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Home My Public Portal About5200, 5202, 5204 ROSEMEAD BLVD_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 675 (t t-84)a M ISCELLANEOUS APp ' LICATION CE 67 1 hereby affirm that 1 have a certificate of coftsent Insurance, tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurancc e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company — FOR APPLICANT TO FILL IN BUILDINEG M AD DR SS Certified copy is hereby furnished. XX BUILD ING ADDRESS 52" IV. G�gSCAAC^0 LOCALITY E Certified copy is filed with the county building inspection LOCALITYNEAREST department. XX fE oKl�l G(r�s� CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE CESSED BY CROSS ST. �"�O� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL {�� liG�G COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY No. ICIRCLC) 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. a 1 certify that in the performance of the work for which this _ $X OWNER of buildin permit is issued, I shall not employany person in any manne '=– c so as to become subject to the Workers' Compensation=Laws: MAIL OCCUPANCY GROUP ® c3 Date Applicant ADDRESS "2_'70 e NOTICE TO APPLICANT: If, after makingthis Certificate of CITY TEL. L/ 17 OCCUPANT LOAD D- �atr+-' L'('•1 R{ystd� No. 'I�.. i i tS 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 or this permit shall be TRAILER USE I] 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 PERMIT [] (LIST ITEMS BELOW) F^-� 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ILEI ness and Professions Code, and my license is in full force anX �I effect. Name of business PARKING REQ'D 1 1 PROVIDED I I L.� LLJJ License Number_— _— Lic. Class �d ULe T' DSL 7 �G� SPAT 6S LIMITED TIME USE Contractor Date- DATE DATE ElI am exempt from the licensing requirements as 1 am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES Si5rTURE FINAL APPROVAL PRESENT USE OF BUILDING iness and Professions Code). Lic.or Reg.No. — _ Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON Lor AND USE 1 hereby affirm that I ant exempt from the Contractor's ;,`;it ii t••••'s,t,,;;' 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). CONSTRUC"IION 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 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 above-mentioned property for inspection purposes: I SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX WORKERS'COMPENSATION DECLARATION 76M444 5? CE 875 (11-84) M ISCELLANEOUS APPL I.CA,i ION {� I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Ll 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 ADDRESS o�- Certified co is hereby furnished. BUILDING /J copy yDDRESS LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GRQQQ UP TYPE P SSED BY CROSS ST. D� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C/fl Y COMPENSA'T'ION 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.) us E OF SIZE OF LOT EXE STING certify that in the performance of the work for which this STING BLDG. / O permit is issued;I shall not employ any person in any mannerowNER = Ems' 4,3-�" =-D so as to become subject to the Workers' Compensation Laws. MAIL ` OCCUPANCY GROUP p ADDRESS ----7 1 I^^' Date Applicant / NOTICE TO APPLICANT: If, after making this Certificate of CITY � '� o -`+`�7 OCCUPANT LOAD Exemption, you should become subject to the Workers' APP LICA I N 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 E] 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• REQ'D PARKING I I PROVIDED SPACES LL��JJ License Number Lie. Class 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 L- •'J,� ,_C}j/•} Lie.or Reg.No. Date PRESENT USE OF BUILDING G- HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS O ON LOT AND USE /Jl/ I hereby affirm that I am exempt from the Contractor's j (d License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING ❑ SPACES PROVIDED q'/V .i^••.t .+. a .... I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section !f 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency �'- -�, � i for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). i Gn Lender's Name • PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL. FEE upon the above-mentioned property or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ermittee Date WORKERS'COMPENSATION DECLARATION. 76 CE 845(i 1-84) 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. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS L FICertified copy is hereby furnished. AUILDING LOCALITY QDRESS PL Certified copy is filed with the county building inspection L CALITY " NEAREST department. CROSS ST. Date Applicant V NEAREST DISTRICT NO. ✓G UP TYPE PROCKD BY CROSS ST. �/� T' �� CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJ SEC ND 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 ZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this C:) permit is issued, I shall not employ any person in any manner OWNER y so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP. o DRESS `�_ I Date Applicant �p TEL LU NOTICE TO APPLICANT: If, after making this Certificate of clrY f O e ��,I o. 2 �j' 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 USEEJ GEOLOGY INSPECTION E] No Spec. Knowl. Y INPECTIO ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic DEVICeS El 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 �I effect. PARKING SPACES REQ'D PROVIDED I J License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: 0 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- EX TING BLDG. STORIES SIGNATURE inessand Professions Code). �� IL FINAL APPROVAL 9 PRESENT USE OF BUILDING Lie.or Reg.No. Date �- O • 88 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 0 0 0 0 0 0 0 U) I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- 0 7j, 1 7-88 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 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). xv Lender's Name `` 9 PROPOSED MAX. OCC. Lender's Address PERMIT FEE `I-{ 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, 1 and hereby authorize-representatives of this County to enter TOTAL. FEE a� �ontl'above mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date j WORKERS'COMPENSATION DECLARATION CE 8754(2-80) 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 APPLIC T TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. ILDING /1 DRES `/ LOCALITY ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT fVO GROUP TYPEPRO SSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL- COMPENSATION EGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP lIGNWar NO. (CIRCLE) STATE MAJOR SECOND,LOC AL O NO. OF BLDGS. (Thts section need not be completed if the work 1RVO1Ved TRACT NOW ON LOT USE ZONE SPECIAL,CONDITIONS V by. the permit is for one hundred dollars ($100) or less.) USE OF IZE OF LOT EX D I certify that in the performance of the work for which this IN. 0 permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. IL / OCCUPANCY GROUP W � a AD RES N Date Applicant NOTICE TO APPLICANT: If, after malting this Certificate of 6 . THE 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 INSPECTIONCl No Spec. Knowl_ ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION occuPArvcr INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) ❑ NO. of Exlrs 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING *feet. SPACES REq'D PROVIDED License Number Lie.Class LIMITED TIME USE 6. q-ontractor 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- XISTING BLDG. STORIES ///SIGNATURE iness and Professions Code). RE NT USE of BUILDING FINAL APPROVAL ��/ Lie.or Reg.No. Date / [J 4( 1 n n NO. OF EXISTING BUILDINGS tT10 G O O 8 8 HOME OWNER-BUILDER DECLARATION ON LOT AND USE N I hereby affirm that, I am exempt from the Contractor's o ° ° ° ° o ° z 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). ' O SED USE 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's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE an i eby authorize representativ s of this Countkpeoses.er above menti prope y for inspection919E REVERS FO EXPLANA NGUAGE vim, /�(% Signature of Permittee ate WO,WKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION •- CE 875 f� •I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION "IUI 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 ABUILD DDR NG ADDRESS !lJJ77 Certified copy is hereby furnished. BUILDING �r LOCALITY ADDRESS Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT N9,. OUP �ICON;�/ YPE P SSED BY CROSS ST. ��(CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ((JJ 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 I EXISTING BLDG. 4 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 OWNER � y so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP �(/J :1 MAIL /l,J�✓�' O ADDRESS _ Q S� r+ � Date Applicant TEL w NOTICE TO APPLICANT: If, after making this CBrtificate of CITY " No. t, y `�/ OCCUPANT LOAD z .r- 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 ❑ � EPETE] 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. 9 PARKING REQD PROVIDED ED License Number Lic. Class SPACES 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 engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professi ons Code). FINAL APPROVAL r /� Lic.or Reg.No. Date PRESENT USE OF BUILDING 2 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS /" D a : _: ri_= = 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- `,72'7 ness and Professions Code): No. PARKING SPACES PROVIDED I, as owner of the property, will do the work and the ?tt structure is not intended or offered for sale (Section m'i 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING u' 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 2-5 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 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of rmittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M ISCELLANEOUS APPLICATION CE 875 I 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.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADIJR ESS R Certified copy is hereby furnished. BUILDING y� LOCALITY ADDRESS Certified copy is filed with the county building inspectio LOCALITY NEAREST department. y. CROSS ST. Date Applicant NEAREST 8„�d.o V� DMTRICT NO. GROUP JT11E PROCESSED BY CROSS ST. „ A CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAC 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.) -US USE OF SIZE OF LOT - - EXISTING BLDG. �� — O} I certify that in the performance of the work for which this CD permit is issued, I shall not employ any person in any manneXX wNER of building —7- e-, G so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP c; ADORE7S1�1��P�q II .�� Date SrSS Applicant LL, :] TE NOTICE TO APPLICANT: If, after making this Certificate of CITY NOLwx, �% CG�� 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 p No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION EJ 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 BuZ)�ame �s"q NO. OF EXITS ness and Professions Code, and my license is in full force II� r effect. of business PARKING I I SP/ICES REO'D 1___� PROVIDED License Number Lic. Class INTE�Tl0hA•L Zt•ITOZAA-L. WAIZTIA4-Al2TS �J LL�� S'5oc/�Tlo/l . LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FRCIM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF I INSPECTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PREFINAL APPROVALSENT USE OF BUILDING Lic.or Reg. No._ _ Date HOME OWNER-BUILDER DECLARATION ND. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I and 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 317 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OP 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 - I certify that I have read this application and state that the 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 Ipon th o -mentioned property for inspection purposes. • SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX Siena rl Permittee Date WORKERS'COMPENSATION DECLARATION CE 87 5 4(1 1-84) MISCELLANEOUS APPLICATION 1reaffirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, o or a certificate of Workers'Compensation Insurance,or a certified y thereof(Sec. 3800,Lab.C.). Policy No-425697Company State Comp.Ins.Fu.nd FOR APPLICANT TOFILLIN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS 52.02-5204 Rosemead. Blvd. 0 Certified copy is filed with the county building inspection 4LOCALITY CA 91"$. NEAREST department. CROSS ST. / Date Applicant EAREST DISTR�T NQ. !