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HomeMy Public PortalAbout5646-5648-5650-5652-5654-5656 ROSEMEAD BLVD_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 MISCELLANEOUS APPLICATION ICE 875(17-84) I hereby a Berri that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a iiertifica.te of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.Q. I I Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS FICertified copy is hereby furnished. BUILDING./ I ADDRESS ,��J. �if'r,T� 0h�• LOICALITY Certified cc y•is filed with the county building inspection LOCALITY NEAREST department. clioss sr. Date Applicant NEAREST k" , -5 - DISTRICT NO. FGRO"P rYFEPR CESSED BY CROSS ST. 6�V I CONST.CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MwP HIGHWAY NO. OF BLD GS. STATE MAJOR SECOND LOCAL Nal. (CIRCLET (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 ($100) or.less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner 'ALI ,))a,/Gj s> so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP C3 ADDRESS/ .�•I S �J U Date Applicant NOTICE TO APPLICANT: If,after making this Certificate of CITY StOC—IA— rTio� �$ _ s OCCUPANT LOAD y 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 deemed Ievoked. TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl, LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION1�4 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. OR EXITS ness and Professions Code,and my license is in full force and effect. Z / PARKING REq'D PROVIDED SPACES License Number Lie. Class • LIMITED TIME USE Contractor Date DATE GATE El I am exempt from the licensing requirements as I am a FROM? TOI 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 _9QJ PRESENT USE OF BUILDING +/�vv 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- D ness and Professions Code): NO. PARKING v 4621: i P. 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. �D Lender's Address (�- i I certify that I have read this application and state that the PERMIT FEE �S• 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 2?-IS 0 upon thea v -mentioned pro y for inspection purposes. 24 92_ SEE REVERSE FOR EXPLANATORY LANGUAGE Sign(Autfof Permittee 6f Date 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 copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS , Certified copy is hereby furnished. BUILDING �• �fOJC�p J`�� �' • LOCALITY ADDRESS 1C (J(JT c Certified copy is filed with the county building inspection S CALITY NEAREST -7��� department. M"_ L tr C/7^f CROSS ST. /w' Date Applicant AREST �/�(r J DISTRICT G UP TYPE / PR •SSED BY OSS ST. J13�✓�:Hw RI Jam' �7 CONST. �' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J l �I COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY MAJOR SEC D LOCAL NO. OF BLDGS. NO. (CIRCLE) STATE (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. dam.. I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner I OWNER cQ2 s� so as to become subject to the Workers' Compensation Laws. AIL c `�� OCCUPANCY GROUPa�] Date Applicant J�DL�LI TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of CITY . Ll � No. $I& " --o13 y 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know[. 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 SPACES REq•D D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: TO: INSPECTOR'S fSOI acting in my professional capacity (Section 7051, Bus (STING BLDG. STORIES SIATURE iness and Professions Code). h FINAL APPROVAL ,? 1 PRESENT USE OF BUILDING L V 7 , t� Lic.or Reg.No. Date I ,'1 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's b b Q 3 A 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 wgrk and the SPACES PROVIDED # o 0 o c 8 8 structure is not intended or offered for sale (Section U37044,Business and Professions Code). 0 0 0 D 0 o D z CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINGAd-M& AJ0 a 0 2-8 7 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is AR 1131 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 t��Signature �ofPerm�lttee fpr ins ection purposes.��� E REVERSE FOR EXPLANATORY LANGUAGE Date kVORKERS'COMPENSATION DECLARATION I 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 insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). i Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BU"DIADESNG5654 Rosemead Blvd• LOCALITY DRS ❑ Certified copy is filed with the county building inspection CALITY Temple Cit CA 91780 NEAREST op department. p City., CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE SSED BY OSS ST. Las Tunas Drive `.0 d CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP NO. HIGHWAY SL N O.j 7A 4.1—(CIRCLE) TATE MAJOR SECOND LO NO. OF BLD GS. (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.) IU e-3 OF //•� �J I certify that in the performance of the work for which this SIZE OF Lor EXISTING BLDG. / J C) C) permit is issued, I shall not employ any person in any manner OWNER Alice Chone so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP �j o OOM ADDRESS 5654 Rosemead Blvd. r- Date Applicant a NOTICE TO APPLICANT: If, after making this Certificate of CITY Temple City No.' 818-285-3589 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 oI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PER ❑ (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 SPACES REQ'D PROVIDED 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 engineerSIZE OF NO.OF INS ECTOR'S acting in my professional capacity (Section 7051, Bus- EX STING BLDG. STORIES G14ATURE iness and Professions Code). FINAL APPROVAL fJ Lic.or Reg.No. Date PRESENT USE OF BUILDING Z'J Officeq Trainings Show Room 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 9 2 7,0 A 7044,Business and Professions Code). 0 0 0 0 8 8 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING o D a a o 0 o z I hereby affirm that there is a construction lending agency Offices Trainings Show Room for the performance of the work for which this permit is 0 3,29-88 issued(Sec. 3097,Civ.Q. 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 1 \� ordinances and State laws relating to building construction, y and hereby authorize representatives oFthis County to enter TOTAL FEE upe a ve-mentioned p3 rty r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3-28-88 Sig ure of P rmi a Date ` r WORKERS'COMPENSATION DECLARATION 76nn444 t M I SC E LLA N EO U� APPLICATION I hereby a erthat I have a certificate of consent tself CE 875(11-84) insure, or a certificate of Workers'Compensation Insurance,e,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a ceifified copy thereof(Sec. 3800,Lab.Q. - Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. pDORE55 5bV OSQI11 III Q C LOCALITY ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. O TYPE P ESS BY CROSS ST. LqS TW �/.7Gwe ICONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL r COMPENSATION INSURANCE DESCRIPTION LT...' BLOCK MAP HIGHWAY STATE MAJOR SE CON LOCAL NO. (CIRCLE) NO. OF BLD GS. (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 ($100) or less.) USE OF d I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG, permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL ADDRESS �0. Bo)( -;2 .S U Date Applicant � A LU NOTICE TO APPLICANT: If, after making this Certificate of CITY ads- l.A 9110 o" LJ$' -2?S-3Sp� OCCUPANT LOAD y 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. 1-1 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. LME or-BL&WESSPARKING SPACES REQ'D D PROVID 6D-� License Number Lic. Class CI LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a FROM: TO: I architect or a registered professional engineer SIZE OF NO. OF PE CTO R'PS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S GNATUR iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date Idne N1101 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 1/29/50 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 BUILDING I hereby affirm that there is a construction lending agency ` S'L S for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). q� ,P y' Lender's Name sel3ftj m. PROPOSED MAX. OCC. Lender's Address PERMIT FEE 00 I certify that I have read this application and state that the V\rn 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 uppri the above-mentioned property for inspection purposes. 