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HomeMy Public PortalAbout5926 TEMPLE CITY BLVD_Miscellaneous__ { I WORKERS'COMPENSATION DECLARATION 2000 3DPW12/90 MISCELLANEOUS APPLICATION I hereby'affirm that I have a certificate of consent to self COUNTY OF LOs`ANGELES ! BUILDING AND SAFETY DIVISION �I ;insure,•or a certificate of Workers'Compensation Insurance,or y� L 1 a certified copy thereof(Set 3800, 1.&C.)• (� Policy Na Company - FOR APPLICANT TO FILL IN BUILDING BU[.DING DORESS t�"" _ _ ADDRESS •I n Certified copy,is hereby.furnished g 7,(�o T 1R C" I.I t ti I Lam• LOCALITY lul Certified copy is filed with the county building inspection cl ( ZIP { I department ( cRoss sr. _tzDate " ° Applicant SIZE OF Lot ^ NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY a CEIMFICATE OF EXEMPTION FROM WORKERS' ( coNsr. C [ I COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY l+ • NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less.) USE zoNE SPECIAL CONDITIONS s, I certify that in the performance.of the work for which this scar eI TEL NO. U _A7 LU permit is issued. I shall not employ any person in any manner a n p ADDR S " . so as to become subject to the Workers' Compensation Laws. � � OCCUPANCY GROUP � ( I Date Applicant , CITY ZIP NOTICE TO APPLICANT: If. after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: ( comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) NO.OF EXITS t I 9(commencing with Section 7000)of Division 3 of the Business ame o usiness and Professions Code.and my license is in full force and effect. i License NumberLie Class PARKING• REO'D PROVIDED Tasonj C, t SPACES [ I I Contractor Date 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 SIZ OF NO.STOR ES INSPECTOR'S EXISTING BLDG. and Professions Code). yy SIGNATURE' Lic. or Reg.Na - Date PRESENT USE OF BUILDING 1-3-03 �FINAL APPROVAL 1 r J-03 HOME OWNER-BUILDER DECLARATION NO'OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am'exempt from the Contractor's License Law for the following reason (Section 7031.5• Business and I I Professions Code): NO.PARKING i ❑ I, as owner of the property, will do the work and' the SPACES PROVIDED structure is not intended or offered for sale(Section 7044,1 PROPOSED USE OF BUILDING ! Business and Professions Code). , CONSTRUCTION LENDING AGENCY iI hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sea 3097,CIV.Q. PROPOSED MAX.OCC. j Lender's Name APPLICANTI=( EL NO. . ( CFL� •–�2 —�[ •- Lender's Address ADDRESS { j I certify that I have read this application and state that the 90 ld S . t above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and ' hereby authorize representatives of this County to enter upon ISSUANCE FEE <r the above-mentioned p erty for inspection purposes - TOTAL FEE••• g SEE REVERSE FOR EXPLANATORY LANGUAGE r Signature of Nmittee Date ' I WOR KLRS* CONI PI.NSA HON DL( 1.ARAIIONl MISCELLANEOUS APPLICATION n 0M,,nrt71., 'al C hercb) afl'irnt that I have a certiricaie of coll,eni Ia '.ell COUN'l l' 01 1 OS AN(ila FS 131111-DING AND SAFETY DIVISION 1!I insure,or a certificale of Walkers'Compensation Inwr,lncr. III. I a certified cap) thereof (Sec. 3801). Iah. Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADD ESS ms,µ ADDRESS ❑ C'ertified copy is hcrcb) furnished. / Z �i"v` ��v' l �J�. Sw I t� �_ LOCALITY ❑ C'ertif'ied cop)' is filed \\ilh the cutnu) huildiu) nr.pel tion C -- p ! --- ZIP -- - 1 departiiiciit. _4949 Il � C���7$'I� NEAREST CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY ' C'ERI'II'ICAfE OF EXEMPTION FROM \%oitki.RCONST. S' - -- -- C'OMPENSAT'ION INSURAN(.1: rRacr BLOCK LOT NO. MAP HIGHWAY [ NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This til`CI1011 R(Cd 1101 Ile completed If theNUrk In\01\L`(I ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS t by the permit is li)r one hundred dollar% Is. 100) or les~.) — OWNER TELO. p� �•,; I I certify that in the perliuu rrnlre of [lie \cork I� hirh this - 04-7�0 permit is issued. I shall not enlplo) in) person in an) nu.nner so as to become subject to the Workers' Conlpen,atilm 1a\\s. ADDRESS OCCUPANCY GROUP F=-G '. Date Applicant CITY ZIP -' NOTICE TO APPLICANT: II'. alter nlakinp this ('ertilicate _ OCCUPANT LOAD of Exemption• you should become subject to the Noikers' APPLICATION FOfi EXIT HARDWARE: pro\isionsof the Labor Code.you niml I61,111Ni111 comply with such pro\isions lir this Beni It shall be deemed TRAILER USE GEOLOGY INSPECTION Ll No S revoked. {{�� Spec.Knows. El OCCUPANCY INSPECTION93 Panic Devices El' LICENSED CON'fRAC-FORS I)li('LAR.CIION ^ 1 hereby'afflrllt that I am licensed under pro\isions of (Ilapter SArETY PERMIT O (LIST ITEMS BELOW I 1 I 9(commencing with Section 7000)of Division 3 al the Bu.iness - NO.OF EXITS J and Professions Code.and my license is in full force and yflect. PARKING• REO'D PROVIDED i License NumberL.ic.('1:1,1 �/ l L z-Op-n• SPACES I I Contractor Date ` — P•- - — --- LIMITED TIME USE - --- DATE DATE ❑ I am exempt from the licensing reyllll't:lllt:llt% ill 1 11111 :1 FROM: TO: licensed architect or a registered prol'e%sional engineer — - acting in my professional capacn) (Sccihill 7011. Ilei h1C11 SIZE and Prul'essiuns Code). OF N0.01 INSPECTOR'S -1 EXISrIN(,BLUG. _-_------_— SIORILS _ SIGNATURE PRESENT USE OF BUILDING FINAL APPROVAL • Lic. or Reg. No. Dale I —� — e s- © - - — IIl)A1l: OWNER-111 III DI.R IN ( I.A It:111(1N NO OF'1'XISIING BUILDINGS I ON LOT AND USE ' I hereby affirm that I am c\cnlpl frons the Conlracloi'% I wense ---- --- --- Law for the following reason (Section 7031.5, B1:,ine,s and Professions Code): NO.PARKING ElL as owner or file property. it 11 du the \%",_kand Thr S—PACES PROVIDED._____ ---- -------- - ---•-- structure is not intended orulleled lin %alc(Seclnln II1.1.1. PROPOSED USE OF BUILDING Business and 1'nlfessions Code). - --- -- - i CONSTRUCTION LENDING AGI NCC 1 hereby affirm that there is a conslruciion Iendim. ,igelli•\ 1`111- the 1+rthe performance of the eork for Mlich this pernut i% issued --- --_.— _.- -- ('IV.('.), PROPOSED MAX.OCC. (Sec. 3097, Lender's Name - APPLICANT(PHI!!il Y/ 76 /� Lender's Address certify that I have read This application and %iaie Ilial the1Q , L above in forma lion is correct. I agree(O Conlp!)•\\iIII all'('ou ut), PERMIT FEE I ordinances and State laws relating to building construcllon.and hereby authorize representatives of this County to cnt:r upon ISSUANCE FEE the above-mentioned property for inspection purpows. TOTAL.rCE 7 X _ SIA RIWURSL' I.OR I.XPLANMORY I.ANGl1AGE 1 i Signature of Permittee 1),'Ic WORKERS'COMPENSATION DECLARATION 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. Policy No._,, FOR APPLICANT TO FILL IN BUILDING—Company 9 ADDRESS FICertified copy is hereby furnished, uILDING 9 �.. d 'l LOCALITY ADDRESS _ry 0 Certified copy is filed with the county building inspection LOCALITY NEAR sT. department. TQM LPs. S LA Date Applicant NEAREST �� ���� DI TRICT O. ff,,��ROUP TYPE PROCESSED BY CR099 ST. i/ ' CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL , COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP IGHWAv NO. OR BLD6S. TCIR CSTATE MAJOR SECOND LOCAL NO. L6) (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 / I certify that in the performance of the work for which this SIZE OF LOT EXISTING DLDG. o permit is issued,I shall not employ any person in any manne OWNER s' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP , o ADDRESS 1--' Date Applicant ,may, NOTICE TO APPLICANT: If,after making this Certificate of CITY ,Tool. 