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HomeMy Public PortalAbout5611-5617-5623-5629-5633 ROSEMEAD BLVD_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444p LAN �p p p I I hereby affirm that I have a certificate of consent to self +CE 875 (2-80) M I SCEL LSA 9�9 EO U SI APPLICATION insure, or a certificate of Workers'Compensation Insurance,or j COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISIONi a.certified copy thereof(Sec.3800,Lab.C.) i Policy No. CompanyFOR APPLICANT TO FILL IN 113 AU,.LDI NG ' E] ADDRESS Certified copy is hereby furnished. BUILDINGi"I i ADDRESS //I�// LOC gLITY ❑ Certified copy is filed with the county building inspection n J NEAREST y department. , P CALITr `l CROSS ST. Date ApplicantNEAREST ��/� / (STRICT NO., ROUP TYPE OCESSED BY (CROSS ST. �� S �//Ayl / CONST. �• CERTIFICATE OF EXEMPTION FROM WORKERS' j LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL d I -• NOOF SLOGS. O (This section need not be completed if the work involved TRACT NOW. ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) 1 USE OF ISIZ OFT + EXIS BLDG. _iG,.. I certify that in the performance of the work for which this O permit is issuo, I shall'not employ any person in any manner WNER U so as to become"subject to the Workers' Compensation Laws. 'MAIL , OCCUPANCY GROUP �� yJ�J� VI ADDRESS a Date.Applicant TE _ 7 Cn NOTICE TO APPLICANT: If, after making this Certificate of CITY �% M� �C NOL OCCUPANT LOAD Exemption, you should become subject to the Workers' App LIC ION 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. ❑ 1 No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIOTO Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT (LIST ITEMS BELOW) ❑ 9 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 PARKING. effect. REq'D O PROVIDED O - i SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE D AT E ❑ FROM: TO: I am exempt from the licensing requirements as I am•a licensed architect or a registered professional engineer ISIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- XXISTING BLDG. STORIES SIGNATURE mess and Professions Code). R �/� F'ML APPROVAL ESENT 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 '6424A License Law for the following reason (Section 7031.5, Busi- # 0 0 0 0 ness and Professions Code): N0. PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the ,0 0 0 0 0 o z structure. is not intended or offered for sale (Section 7044,Business and Professions Code). ,10,2 8.—8 3 • OPOSED 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 la elating to building construction, TOTAL FEE and hereby authorize re r e=tIv.s of this County to enter upon tke-ago—v-D NnentioiVproperty for. inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa f er t e Date I WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS APPLGCATION CE 875 (2-80) I hereby-affirm that I have a certificate of consent to Belt 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.) 7 Policy No. Company FOR APPLICANT TO FILL IN aoneess J ❑ Certified copy is hereby furnished. A L'rN LOCALITY t.-. ❑ Certified copy is filed with the county building inspection ` NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST h ^ DISTRICT NO. GROUP TYPE P SSE BY CROSS ST. i..� 'C-- /� G IS , CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V V a COMPENSATION INSURANCE DESCRIPTION LOT NO. LOCK MAP 5 HIGHWAY NO. y� (CIRCLE) STATE MAJO SECOND LOCAL } JJ N . OF BLDGS. Lt (This section need not be completed if the work involved TRACT c0 NOW ON LOT USE ZONESPECIALCONDITIONS O by the permit is for one hundred dollars ($100) or less.), USE OF C� U SIZE OF LOT EXISTING BLDG. 1 certify that in the performance of the work for%which this cc permit is issued, I shall not employ any person in any manner wroERO so as to become subject to the Workers'Compensation Laws. M L 4 _Al. UGQP.rs+e�a C S OCCUPANCY GROUP U DRESS S W Date Applicant � TEL. NOTICE TO APPLICANT: If, after making this Certificate of Y NO. OCCUPANT LOAD 2 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 INSPECTIONJa Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT L-1 (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 i effect. — i Il ARKING REq'D PROVIDED if PACES ��JJ License Number Lic.Class — L If LIMITED TIME USE Contractor Date DATE DATE ❑ ^ 1/o FROM: TO: I am exempt from the licensing requirements as 1 am a e hone -C 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). 