�',ryl`ONST►/ PROCESSED BY CROSS ST. Broadwa G\4y/ III/// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECON 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.) US 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 OWNER Wing On Tong Inc. ,Francis bong s? so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ® o Date Applicant ADDRESS 617 MontereyPass Rd. W NOTICE TO APPLICANT: If, after making this Certificate of CITY Monterey Park NOL 818-282-6120 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 INSPECTION ❑ ❑ ❑ No Spec. Knowl. deemed revoked. Panic Devices El CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] 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 LIMITED TIME USE Contractor Date DATE DATE 0 1 am exempt from the licensing requirements as I am a O: 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). PRESENT USE OF BUILDING Retail, commercial FINAL APPROVAL Lic.or Reg.No. Date 5 2+1 A HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE o.e o * 88 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- o D o o © o o z ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED •1 206---'87 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING retail, commercial �v 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 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Oct.26, 1987 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 MISCELLANEOUS APPLICATION • CE 875 (11-54) I hereby affirm that I 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..C BU Policy No Company �-�"`- "' „ FOR APPLICANT TO FILL IN ADDRESS /J .;7 27 ADDRESS Certified copy is hereby furnished. 'BUILDING I LOCALITY ADDRESS F1Certified copy is filed with the county building inspection LOCALITY NEAREST department. _ CROSS ST. Date Applicant NEAREST 77 DISTRICT NO. GROUP TYPE P ES5ED BY CROSS ST. 'tJ, �a "J CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a O` �_ `•Gy COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rvo. (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 SIZE OF LOT EXISTING BLDG.OF -a 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 " =� so as to become subject to the Workers' Compensation Laws. MAIL �i OCCUPANCY GROUP a ADDRESS Date Applicant b.4- uvJ NOTICE TO APPLICANT: If, after making this Certificate of CITY1�Rs No. OCCUPANT LOAD a 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 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 1 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 Exlrs ness and Professions Code, and my license is in full force and effect. PARKING REQ•D PROVIDED wXPACESJJ License Number Lic. Class LIMITED TIME USE Contractor Date O 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. OF3•_ h�TSP.ECTOR 5 acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNP9RE iness and Professions Code). FINAL APPROVAL %r PRESENT USE OF BUILDING LVA 4F.• i 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 17 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.C.). Lender's Name PROPOSED MAX. OCC, Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct:I agree to comply with all County ISSUANCE FEE ordinances a State laws relating to building construction, and hereb uthorize re re entatives of this County to enter TOTAL FEE upon t e ed proper spection purposes. G SEE REVERSE FOR EXPLANATORY LANGUAGE Signohre of Permittee Date WORKERS'COMPENSATION DECLARATION cE B4e(11.841 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 Certified copy is hereby furnished. BUILDING ('Z XX A D tl R E S S��ADDRESS J ON nJ• `U LOCALITY 1:1Certified copy is filed with the county building inspection LOCALITY NEAREST department. XX 5Ct 1/L_ Ct 6yi e c.,3 1 '7 Tb CROSS ST. Date Applicant NEAREST /J DISTRICT NFO 1,aOUP TYPEOCESS ED BY CROSS ST. e A, �' _�-+( `"O CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. ` BLOCK MAP HIGHWAY HD• (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLOCS. (This section need not be completed if the work involved TRACT NO.W ON LOT USE: ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE•OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this Permit is issued, I shall not employ any person in any manneRX OWNER of building - �r cl_e" o so as to become subject to the Workers' Compensation Laws. MAIL C� OCCUPANCY GROUP ® o Date Applicant ADDRESS d l Q Q �'Yj p-,,teye- TEL' NOTICE TO APPLICANT: If, after making this Certificate of CITY 5C.tvti VII&YIV1.Cn- NO.(9-4 fJ .Z YJ'Zll I 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 USEGEOLOGY INSPECTION ❑ E] ❑ No Spec. Know(. deemed revoked. LICENSED CONTRACTORS DECLARATION occuPANcv 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 anj effect. Name of business PARKING SPACES REQ'D PROVIDED �JJJ License Number Lie. Class LIMITED TIME USE Contractor Date L C Pe I DATE DATE FROM: EJ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO, OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING I SUd �• FINAL APPROVAL Lie.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 ElI, 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 O 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 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX j, LLa(,w �L i -xxtoS Signature of Perm` tee Date —A r WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (,1-84) MISCELLANEOUS APPLICATION I hereby, affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'fl insure, or a certificate of Workers' ompensation Insurance,or a certified copy thereof(Sec. 3800, ab.C.). Policy No.'!, Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furcounty BUILDING ago �` ,�e, LOCALITY ADDRESS Certified copy is filed with ing inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP JTYPE PR CESSED BY CROSS ST. `D� CONST. ,/ CERTIFICATE OF EXEM ION FROM WORKERS' LEGAL v COMPENSATI N INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be ompleted if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. , d I certify that in the perfo ance of the work for which this u r o permit is issued, I shall no employ any person in any manner OWNER so as to become subject o the Workers' Compensation Laws. �1I {/.�(1 OCCUPANCY GROUP [W�E] Date Ap icantMAIL AD DR E S N) ♦ �IAJ+ \J`, IO' NOTICE TO APPLICANT: If, after making this Certificate ofclrY , { TEL. OCCUPANT LOAD a 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 USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 andi�� _ effect. PARKING REQID PROVIDED SPACES License Number Lie. Class 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 engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL ,i Lie.or Reg.No. Date P. X11 5cz�tt�i-�av� qq 'I-. — HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �3—j ' 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 usi ;_;;« ;a r ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED „;Yi 4 yA+� structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING V_AIK-(JL.-1 I hereby affirm that there is a construction lending agency �Y N�6 / for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). -Lender's Name I PROPOSED MAX. OCC. \ Lender's Address I certify that I have read this application and state that the PERMIT FEE O J above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, 1 and hereby authorize representatives of this County to enter TOTAL FEE 17 YyD upon the ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permitteve if. Date WORKERS'COMPENSATION DECLARATION CE 8754(2-80) MISCELLANEOUS ^PPLICATI®N 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 copyrthereof(Sec. 380 Lab.C. Policy No. Ll J Z► Company +� �'�'� FOR APPLICANT TO FILL IN BUILDING ADDRESS z E] Certified copy is hereby furnished. BUILDING2 � N �S LOCALITY ADDRESS q- , Certified copy,is filed with the county building inspection NEAREST de artment. LOCALITY CROSS ST. i Date Applicant_ NEAREST - DISTR IC O. G OUT PE PR ESSED BY CROSS ST. CONST 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 ZONE S CIAL CONDITIONS 0 by the permit is for one hundred dollar's;($100) 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 Ow oA C3aJ`�@m ��, � !-- so.as to become subject to the Workers' Compensation Laws. MAIL c OCCUPANCY GROUP S2-9� � � ._ CL ' ADDRESS � � Date Applicant to TEL. NOTICE TO APPLICANT: If, after making this'Certificate of CITY p N0. 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 ElGEOLOGY 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 q (LIST ITEMS BELOW) a 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. /. PARKINSPACES G REQ'D PROVIDED License-Number 2-9-A O4a Lic. Class Cl J � LIMITED TIME .USE Contracto 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 t NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXI ING BLDG. ��© STORIES r SIGNATURE iness and Professions Code). fi FINAL APPROVAL R SENT USE OF BUILDING - Lic.or Reg.No. Date nn 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- `'8,9 Q,3 P, ness and Professions Code): NO. PARKING ' SPACES PROVIDED , I, as owner of the property, will do the work and the #` o D'o o 8 g structure is not intended or offered for saleSection 7044, Business and Professions Code). ( OPo 0 0 0 0 0 0 'POSED OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency Dy LA T l,ra 1 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). ' Lender's Name PROPOSED MAX.. OCC. - Lender's Address ' PERMIT FEE I certify that I have read this application and state that the _above information is correct..I agree to comply with all County ISSUANCE FEE rdinances and State laws relating to building construction,, a hereby ihorize representatives'of this County.to enter TOTAL of 5, 00 U b -mentioned property-for inspe n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE d I Signature of-Pe date WORKERS'COMPENSATION DECLARATION CE 875(2-80) 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 APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING ® �w . oCALITY DRESS �s ❑ Certified copy is filed with the county building inspection , NEAREST department. LOCALITY 1A �� CROSS ST. Date— Applicant NE 'REST I� DISTRIC NO. G UP TYPE PRq CESSED BY OSS ST. u.. 0 410 w CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE MAP HIGRwnv '. . 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 rCIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) 0 USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this i�cyy permit is issued, I'shall not employ any person in any manner 4. WNER I V so as to become subject to the Workers' Compensation Laws. AIL r r/ r OCCUPANCY GROUP J ADDRESS ,qeA4 �S' jmlr �� UJ Date ApplicantCL TELrEn NOTICE TO APPLICANT: If, after making this Certificate of CITY 'r x NC). – 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. of this permit shall be TRAILERUSE❑ GEOLOGY INSPECTION❑ No Spec. KnowL ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS ❑ • (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. SPACES SPACES REO'D O PR--I-E- J ROVIDED O . License Number Lie.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- EXISTING BLDG. STORIES (S'IGNATURE IneSS and PI'OfeS510R5 COde). RESENT USE OF BUILDING • . Zr FINAL APPROVAL '`'_ .� � � ;•. ' Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION O. of AND D UNG BUILDINGS ON LOT AUSE I� I hereby affirm that, I am exempt from the Contractor's 1. License Law for the following reason (Section 7031:5, Busi- 1#I0 o D o 8 8 ness and Professions Code): NO. PARKING i SPACES PROVIDED 1 ❑ I, as owner.of the property, will do the work and the .0 D .o e o 0 o z structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1 �/ .0a 0 6'.-.8 3 OPOSED USE OF BUILDING • ,4 4Z c• mss/ CONSTRUCTION LENDING AGENCY i �— /Fr(V/ C�� {r I Hereby affirm that there is a construction lending agency 1,2r rd I for the performance of the work for which this permit is' issued(Sec. 3097,Civ.C.). I Lender's Name PROPOSED MAX. OCC. t Lender's Address PERMIT FEE } 1 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 ordinanc and State laws relati o building construction, !0 and•h e authorize represent Iy of this County to enter TOTAL FEE (f upon h above-mentio ed ty for inspection'3urppooseL SEE REVERSE FOR EXPLANATORY LANGUAGE ature o ermitt a Date f WORKERS'COMPENSATION DECLARATION CE 875 MISCELLANEOUS A P P L I C A T I O N ` 'p .. CE 875 (11-84) I her, or 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, C Policy No. Company -l�L� FOR APPLICANT TO FI LL IN BUILDING _�-�/II ADDRESS — V GT 61� LO Certified copy is hereby furnished. BUILDwG `7�� ADDRESS OL CALITY llL Certified copy is filed with the county building inspection LOCALITY NEAREST TW�_ZApplicant CROSS Sr. Date � :V T NEAREST DISTRICT NO. G OUP TYPE P. ESS'ED BY 1 CROSS ST. �„ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �i COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDG$. ' (This section need not be completed if the work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) us OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER o so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP 0_1p MAIL ADDRESS Date Applicant us NEL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of clrY NO. Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ N deemed revoked. o Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter ^ SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq'D D PROVIDED O f� SPACES License Number / Lic. Class LIMITED TIME USE Contractor ate DATE DATE EJI am exempt:from the licensing requirements as I am a FROM: To: licensed architect•or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND-USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.$, Busi- ness and Professions Code): NO. PARKING - -' F1I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section -_ ,• s .�,�_y 7044,Business and Professions Code). -.Di-_ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING `'•= r'=` a I hereby affirm that there is a construction lending agency ,;; =_( - ,;.l's.i for the performance of the work for whicq this permit is issued(Sec. 3097,'Civ.C. Lender's Name PROPOSED MAX. OCC. "" "' •• •'• Lender's Address I:�s:- ;- ^r PERMIT FEE .e I certify that I have read this application and state that the 2 above information is correct.I agree to comply with all County ISSUANCE FEE a S' ordinances and State laws relating to building construction, and hereby aut orize representatives of this County to enter TOTAL FEE up n the tioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature of Permittee Date a W0KKLKJ Ut�_Lilm,iLIlvv 1. ISC:�LLAN��:% �I-'I-'L.iC:A I IUN j' I hCC 875 (11-84) ,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.). _ Policy No. Company FOR APPLICANT TO FILL IN SU iLOING ADDRESS Certified copy is hereby furnished. BUILDING !_ 7 ADDRESS 2_00 ,�,f.i.1.�' l LSCA LiTY r r I Certified copy is filed with the county building inspection LOCALITY Tem le Cit f/1 c.ROSS sr. department. P Y S��►, `7Ci/v;'.t Date Applicant NEAREST11 STRI NO. GR P TYPE OCESSED BY CROSS ST. _ n� // CONST. ` CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY r:D. (C-CLE) 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 (SI00) or less.) USE OF I }. 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 I - so as to become subject to the Workers' Compensation Laws. ,SAIL � ` Rol, OCCUPANCY GROUP tt ADDRESS 2 Oahj" Date Applicant - Q 'P i- NOTICE TO APPLICANT: If, after making this Certificate of X cITY �la No� �j2G-lHt�(-1�Ey 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 DISE GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. r` r OCCUPANCY INSPECTION$$ Panic Devices �7 N LICENSED CONTRACTORS DECLARATION I J 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 eIieCL. 3 _i=ARK:NG ;,PACES EO D PROVIDED 1�1 IBJ License Number Lic. Class [ Tt LIMITED TIME USE 1 Contractor Date LG. OArE DATE ro: n J I am exempt from the licensing requirements as I am a — T I licensed architect or a registered professional engineer I SIZE OF Nc. OF i INSPECTORS z acting ii my professional capacity (SeCLlon 7011.. X11$' EXISTING BLDG, STORIES ( SIG URE r iness and Professions Code). I !PRESENTE USE: OF BUILDING }F'yAL APPROVAL N Lic.or Reg. o. Date - 1 I HOME O\VNER-BLILDER DECLARATION No. of EXISTING BUILDINGS ON LOT AND USE '1 rl••' •• • [ hereby affirm that [ am exempt from the Contractor's -- -- .- LF.�• -`•�% `--' i License Law for the following reason (Section 7031.5, Busi y w:i`i,) ^} ',; ness and Professions Code): ;NO. PARKING 'Tvvv( I. as owner of the property, will do the work and the SPACE: PROVIDED structure is not intended or offered for sale (Section i 7044,Business and Professions Code). p A_ PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY _ I lterebv affirm that there is a construction [ending agency for (, ) for the performance of the work for which this permit is LIZ issued(Sec. 3097,Civ. Q. Lender's Name s PROPOSED MAX. OCG. ) Lender's Address � - I I certifv that I have read this application and state that the I PERMIT FEE 25.�U 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 upon thea ove-mentioned property for inspection purposes. f SEE REVERSE FOR EXPLANATORY LANGUAGE • ' � �Y'�Z u O n Signature O ermittee Date f WORKERS' COMPENSATION DECLARATION 4 CE87e :i i aa) MISCELLANEOUS APPLICATION r se . [ hereby affirm that I have a certificate of consent to self COUI`:T`i v LOS .ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate oC\Yorkers•Compensation Insurance.or a certified copy thereof(Sec. 3800.Lab. C.I. Policy No. _CompanyFOR APPLICANT TO F!LL IN BUILDING ❑ ADDRESS - Certified Copy is !tereb} furnished. g qD ILDING DR ESS LOCALITY Certified copy is filed with the count\ building inspection LOCALITY NEAREST department. Temple City CROSS ST. Date Applicant NEAREST DISTRI T NO. GRRR{{��JJJlP TYPE //// OCESSED BY r r CROSS ST. /�/)yy'` ICONS:k i CERTIFICATE OF L\E\(PT ON FRO�[ '\CR1`E RS LEGAL t_ ff////'� COMPENSATION INSURANCE DESCRIPTION LOT NO. !BLOCK M P GRwAY I O. (CIRCLE-) STATE MAJOR SECOND LOCAL NO. OF -LDGS. }— (This section need not be completed If the ',%ork involved I-RAC- N.", ON LOT rSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars iS100) or less.) i USE SI.--E OF LOT EXISTING BLDG. I certify that in rlte perfo-mance of :he .cors: `or vItich 'his permit is issued. I shall not empley an} nerson !n any manner owNER so as to become Subject to the +.::rnpensatien La\re. x ,AIL _ 1 08 OCCUPANC`• GROUP ! Date—Applicant g ADDREss7 NOTICE TO APPLICANT: If, nitermakim_ :! s t:crriicatc i Xi c:T r �o �a�L�GL( e� � OCCUPA.N- LMAC Exemption, v-ou iiwuld become Subiect Compens:ition Pro,.isions of ,he Labor .bode, cou must forth- i APDL!CATiON =OF = !T HP.^nCy\l?PLF i with coltlpi% \cith afch cro\is;on,s o, .his ,crmit ihail be _ — RaiLEa u;E !1 �EOLDGv :NIP='--r.oN NO SUBC. deemed :t\(-,t;eQ. 'J - - LICENSED CONTRACTORS DEC L.-\R.�Tjo � OCCJPANCY iNSPEC71ON� Pan(c Devlres I llereby affirm :hat I am licensed undo:orcvisfonso Chanter SAFETY PERMIT (LIST I M5 BELOIV) t 9 Icommencmg with Section 000) of DI\rsion : Jt the Busi- NO. OF EXITS ness and P:�)fessions Code. and rm license is in 'ull force and ej legit. P\RKING 'Pq CES REOD I ' PR C`✓IO ED License Number Lic. Class LIMITED TIME USE N Contractor— _E w I am exempt ;rpm the icensin,L, reauirentents :is Ian: ! licensed architect or a -e_isiercd o-ofessional engtreer :IZE of No. OF INSPECTOR'S Z actin" :n :n\" l _ .•, _�,. -i1:I, ! =\(STING BLDG. -TOR!=3 SIGNATURE prcf-s 1L nal .U:1 _ llll- _ _ x ineSJaila ::otessicrls l.odel. iJPRESENT USE OF BUILDING FINAL APPROVAL _ L`.C. OI Re_ NIS. — — D:-, �? �r/• � _ H0%lE °r.NNER-BLILDER DECLARA ION NO. OF EXISTING BUILDINGS ON LOT AND USE V ''-rji''y } " I hereby affirm that 1 am exempt from the Contractor's I/1 I License La\a for the fotlokvimg reason (Section -031.5. Busi- ness and P-ofessions Codel: NO, PARKING ,7 d 1, as owner of the propert}. will do the \Fork and the SPACES PROVIDED structure is not intended or offered t(-.r sale (Section 1 1 7044. Business and Professions Code). �� 1 CONSiRLCTION LENDING AGENCY X PROPOSED USE OF BUILDING I Iferebc affirm that there is a construction lending ;tgencv C I for the performance of the �.vork for vNhich this permit is C C �� C )r issued (Sec. 3097,Civ.C.). Lender's Name s la 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 thea ove-me tioned property for inspection purposes. SEE REVERSE- FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, nr a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.) Policy No. I Company ADD DN FOR APPLICANT TO FILL IN BUILDNG tJ - ❑ Certified copy is hereby furnished. BUILDING LOCALITY ADDR N- LOCALITY O Certified copy is filed with the county building inspection NEARES IDT department. LOCALITY CROSS ST. Date Applicant NEAREST y" DISTRICT No GROUP TYPE PROCESSED BY CROSS ST.1� D y CONST. V J CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP (CIRCLE) AY STATE MAJOR SECOND LOCAL } NO. (CIRCLE( 0 (This section need not be completed if the work involved NO. OF BLDGS. p TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG. cc I certify that in the performance of the work for which this E ON O permit is issued, I shall not employ any person in any manner OWNER U so as to become subject to the Workers' Compensation Laws. /'„ OCCUPANCY GROUP MAIL LU ESS $ /V/ FFF�� a ADDR Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate of CITYq OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Cede, 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 Q (LIST ITEMS BELOW) No. of EX ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. d PARKINSPACES REO'D F—= PROVIDED 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 m my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date ^� v I` HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS C3 ,....MEF. ON LOT AND USE B-4- ,., a :'",—F 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 �Jlfi;:L-i i._!ss y s1`4•'-'1 SPACES PROVIDED �\ ` ' --- ': i /•)y ❑ I, as owner of the property, will do the work-and the -- structure is not intended or offered for sale (Section Li'=` - 7044, Business and Professions Code). M t PROPOSED USE 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's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 4.0 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, TOTAL FEE 0.4 and hereby authorize representatives of this County to enter upon thve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE IL z-6-!7/ ISignat re of Permittee Date WO! KERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L LA N E O 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.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. ADDRESS .417-1 5206 ROSEMEAD, BLVD LOCALITY Certified copy is filed with the county building inspectioni LOCALITY SAN GA BRI EL, CA . 91776 NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP TYPE PR SSED BY CROSS ST. O _ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL •d J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP 't /SIG HWAY rvo.��/7_�pJ (CIRCLE) STATE MAJOR SECOND L AL 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 C� permit is issued, I shall not employ any person in any manner OWNER I—CHANG CHEN so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ' � DDR ESS 2700 MONTEREY RD, o e-- Date Applicant LLLI TEL NOTICE TO APPLICANT: If, after making this Certificate of CITY SAN MARINO NO.* 818-441 -4698 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 ❑ I o Spec. Knowl. El 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 JJ License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ 1 am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSP CTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). PRESENT USE OF BUILDING SET UP FOR FINAL APPROVAL 0 Lic.or Reg.No. Date _ APPLIANCES STORE HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's el 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 (' "�.._ :i Vo 7044,Business and Professions Code). •• - .. A? CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency THE RETAIL SALE OF MAJOR for the performance of the work for which this permit is APPLIANCES. issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address / PERMIT FEE Q I certify that I have read this application and state that the VVV above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby orize represe tives of this County to enter TOTAL FEE up n th.ab - entioned ert inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby a cert that•I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDIN&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 ENEAREST Certified copy is hereby furnished. uILDING DORESSs�0b O Certified copy is filed with the county building inspection OCALITY/ n / Jrifdepartment. . Date Applicant NEAREST DISTRICT NO. GROUP TYPE P OCES5ED BY CROSS ST. � �j iQ CONST 0 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O 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. -� d I certify that in the performance of the work for which this permit is issued, I shall not employ any person p P Y eron in anmanner OWNER of building: C e.n y so as to become subject to the Workers' Compensation Laws. ItMAIL () n OCCUPANCY GROUP2i] I , o DDRESS�70 Mom :� lUp'Date ApplicantL J TEL' j' OCCUPANT LOAD o_ NOTICE TO APPLICANT: If, after making this Certificate of ITY42M �Inr7. (i7� No. �1 �� flD L4 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. El 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. Name of business : ttkt TI /p t�PAPARKING REQ'D PROVIDED 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 NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG �TUBE iness and Professions Code). FINAL APPROVAL Vi-RESENT USE OF BUILDING / PrL• �. i` Lic.or Reg.No. Date (( HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 00 . O' FEE ON LOT AND USE I-hereby affirm that I am exempt from the Contractor's ,a) / _ _ License Law for the following reason (Section 7031.5, Busi- �1 '►/ ?fi?? ?}—{_''.`(� -_ ness and Professions Code): NO. PARKING ® ✓J-M/�• - Iyt SPACES PROVIDED I I ,•L}%,i4;LE ^+ ; i�f) .'