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 ❑ ❑ No Spec. Knowl. P Y P P TRAILER USE GEOLOGY INSPECTION deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSP6 CTION 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- R No. OR EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ.D I PROVIDED J License Number' Lic. Class LIMITED TIME USE Contractor Date D ATE OA T6 PROM: I am exempt from the licensing requirements as I am a licensed architect oI a registered professional engineer 5IZE OF NO. OF IN CTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES sl1 ATURE iness and Professions Code). ` FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS N 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 v 1, as owner of the property, will do the work and the SPACES PROVIDED 4874 1 Pit 3-029 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OR BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX. OCC, Lender's Address HH ^- 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 a rize representatives of this County to enter TOTAL FEE o the ab e- entioned op t for ins ction purposes. ���^ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit ee Date �1 WOP!KERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION {� CE 875 LI I h:seby 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.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING cti ADDRESS l.J Certified copy is hereby furnished. BUG ILDIESN �Pr� /! LOCALITY tf DRS �Tr Certified copy is filed with the county building inspectionLOCALITY �A n CC NEAREST department. r1empl-V CI CROSS ST. Date Applicant NEAREST /�/` /�// /� DISTRICT NO G TYPE PROC SED BY CROSS ST. `j/JV TC//vtf AM. CONS'C.� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL IV1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY CiR CLQ) E O STATE MAJOR SD LOCAL ND. ( NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued,I shall not employ any person in any manner owNER L E /��(� so as to become subject to the Workers' Compensation Laws. A 11. _ OCCUPANCY GROUP �� a ® �� DRESS ��a S L d /�,Se 14V C] Date RC2 Applicant OPI E" S��� C:� r NOTICE TO APPLICANT: If, after making this Certificate of CITY NOL' —g 5,� 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 PER IT ❑ LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code,and my license is in full force and effect. PARKING SPACES R9Q'D PROVIDED �� JJ 11�� License Number Lic. Class LIMITED TIME USE Contractor Date DATA DATE ❑ I am exempt from the licensing requirements as I am a PROMt • 11CCI1Sed aIChiteCt Or are registered rofessional engineer SIZE OF NO. OF INSPECTORS g P Iii SIGN TORE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL •� Lic.or Reg.No. Date m5' GESrf GF, HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANI 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 PROVIDED PARKING I, as owner of the property, will do the work and the SP structure is not intended or offered for We (Section ;9 0 5 9.9 A 7044,Business and Professions Code). �{ 0 0 0 0 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING $ ° ° °G-8$� I hereby affirm that there is a construction lending agency 09. 0 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 PERMIT FEE �} I certify that I 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, and hereby authorize representatives of this County to enter TOTAL 10 n ,up.on the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Ni Z f-, p Signature of Permittee 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 re, or a certificate of Workers'Compensation Insurance,e,or rtified copy thereof(Sec.3800,Lab.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS FiCertified copy is hereby furnished. UDDRESS ILDING A � LOCALITY _/ G Certified copy is filed with the county building inspection LOCALITY " NEAREST department. GROSS ST. Date Applicant NEAREST DISTRICTNO G U TYPE PROCE ED BY CROSS ST. c ! CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J•u COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HI HW AY STATE MAJOR SE 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 ($100) or less.) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. do permit is issued,I shall not employ any person in any manner NJOINNER s'J so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o 14 ADDRESS '^ ;ite&P/ • t3 Date Applicant L„ =gwLTEL' OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of cIT � No. 8 � � Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APP ATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ E] No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT E] (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 REp'D O PROVIDED SPACES LL�� 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 engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL t Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS o ON LOT AND USE F O I hereby affirm that I am exempt from the Contractor's J$31 0 0 0 0 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING c9. 1 1 -87 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). (JO CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency IU 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 //��0 PERMIT FEE V V I certify that I hw&read this application and state that the above inform on is corer ct.I agree to comply with all County ISSUANCE FEE ordinances a State laws relating to building construction, and hereby au ize representatives of this County to enter TOTAL FEE up n the above-me 'oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Dat WOrKERS'COMPENSATION DECLARATION 5CE 87 (2-80) M I SC C L LA NE O U 5{ A®PU C A T I®N 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. BUILDING ADDRES ��. LOCALITYEl ��� C F S� , � Certified copy is filed with the county building inspection //f� �f NEAREST department. LOCALITY L`MPiz �d� <2 �r/1 cRoss ST. Date Applicant NEAREST ,!' ��. /t �7 4'G� DISTRICT NO. GR UP TYP PR ESSED BY CROSS ST. UN� [ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. STATE MAJOR SECOND LOCAL NO. OF SLOGS. c•3' (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SP179C IALIC O N DI T IO N S O by the permit is for one hundred dollars ($100) or less.) USE of I ' U S E OF LOT EXISTING BLDG. I certify that in the performance of the work for which this . GGGrVrr�/ cc permit is issued, I shall not employ any person in any manner. OWNER /100 ICA O so as to become subject to the Workers'Compensation Laws. A!L4`�y { OCCUPANCY GROUP U ADDRESS 1 6frAe CST A. tLU 7. Date Applicant I NOTICE TO APPLICANT: If, after making this Certificate of No 1-7—7410OCCUPANT LOAD z Exemption, you should become subject 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 occuPArvcv INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter• SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS a 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING SPACES REQ O PROVIDED License Number Lic.Class• LIMITED TIME USE Contractor Date I DATE DATE (--� • L,J1 I am exempt from the licensing requirements as I am a FROM: TO: 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). e IPRESE NT USE OF BUILDINGFINAL APPROVAL /i/ j66 c� 1 `iii. V r Lic.or Reg.No. Date ' 1 7. • r - HOME OWNER-BUILDER DECLARATION No.of AND UrvG BUILDINGS fON LOT AND USE I hereby affirm that- I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- nessand Professions Code): NO. PARKING c SPACES PROVIDED I EJ I, at owner of the property, will do the work and the c 0 D R structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1 a o`o o a o o ROPOSED USE OF BUILDING I , CONSTRUCTION LENDING AGENCY I ► E i0329--84,' I hereby affirm that there is a construction lending agency i �� ff-s aA lvs for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. I 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 he eby authorize representatives of this County to enter �pon a abov -me Ione p"ro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I Signature of Permittee Date ) I ' i • WORKERS'COMPENSATION DtCLARATION I CE 876(2 80) MISCELLANEOUS APPLICATION Hereby affirm that 1 have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate of Workers' j Compensation insurance,or � a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING S ,0G /1 (. 4/ LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY 7 7 CROSS ST, Date Applicant NEAREST / DISTRICT NO. GR���QQQUP TYPE PR SS ED BY CROSS ST. (o {{ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL u COMPENSATION INSURANCE DESCRIPTION LOT NO. BNO. (CIRCLE) AJOR SEGO 0LOCK MAP HIGHWAY STATE MLOCAL LL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars (S100) or less.) USE OF SIZE OF LOT EXISTING BLDG. C' I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner OWNER ���artGfr y so as to become subject to the Workers' Compensation Laws. MAIL 61t6G OCCUPANCY GROUP 2 W ADDRESS C I%l/d/67 a Date Applicant C40NOTICE TO APPLICANT: If, after making this Certificate of CITY (�►` / -"2-97- 21t� 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 INSPECTION❑ Panic Devices ❑ I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect' SPACES REQ'D O PROVIDED O License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as 1 am y licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL 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 � , 3 1,2A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED # 0 0,0 0 8 8 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section O o 0 0 0 o O 12 7044, Business and Professions Code). PROPOSED USE OF BUILDING • 01, 08-85 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of tate work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX.OCC. Lender's Address PERMIT FEE I certify that 1 have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the ab ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatu a of Perml tee Date WORKERS'COMPENSATIONDECLARATION 76M444 E MISCELLANOUS APPLICATION CE 875 (2-80) MISCELLANEOUS G �(I I hereby affirm that I have certificate of consent to self insure, or a certificate of Workers' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISIONrs'Compensation Insurance,or Erl a certified copy thereof(Sec.3800,Lab.C.) I Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. Lo BUILDING 5926 Temple Clt Blvd. O LOCALITY ❑ ADDR5S5 Certified copy is filed with the county building inspection NEAREST department. L ALITY Temple CROSS ST. Ir Date Applicant VNEAREST DISTRICT N .. GROUP E PRO SSED BY CROSS ST. Las Tunas CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL '- (This section need not be completed if the work involved NO. OF BL T USE ZONE SPECIAL CONDITIONS ti P TRACT NOW ON LOT ; by the permit is for one hundred dollars ($100) or less.) USE OF J I certifythat in the SIZE OF LOT EXISTI G E;3LDG. performance of the work for which this ; permit is issued, I shall not employ any person In any manner I WNER so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP fI, Temple City Blvd. Room E U.1 ADDRESS Date Applicant f'. NOTICE TO APPLICANT: If, after making this Certificate of CITYTemple City NO. 285 1576 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 C] No Spec. Know[. ❑ deemed revoked. Panic DeVIC2S ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS a 9 (commencing with Section 7000) of Division 3 of the Busi- ness Land Professions Code, and my licence is in full force and PARKING. I--- effecl. REQ'D PROVIDED SPACES Liceqse 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 engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ESENT USE OF BUILDING Offices FINAL APPROVAL Lic.or Reg.No. Date V i NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION 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 E 6 9 9. 1 A E-1 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section #,f o I, o o $$ 7044, Business and Professions Code). ROPosED USE of BUILDING Office 0 0 0 0 0 0 0 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency I Q 1 9-8 2 for the performance of the work for which.this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCG. 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 thoriZ repr n Iv of this County to enter .26. 00 upon the o e-me on pr, a ty for inspec '6n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign77 Permittee Date WORKERS'COMPENSATION DECLARATION i CE 875(2-80) MISCELLANEOUS APPLICATI®N 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 FOR ADDRESS _ ._ ❑ Certified copy is hereby furnished. BUILDING /�•/ / LOCALITY $ � ��j�'� ADDRESS 4 'l./�) �� -Z1 ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY It Pi D cRoss ST. Date Applicant NEAREST / (` DISTRICT NO. G UP TYPE PROCESSED BY CROSS ST. (,/IIr�JTJ '�� CON ST��' I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL d e wornvo P TRACT NOWCON(This section need not be com leted if thk ilved NO. CO BLN LOT T USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF " U GI certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. Ir permit is issued, I shall not employ any person in any manner OWNER `p O so as to become subject to the Workers'Compensation Laws. J OCCUPANCY GROUPMAI �J V ADDRESS f L 4iY e ' rrf�+ Q Date Applicant TEL NOTICE TO APPLICANT: If, after making this Certificate of CITY �,g� f� /Ty No.' OCCUPANT LOAD Z Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE[] GEOLOGY INSPECTION No Spec. Know(. ❑ deemed revoked. Panic D2VICe5 ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 pp RKINe. e7Ct. SPACES REQ'D PROVIDED License Number Lic.Class LIMITED TIME USE Co-stractor Date DATE DATE ❑ FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING / J� FINAL APPROVAL �� . f Lic.or Reg.No. Date Lill ' HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 5 5 C U r License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ;' 0 0 0 0 [' 0 SPACES PROVIDED ' r_1 I, as owner of the property, will do the work and the o o D 0 0 0 o I` structure is not intended or offered for sale (Section I 7044, Business and Professions Code). PROPOSED USE OF BUILDING �,f,� � r � CI 1 I 1 —8 CONSTRUCTION