF NO OF BLDDGGS NOW ON LOT DISTRICT NO GRouP TYPE PROCESSED SYI CON" 0 CERTIFICATE OF EXEMPTION FROM WORKERS t l i COMPENSATION INSURANCE TRACT BLocK LOT No MAP ice„ ` NO (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL I STATE MAJOR SECOND LOCAL OI by the permit is for one hundred dollars ($100) or less) ma USE zoNe SPECIALL CONDITIONS t I I certify that in the performance of the work for which this r Omer permit is issued I shall not employ any person in any manner r 3 W a so as to become subject to the orkers Compensation Laws ADDRESS x 0�� OCCUPANCY GROUP v ( Dau Applicant CITY rYIP ? NOTICE TO APPLICANT If after making this Certificate ' � L �!! of Exemption you should become subject to the WorkersOCCUPANT LOAD Compensation provisions of the Labor Code,you must forthwith APPIJCATION FOR EXIT HARDWARE ( comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl El' revoked.LICENSED OCCUPANCY INSPECTION I Panic Devices ❑ LICENSED CONTRACTORS DECLARATION , I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (Liar rrams eELowi I I 9(commencing with Section 7000)of Division 3 of the Business o its ss NO or incus and Professions Code and my license is in full force and effect J am ^ Cl PARKING REQ D PROVIDED � 1 License Number Lie Class SPACES ( i Contractor Date LIMITED TIME USE 2 ' I ❑ I am exempt from the licensing requirements as I am a FROM DATE To DATE ' licensed architect or a registered professional engineer acting III my professional capacity(Section 7051 Business SIZE OF NO or INSPECTM S { i and Professions Code) EXISTING BLDG STORIEg siGNw RE- Lim or Reg No - Dat PRESENT USE OF SUSAING FINAL APPROVAL I HOME OWNER BUILDER DECLARATION NO OF EXISTING euILDINGS j ON LOT AND USE I hereby affirm that I am eiaesnpt from the Contractor s License Law for the following reason (Section 7031 S Business and I Professions Code) NO PARKING I F-1I as owner of the property will do the work and the SPACES PROVIDED I structure is not intended or offered for sale(Section 7044 PROPOSED USE OF BUILDING Sea it Business and Professions Code) t ' I CONSTRUCTION LENDING AGENCY 1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( i (Sea 3097 Civ C) PROPOSED MAX occ 1 Lander s Name APPLICANT(Ralf) TEL NO Lender s Address ffA ( I certify that I have read this application and state that the above information is correct. I agree to comply with all County A � 4ordinances and State laws relating to budding construction and eA `!-7County to enter uponthe above-mentioned property for inspection purposes ' I SEE REVERSE FOR EXPLANATORY LANGUAGE na ire of rmittee Dole