HomeMy Public PortalAbout5539 PARMERTON AVE_Miscellaneous_8/2/1991_ eat. I
.1VORh25 COMPENSATION-DECLARATION 76M444(11 84)
- MISCELLANEOUS APPLICATION {�
IJ
1 hereby a that 1 have CE 876 e a certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
msu re, or a certificate of Workers'Compenauon Insurancnc e,or
a certified copy thereof(Sec 3800,Lab C)
Policy No Company FORAPPLICANT TO FI LL IN BwoDPHaUDR9SS
❑ s
Certified copy is hereby furnishedDRESS
ADDRESS wcwury
Certified copy is filed with the county building inspection OCALITYNEAREST
departmentft SST
Date Apphmnt PEARMST DISTRICT Nq/ _Gw uP TYPE P cisawo BY
ST
CERTIFICATE OF EXEMPTION FROM WORKERS' cRo 3consr�
COMPENSATION INSURANCE BiSewlPnon Lor No 3 •eLocX •'� (J Ia,.ww
r NAv STATE MAJOR SECOND LOCAL
NO 0O.0
P BLD68
(This section need not be completed if the work involved TRACT 13 I Now oN LOT
USE zone sPecuL CONDITIONS
by the permit is for one hundred dollars ($100) or less) _ Q 1`9 or
1�V O 1 EXISTING
1 certify that m SIZE P LOT the performance of the work for which this o
permit is issued, 1 shall not employ any person in any manner owniR ¢iITAL Es IT
v as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP 3 0
Date Applicant AD DR HES 13
NOTICE TO APPLICANT If, after making this Certificate of cIr>� 1/x1 OCCUPANT LOAD 0-
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 pmvmons or this permit shall berw RILES USE ❑
deemed revoked ❑ GEOLOGY INSPECTION ❑ No Spec Know[
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices
1 hereby affirm that I am licensed under provisions of Chapter SAFETY eEw'
9 (commencing with Section 7000) of Division 3 of the Busr MIT ❑ (LIST ITEMS 691-0.) NO OF EXITS
ness and Professions Code, and my license is in full force and
effect T Pw wX I NG
9PACH5 REDO D PPOVID HO D
License Number Lrc Class
1 LIMITED TIME USE
Contractor Date "f OAT. D.r.
I am exempt from the licencing requirements as I am a
licensed arclutect or a registered professional engineer SIZE or No orINSPECTOR S
acting m my professional capacity (Section 7051, Bu¢ Hs EXISTING BLDG STORI // SIGNATURE
mess and Professions Code) FINAL APPROVAL
Lrc or Reg No Date
PRESENT uSH of BUILDING ,r
HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS
ON LOT AND USE
n A
I hereby affirm that I am exempt from the Contractor's ` 1^
Licen Lew for the following reason (Section 7031 5, Bust '� Il
Hess d Professions Code) No PARKINS J L'OSED _ =
I, as owner of the property, will do the work and the SPACES PROVIDED L
structure is not intended or offered for ale (Section A G1 11Er_
7044,Business and Professions Code) TI-11 AL 9:3 - 00
_
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING
)y,A�) (CHECKI hereby affirm that there is a constmction lending agency 1 J)JLe CFIr1N']� ,lil
for the performance of the work for which this permit is J
issued(Sec 3097,Civ C)
Lender's Name
Lender's Address PROPOSED MAX OCC
PERMIT FEE
I certify that 1 have reed this ap on and state that the / --"- I a =
above information is corzec[ I.
a e to omply with County ISSUANCE FEE
mdma s and State la(Tnt'o'ttwe
ing t6 build[ ns[ruct1on,
and r uthorize repof th my to enter TOTAL PEEupo 1 b nh rfor ec on purposes
SEE REVERSE FOR EXPLANATORY LANGUAGL
SVWure of Per tee Date