„-=Ji' ElI, 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 ROPo sED 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 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 above-mentioned property for inspection purposes. f J SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date WORKERS'COMPENSATION DECLARATION 75M444 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 ,i3tsure, 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 BUILDING �P-D ADDRESS , Certified copy is hereby furnished. wUILDIN.DR re LOCALITY `GI, 0 Certified copy is filed with the county building inspection LOCALITYJ r L NEAREST department. r CROSS ST, Date Applicant NEAREST �(i'�j/ DISTRICT O G OUP TYPE PROC SS BY CROSS ST. Ba ?1 4 Vic 1 �`J CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 6 COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SEC 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 I certify that in the performance of the work for which this �E" BLDG. EXISTING � permit is issued, I shall not employ any person in any manner OWNER I— C J1 C I 0— o so as to become subject to the Workers' Compensation Laws. MAIL n oYI p OCCUPANCY GROUP Ei2' o ADDRESS !-- Date E3 Applicant NOTICE TO APPLICANT: If, after making this Certificate of clrY 4r - rTio� 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 effect. PARKINGSPACES READ D PROVIDED License Number Lie. 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 engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING � Lie.or Reg.No. Date / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS O o o s 8 8 ON LOT AND USE ' I hereby affirm that I am exempt from the Contractor's o 0 0 0 0 0 o z 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). PROPOSED USE OF BUILDING CJI W ,p 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's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE 09 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 mjW the above-mentioned property for inspection purposes. ' \ �EE REVERSE FOR EXPLANATORY LANGUAGE _ i L,)_f, nature of Permitte Date WORKERS'COMPENSATIONDECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab. C.) if Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS F1Certified copy is hereby furnished. BUILDING �71/� ♦./ oY I� LOCALITY DDRESS �vL �li• f,K'L�'l.>�/ V Com•' ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. An Date Applicant NEAREST DISTRIC� NO.r ROUP TY E PROCESSED BY CROSS ST. Ci t.t:3 / CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v > COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP (CIRCLE) R LE) STATE MAJOR SECOND LOCAL NO. (G IRCLE) (This section need not be completed if the work involved NO. OF BLDGS. 0 p TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS - by the permit is for one hundred dollars ($100) or less.) USE OF / 0 SIZE OF LOT EXISTING BLDG. J I certify that in the performance of the work for which this V permit is issued, I shall not employ any person in any manner OWNER ^a IivL. O i�fc 6' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP DDRESS � `^.. ^ LU Date Applicant �^ / TEL ry NOTICE TO APPLICANT: If, after making this Certificate of IT��CC. G�c L'-' NO. `I ( 5 7`i OCCUPANT LOAD Exemption, you should become subject to the WorkersAPPLICATION 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 q (LIST ITEMS BELOW) No. of Exlrs ❑ 9yfcommencing with Section 7000) of Division 3 of the Busi- ni:ss and Professions Code, and my license is in full force and effect. PARKING SPACES REO'D E:= PROVIDED Rf - r�cense Number Lie.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- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg.No. Date- HOME ate HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's z 1 1 0.'1 A 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 # o o D o 88 structure is not intended or offered for sale (Section o 0 ,0 0 o D 0 z 7044, Business and Professions Code) ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 0.4, 1 1 -83 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 above information is correct. I gree o comply with all County ISSUANCE FEE ordinances and State laws re!at' to building construction, TOTAL FEE a here tithorize represeNtsofthis County to enter Y01 e-mentio edfor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE _b - 163 ure of Permittee Date WbRKER6'COMPENSATION DECLARATION CE 8754(11-84) MISCELLANEOUS APPLICATION I hereb}= affirm,+.hat 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 fl a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING o2� � ADDRESS p Certified copy is hereby furnished. BUILDING / LOCALITY ` ADDRESS �+ FICertified copy is filed with the county building inspection LOCALITY NEAREST department. cRoss sT. Date Applicant NEAREST DISTRICT NO. GROUP TYPE RO ESSED BY CROSS ST. �J�G'' CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL _ COMPENSATION INSURANCE DESCRIPTION LOT NO•. BLOCK MAP_ IGR AY 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 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 L so as to become subject to the W ke s' Co do Laws. �� o MAIL OCCUPANCY GROUP,. ADDRESSd5w -- Date Applicant L I TEL OCCUPANT LOAD NOTICE TO APPLICANT: If, of r making this Certificate of CITY (MI/7 No. ran 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. El 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. PARKING REQ'D PROVIDED 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 NO. OF INSPE CTOR 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 Ci CLE. S' 6 Z P HOME OWNER-BUILDER DECLARATION NO. OF E ISTING 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 structure is not intended or offered for sale (Section 7044,Business and Professions Code). o(/ CONSTRUCTION LENDING AGENCY PROPOSED USE OF B-blf-� r Jp 1jp�Zt J 5 7 2 2 A I hereby affirm that there is a construction lending agency # ® o 88 for the performance of the work for which this permit is C issued(Sec. 3097,Civ.Q. N � v o • o o © N Lender's Name 011 • z PROPOSED MAX. OCC. Lender's Address 1 0,21 —86 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 ilpon t above-m ted property for insp ction purposes. f/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dated WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS A PL9CAT0 N 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 euILOING ADDRESS ❑ Certified copy is hereby furnished. IL0IN5216 N. Rosemead Blvd. LO - DRES CALITY ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY Temple Cit CROSS ST. sm Date Applicant NEAREST DISTRICT NO. UP TYPE PR ESSED BY "- CROSS ST. Sereno � O �� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT NO. BLOCK _ HIGHWAY COMPENSATION INSURANCE NOP (CIRCLE) STATE MAJOR SECOND LOCAL .. (This 50CtlOn need not be completed NOOF BLDGS. if the work involved TRACT NOW ON LOT USE ZONE SP CIAL CONDITIONS - UC. by the permit is for one hundred dollars ($100) or less.) USE OF IE OF LOT EXISTING BLDG. �� LC I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner eo NER Contem orar Investments so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP 0 I(VIDRESS 5200 N. Rosemead Blvd. CL Date Applicant t TEL 0) NOTICE TO APPLICANT: If, after making this Certificate of ITY San Gabriel, NO• 285—9955 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 INSPECTIONNO Spec. Knowl. ❑ deemed revoked. Panic Devices 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- nesr.i andProfessions 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 DATE DATE FROM: TO: , ❑ I am exempt from the licensing requirements as I am a . licensed architect or a registered professional engineer SIZE of t NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 27 x 37 STORIES 1 SIGNATURE iness and Professions Code): FINAL APPROVAL C` ESENT USE OF BUILDING car radio install Lie.or Reg.No. Date z1923A NO.of EX{STING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE #'D,o 0 -'8 8' I hereby affirm that I am exempt from the Contractor's License Law for',the following reason (Section 7031.5, Busi- "0 0 0 "0 0 0 0 z Hess and Professions Code): NO. PARKING F SPACES PROVIDED ❑ 1, as owner 'of the property, will do the work and the D rJ 1 2—II 3 structure is not intended or offered for sale (Section 7044, Business and Professions Code). I ROPOSED.USE OF BUILDING - - CONSTRUCTION LENDING AGENCY .. Car rad l0 installations 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 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 /✓_ T c ordinances and State laws relating to building construction, roTAL FEE U0 C / and hereby authorize representatives of this County to enter up he ab o -men oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE May 9,19 8 3 W 9�tgha(Tq Permitte Date WOKERS'COMPENSATION DECLARATION CE 87 5 (2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES 'BUILDING-AND SAFETY DIVISION insurz,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 -- LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection1,or // NEAREST department. Lo LITY17F/11 P2.00!5'/� J // B ` l� !tom( cRoss sr. Date Applicant AREST \ DISTRICT�]� G UP TYPE // PRO ED BY CROSS ST. ` 5a 7 CONST._ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VV/o V v COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK LN P RIGR Y . (CIRCLE) STATE MAJOR SECO D LOCAL Q- (This section need not be com leted if the work involved NO. OF BLOGS, 0 p TRACT NOW ON LOT E ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT EXISTING BLDG. �� cc 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 NSR -� UJA f" so as to become subject to the Workers' Compensation Laws. AIL W `ry OCCUPANCY GROUP ADDRESS 3 J K i D. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY 'LlNo� J 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 GEOLOGY INSPECTION El No Spec. Knowl. ❑ deemed revoked. Panic DBVIC@S El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT L J (LIST ITEMS BELOW) No. OF Exlrs ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING SPACES REp'D O PROVIDED License Number Lie.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO. OF acting In my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). rNO. ENT USE OF BUILDING �� FINAL APPROVAL Lie.or Reg.No. Date- 0 ate HOME OWNER-BUILDER DECLARATION f EXISTING BUIiDINGS T AND USE - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- NO. PARKING Hess and Professions Code): sPAces PROVIDED ' ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # • • o a 8 8 7044, Business and Professions Code). P OSED USE 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 0 71 1 .'-85 issued(Sec. 3097,Civ.C.). i Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE - I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter bu upo a ve-mentioned op t or inspectT furrposes. SEE REVERSE FOR EXPLANATORY LANGUAGE po e , Date ��/y\v f WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION `f 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 BUILDING ADDRESS Certified copy is hereby furnished. UILDINGK220 ROSEMEAD BLVD LOCALITY ADDRESS J (Y El copy is filed with the county building inspection TEMPLE CITY NEAREST department. ocALITY CRO SS's T. Date Applicant - EARE ST - DISTR CT NO. GR UP TYPE PR SED BY CROSS ST. BROADWAY � CONST. , CERTIFICATE OF.EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SEC D LOCAL NO. OF BLDGS. NO. (CIRCLE) a (This section need not be completed if the work involved TRACT NOW ON LOT. USE ZONESPEC IAL CONDITIONS " O' by the permit is for one hundred dollars ($100) or less.) USE OF /�I IJP SIZE OF LOT EXISTING BLDG. c I certify that in the performance of the work for which this LAYTON CONST CO . INC VVV 0 permit,is issued, I shall not employ any person in any manner N so as to become subject to the Workers' Compensation Laws. tj OCCUPANCY GROUP FPN r�A2ADRESS P.0 • BOX 60 aDate Applicant 7 '1 U) NOTICE TO APPLICANT: If, after making this Certificate of so ,TY WALNUT No`" ( l4 594-2645 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. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic D@VIC@S ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO, OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and - PARKING effect. SPACES REO'D D- PROVIDED O License Number Lic.Class LIMITED TIME U 5 A 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 INSPECTORS L 8&jR acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES swruRE iness and Professions Code). &oP<ESENTUSE OF BUILDING OFFICE FINAL.APPROVAL Lic.or Reg.No. Date I NO. OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON-LOT AND USE � C 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). I OFFICE OPOSED USE OF B'ILDING CONSTRUCTION LENDING AGENCY \V\ I hereby affirm that there is a construction lending agency for the I performance of the work for which this permit is t issued(Sec. 3097,Civ.C.). l' / Lender's Name 'PROPOSED MAX:OCC. r, Lender's Address PERMIT FEE VJ� Rbtion I have r a this application and state that the i or' ct. I agree to comply with all CountyISSUANCE FEEd to t•ws relating to building construction, or ze epresentatives of this County'to enterTOTAL FEE nt' rred property for ins�iioon rpp ses• SEE REVERSE FOR.EXPLANATORY LANGUAGE Si ature of Permittee Date i I I WORKERS'COMPENSATION DECLARATION0MISCELLANEOUS APPLICATION 1. 