40 6Yi FINAL APPROVALL ESENT USE OF BUILDINGJ Lic.or Reg.No: Date 1?-341) A�,'' 1 HOME OWNER-BUILDER DECLARATION N OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ess and Professions Code): NO. PARItING SPACES PROVIDED 1, 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). OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY v Vv' C/ 3 % 1 9,6 4 a reby affirm that there is a construction lending agency # 0 0 0 0 (j Q he performance of the work for which this permit is d(Sec. 3097,Civ.C.). r'sName D D D o D D O0 PROPOSED MAX. OCC. . ler's Address PERMIT FEE 09,02-80 I ertify that I have read this application and state that the ISSUANCE F eve information is correct.1 agree to comply%%ith all County 1 inances and State laws relating to building construction, TOTAL FEE J hE eby authorize representatives of this County to enter ion the hbove-mentioned property for inspection purposes.. SEF. REVERSE FOR F LANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 I (2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS Ag, jell Certified copy is hereby furnished. Bu1LDING -61 ®�� Iran UeL LOCALITY ❑ ADDRESS !� I� Certified copy is filed with the county building inspection NEAREST department. ocALITr Q L' CROSS ST. Date ApplicantAREST DISTRICT N GROUP TYPE4ROCESSED BY CROSS ST. Idiv CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. $� (CIRCLE) STATE MAJOR SECOND LOCAL >_NO. OP BLDGS. d (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SP CIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE OF L) SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this VVV permit is issued, I shall not employ any person in any manner OWNERO so as to become subject to the Workers' Compensation Laws. IL i OCCUPANCY GROUP tDORESS Il.l Date Applicant t1 ECl) NOTICE.TO APPLICANT: If, after making this Certificate of CITY TNO.L. TD-5 23 —14373 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. 11 Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) I NO. OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi- El nesiland Professions Code, and my license is in full force and effect. PARKING REQ'D O PROVIDED D Licel SPACES se Number Lic.Class ,� LIMITED TIME USE Contractor Date DATE DATE ❑ FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). AP<SENT USE OF BUILDING FINAL APPROVAL r Lic.or Reg.No. Date 1 Ir HOME OWNER-BUILDER DECLARATION No.of EXISTING BUILDINGS ON LOT AND USE I hereby affirm that- I am exempt from the Contractor'sb 7 9 A License Law for the following reason (Section 7031.5, Busi- ' ness and Professions Code): I NO. PARKING # o D o 0 8 8 SPACES PROVIDED I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section o ulo o D o o In 7044, Business and Professions Code). IOPOSTJ�T4 T" rAtA C-'6 ,h 0 1 -84 84 ED 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 i 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, I TOTAL FEE and hereby authorize representatives of this County to enter i upon the above-mentioned property for inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE Signare of Pe y� I r �� 11 _� /Y 161n1C.pn OIn. 2.� �L.l ' rmittee Date --rl I WORKERS'COMPENSATION DECLARATION 875 (2-80) CE MISCELLANEOUS APPLICATION • CE 875 I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or aArtified copy thereof(Sec.3800,Lab.C.) Policy No. Company. FOR APPLICANT TO FILL IN BUILDING � ADDRESS Certified copy is hereby furnished. auILDING �J/ /, LOCALITY ADDRESS mfo �/j4__ Certified copy is filed with the county building inspection NEAREST department. OC A L I TY �/ / CROSS ST. Date Applicant NEAREST / L a DISTRICT NO "OUPTIP _707M D BY CROSS ST. !� 2_4GON T., / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL YV/ COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL } NO. OF SLOGS. NO. (CIRCLEI tl (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS V SIZE OF LOT EISTING BLDG. by the permit is for one hundred dollars ($100) or less.) USEXOF //^•r //� 1 .�(/ it I certify that in the performance of the work for which this VVV Q permit is issued, I shall not employ any person in any manner WNER C 94, yllyzezU so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP W ADDRESS �J d EEE Date Applicant f� NOTICE TO APPLICANT: If, after making this Certificate of CITY O �L L NE.