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Home My Public Portal About5721 SULTANA AVE_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 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 ceftified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN ADUILDI 0RESSV6 Certified copy is hereby furnished. BUILDDRDIESSG NA LOCALITY ` , ElCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. O TYPE P CESS D BY CROSS ST. CONST. ' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (SI00) or less.). USE OF a I certify that in the performance of the work for which this. SIZE OF LOT EXISTING BLDG. o permit is issued, I shall not employ any person in any mannerOWNER M . so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS 3 I 16 Date Applicant 1J NOTICE TO APPLICANT: If, after making this Certificate of CITYT'rorn i NOJ & �S-Q.�j' OCCUPANT LOAD y Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- ❑ with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of the Busi- No. of EXITS ness and Professions Code,and my license is in full force andS( nCOS effect. IV\ PARKING REQ D PROVIDED - , SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE! DATE D I am exempt from the licensing requirements as I am a FROM: To. licensed architect or a registered professional engineer SIZE OF NO. O F INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES NATURE iness and Professions Code). PRESENT USE OF BUILDING �Llf=rIC� FINAL APPROVAL Lic.or Reg.No. Date / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 1 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 NO FEE ' structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY J TROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency �7Ci Qg�-y� for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Addresst\v\4 PERMIT FEE e \ I certify that I have read this application and stale that the above information is correct.I agree to comply with all County ISSUANCE FEE \ ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL.FEE u on t11e abo -mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1 \"14 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION -1 hereby affirm that 1 have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.C.). - Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING 5-7,41 A Shnowef �V e— LOCALITY i C ADDRESS FCertified copy is filed with the county building inspection LOCALITY G j CROSS sT. / ^ department. ��.,IYI/®/� IA-5 Date Applicant NEAREST DISTRICT NO. GI7OUP TYPE PROC 5/ CERTIFICATE BY CROSS ST. /'',g .f _ CONST. { % CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL - 0 �D COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECO 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 ($100) or less.) us9 OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING HLD 6. 0 permit is issued, I shall not employ any person in any manner OWNER fpwj-/ Co",/a 1/,-2 so as to become subject to the Wo ers' Compensation La s. MAIL OCCUPANCY GROUP L—� o G- ADDRESS y r Date O Applican ' � u�-, 00,NOTICE TO APPLICANT: If, after making this Certificate of CITY G��yUit/ff / /,f NO. -$c/ s— ..-1 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 PERMI [] (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- �, NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REq•D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineerSIZE OF NO.OF INSPE TOR s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). r o. PRESENT USE OF BUILDING SG� FINAL APPROVAL �p Lic.or Reg.NDate _ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING eVf,,ICj"G-e_ �QC- I hereby affirm that there is a construction lending agency a_o for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 0 0 X 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 (A ordinances and State laws relating to building cpnstruction, _l and hereby authorize representatives of this County to enter TOTAL FEE f7a u on thea ve-mentioned proper for inspection purposes. ��' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of fermittee Date WORKERS'COMPENSATION DECLARATION CE 876(2-80) MISCELLANEOUS APPLICATION 1 hereby affirm that I have certificate of consent to self ' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers'rs'Compensation Insurance,or � I a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ,ADDRESS ❑ Certified copy is hereby furnished. UILOING LOCALITY ❑ ADDRESS Certified copy is filed with the county building inspectionT NEAREST department. I LOCALITY /Q� R r CROSS ST. Date Applicant AREST C ` DISTRICT N GROUP— T P OC SSED BY CROSS ST. CONST. I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE I DESCRIPTION LOT NO. BLOCK MAP J NIGH WAY 3 I No. (r+L�Cr "CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved NO. CO SLOGS. ,USE ZONE SPECIAL CONDITIONS ^ P TRACT NOW ON LOT (✓ by the permit is for one hundred dollars ($100) or less.) USE OF , Q SIZE OF LOT EXISTING BLDG. " tm I certify that in the performance of the work for which this 1 0 permit is issued, I shall not employ any person in any mannerT.MAIL WNER A— so as to become subject to the Workers' Compensation Laws. DDRESS OCCUPANCY GROUP Date Applicant � � CL NOTICE TO APPLICANT: If, after making this Certificate of L400CITY r NOL OCCUPANT LOAD Exemption, you should become subject to the Workers' AP LIGATION FOR EXIT HARDWARE Compensation provisions or 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 i Panic Devices I Ifereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT L-1 (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and 1 eel t. I PARKING REQ'D PROVIDED 5 I SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE I ❑ FROM: TO: I am exempt from the Licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date ^ TING HOME OWNER-BUILDER DECLARATION ON LOT AND USE NO.OF XI USE BUILDINGS 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 n 0 4 r ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section ; D o D D t 7044, Business and Professions Code). ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY i i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX.OCC. Lender's Address I PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon h above-mentio ed property for inspection ,u,,,es, i SEE REVERSE FOR EXPLANATORY LANGUAGE S' ature of Permittee Date WORKER!'COyPENSATION DECLARATION CE 8754(2-80) MISCELLANEOUS APPLICATION I hereby affirm that 1 have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN aUILDIN 2 1 ❑ Certified copy is hereby furnished. Bu1LDINS L�( �.A LOCALITY e Certified co ADDRES � �j/ ri copy is filed with the county building inspection department. LOGALITY-t-G� & �,rY NEAREST CROSS ST. Date Applicant NEAREST ��// 1� DISTRICT 11yyp. Gg�OUP TYPE PR ED BY CROSS ST. / (�,�/f_� Y E•� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o L/�� COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK } MAP HIGHWAY AY NO. (e IR CLE) ' STATE MAJOR SEC o D LOCAL tZ (This section need not be completed if the work involved NO. F BLOGS. OTRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars (5100) or less.) USE of U SIZE OF LOT EXISTING BLDG, (X 1 certify that in the performance of the work for which this iSD permit is issued, I shall not employ any person in any manner OWNER At Q OF IL _� U MAIL so as to become subject to the Workers' Compensation Laws. / OCCUPANCY GROUP W ADDRESS ��0 C. Date Applicant TW �� /J�r �J _ �I NOTICE TO APPLICANT: If, after making this Certificate of clrY-r (�c- (j NoEL. OCCUPANT LOAD. v Exemption, you should become subject to the Workers' IAPPLICATION 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. 11 No Spec. KnOWi. ❑ P OCCUANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT V (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. REO'D PROVIDED SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE OFRPM: TO: I am exempt from the licensing requirements as I am a, licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date J 1Cr HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that- 1 am exempt from the Contractor's ;24227A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING '# 0 0 0 0 8 8 SPACES PROVIDED I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section a 0 D D D o 0 o (n 7044,Business and Professions Code). 111 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 0313-86 3—$6,,,///�� 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 r d this application and state that the above information i c ect.I agree to comply with all County ISSUANCE FEE orcWnances and St a aws relating to building construction, TOTAL FEE an li by III tho z representatives of this County o enter u the abo e- ione property for it a ion r oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu P of 1 ermittee D to WORKlcs'; > Y1;NSAl1UNll1(-LARAl1UN CE 8754(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. PolicvNo. Company FOR APPLICANT TO FILL IN BUILDING ��/ ADDRESS J , Certified copy is hereby furnished. �y ABUID13H NG �/ �vl�p�� LOCALITY ADDRES �.�y DCertified copy is filed with the county building inspection LOCALITY��/1'C ,[r Cr &A- 9 NEAREST department. K CROSS ST. , Date Applicant NEAREST DISTRICT O TYPE IP CESSED BY GROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL / Z COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP Hic NO. OF BLDGS. HWAY STATE MAJOR SECOND LOCAL 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 (5100) or less.) USE OF SIZE OF LOT EXISTING BLD 6, r• 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 �, �,[�� V �•4 ® ~' so as to become subject to the Workers' Compensation Laws. MAIL / ``// �f OCCUPANCY GROUP Date Applicant ADDRESS �`� ,%- �d.Clr�[� /'{. NOTICE TO APPLICANT: If, after mak' this Certificate of CITY 'J ��,� Tnlo� OCCUPANT LOAD C- NOTICE tion /7 N A-0� — Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- q151,V APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ® Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING REQ'D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElFROM: To: INSPECTORS I am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE OF NO. OF SIG TURE acting in my professional capacit% (Section 7051. Bus- EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL ]• � Lic.or Reg.No. Date ` Ah HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS D Qq _09 flE I hereby affirm that I ant exempt from the Contractor's ON LOT AND USE License La-vv for the following reason (Section 7031.5. Busi- ness and Professions Code): NO. PARKING (y/, 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.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address 1 certify that 1 have read this application and state that the PERMIT FEE O!7 above information is correct.I agree to comply with all County ISSUANCE FEE ordir&- ces and State laws .relating to building construction, and 'hereby authorize representatives of this County to enter TOTAL FEE 1 C7 upon the above-Volitioned prope ,fo inspection purposes. SEE REVERSE FOR EXPLAI�.I,TORY LANGUAGE Signature of Perm i Date I