0/ 4- ___& 01— — 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitte Date X WORKERS'COMPENSATION DECLARATION CE 8754(1 1.84) M I SC E L LA N EO U S,, APPLICATION I hereby affirm that I have a certificate of consent self COUNTY 'c insure, or a certificate of Workers'Compensation Insurance, COTOF LOS ANC BUILDING AND SAFETY DIVISIONe,or ,�,�� � a certified cony thereof(Sec.3800,Lab.C.). Polic*No. Company FOR APPLICANT TO FILL IN BUILDING ADORESS� �� Certified copy is hereby furnished. BUDDRESILDINSG 5656 Rosemead Blvd. LOCALITY ❑ Certified copy is filed with the county building inspection LOCALITY le Cit CA 91780 NEAREST department. NEARESTTT�BP�7p� 7Y�.r cRoss ST. Date Applicant TYPE CROSS ST. IJas ^--" s Ll•/ DISTRI NO G OUP CONST. ESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �, Z =- COMPENSATION COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF HLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESP ECIAL 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 the work for which this p o permit is issued, I shall not employ any person in any manner OWNER 0� VLMIa� Alice Chma S' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP � o Date Applicant ADDRESS P. W TEL' NOTICE TO APPLICANT: If, after.making this Certificate of CITY Wasadena,CA91117NO. )eJ818)285_3589OCCUPANT LOAD e�iJ 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION [R 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 PARKINGeffect. Q(4'p L3ic _,+ ii SPACES REq'D D PROVIDED D License Number Lic. Class &A i -J13 ��^l 1 L 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 OFNO.OF INSPE CTon's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL Of PRESENT USE OF BUILDING x Lic.or Reg.No. Date �— HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDe'e INGS D O FEE 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 l 0000-0001 6/24/93 ElI, as owner of the property, will do the work and the SPACES PROVIDED 0444 1 AN11:20 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING Office For I hereby affirm that there is a construction lending agency Loan Broker 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 5 U� 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 upon th rv?-mentioned property for inspectionrpo e I >r 3SEE REVERSE FOR EXPLANATORY LANGUAGE ignature Permittee �7 Date WORKERS'COMPENSATION DECLARATION CE 875(1 1-84) MISCELLANEOUS A P P L I C A T I O N I hereby aff(rmrthat I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, os a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FI LL IN BUILDING / ADDRESS U� Certified copy is hereby furnished. pDDRES3 �j•j 6 Y RpSe ( LOCALITY Certified copy is filed with the county building inspection LOCALITY ep,, f (;t CA 1 NEAREST department. T � D CROss ST. Date Applicant EAREST1 DISTR T GP TYPE , PROC SED Y CROSS ST. Alo h os cLi. lG(S 4,as '6 �(RQ- CONSTV CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VVVV!!!!//// U COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAYNO. OF STATE MAJOR SE CON LOCAL NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ONLOT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF n SIZE OF LOT EXISTING BLDG. V �-• 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 ] ® SP o so as to become subject to the Workers' Compensation Laws. MAIL '� OCCUPANCY GROUP ADDRESS 16 Date Applicant TEL. Iy NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. ]�' '-,3, 89 OCCUPANT LOAD y 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 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 D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date GATE DATE ❑ I am exempt from the licensing requirements as I am a No. of FROM: io: INSPECTOR'S licensed architect or a registered professional engineer SIZE OF E acting in my professional capacity (Section 7051, BAS- XISTING BLDG. STORIES SIGNATURE iness and Professions Code). Lic.or Reg.No. Date PRESENT USE OP 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, 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). A-662�} p CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING H z I hereby affirm that there is a construction lending agency cSd'2 �r e Pce 3/5"!-7 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 - -s� Signature of Permitte Date ( r WORKERS'COMPENSATION bECLARATION CE 875(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 I BUILDING r_1 Certified copy is hereby furnished. BUILDING I ADDRESS i F1ADDRESS6656 N. ., LOCALITY Certified copy is filed with the county building inspection NC/ EAREST department. LOCALITY Tem le City., Ca.. CROSS ST. Date ApplicantNEAREST DISTRICT'NO. ROU TYP PROCESSED BY • CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL d COMPENSATION INSURANCE' DESCRIPTION LOT NO. BLOCK MAO HG cw ET } (C ) STATE MAJOR SECOND LOCAL a NO. OF SLOGS. (This section need not be completed if the work involved' TRACT see .att.ac ed NOW ON LOT USE ZONE SPECIAL CONDITIONS Q by the permit is for one'hundred dollars ($100) or less,) USE OF U SIZE OF LOT EXISTING BLDG. ' �� W I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mander OWNER Goetz/GarciaO so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ADDRESS 5652 N. Rosemead Blvd. �- Date Applicant til NOTICE TO APPLICANT: If, after making this'Certificate of CITY Nol. OCCUPANT LOAD g Tem le Cit Ca. 213 287-97.01 . Exemptioh, 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 GEOLOGY INSPECTION deemed revpked. be TRAILER USE 0 ❑ No Spec. Knowl. El 1 OCCUPANCY INSPECTION Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 1 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS 9•Q( ommencing with Section 7000)of Division 3'of the Busi- El I--t ria.. and Professions Code, and my license is.in full force and effect. PARKING. _ SPACES REQ'D '� PROVIDED Afcense Number Lie.Class :l: j LIMITED TIME USE I Contractor Date 1 DATE- DATE ' 'FROM: TO: I am exempt from the licensing requirements as I ami a licensed architect or a registered professional engineer SIZE OF Ivo. of i INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. ,,600 sq. ft. $TORIES 1 SIGNATURE mess and Professions Code). ! PRESENT USE OF BUILDING Office �kINAL APPROVAL 7_./ - ' 7-- Lic.or Reg.No. Date 1, C► r , HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that- I am exempt. from the Contractors License Law for the following reason (Section 7031.5, Busi- 4"7"7.9 A ness and Professions Code): NO.PARKING Y SPACES PROVIDED ❑ I, as owner_of the property, will do the work and the # o:o'o'o 40 stricture is not intended or offered for sale (Section t : : 7044,Business and Professions Code). 0 0 0 0 0 0 o U3 PROPOSED USE OF BUILDING 1 1 • 1 CONSTRUCTION LENDING AGENCY O 0`6±—8 2 I hereby affirm that there is a construction lending agency for the performance of the work for wJiich this, permit is issued(Sec.3097,Civ.C.). Lender's Name i PROPOSED MAX. OCC. Lender's Address a PERMIT FEE li I certify that I have read this application and state that the j above information is correct.I agree to comply with all County ISSUANCE FEE i ordinanc an State laws 'relating to building construction, TOTAL FEE and he a horize r esenta ' s of this County to enter i upo /t va- en ' d p er y for inspection purpos i E REVERSE FOR EXPLANATORY LANGUAGE Signaturof ermittee. WORKERS'COMPENSATION DECLARATION i CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent to i COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,,or or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN AD ADDRESS ❑ Certified copy is hereby furnished. I ILDING LOCALITY / ADDRESS ❑ Certified copy is filed with the county building inspection NEAREST department. OCALITY MA K ^ CROSS ST. Date Applicant I AREST �` l`• DISTRICT O. GROUP TYPE PROC SSED BY CROSS ST. �y _L CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' I LEGAL r �✓ , COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO.Zo (CIRCLE) STATE MAJOR SECOND LOCALNO. OF } (This section need not be completed if the work involved i TRACT NOW ON LOT BLDGS. USE ZONE SPECIAL CONDITIONS d by the permit is for one hundred dollars ($100) or less.) U I USE OF f SIZE OF LOT EXISTING BLDG. G�3 I certify that in the performance of the work for which this � permit is issued, I shall not employ any person in any manner PeNERO ri C O C.