LENDING AGENCY Li/J 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 j 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 and hereby authorize representatives of this County to enter upon e above-menti ned po erty for inspe tion purposes. I EE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee liateK I WORKERS'COMPENSATION DECLARATION :CE 875(2-80) MISCELLANEOUS A P P L I C A T I O N • • 1 hereby aNcert that I have a certificate of consent to self COUNTY OF LOS ANGELES B(JILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a ceftified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN pDORESS 2� r ❑ Certified copy is hereby furnished. BUILDING• �0 7e�a �(LL IA�Ti= n LOCALITY DDRESS 1 L 1/ ❑ Certified copy is filed with the county building inspection f7 NEAREST / department. LOCALITY cEAR T �Y Date Applicant NEAREST DISTRICT UP TYPE PROC SSED BY CROSS ST. CONST. / r+ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL r 1/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK } rvoP :LV � (CIRCLE) STATE MAJOR SECOND LOCAL CL (This section need not be completed if the Work involved TRACT NNOOWOF BLD GS.ON LOT USE ZONE FCIAL CONDITIONS U by the permit is for one hundred dollars (5100) or less.) USE OF ^J SIZE OF LOT EXISTING BLDG. r 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 TWNER OF' Butul qmcc so as to become subject to the Workers' Compensation Laws. NOAIL OCCUPANCY GROUP W DDRESS ,Zb. k& d Date Applicant U) TEf NOTICE TO APPLICANT: If, after making this Certificate of ITY N0LZ3Da 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 S ❑ deemed revoked. ❑ Pec. KnoWl. CCE]OUPANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and Pp RKING. r' = effect. REQ'D PROVID EO SPACES License Number Lic.Class LIMITED TIME USE Contractor Date O AT E DATE ❑ FROM: To: I am exempt from the licensing requirements as 1 am a 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). I lLG FINAL APPROVAL Y RESENT USE OF BUILDING G -3• Lic.or Reg.No. Date NO.OF EXISTING BUILDINGS -3728P, HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, BUST- Wo. PARKING o 0 0 0 0 o D nese and Professions Code): tiPACES PROVIDED ❑ I, as owner of the property, will do the work and the 1 0 1, 13-81 structure is not intended or offered for sale (Section 7()44,BUS1neSS and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY ll 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 1 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 representat(v of this County to enter pon th abov -mention d pro e y for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date .)R,KERS'COMPENSATION DECLARATION 76M444 CE 876(2-80) MISCELLANEOUS APPLICATION Ihereby affirm that I have a certificate of consent to selfCOUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION nsure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN Is.oRM's S J ❑ Certified copy is hereby furnished. B ILDING � • n LOCALITY ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date ApplicantN AREST C DISTRICT NO. ROUP TYPE PROC S D BY ROSS ST. !,°�S TNA-r$ L- – ONST� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE MAP ,j HIGHWAY STATE MAJOR SEC D LOCAL a NO. OF BLDGS. (This 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 ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. Cc I certify that in the performance of the work for which this Q permit is issued, I shall not employ any person in any manner OWNER ��� ��KgBg�j� U so as to b co a subject to the Workers'Compensation Laws. IL OCCUPANCY GROUP W __ ADDRESS a __ Date 9 /t $;Applicant ,�'�/ to TEL. Z NOTIC TAPPLICANT: If, after making this Certificate of Irr �j f No. OCCUPANT LOAD Exemption, you should become subject to the Workers' APP KATION 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 INSPECTION❑ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. SPACES ' REO'D O PROVIDED D License Number Lic.Class LIMITED TIME USE Contractor Date D ATE DATE ❑ FROM: TO: I am exempt from the licensing requirements as I am •r. licensed architect or a registered professional engineer SIZE OF NO. OF I INSPECTOR'S acting in my professional Capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING L/ .r 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 SPACES PROVIDED ❑ I, as owner of the property, will do the work and the # 0 0 0 0 $8 structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1ROPOSED USE OF BUILDING s 0 0 0 0 0 0 0 M CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 09,24-85 for the performanceof 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 representatives of this Count to enter upon the ab ve-mentioned f r in o purp REVERSE FOR EXPLANATORY LANGUAGE ignature of Permi tee /Date ���` WORKERS'COMPENSATION DECLARATION CE 875(11-a4) MISCELLANEOUS APPLICATION �3 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 (� ICaJ Certified copy is hereby furnished. AODRe4S 0 Certified copy is filed with the county building inspection LOCALITY QNEARS 7 department. CROSS ST. 6 Date Applicant NEAREST DISTRICT NO. G OUP JTYPE:;:r IP ES ED BY CROSS ST. '„ _ +1 CONSd CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL iv 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 ($100) or less.) usa OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER Q y so as to become subject to the Workers' Compensation Laws. MAIL ✓ OCCUPANCY GROUP Jr.[ I CD ADDRESS 0 /�^ 660"?04, ts Date Applicant TLLU NOTICE TO APPLICANT: If, after making this Certificate of CITY ��d ee_. Ivo. �_� s' OCCUPANT LOAD z 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. 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 andJ-'D��nC effect. it J PARKING RSQ'D PROVIDED SPACES License Number Lic. Class u� �' rt� rs LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a PROM? TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL 5.4? PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS MC1 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 usi ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address h!r I certify that I have read this application and state that the PERMIT FEE �CJ� above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter I TOTAL FEE 66,a2 up t above-mentioned pr city for ipspection purposes. 