20-0063DPW 7 2/90 006 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,Wdrkers'Compensation Insurance,or i a certified,copy thereof (Sec. 3800, Lab.C.)" - PolicyNO. Company .: i FOR APPLICANT TO FILL.IN BUILDING • BUILDING ADDRESS f, ADDRESS ❑ Certified copy.is hereby;furnished. $ `7a}p tai FF LOCALITY ❑ Certified copy is filed with the county building inspection CITY t department. , s ct pr ZIP J'�7� NEAREST 'r: - CROSS ST. Date Applicant SIZE OF LOT NO.OF BCDGS.NOW ON LOT DISTRICT NO. GROUPPROCESSED BY CONST. Q CERTIFICATE OF EXEMPTION FROM WORKERS' J TYPE ( 1 COMPENSATION INSURANCE TRACT BLOCK LOT NO. NAP HIGHWAY V (This section need not be completed if the work involved NO. (CIRCLEI STATE MAJOR SECOND LOCAL.. p ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less.) USEZONE SPECIAL CONDITIONS � I.certify that in the performance.of the work for which this rrc erfy er TEL No. Q permit is issued.I shall not employ any person in any manner Compensation so as to become subject to the Workers' Compensa on Laws. OCCUPANCY GROUP ( Date Applicant . CITY ZIP L� Z NOTICE TO APPLICANT: if'. after making this Certificate of Exemption. you should become subject to the Workers' OCCUPANT LOAD Compensation provisions of the Iabor Code,you must forthwith APPLICATION FOR EXIT HARDWARE: comply revoked.with such provisions or`this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 58 Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LI r 1 9(commencing with Section 7000)of Division 3 of the Business ST ITEMS BELOW) NO.OF EXITS and Professions Code.and my license is in full force and effect. Name ot Bus-Luess License Number Lic. Class PARKING SPACES REQ'° PROVIDED ( I I Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements-as I am a DATE DATE licensed architect or a registered professional engineer FROM: TO: s acting in my professional capacity (Section 7051,Business SZE OF NO.OF and Professions Code). EXISTING BLDG. STORIES INSPECTOR'S SIGNATURE, Lic. or Reg. NO. -- Date V PRESENT USE OF BUILDING FINAL APPROVAL(?/ .Cr 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): 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 7044,1 PROPOSED USE OF BUILDING Business and Professions Code). I i 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 a 1 (Sec. 3097, CIV. C.). PROPOSED MAX.OCC. Lender's NameAPTEL NO. - I PLICANT(PRINT) /gi /4t A/� L ri✓ 6 'a$�—�� Lender's Address ADDRESS I j I certify that I have read this application and state that the �" ,KR.40 /we-, SMJC-TA- above information is correct. I agree to comply with afl County PERMIT FEE 77 e 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. e f TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PeAittee Da e 1 WORKERS' COMPENSATION DECLARATION '°"'"0-006�'" M15C'tLLHIVtVuS ��rrr_r`.r►r rvr� 23DPW 12/90 I hereby affifm That I have a certificate of consent to self COUNTY OF LOS ANGELES B411LDING AND SAFETY DIVISION instfe,or a certificate of Workers'Compensation Insurance, or ` a certiited copy thereof (Sec. 3800, Lab. C.) __- Policy No. _ Company _ FOR APPLICANT TO FILL IN A BUILDING BUILDING ADDR SS ❑ Certified copy is hereby furnished. 5 0. LOCALITY �G2! Certified copy is filed with the county building inspection CITY �� ZIP NEAREST t' ,.:department. CROSS CT. Date Applicant _ SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICTT NO, I GROUP TYPE 14,46CESSED BY 47, CERTIFICATE OF EXEMPTION FROM WORKERS' O(� coNST. e COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY - No. (CIRCLET 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.) OWNER ''``__ TEL No. I certify that in the performance of the work for which this: property l'L (.�1 h permit is issued, I shall not employ any person in any manner ADDRESS 1 so as to. become subject to the Workers' Compensation Laws. � � m RO OCCUPANCY GROUPE4:1 Date Applicant CIT�aV\ z�� 9110 'Ifl SNOTICE TO APPLICANT:' If, after making this Certificate` OCCUPANT LOAD of: Exemption', you should becomesubject subject to the Workers' APPLICATION FOR E>:IT HARDWARE: Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business ' NO.OF EXITS El and Professions Code,and my license is in full force and effect. �l 1 z� �` "�✓'� PARKING'• License Number — Llc. Class SPACES REQ'D � PROVIDED 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 SIZE NO. INSPECTOR'S .acting in my professional capacity(Section 7051,BUSIneSS EXISTING BLDG. STORIES SI ATURE and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic. or Reg. No. Date .// HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS /�0 ON LOT AND USE O hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Ninfessions 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 7044X PROPOSED USE OF BUILDING ` Business and Professions Code). g �� c fit• 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.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 ordinances ad State laws relating to building construction,and hereby auth ize epresentatives of this County to enter upon ISSUANCE FEE the above- t' ed p erty for inspection purposes. TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE Si ure f Permittee D• e WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereb ,-firm that I have a certificate of consent to self in's>xr a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO Fi LL IN BUILDING ADDRESS a/(Jt ADDRESS �,{/ Certified copy is hereby furnished. BUILDI ADD RESNG S LOCAL TY l i 0 Certified copy is filed with the county building inspection LOCALITYNEAREST department. 1!5cRosS ST. Date Applicant NEAREST DISTRICT NO. GR Upp TYPE PR C SSED BY CROSS ST. - {/ ) CONST../ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL OE (� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP I6HWAY NO. CIRCLE) STATE MAJOR SE CON LOCAL ( NO. OF SLOGS. (This SBCneed not be completed lthe Work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS If by the permit it is for one hundred doll ($100) or less.) usE SIZE OF LOT EXISTING BLDG.of I certify that in the performance of the work for which this o permit is issued, I shall not employ any person any manner OWNER s� so as to become subject to the W r rs' Compen i La -s. MAIL OCCUPANCY GROUP' DateJ �;4Iican ADDRESS (p � I—s o, NOTICE TO APPLICANT: If, after making this ertificate of CITY No.rEL. OCCUPANT LOAD Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ With comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ ❑ deemed revoked. No'SpeC. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices a 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 r .effect. IN PARKG REq•D PROVIDED 1 SPACES KIN License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a PROM. ro: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIESi SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm 'that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 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). ;9.6 5 Q 4.A PROPOD USE OF BUILDING CONSTRUCTION LENDING AGENCY • • • • I hereby affirm that there is a construction lending agency 'L't a` a for the performance of the work for which this permit is f issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I Certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize represe atives of this County to enter TOTAL FEE u t above mention r erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit e Date WORKERS* CON-1 PF MAHON OBTARAI PIN MISCELLANEOUS APPLICATION I,herebx- affiren that I 11,1%re a Cel-jifiCcjle of coll"'I.11 lo self COUN'FY OF I.OS ANGI-1-17S 13111I.DING AND SAFETY DIVISION II insure.or a certificate of \Voikcis' Comimismion hisill;tIlt:C,Ill a certified cop)' (hereof (Sec. 3800. I-ah. C.) J Policy No. Company FOR APPLICANT TO FILL 114 BUILDING BUILDING ADDRESS. ADDRESS ElCertified colt}' is 11cl-ch) lujilislIC& Al. LOCALITY El Certified copy is Idled with the comm building m,,I)CCh0II CIT ZIP NEAREST department. Kea,, (a,4rl -e_1 1—C,,1 6 CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY I CONST. LOT NO. N11 S ION INSURANCE Al' HIGHWAY ✓ CO- PLN- AI* IPACI` BLOC K NO. CIRCLE, STATE MAJOR SECOND LOCAL R I I I R Al F Of (This section need nol lie completed if' the "ork. iiw)hed ASSESSOR MAP BOOK PAGE PARCEL I USE ZONE SPECIAL CONDITIONS 1)), the permil is for one hundred dollars (.S. IOU) or lc%s.) I certify Ilml in the pci-lomiance of dic Mork for Mli ii, ihi� OWNER TEL NO. perinit is ISSUCLI. I Shall 1101 CIIII)IO\ an} person Ill .ill}' Illillillci — I — I � so its to become subject to the Workers' (ompen,mion Lalvs. ADDRESS OCCUPANCY GROUP Date Applicant CITY NOTICE TO APPLICANT: 11'. after milking This ( Clti;ILZjIC OCCUPANT LOAD of' Exemption. VOLI ShoUld become -SLihiect to the WcAcrs' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.NOLI 11111'st f"III'mith comp(}' with such provisions or this I)CIIIIit siUlll be LICellIC(I IRAILERUSE L-1 GEOLOGY INSPECTION revoked. — '7 j"[ No Spec.Knowl. ❑ LICENSED CONI -ORS DECI ARAI I()N' OCCUPANCY INSPECTIONPanic Devices I hereby affirm that I am licensed LIIILICF I)I-0ViSi0IIN Of 01:11)ler SAFETY PERMIT IA LIST ITEMS BELOW, NO.OF EXITS 4I 9(commencing willi Section 7000)of Di\IS1011 .3 of the Business less and Professions Code.and my license is in full force and C.-Ilm. PARKING: SPACES REQ'D License Number L (ic. klsS D PROVIDED ('01111,3CtOr DateT LIMITED TIME USE DATE DATE I El I ani exempt front the licensing reLtimemems its I ani it I FROM: TO: licensed architect or it re6istered professional cni:ineer acting in In) professional c-,ip:wi(\ (Section 701, liLl,ilICSS "ZE OF N1 01 INSPECTC)r"S and Plole, EXIS! ,BLDG. _j SI'OR I 4TURE ions Code). Lic. or Reg. No. Dmc PRESENT USE OF BUILDING FINAL APPROVAL C �-2 HOME OWNI:R-131 4I.DER DF( LARAHON 1,11.1.01 XI�IINGBUILDINCS I UN LOT AND USE I hereby affiiiii that I am cwtupt hoin ilic Conimcioi's I ;L-C sc Law fur the following reason (Section 7031.5. lltiSine's and A5 Professions Code): NO.PARKING SPACES PROVIDED ❑ 1. as owner of the property. \\ill III. the \\oik :Ilial stlucturc is not inicilded oi. killcicki Iol sale (.S'xiloll PROPOSED USE OF BUILDING BLIS11"IeSS' and Professions Code). CONSTRUCTION LENDING AGI:N( Y I herchy affirm flial there is :I construction IciiLlmu for the perItirmance of the work for MIMI (his permit is IsSticd ------- (Sec. 3097. Civ. C'.). PROPOSED MAX,OCC. Lender's Name TEL NO. A3*Wj IT) C,HE &-16- 3 7-r- Lendei's Address ADDRESS I certify that I INIVC read [[]is al)1)11C:111011 and SIJIC (11:11 [lie above information is correct. I agree 10 C01111)1y With Al CTLInly PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatiIcs of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of t1fill ee Dale { I WORKIRS' COMPENSATION DECLARATION (6M444 MISCELLANEOUS APPLICATION 20-0063DPW?2/90 I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES BUILDING:.AND SAFETY DIVISION insure,or a cereifieate of,Workers'Compensation Insurance,or t. a certified cope thereof (Sec. 3800, Lab.C.) " Policy No. Company FOR APPLICANT TO FILL IN BUILDING ' BUILDING ADDRESS p r ADDRESS - ❑ Certified copy.is hereby:furnished. X j214 B-1 1�0&ckI F.L,V 0 LOCALITY ❑ Certified copy is filed with the county building inspection CITY zip department. SAM CA 6 R I L L 9177C 22 a� GROSS ST. Date _ Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE I PROCESSED BY 4 AT CERTIFICE OF EXEMPTION FROM WORKERS' corvsT. TRACT BLOCK LOT NOC . COMPENSATION INSURANCE No HIGHWAY Rc e 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 ($100) or less.) C s I certify that in the performance.of the work for which this ,p4parfy Uwner TEL NO. LL permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. ADDRESS a OCCUPANCY GROUP ( Date Applicant CITYziP NOTICE TO APPLICANT: If; after making this Certificate OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: ( comply With such provisions OC this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTION LICENSED CONTRACTORS DECLARATION [$ 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 NO.OF EXITS and Professions Code.and my license is in full force and effect.2 Name ot Business /l PARKING• REO'D E::= PROVIDED D License Numbei Lic. Class SPACES 1 i Contractor _ Date LIMITED TIME USE ❑ I am exem:rt from the licensing requirements as I am a DATE DATE FROM: TO: licensed architect or a registered professional engineer acting in my professional capacity (Section 7051,Business SIZE OF NO.OF INSPECTOR'S (` I and Professions Code). EXISTING BLDG. STORIES SIGNATURE. Lic. or Reg. No._ - Date PRESENT USE OF BUILDING FINAL APPROVAL S-'7- 3 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 { PIofessions Codc): 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 70441 PROPOSED USE OF BUILDING ( DE Q P-4FN7lN-i— Business anti Professions Code). I i 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 f (Sec. 3097, Civ. C.). 