•r so as to become subject to the Workers' Compensation Laws. �M��iL ^ ^ OCCUPANCY GROUP J AW.RE55 J v� v �� W Date Applicant M NOTICE TO APPLICANT: If, after making this Certificate of Iry c N-7 � ID OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICA 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 No Spec. Knowl. ❑ deemed revoked. Panic Devices N ❑ LICENSED CONTRACTORS DECLARATION I OCCUPANCY INSPECTIO 19 I hereby'affirm that I am licensed under provisions of Chapter I SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS E-19 (Commencing with Section 7000)of Division 3 of the Busi- ness ands Professions Code, and my license is in full force and PARKING. effect. ) RE.Q'D PROVIDED i SPACES License Number Lic.Class LIMITED TIME USE Contractor Date I DATE DATE ❑ I am exempt from the licensing requirements as I am a � FROM: TO: licensed architect or a registered professional engineerslzE of NO. OF INSPECTOR'S acting in my professional Capacity (Section 7051, BUS- i EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). -rFINAL APPROVAL ��oESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I I hereby affirm that, I am exempt from the Contractor's 4 9 2 6 P License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING o 0 0 0 4 C SPACES PROVIDED El 1, as owner of the property, will do the work and the a•0 0 o n o n s structure is not intended or offered for sale (Section ` 7044,Business and Professions Code). P OSED USE OF BUILDING / ! /� CONSTRUCTION LENDING AGENCY vV 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 haveread this application and state that the / above information is correct.I agree to comply with all County ISSUANCE FEE C _ ordinances and State laws relating to building construction, and Hereby authorize representatives of this County to enter TOTAL FEE upon the ove-mentio pro Vert for inspection opos s. SEE REVERSE FOR EXPLANATORY LANGUAGE I01 , Signa re&Vermitt Dat I I i �itKERS'COMPENSATIONDECLARATION . CE 875 MISCELLANEOUS APPLICATION "• I .-•,,� CE 875(11-84) I hereby affirm that I have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insufe, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN FAD DING ��r RESS FlCertified copy is hereby furnished. BUILDINGJ�C LITYADDRESS - (ISA ./� ///jjjCertified copy is filed with the county building inspection LOCALITY "}�'f/ i / �/ /+/J_�� REST department. ���SI rV ��f/ qqp girl CROSS ST. Date Applicant EAREST /I/L` �fJ7'/1 DISTRICT NO. GROUP TYPE PROCESSED HY CROSS ST. GJy QO �Oq CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAr /J +H IGNWAv STATE MAJOR SECOND LOCAL NO./ j�� ICIR CLE) 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. 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. OCCUPANCY GROUP Date Applicant AD DRESg�=�:7s7�' ��C7v� t~I ��// v NOTICE TO APPLICANT: If,after making this Certificate of ITY N j1,3) � 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. PARKING SPACES ,REQ'O PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE F1 I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). F �� `C FINAL APPROVAL BUILDING Z� RESENT USE O 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). 5$2 A CONSTRUCTION LENDING AGENCY " PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency 4G4U^*VC LP'1—,— # D D o D g 8 for the performance of the work for which this permit fs o o G o o G o issued(Sec.3097,Civ.Q. z Lender's Name = 0.30-86 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 pro erty for insp tion purposes. q _)_7—'�6 SEE REVERSE FOR EXPLANATORY LANGUAGE O Signature of&Mittee Date �� I WORKERS'COMPENSATION DECLARATION I M I SC E L LA N EO U S A P P L I C A T I O N I hereby affirm that I have a certificate of consent tself CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.C.). i Policy No. CompanyBUILDING FOR APPLICANT TO FILL IN /� L/�- pp ADDRESS !�V //• Certified copy is hereby furnished. ADDRESS �195� �� -�1� g7ilj�, LOCALITY ❑ Certified copy is filed with the county building inspection LOCALITY TMPG- GiY, GA-gl-WD NEAREST department. CROSS ST. Date Applicant NEAREST QQ,�,[[�J f�j�(� jj [.A TRICT NO. GR pyP TYPE P • SSED BY CROSS ST. ROssM. t K"iD d /5�`I CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MIG Nw Av STATE MAJOR SECOND LOCAL (CIRCLE) NO. OF BLD GS. (This section need not be completed if the work involved TRACT NOW ON LOT 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 CC CROR J so as to become subject to the Wor ers' Co=eT, n s. y MAIL P firh'x OCCUPANCY GROUP.y •(\ ADDRESS 1 , I 5vx ,1;Z1 Date Applicant /� L. NOTICE TO APPLICANT: If, aft r making this Certificate of CITY s�pr(�j�(/� C�-l�I��0., IJI� 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❑ 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 �e/��r Ems j a (����(/���/' effect. X "1 I mss 1�� PARKING (r� SPACES REq'D D PROVIDED D License Number Lic. Class ( CWL LIMITED TIME USE Contractor Date ,�'v/ �� � OATH 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- EXISTING BLDG. STORIES sI TORE 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 / )113030-01001 6/ 36/9(335License 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 We (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency IRWT4W pFftei-6- 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 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 ie above- exit' ned pro er for inspection purposes. 1.Z,-?y SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (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 Certified copy is hereby furnished. ILDING LOCALITY ❑ ADDRESS Certified copy is filed with the county building inspection I NEAREST department. , OCALITYPea nAA ./ ^ CROSS ST. Date Applicant AREST / Y�• DISTRICT O. GROUP TYPE PROC SSED BY CROSS ST. IA —L CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' I LEGAL , COMPENSATION INSURANCE" DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL >_ (..RCL.) OF BLDGS. (L (This section need not be completed if the work involved I TRACT NO.W ON LOT USE ZONE ffCIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) � USE OF V I certifythat in the SIZE OF LOT EXISTING BLDG. performance of the work for which this permit is issued, I shall not employ any person in any manner NERC C l: .r O so as to become subject to the Workers'Compensation Laws. M��lL ^ OCCUPANCY GROUP a �ZW.il Ess -6'S �� LU Date Applicant c- TEL. NOTICE TO APPLICANT: If, after making this Certificate of IrY C� No. �� a OCCUPANT LOAD Z Exemption, you should become subject to the Workers' gppLICA ION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER u5E GEOLOGY INSPECTION NO Spec. Know(. EJ revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic DeVIC@S I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS 9 lip:ommencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. I PARKING. SPACES REWD O PROVIDED O Lic'°nse Number Lic.Class LIMITED TIME USE Contractor Date I 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'5 acting in my professional capacity (Section 7051, Bus- I EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ' FINAL APPROVAL ESENT USE OF BUILDING 10^ le Lic.or Reg.No. Date -04 d G� HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's . 