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HomeMy Public PortalAbout5429 PAL MAL AVE_Miscellaneous__ WORKEm that IP have a ON DECLARATION CE 875 M ISCELL�N�OUS APPLICATION {� CE 4 (11 941 LJ 1 hereby a cert that 1 have a ceCompee or consent to self COUNTY OF LOS ANGELE BUILDING AND SAFETY DIVISION unsure, m a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING LI ADDRESS �-{ Z �� Certified copy is hereby furnished BuI D [, awl 6&Q woo.KSS '7WELNI� e� LOCALITY i 1 ❑ Cep --re_n(fled copy Is filed with the county building inspection LOCALITY NEwRKaT department 1e— C1 caoSS ST G V QJ Date Apph©ntNEARQST DISTRICT NO OR CRO LEGAL ST Vr rrrH PRO aQD BY ' CON CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL �CN 14 COMPENSATION INSURANCE DESCRIPTION LOT No BLOCIc IG Nwwr STATE MAJOR Secory LocwL .7 q NO Or SLOGS MwP (CIRCLE) (711Is section need not be completed If the work involved TRACT /!j 'I nov ON LOT ' USE :ONS .PQCIAL CONDITIONS by the permit Is for one hundred dollars ($100) or less) S / `` 13O USE or aIZQ OP LOT / b EXISTING BLDG 1 artily that in the performance of the cork for which this o permit is Issued, I shall not employ any person in any manner OWNER v m as to become subject to the Workers' Compensation Laws O GSC EW 3 m NAIL yytt OCCUPANCY GROUP /C o Dale A hcanl ADDRESS Z RU� PD w NOTICE TO APPLICANT If, after making this Certificate of CITY�Q-M - noLg l�f - Ai -2377 OCCUPANT LOAD o_ Exemption, you should become subject [o the Workers' Compensation provisions of the Labor Code, you must forth- gppLATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE ❑ G¢Ol.o or INSPECTION ❑ No Spec KOOWI deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPHCTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bust SAFETY PHRMIT ❑ (LIST ITEMS BELOW) NO Or EXITS ness and Professions Code,and my license is in full force and effect r PA RR I Na arwc¢a REG D F PROVIDED License Number Lie Class fi 3 — — LIMITED TIME USE Contractor Date Al.GAT. I am exempt from the licensing requirements as I am a PROM licensed architect or a registered professional engmeer SIZE orNo Or INSPECTOR a acting professional Con capacity (Section 7051, Bus. EXISTING BLDG STORIES ala TURK mess and Professions Code) FINAL APPROVAL Ltc or Reg No Date PRESENT USE or BUILDING ' L HOME OWNER-BUILDER DECLARATION NO or KE'STING BUILDINGS _ `I ON LOT AND USE AUT3 I hereby affirm that I am exempt from the Contractor's7 License Law for the following reason (Section 7031 S, Buss- 219.75 Reis and Professions Code) NO PARKING D1, as owner of the property, will do the work and the SPACES PROVIDED 1 ITEM: structure is not intended or offered for sale (Section - MAL1� . � 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING CECK 219.75 1 hereby affirm that there Is a construction lending agency X00 for the performance of the work for which this permit Is issued(Sec 3097,Civ C) Lender's Name PROPOSED MAX Dee 13GW-3001 1/12/90 Lender's Address /�►i ('� PERMIT FUR ` I certify that I have rend this application and state that the �G AM10 73 1 :59 above Information is Correct I agree to Comply with all County ISSUANCE FEB Z ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upppotttyyythe aa,,b�ove-mentioned gropgr{R for Inspection purposes � � ` (Y �/� a SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnatur f Permittee - Date