1 C _ `_ _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitt a Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, o or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company I FOR APPLICANT TO FILL IN nooRess �a� _ Certified copy is hereby furnished. nn �pI y . ADD Q� 1Ci 6� LOCALITY 0 Certified copy is filed with the county building inspection�-O NEAREST �" •�° department. y y e, �� C, I i��O c.Dss s G Date Applicant NEAREST p DISTRICT NO. GR P TYPE P OCESSED BY CROSS ST. , �tA�q, ��"t(� / CONST CERTIFICATE OF EXEMPTION FROM WOItKERS' LEGAL06 COMPENSATION INSURANCEDESCRIPTION LOT NO. BLOCK MAI' HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OR BLOCS. (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 I certify that in the performance of the work for which this slzE of Lor EXISTING BLDG. 0 permit is issued,I shall not employ any person in any manne _ so as to become subject to the Workers' Compensation Laws. MAIL-- // lei � :7 OCCUPANCY GROUP o Date Applicant ADDRESS �O, �(p 1--' uUJ NOTICE TO APPLICANT: If,after making this Certificate of CITY `'jf G? TEL ' OCCUPANT LOAD z Exemption, you should become subject to the Workers' — Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION❑ 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 9 (commencing with Section 7000) of Division 3 of the Busi- ❑ (LIST ITEMS BELOW NO.OF EXITS ness and Professions Code,and my license is in full forca X ; effect. Ui:L PARKING 4ll� ��ef�e t+ �g ,y/ _ _ � SPACES R6q'D = PROVIDED License Number Lic. Class �/l.Gwi ��"iI�/If F^'dot II��JJ LL�� JJ LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a PROM' TO: licensed architect or a registered professional engineer SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE I_. r- inessandProfessionsCode). FINAL APPROVAL u=t I�a r- PRESENT PRESENT USE OF BUILDING iP Lic.or Reg.No. Date— HOME OWNER-BUILDER DECLARATION NO. OF1dXISTING hUILDINGS ON LOT AND USE V9M P 0709 j 101 e I hereby affirm that I am exempt from the Contractor's ��� t 1' IJ 1 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING /t 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). 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 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 25-00 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturc of Permittee Date 1VORKERS'C0111PENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I 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. BUILDING Policy No. Company FOR APPLICANT TO FILL-IN pDDRES `I, ❑ Certified copy is hereby furnished. aeoe ess2Z6 LOCALITY FICertified copy is filed with the county building inspection LOCALITYNQAREST department. ?1-7 �`l �D CROSS ST. Date Applicant NEAREST DISTRICT NOOUP TYPE / PR ESSED BY CROSS ST. h� •� CONST i// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF(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 (SI00) or less.) USE OF SIZ Ci 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 OWNERSP so as to become subject to the Workers' Compensation Laws. MAIL 1QQ OCCUPANCY GROUP o ADDRESS '� V Date_ Applicant • W NOTICE TO APPLICANT: If,after making this Cert' ate of CITY AP,240 NO. j — _ OCCUPANT LOAD y Exemption, you should become subject to th 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 11Panic 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 o PR ONTO ED 1�—J SPACES License Number Lic. Class2&01,6441.101, L L LIMITED TIME USE Contractor Date FDATE DATE I am exempt from the licensing requirements as I am aF FROM: TO: INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO.OF SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING � I Lic.or Reg.No. Date ` HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �Q ON LOT AND USE I [✓/ I hereby affirm that I am exempt from the Contractor's VLW License Law for the following reason (Section 7031.5, Busi- 0300-01001 5J 3/93 ness and Professions Code): NO. PARKING SPACES PROVIDEDf'CI 4 'I yA,1 9: 9 I, as owner of the property, will do the work and the '-�� s48 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 !sj/7/O D TitJ 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 the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Da(e \VORK�ERS'COMPENSATION DECLARATION 75M444 MISCELLANEOUS APPLICATION • 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\Vorkuas'Compensation In§urance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING pDDRE55 Certified copy is Hereby furnished. BUILDING RESS5926 Tem le City Blvd . LOCALITY G e ADD Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED 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 ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this OF N :=z C:) permit is issued,I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. Walter K _ Lonkghaugh MAIL OCCUPANCY GROUP o ADDRESS/— P . O . BOX 206 Date Applicant w NOTICE TO APPLICANT: If,after making this Certificate of CITY Arcadia NO�18 44 6—8 7 5 5 OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONpr— Panic Devices El I Hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT E] (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. PAY\e, J PARKING SPACES REq•D D PROVIDED License Number Lic. Class BOB H ERNANDEZ CONSTRUCTION C0 LL�� LIMITED TIME USE Contractor Date DATE DATE 'T� ~ I am exempt from the licensing requirements as I am a FROM: TO:I Cj licensed architect or a registered professional engineer SIZE OF NO.OF I SIGN TOR E g P in acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL irl_� `—'i Lic.or Reg.No. Date PRESENT USE OF BUILDING Office _ I ��; { . !"Q, HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 2►�9� -►� � 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 usiness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I Hereby affirm that there is a construction lending agency O for the performance of the work for which this permit is 1 issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. I �� Lender's Address f PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and h eby author' represents i of this County to enter TOTAL FEE upo t ab e e i ned proper r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f Permitte 16ate WURlCL•'IiS'COl11PL'NSATION DECLARATION CE a75(11-84) MISCELLANEOUS APPLICATION . I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION • bisure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.C.). >` Policy No. Company FOR APPLICANT T01�1LL' IN BUILDING �2 AD DRESS 1 :�JJC.� CCS ('Crllfled copy IS hereby furnished. BUILDING S9.2 r_ 14 LOCALI1 �" y. _- , �"L XXADDRESS Certified copy is filed with the county building inspection LOCALITY •-'� NEAREST department. ][,y I em k—, C(, CR089 ST. Date Applicant NEAREST II n,.c DISTRICT NO. GR. UP TYPE DES9ED BY CROSS ST. WS _VV(.t\� iD/ CONST. �� `� CERTIFICATE Of EXEMPTION FROM WORKERS' LEGAL I/Y 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 ($100) or less.) USE OF E I certify Ilial in the performance of the work for which this SIZE OF LOT ...TINGXISTING BLDG. r, permit is issued, I shall not employ any person in any manneiKX OWNER Of buildin -61e_ so as to become subject to the Workers Compensation Laws. AIL OCCUPANCY GROUP ® C ADDRESS Date—_ Applicant LLI NOTICIi TO APPLICANT: If,after making this Certificate of OCCUPANT LOAD Vi Exemption, you should become subject to the Workers' — Compensalion provisions of the Labor Code,you must forth- �i7�� 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 ❑ ❑ LI('FNSI'.0 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 Busi- NO. OF EXITS ness and Professions Code,and my license is in full force an eft'cct. X Name of business PARKING r SPACES REQ D PROVIDED License Number _ _ Lic. Class �U2�L� Zr/ee7�J�oRJIG OL'!/J79'A611 -- — �N ' LIMITED TIME USE Contractor Date— DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO.OR SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING I.ic.or Reg.No. ___ _ ___ — Date � T HOME OWNER-I1111LDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I r• � 1 hereby affirm that I ani exempt from the Contractor's (� 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). f CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency � r for the performance of the work for which this permit is J I= issued(Sec.3097,Civ.C.). t Lender's Name _ PROPOSED MAX. OCC. Lender's Address --i 1 certify that 1 have read this application and state that the PERMIT FEE 25.00 .j; 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 Bove-mentioned property for inspection purpo S. SEE REVERSE FOR EXPLANATORY LANGUAGE I ]�� XX GL`Z!