4926P License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ;'; O D D o 4 C SPACES PROVIDED ❑ I, as owner of the property, will do the work and the 0,0 D a o o D :C structure is not intended or offered for sale (Section 7044,Business and Professions Code). PWPOSED USE OF BUILDING iLA (a 17 1 3—8 r CONSTRUCTION LENDING AGENCY 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 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 '�� 0"Oe, and hereby authorise representatives of this County to enter upon the ove-mentio pro ert for inspection pu'pos s. SEE REVERSE FOR EXPLANATOANGUAGE' I Signa re f ermitt Dat ; WORKERS'COMPENSATION DECLARATION I CE 875(2-80) MISCELLANEOUS APPLICATION 1 hereby affirm that I have certificate of consent to d COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers'Compensation Insurance,,�r a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS (o Certified copy is hereby furnished. I ILDING A S1 A/C RO-T I,A-� �L DRESS (U��,J �v J M BLOC ALITY Certified copy is filed with the county building inspection �TT7� department. LOCALITY T,F /"' /l�n�L,. C tTlp NEAREST ' CROSS ST. � Date Applicant I NEAREST nS T t/�H (� DISTRICT NO. O P TYPE PROCE SED�Y CROSS ST. /I" / ! A J CONST.,/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �� — COMPENSATION INSURANCE 1 DESCRIPTION I LOT NO. BLOCK Mpp L D(p STATE MAJOR SECOND LOCAL } (This section need not be completed if the work involved NO. OF BLDGS. Use ZONE SPECIAL CONDITIONS d P TRACT NOW ON LOT Q by the permit is for one hundred dollars ($100) or lest.) USE OF //a U SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this _ 0 permit is issued, I shall not employ any person in any mannerIDDRESS NER 7-eP,#E' T G Q C 7,z H so as to become subject to the Workers' Compensation Laws. 1L (� �l . OCCUPANCY GROUP ® U f(O �l� A10 �1VSL/Lf/q/•(� RL v� VDate Applicant ,_ �/E'Al C / TEL.vNOTICE TO APPLICANT: If, after making this Certificate ofY % No. OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: r Compensation provisions of the Labor Code,.you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION E] C] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 1:1Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (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 • REQ'D PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO! ElI 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- (STING BLDG. STORIES SIGNATURE iness and Professions Code). ESENT USE OF BUILDING A47,* FINAL APPROVAL � ?f J� { C—i Gs , Lic.or Reg.No. Date NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that- I am exempt from the Contractgr's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): • NO. PARKING n �/ 1.3 A I, as owner of the property, will do the work and the SPACES PROVIDED G 2 / structure is not intended or offered for sale (Section 7044,Business and Professions Code). # a o o o 8 8 PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY _Q o o a o o D o z I hereby affirm that there is a construction lending agency *01 9 NCE D IFIV 7 / —_1-4460441 for the performance0 of the work for wjiich this permit is 1.221--82 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 ,4 ISSUANCE FEE � above information is correct.I agree to comply with all County ordinances and State laws relating to building construction, TOTAL FEE ®© and hereby authorize representatives of this County to enter ponjiP above-mentioned property for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) M I SC E L LA N EO U SI 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 ADDRESS ❑ Certified copy is hereby furnished. to 06 UILDING _ U LOCALITY ADDRESS Certified copy is filed with the county building inspection NEAREST department. LOCALITY% \� CROSS ST. Date Applicant AREST G\`1 DISTRICT NO. OUP TYPE PROC SED BY CROSS ST. I bw '.s. � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE I DESCRIPTION LOT NO. BLOCK MAF HIGHWAY NO. ''jp CJ (CIRCLE) STATE MAJOR SECOND LOCAL tL NO. OF SLOGS. O by t section need not be completed if the Work involved TRACT NOW ON LOT USE�ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars (5100) or less.) USE OF S13E OF LOT EXISTING BLDG. VI I certify that in the performance of the work for which this Os permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers'Compensation Laws. AIL z, I OCCUPANCY GROUP LU DORESS� � N Date Applicant A NOTICE TO APPLICANT: If, after making this Certificate of CITY Crn NE.. OCCUPANT LOAD Exemption, you should become subject to the Workers' gppLICATION 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. KnOWi. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION Panic Devices ❑ OCCUPANCY INSPECTION , I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT I (LIST ITEMS BELOW) NO.-OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ess and Professions Code, and my license is in full force and PARKING.e feet. REQ'D O PROVIDED O ) SPACES c ens e Number Lic.Class LIMITED TIME USE I 'ontractor Date I 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 I iness and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date O J HOME OWNER-BUILDER DECLARATION No.of EXISTING BUILDINGS ON LOT AND USE /� I hereby affirm that- I am exempt from the Contractor's IIL5A License Law for the following reason (Section 7031.5, Busi- 0 0 0 o 88 ness and Professions Code): NO. PARKING SPACES PROVIDED F1 1, as owner of the property, will do the work and the 0 0 0 0 0 o C structure is not intended or offered for sale (Section 7044,Business and Professions Code). ROPosED 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 and hereby authorize represent ives of this County to enter =tabove-mentioned pro a ty for i pect' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE &4 Signature of Permittee Date i WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S IA P P L I C AT I O N I hereby-5,Tftrm 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 LI a certified copy thereof(Sec.3800,Lab.Q. 00 Policy No. Company FOR APP LI CANT TO FILL IN BUILDING ADDRESS ADDRESS S Certified copy is hereby furnished. aUILDINDDRESS LOCALITY Certified copy is filed with the county building inspectionOCALITY NEAREST department. CROSS ST. Date Applicant CROSS ST. , DISTR5 INO. G�U T PE PROCES Y Q CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ON (Z COMPENSATION INSURANCE DESCRIPTILOT NO. BLOCK MAP HIGHWAY STATE MAJOR SEC. LOCAL NO. OF BLDGS. No. (CIRCLE) (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 /� I certify that in the performance of the work for which this SIZE of Lor EXISTING BLDG. CD permit is issued,I shall not employ any person in any manner OWNER %C Q oA17 =' so as to become subject to the Workers' Compensation Laws. AIL _ _ _ _ OCCUPANCY GROUP a )DRESS —_ EE� Z3 Date Applicant U1 NOTICE TO APPLICANT: If,after making this Certificate of CITY NOL 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 ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM I ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Bus" No. of EXITS ness and Professions Code,and my license is in full force and CES effect. PARKING Req�D PROVIDED ' License Number Lic. Class SPA LT � � o LIMITED TIME USE Contractor Date Q C a DATE DATE 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No.of FROM: To. INSPECTOR'S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SICrNATURE 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 "91 7 5 A 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 # o o 0 o 8 8 structure is not intended or offered for sale (Section o 0 0 0 0 0 o z 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING o3. 16-88 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 '{ Lender's Address PERMIT FEE PROPOSED MAX. OCC. ,1lyc` 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, t and hereby authorize representatives of this County to enter TOTAL FEE O p n the above-mentioned property for inspection purposes. �i6 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f Permittee Date WORKERS'COMPENSATION DECLARATION certificate CE 876(1 1-84) MISCELLANEOUS A I hereby � erthat I have a certificate of consent tself insure, or a certificate of Workers'Compensation Insurance, e,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certifibd copy thereof(Sec.3800,Lab.Q. Policynlo. Company FOR APPLICANT TO FILL IN BUILDIDDRENG fir/ n e� ,/ ASS ❑ DR Certified copy is hereby furnished. ADZLDIN 6 f M ' '# v� LOCALITY � I• Certified copy is filed with the county building inspection LOCALITy-� ST department. /E7�lALIsr 617-Y 629 9/7f0 CROSS ST. Date Applicant NEAREST �/���i�j��y�/� �l OISTRICTJJVVO. CROUP TYPE PR SE BY CROSS ST.1/`,(�J.C.' 9!59 20 �`✓,� /GG.�rl� �`U�( !1 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ^7 Io1 V COMPENSATION INSURANCE DESCRIPTION LOT NO. HLO CK NO. /�t�'!