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 ali County PERMIT FEE ordinances and Siate laws relating to building construction,and hereby authorize representatives.of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. 1 ( TOTAL FEE _. ... X SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu e of Permittee Date IWORKERS'COMPENSATION DECLARATION CE 875(2-80) 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 NoZ1P6I Company ,ZT 1 Ui5 FOR APPLICANT TO FILL IN BUILDING `�ja DDRESS T ❑ Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS 5214 N. Rosemead Blvd. ❑ _ Certified copy. ' .y is filed h the cou building inspection NEAREST part ent. - A LOCALITY Tem le Cit - CROSS ST. Date A Applicant NEAREST DISTRICT NO. G UP TYPE PRO ESSED BY CROSS ST. r/ - CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VX COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rvo: - `/ (CIRCLE), STATE MAJOR SECOND LOCAL �• NO. OF BLDGS. rL (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE PECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) C� USE OF � SIZE OF LOT EXISTING BLDG. /� - I certify that in the performance of the work for which this (�� I i� 0 permit is issued, I shall not employ any person in any manner OWNER Contemporary Investments so as to become subject to the Workers' Compensation Laws. l i breOCCUPANCY GROUP U MAIL 5220 V. Rosemead Bi&. LLI Date Applicant ' - ADDRESS � � 0; TEL NOTICE TO APPLICANT: If, after making this Certificate of CITY San GaNo.- 287-9754 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❑ deemed revoked. No Spec. Knowl. ❑ PanIC D8VIC8S ElLICENSED 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 700 0) of Division 3 of the Busi- ness and Professions Code, and my license is in fl force and eff t. PARKING SPACES REO'D O PROVIDED D Li nse Number Lia Clas RR r ,� LIMITED TIME USE C.1 o tractor Date'_ �3 ". DATE DATE ElFROM: 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). PRESENT USE OF BUILDING '` A,) FINAL APPROVAL Lie.or Reg.No. Date- V V V HOME OWNER-BUILDER DECLARATION NO. OF EXIST) BUILDINGS ON LOT AND USE ,Z 2 1 5,7 A I hereby affirm that, I am exempt frorn-the Contractor's License Law for the following reason (Section 7031.5, Busi- nessand Professions Code): NO. PARKING' SPACES PROVIDED f , ❑ I, as owner of the property, will do the work and the o 0 0 0 0 0 o z I e structure is not intended or offered for sale (Section 7044, Business and Professions Code). 0.5 2 3-83 PROPOSED USE•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's Name PROPOSED MAX.OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL. Feej and hereby authorize representatives of this County to enter Q pon the (fiove-mentioned property for in ectio purposes T SEE REVERSE FOR EXPLANAORY LANGUAGE �` )3 Signature of Permittee Dale WORKERS' COMPENSATION DECLARATION 0-0063UPW 12/90 2MISCELLANEOUS APPLICATION • 0-006 ' I he. by affirm that 1 have a certificate of consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Il insure, or a certificate of Workers' Compensation Insurance, or l a certified copy thereof (Sec. 3800, Lab. C.) r Policy No. _ Company FOR APPLICANT TO FILL IN BUILDING _..---- • - BUILDING ADDRESS ADDRESS ❑ Certified copy is hereby furnished. rj�t4 ,J, (Zp E.MtA� IGLU LOCALITY f ❑ Certified copy is filed with the county building inspection ITY ZIP NEAREST department. —k t_t G 11-1 G CROSS ST. Date Applicant _ - _ _ _ SIZE OF LOT NO.OF BLDG$.NOW ON LOT DISTRICT NO,., GR P TYPE P CESSED BY (Jy CON ' CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT No. COMPENSATION INSURANCE MAP HIGHWAY NO. (CIRCLE, STATE MAJOR SECOND LOCAL (This section need not be completed If the work Involved ASSESSOR MAP BOOK PAGE PARCEL USE 70NE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) certify that in the performance of the work for which this WNE NTEL NO. _ i permit is issued, 1 shall not employ any person in any manner f.t so as to become subject to the Workers' Compensation Laws. °DRE OCCUPANCY GROUPU-1 -210c, MOIS•LEt?& 221 • Date Applicant_ _ CITY p,[ ZIP _ NOTICE TO APPLICANT: If, after making this Certificate (AA[zk.ao I Q"o v OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forthwith comply with Such provisions or this permit shall be deemed TRAILER U5E❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION occuPANcvwsPEcnoN❑ 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 Business No.of EXITS El and Professions Code,and my license is in fuli force and effect. �l PARKING License Number --- Lic. Class ._ SPACES REO'D � PROVIDED: Contractor __ Date ________,— —_ LIMITED TIME USE DATE DATE ❑ I am exempt from the licensing requirements aS I am a FROM: TO: licensed architect or a registered professional engineer actin in my professional capacity y (Section 7051, Business SIZE OF NO.OF INSPECTOR'S g p } EXISTING BLDG. STORIES SIGNATURE and Professions Code). ' LIC. or Reg. NO. DiItC — PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS c6NJ� 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): NO.PARKING SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING Business and Professions Code). R� CONSTRUCTION LENDING AGENCY c* I hereby affirm that there is a construction lending agency for FAF� ` ,� �� pr, the performance of the work for which this permit is issued (Sec. 3097, Civ.C.). L PR'f� RA 0 sem` Lender's Name APPLICANT(PRINT) TEL NO. T / IK�IA ` ASSa Lender's Address ADDRESS I certify that I have read this application and state that the ' !• v tZ t [. 1 above information is correct, I agree to comply with all County PERM IT FEE ordinances and State laws relating to building construction,and ""'' p,•t hereby authorize representatives of this County to enter upon ISSUANCE FEE ' thea ove-mentio ed property for inspection purposes. TOTAL FEE ..[ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perr tee bate ""3 WORKERS' CUMMNS.AILUIN 20-0063DPW12/90 STI 1L 0%,,L L.a-.L'11 uY..vvv A >, I hereby affirm that I have..a certificate of consent to self COUNTY OF LOS ANGELES - BUILDING:.AND SAFETY DIVISION - 'Tinsure or a certificate of,Workers' Compensation Insurance, or n 11 A certified copy thereof (Seca 3800, Lab. C.) t Policy No._ Company FOR APPLICANT TO FILL IN BUILDING i BUILDING.,ADDRESS ADDRESS ❑ Certified copy.is.hereby:furnished. LOCALITY ❑ Certified copy is filed with the county building inspection CITY zip department. f'� 1 I > 7 NEAREST. P G �ir iG / moss sr. Date App .licant SIZE OF OT NO. BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY >_ CONST, CERTIFICATE OF EXEMPTION FROM WORKERS" TRA CT BLOCK LOT No COMPENSATION INSURANCE MAP HIGHWAY 0 No. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the Work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($'.100) or less.) USE ZONE SPECIAL CONDITIONS TEL I certify that in the performance.of the work for which this s r.f er V I permit is issued, I-shall not employ any person in any manner CC10,1 41 p LU so as to become subject to the Workers' Compensation Laws. ADDRESS �- OCCUPANCY GROUP Date Applicant . CITY ZIP NOTICE TO APPLICANT: If; after making this Certificate OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the.Labor 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 rrLJ (LIST ITEMS BELOW) 'F]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._ ame o usimes. License Number LIC. Class _ PARKING• REO'D E PROVIDED u (J SPACES I Contractor Date LIMITED TIME USE I ❑ I am'exempt from the licensing requirements as I am a DATE DATE FROM: To: licensed.architect or a registered professional engineer acting in my professional capacity (Section 7051, Business SIZE OF NO.OF INSPECTOR'S and professions Code). EXISTING BLDG. STORIES .SIGNATURE. Lic. or Reg. No. - Date PRESENT USE OF BUILDING FINAL APPROVAL ^2 HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS 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, Business and Professions Code): NO.PARKING El1, as owner. of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044,1 PROPOSED USE OF BUILDING Business and Professions Code). I V l -o iZ : --;,qL fALEI 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 i Lender's Name APPLICANT(FAINT) - TEL NO, Lender's Address A Ess 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. TOTAL FEE X I�/� `'� SEE REVERSE FOR EXPLANATORY LANGUAGE S i giypze of Permittee Date WORKERS'COMPENSATION DECLARATION qE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby-affirm Othat I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or certificate a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING AD DR ES Certified copy is hereby furnished. BUILDING ® ADDRESS T LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. �1 ►' ��`��ZP� �U CROSS ST. CJ Date Applicant NEAREST Q y DISTRICT NO. GROUP TYPE P OC SSED BY CROSS ST. 51?1r,/r�Q �� /�/_ CONS T CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v'' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOC. MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND CAL NO, OF BLOGS. (This 50CtlOn 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 x usE of /` SIZE OF LOT `ODL` �� EXISTING BLDG. C- I certify that in the performance of the work for which this a- permit is issued,I shall not employ any person in any manner OWNER eo �!� �� - o so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP o Date Applicant ADDRESS 'P0 lQ0 1�� C~s UJ NOTICE TO APPLICANT: If, after making this Certificate of CITY Vi ITvo. �(.� OCCUPANT LOAD O z Exemption, you should become subject the Workers' APPLICATION FD EXIT HARDWARE: Compensation provisions of the Labor Code,,you must forth011-7&1- 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 REgD PROVIDED �� SPACES ��JJ License Number Lic. Class I �— 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 ExlsrrnG DG, �O STORIES SIGNATURE iness and Professions Code). �J�J/ �� PRESENT USE OF BUILDING FINAL APPROVAL �� s / /s C/(Cj Lic.or Reg.No. Date I -7 HOME OWNER-BUILDER DECLARATION NO. OF ExlsTl G BUILDINGS ON LOT,AND US 1 — 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.PAS ING I, as owner of the property, will do the work and the SPACES ROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). �'��p CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINGQ. 2 6 0 7.6 A I hereby affirm that there is a construction lending agency # 0 0 0 03,0 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C,). l o - 80.50 Lender's Name PROPOSED MAX. OCC. Lender's Address C O 9 80,5010 PERMIT FEE I certify that I have read this application and state that the •1 208-86 above' ormation i c rect.I agree to comply with all County ISSUANCE FEE orcVpa es and S a e 1 ws relating to building construction, an n eby t r presentatives of this County to enter TOTAL FEE u o e io rt for inspection purposes. I� SEE REVERSE FOR EXPLANATORY LANGUAGE ��=ture of Permittee Date WORKERS' COMPENSATION DECLARATION bM444 20-006DPW?2/90 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 cerl_ifieate of Workers'Compensation Insurance, or ' I a certified.copy thereof (Sec. 3800, Lab. C.), ' t FOR APPLICANT TO FILL IN BUILDING y �� Policy No. Compan aDOREss Ali y -- -. BUILDING ADDRESS ❑ Certified copy-is hereby:furnished. X t m �V LOCALITY ❑ Certified copy is filed with the county building inspection CITY �f *+ ZIP NEAREST. ' department. 1 -{ 1� CROSS ST. ' Date Applicant SIZE OF LOTNO.OP gLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY G 1 CERTIFICATE OF EXEMPTION FROM WORKERS' coNST. COMPENSATION INSURANCE TRACT BLOCK LOT NO..a(i MAP HIGHWAY (, 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 09 by the permit is for one hundred dollars ($100) or less.) �� 0 C E91419- y E:r p/ TEL NO. i + I.certify that ilr the performance.of the work for which this G" 441-441 ' Is permit is issued. I shall not employ any 'person Compensation any manner ADDRESS a so as to become subject to the Workers' Com ensation.Laws. p OCCUPANCY GROUP r1 { Date 1 03 Applicant AJ CIAP _ CIT j ZIP NOTICE TO APPLICANT: If, ingik this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of theLaborCode.