�L�� �QC�I �ti ,,,n , .,I I ,.n .. I1•Ilr *„ WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION 1 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. Accaess�5926 TEMPLE CITY BLVD., Ste. C LOCALITY DCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP NIG Nw pv STATE MAJOR SECOND LOCAL NO. (CIRCLC) 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, a 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 D(,6j S' ro as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRE9 6 Date Applicant TEL- 818-446-8755 OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of CIT,y� Q 1+ N z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ E] ElNo 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 andfJ�� ✓6 effect. fyxt� �51y'\w PARKING REQ'D PROVIDED SPACES License Number Lic. Class FIRST AMERICAN MARKETING, TM) LIMITED TIME USE Contractor Date D ATC DATE EJI am exempt from the licensing requirements as I am a FROM. TO. INSPECTOR'S licensed architect or a registered professional engineer SIZE OF No. OF NATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). + OFFICE SPACE FINAL APPROVAL t'1 PRESENT USE OF BUILDING V Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS - � ON LOT ANO USE I hereby affirm that I am exempt from the Contractor's l License Law for the following reason (Section 7031.5, Busi- �[_l�l t-;;lR,iri•,; "i� �fy: ness and Professions Code): NO. PARKING 1 � ! e SPACES PROVIDED 'I Ar,1Ce 0 I, as owner of the property, will do the work and the 3 -�1 - 14 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINcN/ I Hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinance nd State laws relating to building construction, and liero5y authorize representatives of this County to enter TOTAL.FEE above-menti ned property for inspection purposes. J /D SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pe ittee Date ` WORKLRS'COt►iPENSATION DECLARATION ,E 575(11.84) M ISCELLANEOU,� APPLICATION 1 hereby affirm that 1 have a certificate of consent to self CO(JNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or .1 certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL INBlI1LDING��a/— ADDRESS�,/ E] Certified copy is hereby furnished. Bu1LDING 5 XX 10 V {� LOCALITY 'ADDRESS FCertified copy is filed with the county building inspection LOCALITY . r NEAREST department. XX t f `I CROSS ST. Date —Appliclnt 1 NEAREST DISTRICT NO. G OUP TYPE CESSED BY o CROSS ST. •0� _� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLOCS. (This SCCt1Un need not be completed if the work involved TRACT NOW ON LOT USB ZONE SPECIAL 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 LOT EXISTING BLDG. permit ,- is issued,I shall not employ any person in any manneRX OWNER of building - e Lzokc.�tOU c a, as to become subject to the Workers' Compensation Laws. I MAIL (� OCCUPANCY GROUP c Date_ Applicant ADDRESS P •0 • 6 o L 1 g Irt��q IL4— 10�� TEL.%,C_-, 1 yL`61 OCCUPANT LOAD NOTICE TO APPLICANT: If,after making this Certificate of CITY NO• b M 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 i OCCUPANCY INSPECTION❑ Panic Devices El 1 hereby affirm that 1 ant licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEM9 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 alt effect. X Name Of business PARKING SPACES REQ D' PRovIDED C� License Number Lic. Class �� LIMITED TIME USE Contractor Date DATE DATE FROINI TOI I am exempt from the licensing requirements as I am aRISC licensed architect or a registered professional engineer SIZE OF NO.OF 816 uRI acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date rr}}����/� PRESENT USE OR BUILDING pai.(lh' 01 V2 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ///IIIA, //�v ,' ON LOT AND USE / J` 1 hereby affirm that 1 am exempt from the Contractor's -pl 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 1 PROPOSED USE OR BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX"OCC. Lender's Address_ PERMIT FEE 25.00 I certify that I have read this application and state that the • above information is COTreCt.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 25.1 5.QQ • I upon the above-mentioned property for inspection purposes. sZ � Ova x SEE REVERSE FOR EXPLANATORY LANGUAGE XX_ `1••1111 I1 n•nl I'rI it Lv Date •WORKE9tS'COiv1PENSATION DECLARATION 'CE 875 If f(2-80) M I SC E L LAr-4 EO U S 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 INC�Ct- 6 rCertified copy is hereby furnished. UILDING r-1Certified �� �\ I LOCALITY Certified copy is filed with tile ADDRESS _l e county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant EAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. ^� J. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL G, � ��C��3� DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE MAP HIGHWAY >_NO. CIRCLE STATE MAJOR SECOND LOCAL d (This SCCtIOn need not be completed if file work involved NO. OF SL USE ZONE SPECIAL CONDITIONS O P TRACT NOW ONSLOT by the permit is for one hundred dollars (5100) or less.) , USE OF V�() SIZE OF LOT I EXISTING BLDG. • tL I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner Lo rA WNER ,A,.1�� so as to become subject to the Workers' Compensation Laws. //�'I WU OCCUPANCY GROUPMAIL V Date Applicant DDRESS �DX/DC3 -� L -�Jl� b��� NOTICE TO APPLICANT: If, after making this Certificate of v rt� d� No OCCUPANT LOAD z Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: With comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION ❑ deemed revoked. ❑ NOSpec. KnoWl. ❑ ON Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTI ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. . REO'D O PROVIDED D /' SPACES License Number Lic.Class C t� CO- LIMITED TIME USE Contractor Date 5U/ DATE DATE �+ I am exempt from the licensing requirements as I am a Cr o FROM: TO: licensed architect or a registered professional engineer SIft- OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE mess and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL 0 /� Lic.or Reg.No. Date �tn i` S� O•f'�i�-� HOMEOWNER DECLARATION NO.OF EXISTING BUILDING!(/ ON LOT AND USE I hereby affirm that I am exempt from the Contractor'sa License Law for the following reason (Section 7031.5, Busi- V 1� _iLl ness and Professions Code): NO.PARKING V SPACES PROVIDED ryI • ,70W •I y�y« 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). ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEEd I certify that I have read this application and state that the !r above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE �-/fU and hereb a representatives of this County to enter 7<</ upo t a o e-me tinned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r-q1 Si • ure o Permittee Date WORKERS'COMPENSATION DECLARATION CE 876(1 1-84) M I SC E L LA N O l�S APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e.,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRES Certified copy is hereby furnished. ✓ BUILDING, LOCALI ADDRESS Certified copy is filed with the county building inspection✓ LOCALITY- i NEAR EST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. , ^� _� CONST.)