�(GCIIaCLE) STATE MAJOR SEC D LOCAL NO. OF SLOGS. 1 ff:: (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 1 SIZE OF LOT EXISTING BLDG. 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 /Q�t/� -7 0 so as to become subject to the Workers' Compensation Laws. MAIL ,6/uAtiCr OCCUPANCY GROUP' _G� O ADDRESS OO 09,4717;L- �� Date Applicant - W NOTICE TO APPLICANT: If, after making this Certificate of CITY"(,1 2&4 NOL /f �o OCCUPANT LOAD a 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 OI 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 Bu I- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date D ATF DA TF ❑ I am exempt from the licensing requirements as I am a FROM: ro: 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). r PRESENT USE OF BVILDING G��j� FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTINGBUILDINGS 6 6 a 2 A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's #.- 088 License Law for the following reason (Section 7031.5, Busi- 0 0 0 0 0 0 o z ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 2 8 7 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 s.SL'AOGd 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 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 t e above-menti ed property for inspect ion urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE #7 A APP 1cSignature of Per tee Date i p WORKERS'COMPENSATION DECLARATION 76M444i CE 875 (2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self i COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ifsure,or a certificate of Workers'Compensation Insurance,or I a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANTTO FILL IN BUILDING ADDRESS Ah ROM" El Certified copy is hereby furnished. BUILDING �/�/ / ,t/ LOCALITY ` ❑ ADDRESS (� o Certified copy is filed with the county building inspection L /� NEAREST department. LOCALITY T_e le ! }/ CROSS ST. Date Applicant NEAREST ^^T�/�,''�� _7/ DISTRICoT O. C OUP TYPE PR SSED BY IV CROSS ST. h� ' //J!'�(/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAT No. (CIRCLE) STATE MAJOR SECOND OCAL NO. OF LOGS. 1�- (This SOCtIOn need not be completed if the work involved TRACT NOW ON LOT US�ZONE SPECIAL CONDITIONS Qby the permit is for one hundred dollars ($100) or less.) U USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this U permit is issued, I shall not employ any person in any manner 061ME L so as to become subject to the Workers' Compensation Laws. AIL �i ^ OCCUPANCY GROUP old AD RES. I Date Applicant TEL. OCCUPANT LOAD :A NOTICE TO APPLICANT: If, after making this Certificate of CITY No. . CA �Q(' 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 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 EXITS El9 (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 D 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 O O 0141 SPE&TPP acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL '(^,¢� Lie.or Reg.No. Date �l Q 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 SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section IC 7044, Business and Professions Code). 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 Addre PERMIT FEE I cert4thathave read this applicationand state that the above Is orrect.I agree to comply with all CountyISSUANCE FEEordin. Stat laws relating to building construction, TOTAL FEE and hori• representatives of this County to enter�n me t' ed property for inspes ati pure ses. SEE REVERSE FOR EXPLANATORY LANGUAGE it Signat mittee a// ate WORKERS'COMPFNSAT'ION DECLARATION 75M444 CE 875(11-84) M ISCELLANEOUS APPLICATION i heaffirm that 1 have a certificate of consent self COUNTY OF 'LOS ANGELES ^ BUILDING AND SAFETY DIVISION insure, o or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(See.3800,Lab.Q. i Policy No.___.- ..--Conipatly— FOR APPLICANT TO FILL IN BuiLDIADDRESS N: � -� �iJ UILD:NLOCALITY G // ��// O Certified copy is hereby furnished. QX ADDRESS S Certified copy is filed with the county building inspecti OCALITY /� NEARESTEl �•��!�✓ /'�J department. y _ - `j� CROSS ST. NEAREST DISTRICT NO. GROUP TYP CESSED BY D:►tc__— ___Applicant --_ L'/3S %u Na --� `D CO 1 CROSS ST. d. CE..R'Iliw ATI-Of EXEMP'1'lON FROM WORKERS' LEGAL COMPENSATION INSURANCE. I DESCRIPTION LOT NO. BLOCK NoP (c RCLe) 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.) ' Be OF SIZE OF LOT EXISTING BLDG. 1 certify that in the performance of the work for which t c permit is issued,I shall not employ any person in any mann � -wNER of building G( - , 2 O- ql as to beconl suliiecl In the Workers 'Unl ensation IA $'ir1 - AIL OCCUPANCY GROUP C") n� ADDRESS P- tl s ZS LL Date---/__1 I� Ll Applicant - ; NOTICE. TO APPLICANT': If, after Il king thi. Certificate Of I CITY >2S�A� R- No� Zfi�l%3s�8`� OCCUPANT LOAD fR/1 Exemption, you should become subject to the Workersa - Compensation provisions of the Labor Code,you must forth— with comply with such provisions or tills permit shall be TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ I hereby affirin that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of the Bu I No, of Exirs nese and Professions Code,and my license is in full force a Name of business PARKING �t effect. E I E�� RWD �- 1 PROVIO ED � _ SPACES License Number--. Lic. Class �/ ��'fJ/t9 CJOGOR �� LIMITED TIME USE Contractor- Date DATE DATE p q FROM: TD. INSPECTORS 1 ani exempt from tllc licensing requirements as 1 am a , licensed architect or a registered professional engineer SIZE OF NO.OF SIGNATURE acting in my professional Capacity (Section 7051, Bus ExISTING BLDG. STORIES _ — inessandProfessionsCode). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No.-.-__ _ Date 1 Yt 2rS S 1 IIOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS p �1.�i7 f/ 0I��QIR�1f-000 I ON LOT AND USE '1 MVa'�� I,1 I hereby aff•irnl that Iain exempt from the Contractor's i License IAA for the following reason (Section 7031.5, Busi- ,ltd Iles$and Professions Code): SPACES PARKING 1' SPACES PROVIDED I, as owner of the property, will do the work and they structure is not intended or offered for sale (Section' 7044,,Business and Professions Code). i CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING Pr 1 1 I hereby affirlil that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.CA. Lender's Name-_-•----•-------- , Lendcr's Address.-.-.--.-. -- — PROPOSED MAX OCC. I certify that I have road 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,' 25 0� and hereby authorize representatives of this County to enter TOTAL FEE upon the above-ileo Tuned properly for inspection purposes. 1 - -- SEE REVERSE FOR EXPLANATORY LANGUAGE - -. n•Ilnn•nl r•nullln• 'Il;il"('� I I:RS'COMPENSATION DECLARATION 1GM44,4 q CE s, II I tt.tl .WSCELLANEOUS APPLICATION Here „ that I have a certificate I ulconsent to self insure, or a certificate of Workers'Compensationnsalorance,or COUNTY OF LOS ANGELES 13UIL.I)ING ANI) SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. t ' Policy No. Company—_ --- FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING 6�[/ �?Ds�/� �� L / ADDRESS T LOCALITY L 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CRDSS ST. Date Applicant NEAREST DISTRI NO GP IT ESSED BY CROSS ST. CON!R 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 SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USEOF SIZE OF LOT EXISTING BLDG. cr I certify that in the performance of the work for which this / � permit is issued,I shall not employ any person in any manner OWNER6y c(1 G-I ;A16 7rA �' so as to become subject to the Workers' Compensation Laws. r', uCCU A r OUP Date Applicant ADDRESS f, k) . `(/%, O� NOTICE TO APPLICANT: If, after making this Certificate of' CITY r NO.L4b~lf OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EX17 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. SPACESG RKWO PROVIDE- License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF rROM. To. Ii-ISPECTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATUR mess and Professions Code). FINAL APPROVAL 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 J lCi 