�(/ OCCUPANT LOAD Exemption, you should become subject to the Workers' gppLICATION OR 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. ❑ E ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS llECLARATION OCCUPANCY INSPECTION Panic Devices 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 REp'D O PROVIDED O License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a. licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXIS INC BLDG. STORIES IG NATURE iness and Professions Code). FINAL APPROVAL bo RESENT USE OF BUILDING Lic.or Reg.No. Date �J t V HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDI Gs ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED A 2 7 r.3 A I, as owner of the property, will do the work and the r structure is not intended or offered for sale (Section # 0 0 0 0 7044, Business and Professions Code). -POSED USE OF BUILDING 0 o o 0 0 0 0 EO CONSTRUCTION LENDING AGENCY �r/�C!� /; 0 a 2 2-L 8 5 I hereby affirm that there is a construction lending agency �`LG �• (/ 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 1 have read this application and state that the above information is correct. I agree to comply with all County ISSUANCE FEE ordina • a d tate aws r lating to building construction, (/ and er y au oriz epre ntatives of this County to enter TOTAL FEE 7` U p t p t bo - e roperty for insion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 6:1K S re of ermittee Date \VORICERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION {� CE 875 LI I hereby affirm that I have a certificate of consent to self insure, or a certificate of workers'Compensation insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ^r+ ADDRESS V �,QAIW AM Al Certified copy is hereby furnished. BUILDING ' 1 LOCALITY ADDRESSkf. FCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT, G U 1YPE PR9/fFESSED BY v} C CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. ONST.LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR ONO LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE14 SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF (�Izl 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 so as to become subject to the Workers' Compensation Laws. MAIL ( OCCUPANCY GROUP o ARES 151D L I 1--' Date Applicant LULL NOTICE TO APPLICANT: If,after making this Certificate of cITY� ITvo� — 9-j' 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 USEGEOLOGY INSPECTION Eldeemed revoked. ❑ E] No Spec. KnoWl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq'D PROVIDED SPACES License Number Lic. 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 engineerINSPECTOR'S SIZE OF NO.OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL Z PRESENT USE OF BUILDING G Lic.or Reg.No. Date 1AJ 1l C V 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). 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 J � Z :,. iii issued(Sec. 3097,Civ.C.). r . Lender's Name PROPOSED MAX. OCC. I Lender's Address I certify that I have read this application and state that the PERMIT FEE 00 1`.1 I above information is correct.I agree to comply with all County ISSUANCE FEE riI ordinances and State laws relating to building construction, I� and hereby authorize represe tives of this County to enter TOTAL FEE O _I u o thexbioned p p rty for in tion pur oses. (� SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu ermittee Date ie'� :;-; C� WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or a certified cQpy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING A.5' . ADDRESS FlCertified copy is hereby furnished. BUILDING Y LOCALITY ADDRESS /' A633 Al. ?bSes,640 140 ElCertified copy is filed with the county building inspection LOCALITY cRoss sT department. S . Date Applicant NEAREST DISTRICT N OU+p� CYPE ONST. ESSED BY CROSS ST. Las - _.Y C J CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ���/// COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG.ZGTAI - ` 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 OCCUPANCY GROUP o Date Applicant /�/ldC� �Cfr72 ADDRESS x IZZI v W NOTIC TO PPLICANT: If, after making this Certificate of CITY ITvo� - ,)3 Jt.373 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. 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. 