/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. ICIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner V OWNER so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS P © ' V Date Applicant w L.NOTICE TO APPLICANT: If,after making this Certificate of CITY'^ C► TNO. OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: —` Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ ' deemed revoked. � ❑ No Spec. Knowl. , 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 Bus- NO. OF EXITS ness and Professions Code,and my license is in full force and >✓ , Pf �� effect. PARKING REq'D D PROVIDED 1 SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TOI I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineelSIZE OF NO. OF INSPE OR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI � URE iness and Professions Code). 1/ FINAL. APPROVAL. PRESENT USE OF BUILDING /�� Lic.or Reg.No. Date _ _ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ?/ ON LOT ANID I hereby affirm that I am exempt from the Contractor's ,�7 -.-- :•• ,; ,; :I_ License Law for the following reason (Section 7031.5, Busi- I.:F ness and Professions Code): NO. PARKING ! 7A '•_-- '-• I, as owner of the property, will do the work and the SPACES PROVIDED W AN f L structure is not intended or offered for sale (Section Y 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING `%ft CL 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 . 10 PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEES upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of mittee Date WORKERS'COMPENSATION DECLARATION a CE 876(17-84) MISCELLANEOUS APPLICATION CE 87 1 hereby affirm that 1 have a certificate of comsent tsell COUNTY OF LOS ANGELES , �: BUILDING AND SAFETY DIVISION insureInsurance,or a certificate of Workers'Compensation Insurancc e,or . a certified copy thereof(Sec.3800,Lab.Q. r Policy No. Company FOR APPLICANT TO FILL IN BUILDING / / ADDRESS���V Certified co is hereby furnished. BUILDING n py y XX ADDRESS Pi.� �, LOCALITY Certified copy is filed with the county building inspec on OCALITY NEAREST 9/1 department. XX t . C, CROSS ST. Date Applicant NEAREST .s'f Q 01 STRIC�NO. GROUP TYPE CESSED BY pP CROSS ST. '�uu�J�►S �R- CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL f COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL (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.) u9E OR �r SIZE OF LOT EXISTING BLDG. } 1 certify that in the performance of the work for which — n permit is issued, l shall not employ any person in any m ne x OWNER of buildin � w as to become subject to the Workers'Compensation L MAIL OCCUPANCY GROUP "C'-, _ ADDRESS , r Date Applicant d 4 NOTICE TO APPLICANT: if,after making this Certificate of CITY �- SCI No� OCCUPANT LOAD vi 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 1 hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a 9 (commencing with Section 7000)of Division 3 of the Busi- NO.OF EXITS ness and Professions Code,and my license is in full force �t effect. X' ame of business PARKING REWD 1 1 PROVIDED SPACES 1J License Number —__ Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF I SIP N TU BE10 acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). FIN A P vat. PRESENT USE OR BUILDING 6 C�Cf 4R�/I Lic.or Reg.No. Date I ` HOME OWNER-BUILDER DECLARATIONNo. OF EXISTING BUILDINGS 1� - ON LOT AND USE 1/ 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- 2,433 PM 4! 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). CONSTRUCI'ION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency (4 1C9P�� for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). I Lender's Name PROPOSED MAX.OCC. Lender's Address _ I certify that I have read this application and state that the 5.00 PERMIT FEE above info tion is correct.1 agree to comply with all County ISSUANCE FEE ordin s and State laws relating to building construction, and ereby authorize representatives of this County to enter TOTAL FEE 25-00 on the above-mentioned property for inspectio rposes. XX SEE REVERSE FOR EXPLANATORY LANGUAGE i WORKERS'C0IMPENSATION DECLARATION 111.84) 87 4 CE 87,ri M I SC E L LA N EO U`� APPLICATION CE ` .t 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.1. Policy No.-Company FOR APPLICANT TO FILL.) ADDRESS OOtt(v ILDING Certified copy is hereby furnished. BUsFj /fed.ADDRESS LOCALITY I F� Certified copy is tiled with the count building inspection ' LOCALITY NEAREST department. Temple City CROSS ST. Date Applicant NEAREST d DISTRICT NO. GROyP TYPE ESSED BY CROSS ST. Lit (umfs DR . D fi ,/-t CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o �j� I COMPENSATION INSURANCE ' DESCRIPTION LOT NO. BLOCK 1 M.1P HIGHWAY STATE MAJOR SECOND LOCAL I NO• (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work Involved I TRACT NOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) I EXISTING uSE of t I ! I certify that in the aerformance of :he .l,atk for which : !SIZE OF LOT BLDG. � permit is issued. I shall net employ anyperson in anymanner ��R LiSf} Wu so as to become subject :o the Workers* Compensation Lacs. MAIL OCCUPANCY GROUP z ' N ' ADDRESS I Date Applicant NOTICETO APPLICANT: If,af-er making :his Certiliewe nt $I CITY �-EL. OCCUPAN-LOAD Exemption. you siaould become nibiect :o :ale 11'nrkers APOLICAT CO 4 Compensation provisions of the Labor i ode. you must forth- ICN F EXIT HARDWARE with comply with .uch provisions or :his ^ermit ihall be -RAILER USE � GEOLOGY .NSPECT!ON _ NO St7eC. 1�1O1n/�. deemed re%oked. 1:1N LICENSED CONTRACTORS DECLARATION El OCCUPANCY INSPECTIONXX Panic Devices =' 1 hereby affirm :hat I am licensed under provisions of Chanter SAFETY PERMIT (LIST ITEMS BELOIY) t 9 (commencing with Section -000) of Division 1 of the Busi- NO. OF EXITS ness and Professions Code.anmy license is in :till force and effect. PARKING SP REO O 1 I PROVIDED N u License Number Lic. Class LIMITED TIME USE N Contractor Date DATE DATE N W Z F3•J M: TO: A I am exempt from the licensing requirements as 1 am i m i licensed architect or a :e2isteTed prnfessional engineer ;IZE of iness .lo. of INSPECTOR'S z acting In my professional mra::it' J1'.zuon -1)51. Bit,;- EXISTING BLDG. STORIES 1 SIGNAT aU 9 ndl'rofessicnsC�de1' FINAL APPROVAL 2 Z O PRESENT USE OF BUILDING U Lic.Or Rea. No. Date X I HOME 01\VFR-BUILDER DECLARA110N NO. OF EXISTING BUILDINGS 1 ^ / 1 / •�)_ 's"' �f ��t ON LOT AND USE / r1CC, q. {-Uly{ r�e"i•.I !tereby affirm that I am exempt frons the Contractor's �191 - i.