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). PROPOSED USE OF BUILDING CONS'I'Rl1CIlON LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ca n issued(Sea 3097,Civ.Q. I 1iC �1 Lender's Name 1 PROPOSED MAX. Dec. I= Lender's Address Q ' PERMIT FEE F,• I certify that I have read this application and state that the - 1 , M above information is correct.I agree to comply with all County ISSUANCE FEE in ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25 c0 001 upon the above-mentioned property f r inspection purposes. b `` SF.E R1iVliRSI:FOR EXPLANATORY LANGUAGE CA I,yyt Signature a mittee llate O �A WORKERS*C'OMPENSAI'ION DL'C'LARAfION 11,1.1.1.1 MISCELLANEOUS APPLICATION I a0-a00,,,DPWI? 00 J hereby affirm that I have a certificate of conseDt to sell' COUNTY Ol- I-OS ANGELES I BUILDING AND SAFETY DIVISION Il ` i insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800. Lab.C.) a Policy No._ , - Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDR S• //�� ADDRESS El Certified copy is hereby furnished. �0/�� /(f, 0-Y0-/y eAD� LOCALITY ❑ Certified copy is filed with the county building inspection CITYNEAREST ��� ZIP �� •_1 department. � G� � ' CROSS ST. Date--_ Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT No. GROUP TYPE PROCESSED BY CONST. 1 CERTIFICATE OF EXEMPTION FROM WORKI.RS' � COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY No. ICIRCLEI STATE MAJOR SECOND LOCAL (This section heed not be complete(] if the ebrl:. in%ol\ell ASSESSOR MAP BOOK PAGE PARCEL by the permit is for 011e` hundred dollars (S 10011 (11' lc%s.) � USE ZONE SPECIAL CONDITIONS f� 1 � 1 certify that in the performance of the 11•urk Gn• 1lhich this OWNE I TEL NO. I permit is issued. I shall not employ an)' person in any manna. — --- „I so as to become subject to the Workers' Conlpensaulm Laws. "n1--�� ii OCCUPANCY GROUP t!:' I—, Date Applicant CITY__ - ZIP � [E]- NOTICE TO APPLICANT: If. alter making this Certificate I _ OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.you must lorthwilh ^ 1 Comply with such provisions or this permit sllalll lie' deenled TRAILER USE D GEOLOGY INSPECTION El No Spec.Knowl. ❑ revoked. N El INSPECTIOPanic Devices LICENSED CONTRACTORS DECLARATION 1 hereby affirm that 1 am licensed under provisions oI Chapter SAFETY PERMIT O 1LIST 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 lorce and effect. PARKING• REO'DD PROVIDED D License Number Lie.Class spaces I Contractor Dalc -- — ---- — --' -- --– LIMITED TIME USE I — - ----- DATE DATE ❑ I am exempt from the licensing reyuirenlenlsl its 1 :1111 a FROM: TO: licensed architect ora registered pnlfessiontil engineer acting in 111)' professional eapaeil) (Section 7(1;1, fill%Illess SIZE OF NO.OF INS PE OR'S ' and Professions Code). EXISTING BLDG. _— SiORIL.9 --.— SI TURE Lic.or Reg. No. I):Ite PRESENT USE of BUILDING _ FINAL APPROVAL _o = SIC6 HOME OWNER-BUILDER DF(TARAIII)N NO.OF L XIS TING BUILDINGS Z4'? ' oN LOT AND USE 1 hereby arrinn that 1 ani exempt from the Contractor's License ��E Y%%%���� ►►►VVVttt��r' �h Law for the following reason (Section 7031.5. Business and I Professions Code): NO.PARKING SPACES PROVIDED 1, as owner of the properly. sill du the %%ork and thr — ---- -- structure is not intended or olIered Gn sale(Seelton 711.14. PROPOSED USE OF BUILDING Business and Professions Code). I CONSTRUCTION LENDING AGENCY hereby affirm that there is a construction ICI1lIII1L;]gene) lilr I the performance of the work lilr which this pentiii is issued • ; (Sec. 3097,Civ.C.). PROPOSED MAX.OCC. Lender's Name APPLICANT ItailNr) TEL NO. L X i�'!� RAV MA a 63 x47-6.1 2 I Lender's Address -_.... ADDREss �� �� C e e C�Q/'s I certify that 1 have read this application and state that the 6a� Wof tEL 7 above information is correct. I agree to comply with all County PERMIT FEE I 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 urposes. TOTAL FEE J � . 7 _ SEE REVERSE FOR EXPLANATORY LANGUAGE i aturc Of Pl rmittee I Dale ! WORKERS'C 0MYYStYW1ULV vrt..LAxtui tri I 20-00630PW12/90 ��-x 4,t:.1,.•.L,,f''�I`1i�:4fYZD ,!`?!.rr;t_..Id'vr-i.l awit-[ :; hereby,affirm that I have.a certificate bf consent to self COUNTY OF LQS. GEI,ES ;'".BUILDING.AND SAFETY DIVISION { 'riitsure,or a certificateof:W66ers'Compensation Insurance,or• .. _ 1 :a Cued copy'thereof(Se>5.•3800,Leib.C)�- ' ' •Pali 'Na . ' Co + c3' pY -FOR APPLICANT TO FILL•IN Bu1La1NG B IL:D1f(%ADDRESS ADDRESS = Certified copy.is:hereby:furnished i Ce ar iect copy is filed'with the county building inspectio LOCALITY C4,7 ZIP / 7 -,o 1 department. d" " NEAREST. - Date +'' 'r A IiCant CROSS ST. pp SIZE OF LOT NO.OF'BED S.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. C. CERTIFLCATE OF EXEMPTION FROM WORKERS' TRACT BLACK !V1 + `•:. ,COMPENSATION INSURANCE Lor NO. MAP a�IckwAY V (This section need not be completed if the work involved' 00. (CIRCLE) STATE MAJOR SECOND LOCAL.. ASSESSOR MAP 800K PAGE PARCEL USE ZONE SPECIAL CONDITIONS � � by the permit is for one hundred dollars ($:IQO) or dess.} ro TEL NO. I 1c . ceitzfyy'that in the perfornnance•of the work for which th' F _r permit is issued:I "shall not employ any person in any mann DREss a, 1 so as to'become subject to the Workers' Compensation La OCCUPANCY GROUP t13 t Date Applicant . CITYZ ZIP NOTICE TO APPLICANT: If. after making this Certificate OCCUPANT LOAD Df Exemption, you•should become subject to the 'Workers' APPLICATION FOR Compensation provisiotisof the-Labor Code.you must forthwith EXIT HARpWARE: comply with such provisions or'this permit shall be-deemed TRAILER USE Q GEOLOGY INSPECTION❑ revoked. No Spec.Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ 1 I hereby affitm'that I am licensed under provisions of Chapter' SAFETY PERMIT❑ tLtsr ITEMs HEt owt 1 9(commencing with Section 7000)of Division 3 of the Bus ti> 1a1e88 NO.of EXITS and Professions Code,and my license is in.full force and etfec License Number Lic Class p,- ,r�•-�& t t f PARKING• REQ'D PROVIDED ' V G.+ : PACES 1 I Contractor Date LIMITED TIME USE 1I •• I ❑ 1 am_'exempt from*the licensing requirements as I Sm a DATE DATE •• FROM: • To: licensed•architect or a'registered gis professional engineer 1 acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. STORIES SIGNATURE. Lt i or.Re No. - Date PRESENT USE OF BUILDING g d (S1.- FINAL APPROVAL I 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 PACES PROVIDED, i El 1, as owner.of the property, will do the work and th structure is not intended or offered for sale(Section 70 p POSED USE OF BUILDING Business and'Professions Code). ` r�L� 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 ' (Sec.3087,Civ.Q.. PROPOSED MAX.oCC. 'Lender's Name " 'P.PLICA T rPAWT) .. TEt�NO. �' Lender's Address ,?DRESS i ! I certify that•1 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 ielating'to building,construction,and - ... hereby authoii='representatives.of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. • I•;.s. ' �. x. In/� /'•I TOTAL FEE t G �? SEE REVERSE.FOR EXPLANATORY LANGUAGE ignature of Aermittee Date {' I WORKERS'COMPENSATION DECLARATION 76M4" 'MISCELLANrmul S APPLICATION 20-0063DPW12/90 I hereby•affirm that I have a certificate of consent to self COUNTY OF LOS•-ANGELES ( BUILDING•AND SAFETY DIVISION ` •'siitsure,or a certificate of;WdrImrs'Compensation Insurance,or A., A certified copy thereof(Set;.3800, Lab.C.)• .- Policy'Na Company FOR APPLICANT TO FILL.IN ADDRESS BUILDING .I ❑ Certified copy.is hereby:fumished. X BUM �S o�ss se//L(eQL 4 13( V I' LOCALITY ❑ Certified copy is filed'with the county building inspection CITY zIP / { ' I department. e� NEAREST CROSS ST. Date "= = Applicant SIZE OF LOT NO.OF BL'DGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY a ( CERIIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NOCONST. Q I COMPENSATION INSURANCE 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 ($(00) orlless.) Q I certify that in the performance•of the work for which this r 4,re� � 6o-d�Z I permit is issued:I shall not employ any person in any manner a. l so as to become subject to the Workers' Compensation Laws A a 3 /A 1. �-t�µ. •� T OCCUPANCY GROUP to { I Date Applicant , CITY � 6/V IP 6 o ��JJ Z 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. ❑ t ' revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ i 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 �e NO.OF EXITS and Professions Code,and my license is in full force and effect. 