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 D (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business Name O us loess NO.OF EXITS and Professions Code.and my license is in full force and effect. . PARKING• REQ'D D PROVIDED D License Numbei Lic Class 3NMN U�7v �DL�( SPACES 1 I Contractor — Date LIMITED TIME USE DATE DATE ElI am exem rt from the licensing requirements as I am a FROM: TO: licensed aichitect or a registered professional engineer acting in my professional capacity (Section 7051,Business SIZE .NNO.OF INSPECTOR'S ( ( and Professions Code). EXISTING BLDG. C+V STORIES SIGNATURE, Lic. or Reg. No. - Date PRESENT USE OF BUILDING jL� 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, Business and I Professions COdf): 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,X PROPOSED USE OF BUILDING G Business anJ Professions Code). 1 i 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 t (Sec. 3097, Civ.C.). PROPOSED MAX.OCC Lender's Name {CANT( INT) T L NO. Lender's Address A DRESS ��y I certify that I have read this application and state that the � Q `"5d HL,Vn 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 I the above-mentioned property for inspection purposes. I TOTAL FEE % SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu of ennittee Date WORKERS' COMPENSATION DECLARATION 200063DPW;2190 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 BU DING ADDRESS ADDRESS ❑ Certified copy-is hereby:furnished. g �� p Mn,� • I/KM LOCALITY ❑ Certified copy is filed with the county building inspection cory GG ZIP NEAREST department. cRoss sr. Date Applicant SIZE OF LOT NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUPTYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' CONST. I - COMPENSATION INSURANCE TRACT BLOCK LOT NO. 0 Q MAP HIGHWAY 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 by the permit is for one hundred dollars ($100) or less.) 0 I.certify that in the performance.of the work for which this TIerfy er TE N U permit is issued.I shall not employ any person in any manner 4 u g Q_ so as to become subject to the Workers' Compensation Laws. ADDRESS '2-700 0 OCCUPANCY GROUP z IzV Date - Applicant . CITYZIP p NOTICE TO APPLICANT: If, after making this Certificate A o OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of theLaborCode.you must forthwith EXIT HARDWARE: comply with such provisions Of this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Know]. ❑ 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 Business 3101e o uslness NO.OF EXITS and Professions Code,and my license is in full force and effect. .. f� ' PARKING• REO'D �. 1 PROVIDED License Number Lic. Class SPACES I i Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am aFROM: DATE TO. DATE licensed architect or a registered professional engineer acting in my professional capacity (Section 7051,Business EXISTING BLDG. STORIES SIZE OF INS GNATO RE, and Professions Code). Lic. Or Reg. NO. Date 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, Business 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,lt PROPOSED USE OF BUILDING V n y' i J t 1l I 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.OCC Lender's Name APPLICANT(PRINT TEL i 164 ' Lender's Address ADD Es A p I certify that I have read this application and state that the Z c 0 0 Q p �jA q O p above information is correct. I agree to comply with all County PERMIT FEE ordinances and Stat laws relating to building construction,and hereby authorize r p esentatives.of this County to enter upon ISSUANCE FEE the above- i property for inspection purposes. . TOTAL FEE I r �� SEE REVERSE FOR EXPLANATORY LANGUAGE _ 3 y`riure of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) M I SC E L LA N E O U S APPLICATION o c I Pterebaffirm 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 ADDRESS):V Certified copy is hereby furnished. D uILR NG 2 2 h D pQ DRESS _S er LOCALITY 0 Certified copy is filed with the county building inspection OCALITY NEAREST department. e iv► �@. CROSS ST. Date Applicant NEAREST DISTRICT NO. G OUP TYPE P CESSED BY CROSS ST. � - f,� any CONST. �a CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL G(' /��JJ / � D 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 ZONESPEC IAL 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 � � �+'J o permit is issued, I shall not employ any person in any manner OWNER p� l��(JL� �� I-1 (7/71v� CNS S-�- so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS 7UO I-- Date Applicant ,L 'J L, NOTICE TO APPLICANT: If, after making this Certificate of CITY r` No��l� 7/% �� 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. LICENSED CONTRACTORS DECLARATION occuPPanic Devices wNCY INSPECTION ❑ 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 n� a - x�; �� effect. SPACES PARKING REQ'D PROVIDED 1 J License Number Lia Class o � LIMITED TIME USE Contractor Date DATE DATE FROM: TO: 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE f iness and Professions Code). E FINAL APPROVAL PRESENT USE: OF BUILDING 10 7 C Lie.or Reg.No. Date I 1 i HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BU DINGS rn ON LOT AND USE U Oj 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. PARKING0161,31 t -,; ElI, as owner of the property, will do the work and the SPACES PROVIDED I c �'`ft�.. -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 m (� 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 v0 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, i and hereby authorize repres ntatives of this County to enter TOTAL FEE �d0 upontl ove ment' ned operty for ipspection p po s. tri' / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ✓ at WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION !�1 CE 875 r I I laffirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION QUI insureure,,,, o or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FI LL IN ADDRES�a(�C/ 'BUILDIN � ❑ Certified copy is hereby furnished. BUILDING 1 \ �j ADDRESS ..J...f.roAb usC e P LOCALIT Certified copy is filed with the county building inspection`s LOCALITY (r n• 1� NEAREST department. lr' G CROSS ST. Date Applicant NEAREST DISTRICT NOry GTYPE P ESSED BY CROSS ST. �1 If/ �q'f "1. CONST. CERTIFICATE OF EXEMPTION FROM W RKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY rvo. (CIRCLE) STATE MA/-R SECOND LOCAL NO. OF BLDGS. (This section need not be completed if th work involved TRACT NOW ON LOT USE ONE 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 thew rk for which this permit is issued, I shall not employ any pe on in any manner OWNER y so as to become subject to the Workers' mpensation Laws. OCCUPANCY GROUP MAIL nnO ADDRESS UC, eve Date Applicant T E NOTICE TO APPLICANT: If, after m ing this Certificate of CITY I�'1.o�rfn 0. o No� 6XOCCUPANT LOAD Exemption, you should become su ject to the Workers' z Compensation provisions of the Lab 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. E deemed.revoked. LICENSED CONTRACTO S DECLARATION OCCUPANCY INSPECTION E] Panic Devices El I hereby affirm that I am licensqd under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- �c NO. OF !Ts ness and Professions Code,and/my license is in full force and N U�^�r7 effect. 1i PARKING R D PROVIDED SPACES License Number Lic. Class w e� �olh LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from th licensing requirements as I am a / INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO. OF SIGNATURE acting in my professional capacity (Section 7051, BUS EXISTING BLDG. STORIES iness and Professions ode). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNE -BUILDER DECLARATION NO. OF EXISTING BUILDINGS �'O FEE ON LOT AND USE S `1� _ I hereby affirm t I am exempt from the Contractor's 6 N IA License Law for t e following reason (Section 7031.5, Busi- ness and Professi ns Code): NO. PARKING ! U1090-0001I `moi moi; f V ~ i'tI� SPACES PROVIDED 4 I, as own of the property, will do the work and the 1 =:I i Hsi structure is not intended or offered for sale (Section 7044,Bu iness and Professions Code). CO STRUCTION LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency >4 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 or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature off er ittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 L I hereby rt afe ,that 1 have a certificate of consent to self �IUIJ insure,-or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING ,A ADDRESS Z�.O I s ea. - v ^� LOCALIT ' 11 Certified copy is filed with the county building inspection LOCALITY a� 17M NEAREST department. 6 ceoss ST. Date Applicant NEAREST Dw /; DISTRICT NSR. G UP TYPE P CESSED BY CROSS GA "v•` "1. y CONST e� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLocK MAP HIGHWAY NO. F BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE SIZE OF LOT EXISTING BLDG.. d I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER o so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL tj 2 Y, ADDRESS 2 UU r( eve U Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY ,Ih MAVq d No. �4/�(/l�� P' 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 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 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 ,f SPACES REQ'D D PROVIDED D License Number Lia Class 1 [[ U LIMITED TIME USE Contractor Date DATE DATE FROM: 1 am exempt from the licensing requirements as I am a TO: licensed architect or a registered professional engineer SIZE OF NO. OFINSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES g FEs " TURE iness and Professions Code). FINAL APPROVAL 5 PRESENT USE OF BUILDING Lie.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 7 0 I, as owner of the property, will do the work and the SPACES PROVIDED p 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 PROPOSED MAX, OCC. Lender's Address �.�v I certify that I have read this application and state that the PERMIT FEE above information is correct.'l 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION i13M444 E875 (1184) MISCELLANEOUS APPLICATION 1 hereby affirm that 1 have a certificate of consent to seif COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION unsure. 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 ��/V, Qo.�eM a QIV LOCALITY X},(ADDRESS s M1 CeIttfied copy is tiled with the county building inspecti LO ALIT Y / \ NEAREST department. }; , �6yt C'(A�jYI Q CR 095 ST. Date_ _-_.lpplicant NEAREST DISTRICT NO. GRO P TYPE P CE SED BY CROSS ST. Bit) CONS 1[R(lI'iCATE OF EXEMPTION FROM WORKERS' LEGAL UUX COMPENSATiON INSURANCE DESCRIPTION LOT NO. BLOCK awn Rlc ww wr 1+0. (CIRCLC) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not he completed if the `.work involved TRACT NOW ON LOT +.'SE ZONEISPECIAL CONDITIONS y the permit is for one hundred dollars (5100) or less.) —,1 use OF LD I certify that in the performance of the work for which thSIZE OF LOT EX STING B is _' perinit is issued, i snail not entpioy any person in any manne%,. OWNER OL bllzldln sl, :ls !I, bccunle cnhiect to tile.Workers' Compensation Laws`. ----` _ r _ OCCUPANCY GROUP AD OA MAIL �A�J // _ ESS Date__—_—__-- :lppiic:nit -- — �- •? OCCUPANT LOAD NOTICE TO APPLICANT: if, after making this Certificate ut CITY NO. F�enlption, roti should become subject to the Workers' Compensation provisions of the Labor Code• you must forth- APPLICATION FOR EMIT HARDWARE: ,r'ith Comply with such provisions or this permit shall be TRAILER USEV No .,GEOLOGY INSPEC-ION Spec. Knowlj decnlcd rr:oked. ❑ . I ICFNSi:ll(Y)Nl it:1("FORS D[CLARATiON OCCUPANCY INSPECTION Panic Devices ❑ i 1 hrnh} affinrl that 1 and licensed under provisions of Chaptera U SAFETY PERMIT (LIST ITEMS BELOW) ;cunnnencinlz •%ith Section 7000) of Division 3 of the Busr NO. OF EXITS Hess and pruiestionc('ode, and my license is in foil force art _ a Name or business !RAKING PROVIDED � -PACES RECO �' [ I Lic. Class LIMITED TIME USE —_--:I I ( ',Intr:1Ct0r _— .-_ —_ Date OA— —E i I^1 caorn: -o: !1_�Ie\e:11pr :il`m the licensing requirements as 1 am a I IiLensed arc hi[ec[ or a registered professional engineer SIZE OF NO. OF INSPECTORS I acting in n1y professional capacity (Section 7051. Bus EXISTING BLDG. STORIES 2— e AT E iness and Protessions Code). h /� • PRESENT USE OF BUILDING f°INAL APPROVAL V t I.Ic. or Ree- No. _^ _ Date IIO:VF: OWNFR-Mill-DER DECLARATION NO. OF EXISTING BUILDINGS ^ ON LOT AND USE '+ -(f/J i:t li i•^l,lt.t±i,', '�i+ I herehy affirm that I ;un exempt front the Contractor's J.icen,se Law for Hie lullowing rc:[sou (Section 71031.5, Busi- ness [rid Pr(ltesswilsC,UItC): NO. PARKING ED SPA CSS i 117 , as owner of the property, Will do the work and the i PROvID X - structure is not intended or offered for sale (Section 7044.Business and Professions Code). CONS RI'( I JON t.LNDING AGENCYPROPOSED USH Of' BUILDING I hereby affirm that there is a construction lending agency p 'L for the performance of the work for which this permit is t issued(Sec. 3097,Civ. C.). • I.Cnder•s NJame _----------.---- - PROPOSED MAX. OCC. Lender's,Address 25 . 00 I certify that I have read this application anti stale that the PERMIT FEE above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25 . 