�I'* ii f t t _'a. License Lav for the following reason (Section -031.5. Busi- tress and Professions Code): i NO. PARKING SPACES PROVIDED ❑ I, as .owner of the property, will do the work and the I structure is not intended or offered for sale (Section ; I 704.1.Business and Professions Code). CONSTRUCTION LENDING AGENCY %I PROPOSED USE OF BUILDING I 1 hereby affirm that there is a construction lending agency CIRC-Drf REA44 na G I for the performance of the work for which this permit is ! issued(Sec. 3097,Civ.C.). Lender's Name 4 I PROPOSED MAX. OCC, Lender's Address I 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 buildings construction. aiid hereby authorize representatives of this County to enter TOTAL FEE 25.00 I upon the; ove-mentioned property for inspection purposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE v Signature cf Permittee Date . I III tyORKERS'COMPEINSATlONDECLARATION =6M4" MISCELLANEOUS APPLICATION 1 hereby affirm that I have a certificate of consent to self civ 875(11-84) fl insure, or a certificate of Workers'Compensation Insurance,or I COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION � , a certified copy thereof(Sec.3800,Lab.C). - C� Policy Na. Company FOR APPLICANT TO FILL 1N 33U1L42NG y`�p� ADQFtEas /�/'/pr( f gun., LI�iIITC Certified copy is hereby furnished. AOORBUILD' NG���6 � co DD LOCALITY ADDRESS v1VD. UNIT C Certified copy is filed with the county building inspection ' LOCALITY NEAREST department. Temple City CROSS ST. 4AS. TC WAc- Date Applicant I NEAREST � DIST CT GR P TYPE P CESSED BY CROSS ST, "NA(AS QL 1/). ,y/.�[ry/,p CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ( "^ V COMPENSATION INSURANCE DESCRIPTION LOT NO. SLO CK MAP HIGHWAY NO. OF SLOGS. HD. I (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOW ON LOT USE.ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE OF I SIZE OF LOT EXISTING SLOG. >r I certify that in the performance of the work for which this � �y permit is issued,I shall not employ any person in any manner I o wN E R Z�ri j(j FZ so as to become subject to the Workers' Compensation Laws. ' JCCUPANCY GROUP ( MAIL LL�� �+ � ( )�+Q ! Date Applicant AD IL ESS S/'2 /W LL C/ AAA U / �J j '_NOTICE TO APPLICANT: If,after making this Certificate of ' CITY LC/�f jtc >r!T Yom`��, 2�5_ggb} OCCUPANT LOAD J Exemption, you should become subject to the Workers` ( =� Compensation provisions of the Labor Code, you must forth- APPLICATION FOR E>tIT HARDWARE: — I with comply with such provisions or this permit shall be j No Spec. lCnowl. deemed revoked. TRAILER USE_ GEOLOGY INSPECTION LICENSED CONTRACTORS DECLARATION I OCCUPANCY INSPECTION U Panic Devices I hereby affirm that I am licensed under provisions of Chapter , F 9 (commencing with Section 7000)of Division 3 of the Busi- SAFETY PERMIT (LIST ITEMS BELOU) NO. OF EXITS ness and Professions Code,and my license is in fu Il force and i effect. PARIUNG n SPA 9ES 4E0 D i J PROVIO ED !�. License Number Lic. Class L�— Contractor Date ' LIMITED TIME USE A SAT_ DATE a I am exempt from the licensing :equirements asI am a PROM= TO: I licensed architect or a registered professional engineer .SIZE OF , ? acting in my professional capacit}' (Section '051. Bus- i (EXISTING SLOG. �( /3�9 i NO. OF 1 INSPECTOR'S ' STORIES SIGNATURE iness and Professions Code). I } Lie.or Ree.No. Date PRESENT USE OF BUILDING (FINAL APPROVAL 1 HOME OWXER-BUILDER DECLARATION 1 NO, OF EXISTING BUILDINGS 1 hereby affirm that 1 am exempt from the Contractor'sON LOT ANO USE I License Law for the following reason (Section 7031.5. Busi- ness and Professions Code): I NO. PARKING I, as owner of the property, will do tate work and the SPACES PROVIDED structure is not intended or offered for sale (Section i t 7044,Business and Professions Code). Nr CONSTRUCTION LENDING AGENCY " PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency /A CU pu.4J CT(JJ,0 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name i Lender's AddresPROPOSED MAX. OCC. s I I 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, t ) and hereby authorize representatives of this County to enter TOTAL FEE 25.00 s I upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 4 .l , r Signature of Permittee Date i I WORKL'RS'('UMI'l_NSAI'ION DECLARATION "-U() : MISCELLANEOUS APPLICATION o-oto;,nPw l a'eu I, I hereby affirm that I have a certificate of cl,n,cnt uI u:u' COUNTY OF LOS ANGELES ' BUILDING AND SAFETY DIVISION i insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof' (Sec.3800. Lab.C.) Policy No. . , Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified copy is hereby furnished. yC 4A 3 , LOCALITY ❑ Certified copy is filed with the county'building Inspection CITYC t zC'A Cl 172 0 NEAREST J department. GROSS ST. Date Applicant SIZE OF OT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. t C'ERTIFIC'AI'l: OF EXEMPTION FROM WORKI.IiS' TRACTBLOCK LOT NO. - COMPENSATION INSURANCE MAP HIGHWAY NO. (CIRCLE, STATE MAJOR SECOND LOCAL (This section need not be completed if the Work in%olve(l ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS r•" by the permit is for one hundred dollars (�,IU01 or le%s.) OWNER TEL NO. I certify that in the performance of the work fl,r which this permit is issued, 1 shall not employ any person in any manner —711q GROUP I so as to become subject to the Workers' Compensation Laws. ADDRESS I S-q2Z e, (Jt� #4 OCCUPANCY Date_______ Applicant CITY ZIP NOTICE TO APPLICANT: If, iffier making this C'ertil'iCate G G f (0 OCCUPANT LOAD I of Exemption, you should become subject to the Workers' APPLICATION FOR 1 Compensation provisions of the Labor Code,you must rorthwith EXIT HARDWARE: comply with such provisions or this permit %hall be (leemCd TRAILER USE❑ GEOLOGY INSPECTION❑ I revoked. LICENSED CONTRACTOI(S DECLARATION OCCUPANCY Spec.Knowe. ❑ ti I OCCUPANCY INSPECTIONIpp I Panic Devices ❑ • 1 hereby affirm that 1 alar licensed under provisions of Chapter SAFETY PERMIT❑ ILIST ITEMS BELOW I 9(commencing with Se-tion 7000)of Division 3 of the Business NO.OF EXITS and Professions Code—ad my license is in full force and effect. �Akj� PARKING• REQ'D D PROVIDED D License Number Lic.('fins y12 / SPACES I Contractor Dale P LIMITED TIME USE DATE DATE ❑ I am exempt from the licensing requirements as 1 :Im it FROM: ro: licensed architect or a registered professional engineer acting Ill 111)' prOle'titilllllill capacity (Sel'tIOII 7(151• Business SIZE OF NO.OF INSPECTOR'S '�I I and Prole'ssions Code). E%IS TING BLDG. STORIES SIGNATURE LIC.or Reg. No. Dale PRESENT USE OF BUILDING FINAL APPROVAL 2Co D I HOME OWNER-B(IIL.DER DIATARAHON NO.OF L•%ISI ING BUILDINGS LO ON LOT AND USE hereby affirm that I am exempt from the C'ontractor's License Law for the following reason (Section 7031.5, Business and Professions Code): NO.PARKING ElLas owner of the properq•, trill do the l,ln•k and thSPACES PROVIDEDe ---- structure is not intended or ol'I'Cred 101 sale(Seedon 7044. PROPOSED USE OF BUILDING Business and Professions Code). S 41 � J CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agenc) Iia' the performance of the work for which this permit is issued (Sec. 3097,Civ.C.). PROPOSED MAX.OCC. Lender's Name _ ._ __ x APPLI ANT(PR 0 Tl ;w'^ TFj NO. "'�VIJ '11+6 0 — I Lender's Address _ DDREss I certify that I have read this application and state that the Q ttl a 177-0 above information is correct. 1 agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction•and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property, for inspection purposes. �• I TOTAL FEE X 1 6t SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of tit c Date