11S IIe3S ? PARKING• REWD D PROVIDED D License Number Lic.Class � (�AYC 5 '� � V��`/[py a SPACES { I Contractor Date V/,GQs LIMITED TIME USE I ElI am exempt from the licensing requirements as I am a •• DATE DATE ' licensed architect or a registered professional engineer FROM: TO: {`I acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. STORIE§ SIGNATURE. Lic. or Reg.No. - Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE i I hereby affirm that I am*exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ( ' I Professions Code): NO.PARKING SPACES PROVIDED i ❑ 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). CONSTRUCTION LENDING AGENCY 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.Q. 11 PROPOSED MAX._OyCQ /► p Lender's Name A�d Jc NT -70P)�F (Z �(� 7.f;, tf 'd Lender's Address ADD-R( ss I certify that I have read this application and state that the O S e d� va(• �i above information is correct. I agree to comply with all County PERMIT FEE r I ordinances and State laws ielating to building construction,and '•. I hereby authorize representatives.of this County to enter upon ISSUANCE FEE „•,•• :,• the above-mentioned property for inspection purposes - _ -- -• TOTAL FEE I• % ' � L �C•,q b SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date { ' F WORKERS'COMPENSATION DECLARATION I CE 8764(11.84) M ISCELLANEOUSIAPPLICATION - T hereby affirm that 1 have a certificate of consent nc self COUNTY OF LOS AISGE,I ES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.Q. DDREas Policy No. Company FOR APPLICANT TO FILL IN ANG .—� Pop ► ouR Certified'cdpby is hereby furnished. BUILDING 4DSGr"1i�F B LOCALITY ADDRESS Certifigd copy is filed with the county building inspection I, LOCALITY NEAREST department. k E L 17 CROSS ST. Date App icant NEAREST t DISTRICT NO. GROU LP TYPE ��J GINNED BY CROSS ST. - CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL r COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP ""%V'Y STATE MAJOR SECOND LOCAL NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOWNO.00N LOT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) use OF SIZE OF LOT EXISTING BLDG. '� p 1 certify that in the performance of the work for which this J permit is issued,I shall not employ any person in any manner.- OWNER Of building so as to become subject to thMAIL e Workers' Compensation Laws. OCCUPANCY GROUP n g ADDRESS Date 1 Applicant ►%� NOTICE TO APPLICANT: If,after making this Certificate of CITY NO. 7 OCCUPANT LOAD C/3 Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of tite Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deeirred revoked. LICENSED CONTRAC'T'ORS 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 an effect. Name 14f business SPACING NEWS) PROVIDEDCoe License Number _— Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TOI E] 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF I SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date VV HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE ,^ I I 0ClCI0 '(,I���yy II 1 9P. ,?'•:r. 1 hereby affirm that I :Int exempt from the Contractor's �)'IA 8493 t 1110 912, License Law for the following reason (Section 7031.5, Busi- ness 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,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency for tine 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 l have read this application and state that the PERMIT FEE 25.00 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 abov -mentioned property for inspection purposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE WOR h1.1iS'('0111P1{NSn'1IUN DECLARATION ICE 875(11.84) MISCELLANEOUS APPLICATION I�..vteby 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 � S.DDR EIS ADDRSS Certified copy is hereby furnished. 1(uILDINr; CAR'n? R -A '7 LOCALITY XX' ADDRESS 7 IM b L ?-/ LF-e ! Certified copy is filed with the county building inspection LOCALITY CII V1700 J NEAREST department. XY CROSS ST. Applicant---__—_ M€ARES�44� ?WAIAS DISTRICT NO. GROUP TYPE CESSED BY CROSS- /�G CONS CE..RTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Q COn(PENSATION INSURANCE DESCRIPTION LOT NO. BLOCK ROP MAHIGHW(CIRCLAY 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. 1 certify that in the performance of the work for which this - ci permit is issued,I Shall not employ any person in any manne2{X .o.W NC-R-o-f-bu 1-A—ii:• IV?'66 /-/Ufl� Syn aS III hccunnc Subject Ill the Workers MAIL Compensation Laws. , /J OCCUPANCY GROUP D' AUDDRESS r Date-_—__—__. Applicant-- — �//��� /�� ,,rr / "I NOTICE TO APPLICANT: If,after making this Certificate of CITY O/Iaml'zC 44 419ZL• f(le-zsy 6b 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. deenned revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affiant that I am licensed under provisionsof 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 PARKING effect. n -Name- of -busness SPACES II��JJ �REQ'D PROVIDED E:=1 1 License Number__—. Lic. Class I ' S'/� 941-VIN.7-5S LIMITED TIME USE Contractor___ ___ _—_____ ___ Date #PA6 DATE DATE -- 1 FROM: TO: ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OP INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES / SICNATUR iness and Professions Code). PRESENT USE OF BUILDING T�v FINAL APPROVAL 22 1Y Lic.or Reg.Ncr.___-- —_Date 14-1 — IIONIE 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 fallowing reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED % Ell, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions('ode). CONSTRUCTION LENDING AGENCY PROPOSED USB OP BUILDING ��� GZ/C - U S� I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,('iv.C.I. {.endcr's Namc__ PROPOSED MAE OCC. I.enilcr's Address___.__. —_ __----- — -- j 'M e 1 i PERMIT FEE ..i I certify that 1 have read this application and stale that the9-5.00 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 a upon the above-n ntionet iperty for inspection purposes. r: ._r- i �, SEE REVERSE FOR EXPLANATORY LANGUAGE �a x1c 14i!•n11un ! I N.11101 • 111t (' I WORKERS'COMPENSATION DECLARATION 7BM444 MISCELLANEOUS APPLICATION 20-0063DPW12/90 1 r+ 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(Seg.3800, Lab.Q. (� Policy No. Company FOR APPLICANT TO FILL.IN BUILDING BUILDING ADDRESS ADDRESS I ❑ Certified copy.is hereby:furnished. $ .SdSe /V kone~a LOCAUTY { I ❑ Certified copy is filed with the county building inspection CITYn d ZIP ad NEAREST department Q C_ /'f- Q CROSS ST. ' Date Applicant SIZE OF LO0r BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY } CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' 0 ( I COMPENSATION INSURANCE TRACT BLOCK LOT No. V MAP - HIGHWAY • NO. ICIncl.e) 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.) Q ( ' I.certify that in the performance.of the work for which this • Verry er N j permit is issued. I shall not employ any person in any manner icQ c�oh w l e so as to become subject to the Workers' Compensation Laws. ADDRESSa S 2/S OCCUPANCY GROUP . Date Applicant . CITY zIP ? ( Arae a_ 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. ❑ t revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I I hereby affirm that I am licensed under provisions Of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) NO.OF EXITS •�� t I 9(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. ame ot BusluessS� -� Agle PARKING• REWD D PROVIDED D j License Number Lie Class SPACES ( I � Contractor Date LIMITED TIME USE ' ❑ I am exempt from the licensing requirements as I am a DATE DATE I FROM: TO: licensed architect or a registered professional engineer acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S (` 1 and Professions Code). EXISTING BLDG. STORIES SIGNATURE, Lic or Reg Na Date PRESENT USE OF BUILDING FINAL APPROVAL HOZ ' 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 i El I. as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044,31 