41Y1 E+ Q� �4.5 iness . PARKING REQ'D PROVIDED SPACES J License Number Lic. Class LIMITED TIME USE Contractor Date If�"R- DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting,in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGN TORE iness and Professions Code). r ' s FINAL APPROVAL F BUILDING Lic.or Reg.No. Date PRESENT USE O HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ��� � �J I hereby affirm that I am exempt from the Contractor's ON LOT AND USE 1 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKINGr ` SPACES PROVIDED 6/15/97EJ I, as owner of the property, will do the work and the 11 ' 4 L ►(� °11 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING wa— 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 P"POSED 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 relati to building construction, and hereby authoriZ representa s of this County to enter TOTAL FEE A5. ew upon the abov me n I op r for inspection p poses. 1 ?-4(43 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f Permittee ate + WORKERS'COMPENSATION DECLARATION CE 876(1 1.84) MISCELLANEOUS A P P L I C A T I O N 1 hereby affirm that 1 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 ADDRE95 /7 Certified copy hereby XX is hb furnished. BUILDIADDRESSNG _ G _� LOCALITY Certified copy is filed with the county building inspectio1n OCAL. p NEAREST department. =�G.�' � V . Cil 1) -7 CROSS ST. Date Applicant NEAREST i 12 Yl ) ,firDISTRICT NO. GR. UP TYPE CONS OCESSED BY _ �- �(� CERTIFICATECRONEAREST ST. �&.f lOF EXEMPTION FROM WORKERS' LEGAL a COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF 1 certify that in the performance of the work for which this s'zE OF Lor EXISTING BLDG. r-' 0 Perm is issued,I shall not employ any person in any mantle owNER Of bulletin �¢�.—ni I o as to become subject to the Workers' Compensation Caays MAIL OCCUPANCY GROUP Date Applicant ADDRESS c 1 fat n k^21= E ' Nl l� LLI TEL' o if(� OCCUPANT LOAD Dy NOTICE TO APPLICANT: If,after mak' this Certificate of CITY 9 No. - o Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USECTIO P Y GEOLOGINSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 1 hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force a effect. me of business SARKING R9Q'D PROVIDED PACKS License Number Lic. Class �t-y12 �C-TI O VJ TLO . LIMITED TIME USE Contractor Date DATE DATE F] I am exempt from the licensing requirements as I am a PROM: TO: licensed architect or a registered professional engineer SIzE OF NO.of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGATURE iness and Professions Code). FIN L APPROVAL PRESENT USE OR BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS Q�l` O ON LOT AND USE rvl, 1 hereby affirm that I ant exempt from the Contractor's J� License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OR BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is i I= Z issued(Sec.3097,Civ.C.). Lender's Name i PROPOSED MAX.OCC. Lender's Address ;:D5 ! 25.00 •s �� I certify that 1 have read this application and state that the PERMIT FEE above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 :! --upon the above-mentioned property for inspection purposes. XX Dex._Z,161g/SEE REVERSE FOR EXPLANATORY LANGUAGE _ Signalur erntittce Date WORKERS'COMPENSATION DECLARATION a CE 876(71-84) M ISCELLANEOUS APPLICATION ` �CE 87 .. tkthereby 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 f�12yJx` �Q, Certified copy is hereby furnished. xx ADDRESS 56// Al, /�OreHel$0 Igz_ . LOCALITY Certified copy is filed with the county building inspection LOCALITY —• A y NEAREST department. XX /CM G/ T` �6, / (. ��• CROSS ST. Date Applicant I NEAREST /^ DISTRICT NO. GR UP TYPE P ESSED BY CROSS ST. LA-S' 7LIA4W. CONST. G� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (Tills 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 permit is issued, I shall not employ any person in any manner! .-ERof building �T�N /NZ//f JU 61 =' so as to become subject to the Workers' Compensation Laws. I MAIL OCCUPANCY GROUPCC Date Applicant ADDRESS P(f,fj011 (OF7 . LL Amo /'�•Vh[C7 TEL. _ j/ -2.5 7 NOTICE TO APPLICANT: If,after making this Certificate of I CITY NO. OS L L T OCCUPANT LOAD Exemption, you should become subject to the Workers' ir Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with suell provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION❑ No Spec. Knows. 