00 upon the ahnvz-n tiunetl pro x [ psJ iafl irrtrposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i I WORKERS' COMPENSAI ION DECLAVAIION 20-0063DPV�?2/90 j�ij�C.:>* LLAN�,VIJS AeeL_iC:AI IUN 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 (S&6.'3800, Lab. C.), (� 'Folic No._ Company FOR APPLICANT TO FILL IN BUILDING _ y - UIL INGADDRESS(� ///�M ADDRESS ❑ Certified copy.is hereby,furnished. It 0 0'. R04emea d �l�J I V'� LOCALITY t: ❑ Certified copy is filed with the county building inspecti CITv� t:� zIP ( S department. / CROSS ST. ' Date '' Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. I GROUP TYPE P MAP HIGHWAY ROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS,' I O O CONST. t I COMPENSATION INSURANCE TRACT BLocK LOT NO. - • - NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE I SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I certify that in the performance.of the work for which th' �rfy er EL NO. -4 6q permit is issued.I shall not employ any person in any mann r so as to become subject to the Workers' Compensation La DDRESS Z oV Y OCCUPANCY GROUP ! Date Applicant CITY ZIP NOTICE TO APPLICANT: If. after making this Certificate 0 ( �$ OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor 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[it Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT El (LIST ITEMS BELOW) 1 I 9(commencing with Section 7000)of Division 3 of the Busines NO.OF EXITS a and Professions Code,and my license is in full force and effec e o uslness PARKING• REO'D PROVIDED License Number Lic. Class v Th 2 SPACES Contractor Date f LIMITED TIME USE DATE DATE 'I ElI am exempt from the licensing requirements a5 I am a FROM: TO: licensed architect or a registered professional engineer OF acting in my professional capacity (Section 7051,Business EXISTOING BLDG. 5 OR ES INSPECTOR'S and Professions Code). SIGNATURE. Llc. or Reg. No. Dg[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, Business 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 7044,31 PROPOSED USE OF BUILDING p Y,yl Q N 1'.e Y Business and Professions Code). t I 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 j I (Sec. 3097, Civ.C.). PROPOSED MAX.OCC. Lender's Name PPLI ANT(PRINT) TEL NO. .0 rh 2 Lender's Address WOORESS t I certify that I have read this application and state that the 2. C\-1 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-mentioned property for inspection purposes. . TOTAL FEE ..' �-2S'ZUO2 SEE REVERSE FOR EXPLANATORY LANGUAGE L Signature of Permittee Date ( I WORKERS' COMPENSATION DECLARATION 20-006 20-006 3DPVVS2/90 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 ` BUIL ING ADDRES - I ADDRESS ❑ Certified copy.is hereby;furnished. X 22t p e oLOCALITY ;: ( ❑ Certified copy is filed with the county building inspection CITY ZIP q department. ;n { C I / NEAREST CROSS ST. Date - Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP CTYPE PROCESSED BY CERTIFICATE OF-EXEMPTION FROM WORKERS' ONST. I COMPENSATION INSURANCE TRACT BLOCK LOT NO• MAP - HIGHWAY 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 certify that in the performance of the work for which thiserfy J e n o �1 e`V\ TEL NO.��I permit is issued;I shall not employ any person in any manner 0 so as to become subject to the Workers' Compensation Laws. ADDRESS C-0 OCCUPANCY GROUP f Date Applicant CITY ZIP NOTICE TO APPLICANT: If; after making this Certificate CA q 1 0 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USED GEOLOGY INSPECTION❑ 1- revoked. No Spec.Knowl. ❑ OCCUPANCY INSPECTION[ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT D (LIST ITEMS BELOW) A { ( 9(commencing with Section 7000)of Division 3 of the Business Name o uSlness NO.OF EXITSEl _ and Professions Code,and my license is in full force and effect. PARKING• REO'D ❑� PROVIDED License Number Lic. Class sPAces • 1 I i Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer FROM: To: n acting in my professional capacity (Section 7051,Business SIZE OF NO.OF INSPECTOR s I ` and PIOfe$$IOn$ Code). STORIES SI EXISTING BLDG. GNATURE, PRESENT USE OF BUILDING Lic. or Reg. No. - Date 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,.Business and 1 Professions Code): NO.PARKING F1L as owner of the SPACES PROVIDED property, will do the work and the structure is not intended or offered for sale(Section 7044,X 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.OCC. Lender's Name APPLICAN HIN Lender's Address ADDRESS ,(? { I certify that I have read this application and state that the >` C �� v above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize presentative s.of this County to enter upon ISSUANCE FEE I the a6o-ve io ed property for inspection purposes. TOTAL FEE ° _ ° SEE REVERSE FOR EXPLANATORY LANGUAGE i L mature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS "JJitbaffirm that I have a certificate of consent to self 875 (11-84) M I SC E L LA N E O U S APPLICATION i COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISIONinsu or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. PolicyNo. Company BUILDING P FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. BUILDING J�ioS� C p ADDRESS of !�/ rA LOCALITY ,Q Certified copy is filed with the county building inspection LOCALITYNEAREST ` department. t,Pm 1 G eSY CA CROSS ST. � % Date Applicant EAREST �/O _ DISTRICT{� O TYPE PROC ED BY CROSS ST. i .— NS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL U COMPENSATION INSURANCE DESCRIPTION LOT NO, B40 CK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SE D 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. y. I certify that in the performance of the work for which this n_ permit is issued, I shall not employ any person in any manner ow j'h le, st• L%hG2/1 y so as to become subject to the Workers' Compensation Laws. AIL a� OCCUPANCY GROUP Date Applicant ADDRESS `j`L pr,p .11�i%n�tJ� �. C_3 TEL,d1 , OCCUPANT LOAD 0- NOTICE TO APPLICANT: If, after making this Certificate of CITY -ro,* je NO. — 5�� Exemption, you should become subject to the Workers' z A Compensation provisions of the Labor Code,you must forth- PLICATION 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 I� effect, PARKING REgD `.� 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• TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). [/ v ea Lic.or Reg.No. Date RESENT USE OF BUILDING b � y6 FINAL APPROVAL sAO Ian fen low ccdw., T 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- 9 0 0.5 A ness and Professions Code): NO. PARKING F1, as owner of the property, will do the work and the SPACES PROVIDED # a D D • 88 structure is not intended or offered for sale (Section ^t ,�r o D D D.D o o z 7044,Business and Professions Code). 9) 0 01 O O 8 8 PROPOSED USE OF BUILDING �J CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0.1", �;A Se__fw,6a 0 -�" for the performance of the work for which this permit is ` y issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE BOO 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- ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE n t re of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) 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 BUILDING FOR APPLICANT TO FILL IN ADOREss Certified copy is hereby furnished. BUILDING DDRESS 0 ❑ Certified copy is filed with the county building inspection - NEAREST , department..' LocALITY CROSS ST. Date-'Applicant NEAREST DISTRICT NO. GR UP TYPE PROCESSED BY - CROSS ST. U r/ e CONST. p / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK mAP � HIGHWAY NO. �a'i CIRCLE _STATE MAJOR SECOND LOCAL O_ NO. OF SLOGS. 0 (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) USE OF pq SIZE OF LOT EXISTING BLDG. [ I certify that in the performance of the work for'which this V 0 permit is issued, I shall not employ any person in any manner OWNER6AI4V so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP /P/, _. W ADDRESS J12,D lft ,� I P'-' a bate Applicant to NOTICE TO APPLICANT: If, after making this Certificate of clrY S N NoL 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 El GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION D 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- ness and Professions Code,,and my license is in full force and PARKING effect. - - SPACES REQ•D E= PROVIDED. - License Number Lie. Class II��JJ 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 SIGNATURE mess and Professions Code). PRESENT USE of BUILDING SGrG FINAL APPROVAL G �� Lie.or Reg.No. Date G O I . HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's Licelfse Law for the following reason (Section 7031.5, Busi- NO. PARKING 5 0 a 9 A ness and Professions Code): SPACES PROVIDED F1I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # o 0:0 D 4 0 7044, Business and Professions Code). PROPOSED USE OF BUILDING //�'��/ B "C 0 0 0 0 0 0 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency It//,e 0 5,0 4-8 1 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name - PROPOSED MAX. OCC. ------------- Lender's Address PERMIT FEE - I certify that I have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE O and h y authorize representatives of this County to enter p above-me ioned.pro rty for i _pection purposes. SEE REVERSE F R EXPLANATORY LANGUAGE !' Si ure of Permittee Date e u NWO,ZI:ERS C:0\IPLNJ.AIIU:` D1.(.LA1:.111U1, /6 0444 CE 875 (11f;41 MISCELLANEOUS APPLICATION '-. � r ' hzreby affirm that 1 have a certificate of.co'scnt to self COUNTY OF LOS ANGELES 8111-DING ANI) SAI E"I Y IAVISION ,'ILJIII ,sure, or a certificate of Workers'Conipen,.ation Insurance,or certified copy thereof(Sec. 3800.Lab.C.). olicy'No. Company FOR APPLICANT TO FILL IN BUILDING (� ADDRESS OS // Certified copy ereis hereby furnished. BUILDING y [� e LOCALITY X� ADDRESS _7`& !" ��/�/l Certified copy is filed with the count) building inspection LOCALITY ! NEAREST department. y 1'e- CROSS ST, )ate Applicant \ NEAREST 0 DISTRICT NO. GRC�1P TYP , / p.@�CIBY CROSS ST, 'D� /)_ CONST CERTIFICATE O. EXEMPTION FROM WORKERS' LEGAL gyp' LG-- COMPENSA-TION INSURANCE DESCR IPTION LOT NO. BLOCK MAv IG.—A - NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. This section need not be completed if the work involved IRA CT NOW ON LOT USE ZONE SPECIAL CONDITIONS ,y the permit is for one hundred dollars (5100) or less.) USE OF EIZE OF LOT EXISTING BLDG. certify that in the performance of the pork for which this — L ermit is issued, I shall not employ any person in any manner OWNER as to become subject to the Workers' Compensation Laws. t•:AIL OCCUPANCY GROUP _ 0 y�n8� t.D DR ESS Z�O fIl - )ate Applicant p dOTICE TO APPLICANT: If, after making this Cenificate of CITY Q;y� � � C.R NO. 6 t,q+ 6 1 U OCCUPANT LOAD - xemption, you should become subject to the Workers � APPLICATION FOR EXIT HARDWARE: ompensation provisions of the Labor Code, you must forth ith comply with such provisions or this permit shall he ❑ "tF:FILER USE GLOLOG\' INSPE CTIvN No Spec. I<nowl. seemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION © Panic Devices El hereby affirm that I am licensed under provisions of Chapter (commencing with Section 7000) of Division 3 Of the Busi SAFETY PERMIT � (LIST ITEMS BEL W) NO. OF EXITS less and Professions Code, and my licens is in full force and _ ffect. PARKING SPACES REQ' ARKINGREO• SPACES D Q PROVIDED .icense Number Lic. Class LIMITED TIME USE ontractor Date DATE DATE SROM: TO: I am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer -:IZE OF NO. OF NSPEC:O s acting in my professional Capal:il. ISe:tion 7()51. Bus- XISTING BLDG. STORIES SIG T E iness and Professions Cod-, PRESENT, USE OF BUILDING). FINAL A!PP R O V A L /- p-0,0 _ b .ic.or Reg. No. Date _ HOME OWNER-BUILDLIZ DEC L.-%RATION a0. of EXISTING BUILDINGS -�u^ry v^ ,N LOT AND USE \`� MIA hereby affirm that I an; exempt from the Contractor's ,q4 D _��-_t1I1�� PM .icense La\v' for the followin_� reason (Section ,(131.5, Busi- !!! `(J fes- f less and Professions Code): 40. PARKING 1, as owner of the pnlpert\�_ still do thr vcors: and the ;PACES PROVIDED structure is not intended or offered for sale (Section r 7044,Business and Professions Code). CONSTIZU "TION LLNDINCI A(;I NCI ROPosED USE o BUILDING hereby affirm that there is a construction Iendiin, ascnc`, or the performance o-1 the work for \\'high this permit is --- .-sued(Sec. 3097.Cit. C.). .ender's Name PROPOSED MAX. OCC. .ender's.Address - certifv that I have read this application and state that the 'ERr^Ir FEE Ibove information is correct. I agree to comply with all County SSUANCE FEE ,ra•lances and State laws relating to building construction, nd heifby authorize representatives of this County to enter -OTAL FEE ipon the above entioned property for inspection purposes. ElRL\'FRSE FOR EXPLANATORY LANGUAGE Signature of Pcimiltec Dai