PROPOSED USE OF BUILDING Business and Professions Code). t i11167AAy I&Aftig /dt it CONSTRUCTION LENDING AGENCY iI hereby affirm that there is a construction lending agency for QS- � .4o os 6), 0" i 'Pexyft- the performance of the work for which this permit is issued ( I (Sec. 3097,Civ.C.). PROPOSED MAX.OCC. j Lender's Name APPLICANT(PAINT) L N Al /C WAL Gf/G( Lender's Address ADDRESS i I I certify that I have read this application and state that the •'E0 N Ifat.ed eu ( ew CTf CA / 7o'n Q above information is correct I agree to comply with all County PERMIT FEE j ordinances and State laws relating to building construction,and - 1" j hereby authorize representatives of this County to enter upon ISSUANCE FEE `n the above-mentioned property for inspection purposes. .. j TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Peffnittee ate -- - CE 875(11-94) IVI IJI.GLLHIVt.IJUJ f'►I�trLIL,H I lVIV I hereby affirm that I have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I �nyltre, or a certificate of Workers'Compensation Insurance,or � lJ _I a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR�PPLICANT TO FILL IN A00RBUILDING�f/ p ADDRESS Certified copy is hereby furnished. wDORESS 564 -qJ RW/�e.w�La 61vd LO CA LIT �G Certified r irfied II py is filed with the county building inspection LOCALITY Temple City cRoss RAREST Date Applicant NEAREST f) DIST_WT NQ. GRO P TYPECONS CESSED BY CROSS ST. /1/UVL0.� h� LA.bVI eq Oy CERTIFIIQATE OF EXEMPTION FROM WORKERS' LEGAL I 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 (S100) or less.) USE OF I I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG, i•" permit is issued,I shall not employ any person in any manner y OWNER a U aux. 0 so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP c MAIL O ADDRESS 9..°J� - • v I Date Applicant L, NOTICE TO APPLICANT: If,after making this Certificate of CITY M �.ry Mo`'04 —k4 -6 0 OCCUPANT LOAD, Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth- I with comply with such provisions or this permit shall be TRAILER USE E3GEOLOGY INSPECTION ❑ No Spec. Knowl. 9 deemed Ievoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) l 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 y SPACES REO'D PROVIDED I License Number Lic. Class o i LIMITED TIME USE H Contractor Date DATE Dwre N W ZFROM: TO: IR I am exempt from the licensing requirements as I am a D 1 licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S Z acting in my professional capacity (Section 7051. Bus- EXISTING BLDG. STORIES SIGNATURE m iness and Professions Code). p FINA APP VAL F/2—ZZ`4PRESENT USE OF BUILDING Lic.or Reg.No. Date iz { lb HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS D ON LOT AND USE I hereby affirm that I am exempt from tate Contractor's 1 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): s ACES PROVIDED II{l{j i i EJI, as owner of the property, will do the work and the �� structure is not intended or offered for sale (Section 1 7044,Business and Professions Code). i CONSTRUCTION LENDING AGENCY g PROPOSED USE OF BUILDING �ilPple7 I hereby affirm that there is a construction lending agency t 1 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 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 ( ) Signature Permittee Date . I , i WORKERS'COMPENSATION DECLARATION 76M444 ICE 875(11.84) MISCELLANEOUS APPLICATION 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.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS . Certified copy is hereby furnished. eu1LDING ` p, _ DORESS v D OS V EVN LOCALITY Certified copy is filed with the county building inspect LOCALITY NEAREST department. yy; CROSS ST. Date Applicant NKARMS. DISTRICT NO. OUP TYPE P ESSED BY o j, CERTIFICATE Of ECROSS ST. LC dL/n.s �EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BI.DGS. NO (CIRCLE) (This section need not be completed if the work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) use of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which is ' I permit is issued, 1 shall not employ any person in any ma eikg owNER of buildingAy -E HuQrn a;�] w as to become subject to the Workers Compensation �ws. MAIL OCCUPANCY GROUP c ADDRESS ` I� Date_ Applicant 6 O$e IN1 U IU, NOTICE TO APPLICANT: If,after making this Certificate of CITY NO. OCCUPANT LOAD L. v 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. (icelried revoked. I.ICL'.NSEll('UN'1'RAC'I'OItS 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 sl- NO.OF EXITS ness and Professions Code,and my license is in full force an* effect. ame of business PARKING SPACES REO'D � PROVIDED License Number Lic. Class .to LIMITED TIME USE Contractor___ _- Date DATE DATE F11 am exempt from the licensing requirements as 1 am a PROMI 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 `Uz Lic.or Reg.No. _Date PRESENT USE OF BUILDING �{ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS o j(.��fJ� �jLlr1 'if'!1; ON LOT AND USE / 1V'I iJ1. 1, t-Ii'i•1'I n��t i I hereby affirm that I am exempt from the Contractor's /Vi1N� License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING FJ1, 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 I issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAx Lender"s Address—. PERMIT FEE 25,0111 1 certify that 1 have read this application and state that the above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, 25.00 and licreby a izc re ntatives of this County to enter TOTAL FEE l,po tl •Iiti d p pert for ins ion p rpos .. SEE REVERSE FOR EXPLANATORY LANGUAGE . I X 111 I 4 I illrr I)at j WORKERS'COMPENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS APPLICATION �I hereby affirm that I have a certificate of consent to self 'd insure, or a certificate of Workers'Compensation Insurance,or, COUNTY OF LOS ANGELES ' BUILDING AND SAFETY DIVISION a certified cop thereof(Sec.3800, b C. Policy No.Q�Company BUILDING LD I NG �,( -� FOR APPLICANT TO FILL IN .6% 4 ADDRESS �J Certified copy is hereby furnished. BUILDING ADDRESS ' , J 1 )_OCALITY } Certified copy is filed with the county building inspection NEAREST department. LOCALITY Temple City crloss sr. Date Applicant NEAREST ] f 1 P ICT NO GR P TYPE ESSED BY CROSS ST. 1 r 1 , D CON T. j I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK HIGHWAY STATE MAJOR SECOND LOCAL ICIRC LE) NO. OF BLDGS.(This section need not be completed if the work involved TRACT NOW ON LOT NE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF •yj 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 , so as to become subject to the Workers' Compensation IrL�awss. MAIL OCCUPANCY GROUPEw:] = �) Date � _ Applicant �1� t �� - 1`1D/i11K1r _ ADDRESS 1; TEL. 1 NOTICE TO APPLICANT: If, after making this Certificate of CITY No. 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONIX Panic Devices I I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busr SAFETY PERMIT ❑ (LIST ITEMS BELOW NO. OF EXITS ness and Professions Code,and my license is in full force avid effect. I PARKING SPACES REq'O O PROVIDED License Number Lic. Class _ '� • LIMITED TIME USE Contractor Date _ DATE DATE I am exempt from the licensing requirements as I am.a FROM! TO: j licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG TUR iness and Professions Code). FINAL APPRov L PRESENT USE OF BUILDING Lic.or Reg.No. Date _ HOME OWNER-BUILDER DECLARATION NO. OF EXISTINGBUILDINGS 10 �� ON LOT AND USE I hereby affirm that I am exempt from the Contractor's '') + 190 W16 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING DI, 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 X PROPOSED USE of BUILDING 1 Hereby affirm that there is a construction lending agency ,y) for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name _ Lender's Address PROPOSED MAX. OCC. I certify that I have readJh on and state that the PERMIT FEE 25.00 above information is correcmply with all County ISSUANCE FEE ordinances and State lawbuilding construction, and hereby authorize reprf this Count to enter TOTAL. FEE 25.00 .:I I upon the b ve a tioned insp cti n p pose. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature R Perm e t