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 ani effect. Name of business PARKING REO'D PROVIDED License Number SPACE3 Lic. Class Q p�s LIMITED TIME USE Contractor Date DATE DATE FROM: TO: 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OR INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OR BUILDING G Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATIONi I 1 NO. 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 PROVIDED PARKING I, as owner of file property, will do the work and the SPA 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 sued(Sec.3097,Civ.Q. Lender's Name I PROPOSED MAX.OCC, Lender's Address I PERMIT FEE I certify that 1 have read this application and state that the I iy above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, t a.: and hereby authorize representatives of this County to enter TOTAL FEE 25.00 = _ upo�pvepentioned p perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGEXXXx7, _. ignaturc of Permittee Date t I i WORKERS'LUMMNSAIIUN VVILLAKAILUN20-0063DPW12/90 1V11 41:.LLANC;V V Ar1''LlC.A1 1VN i I. hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING•AND SAFETY DIVISION •4ihsure,or a certificatd of.Wdrkers'Compensation Insurance,or a eertiEied copy thereof(Sed 3800, Lab C.) +'" - (� I Policy No.�774bRo/Company T11__ 7,-j/%Z2YFOR APPLICANT TO FILL IN BUILDING i ; BUILDING ADDRESS ADDRESS ❑ Certified copy.is hereby:furnished. �x 6'6_1_1 Al /PO r4 &Vb LDCAL,, { I ❑ Certified copy is filed with the county building inspectioq CITY I zip NEAREST department EfyJ L//T •9/780 u Date _ = Applicant SIZE OF NO.-OF SLOGS.NOW ON LOT DRISTRICT NO. GROUP TYP PROLE SED BY CERTIFICATE OF EXEMPTION FROM WORKERS' c4 &#s b CONST. I TRAC a BLOCK T NO. l ;COMPENSATION INSURANCE �T'�3 � MAP HIGHWAY (This section need not be completed if the work involved NO. ICIwcLe, STATE MAJOR SECOND LOCAL.. P ASSESSOR MAP BOOK � PAGE PARCELI by the permit is for one hundred dollars ($100) or less.) �'�� ©3 �,r USE ZONE SPECIAL CONDITIONS ( iLcertify that in the performance.of the work for which thi ?��r y e I TEL No. permit is issued•I'Shall not employ any person in any manner I so as to become subject to the Workers' Compensation Laws. ADDRESS OCCUPANCY GROUP It ( Date Applicant . CITY p ' `rv" Cs NOTICE TO APPLICANT: !f; after making this Certificate QUO I OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the-1a15or Code.you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ revoked No Spec.Knowl. ❑ ' OCCUPANCY INSPECTION Panic Devices ❑ LICENSED CONTRACTORS DECLARATION f I II 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 and Professions Code,and my license is in full force and effecr� ame O nS e s , PARKING• REWD E= PROVIDED License Number Lie.Class _Z// Al• ��� � I sPAces ( I I Contractor Date7 �� ��r 9/780 LIMITED TIME USE . ❑ I am exempt from the licensing requirements as I!= aDATE DATE licensed architect or a registered professional engineer FROM: To: acting in my professional capacity(Section 7051,Business SIZE OF , D 8 s NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. STORIE1 SIGNATURE. Lic or Reg.No. Date PRESENT USE OF BUILDING /Q / FINAL APPROVAL per®Z. 167- Add 7b SaPe 7Yte uo/iG - ': 1 I HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I amlexempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ( ' Professions Code): I NO.PARKING El 1, as owner of the property, will do the work and the ' structure is not intended or offered for sale(Section.7044 PACES PROVIDED PROPOSED USE OF BUILDING Business and Professions Code). f I �7• C`rsile I CONSTRUCTION LENDING AGENCY ? —Ta%W y�__ ,+ i • 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.). I PROPOSED MAX.OCC Lender's NameAPPLLIICA{J ) TEL NO. Lender's Address ADDRESS i I certify that I have read this application and state that the //'- ov x # ST #� � �'ea�/�• /$� I above information is correct. I agree to comply with all County I ordinances and State laws kelating to building construction;and PERMIT FEE , hereby authorize representatives.of this County to enter upon ISSUANCE FEE J :•+xr�;l the above-mention roperty for in tion purposes. ) -— •'"''• _ __ _. _ TOTAL FEE (J SEE REVERSE FOR EXPLANATORY LANGUAGE' Si u- -6r of en�n& Da