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Home My Public Portal About9448 WOODRUFF AVE_Miscellaneous__ WORKE11 'C0,11PENSATION DECLARATION 76M444 he-c, or aff em that—I have a certificate of consent tCE 875 („-84) M I-SCELLANEOUS APPLICATION self S ANGELES BUILDING AND SAFETY DIVISION nsurcor a certificate of Workers'Compensation Insurance, COUNTYQF LO e,or ., �certified copy thereof(Sec.3800,Lab.Q. 'olicy.No. CompanyFOR APPLICANT TO FILL IN BUILDING �/�/o Ap DRESS '77a Certified copy is hereby furnished. BUILDING FOR �� ADDRESS , LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST. department. G 1 CROS ST )ate Applicant NEAREST pISTDNO. GRO{Jp TYPECONST./ SSED BY CROSS ST. QaavQ �OQfJ `y/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLDGS. NO. (CIRCLE) This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS Iy the permit is for one hundred dollars (5100) or less.) USE OF certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. Iermit is issued,I shall not employ any person in any mannerr-- bti,;NER � � G�'�U�� c„ — o as to become subject to the Workers' Compensation Laws.' MAIL OCCUPANCY GROUP ® co ADDRESSIZ -/ •A U )ate Applicant - J� L3 40TICE TO APPLICANT: If,after making this Certificate of X -CITY Tnlo e OCCUPANT LOAD c`z Exemption, you should become subject to the Workers' _ :ompensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: vith comply with such provisions oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ teemed revoked. ❑ ❑ No Spec. Knowl. LICEATSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION$$ Panic Devices hereby affirm that I am licensed under provisions of Chapter (commencing with Sbction 7000) of Division 3 of the Busi SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS less and Professions Code,and my license is in full force and 'ffeCt. PARKING REO'D D PROVIDED SPACES .icense Number Lic. Class LIMITED TIME USE .'ontractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051. Bus- EY.ISTING BLDG. STORIES SI ATURE iness and Professions Code). FINAL�PPROVAL PRESENT USE OF BUILDING .ic.or Reg.No. Date rev HOME OIVNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE A 1 Hereby affirm that I am exempt from the Contractor's .icense Law for the following reason (Section 7031.5. Busi- ess and Professions Code): No. PARKING ] I, as owner of the property, «•ill do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). p PROPOSED USE OF BUILDING CONSTRUCTION LEADING AGENCY X__ hereby affirm that there is a construction lending agenc,. dip C 3r the performance of the work for which this permit is i ;sued(Sec. 3097,Civ.Q. ,ender's Name PROPOSED MAX. OCC. ,ender's Address certify that I have read this application and state that the PERMIT FEE 25.00 bove information is correct.I agree to comply with all County ISSUANCE FEE Idinances and State laws relating to building construction, P� fid hereby authorize re resents" s.efiiTis County to enter TpTAL FEE 25.00 I`—) pan t e above-mentione i erty for inspection purposes._ SEE REVERSE FOR EXPLANATORY LANGUAGE r .� Signature of Per itt Da =Co G i ti WORKERS'COMPENSATION DECLARATION CE 76M444 (11-84) M lSCELLANEOUS APPLICATION 75 hereby a cert that I have a certificate of consent tself insure, or a certificate of Workers'Compensation Insurance, e,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DVISION a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING v� ADDRESS Q Certified copy is hereby furnished. BUILDING a E__ LOCALITY �� ! ADDRESS [/t/ O�� `�'J [• Z FCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. G Date Applicant NEAREST DISTRICT NO. UP TYPE oC SSED BY CROSS ST. �dlC Cl� ` CONST./J- � CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J ( 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 ZONES PECIAL 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. c permit is issued, I shall not employ any person in an manner OWNER o as to become subject to the Workers' Compensation Laws. `1*�_�� ' MAIL / `/ 7 OCCUPANCY GROUP o ADDRESS f�73 �lG� O��.f /� I-" Date Applicant r3 '2 NOTICE TO APPLICANT: If, after making this Certificate of CITY V6dfd 4-C ,, TN-L We 9Z-3 7' OCCUPANT LOAD y Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: z Compensation provisions of the Labor Code,you must forth- ❑ with comply With such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. of EXITS ness and Professions Code,and my license is in full force and effect. / PARKING SPACES REQ'D PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATa DATa FROM: TO: El I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer s,zE of No.of INs ECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES GNATURE 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 ANO 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). J-8 7 2 2 A CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING # 0 0 0 0 3 0 I hereby affirm that there is a construction lending agency I o - 8(150 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). o o o 8 0.5 0�! 1.07-87 Lender's Name PROPOSED MAX. OCC. 0 I,0 7 8 7 Lender's Address PERMIT FEE O O 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 O 5—D ordinances and State laws relating to building construction, and hereby,2nt}iorize representatives of this County to enter TOTAL. FEE upon the ab mention. property for inspection purposes. /! SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o rmittee Dated— WORKERS'COMPENSATION DECLARATIONCE B75(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.C.). _ Policy No. Company FOR APPLICANT TO FILL IN ADDRESS �tY Certified copy is hereby furnished. woceEss �f/ , ,' �Gi LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST 11.17 department. CROSS ST. Date Applicant NEAREST l� DISTRICT O. OUP TYPE "CESSED BY CROSS ST. / r D CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLD GS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) us9 OF SIZE OF LOT IST; I certify that in the performance of the work for which this _ o permit is issued,I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL / ) _ OCCUPANCY GROUP o 1--' Date Applicant ADDRESS NOTICE TO APPLICANT: If,after making this Certificate of cITY C No. (' 23J' OCCUPANT LOAD Exemption, you should become subject to the Workers' f Compensation provisions of the Labor Code,you must forth- APPLICATION F rQ Ff-- -/ EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed.revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ElPanic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section*7000) of Division 3 of the Busi- e7 NO. OF EXITS ness and Professions Code,and my license is in full force and _ J effect. PARKING REQ'D PROVIDED SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OF ANCAT URITOR Eacting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES inessandProfessionsCode). FINAL APPROVALPRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ((�� ON LOT AND USE U LJ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- !i !:, i_ll 11-11 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). 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 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-men 'oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE k ignature of Permittee Date `N10RK,ElIS'COMPENSATION DECLARATION Cr75 E (11-84) MISCELLANEOUS APPLICATION I Jure, o affirm that I have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, oL"='a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN pDOREss Certified copy is hereby furnished. BUILDING DDR1 LOCALITY ESS Y Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE1PR ESSED BY CROSS STCONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL va COMPENSATION INSURANCE DESCRIPTION LOT NO. B OCK MAP HIGHWAY STATE MAJOR SECOND LOCAL No. OF NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ONL OT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) uSE of SIZE OF LOT EXISTING BLDG. a a I certify that in the performance of the work for which this C3 permit is issued,I shall not employ any person in any manner E OWNR CID so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP _a o Date Applicant ADDRESS L8 TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of ITY ND. Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with Such provisions oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. F] E] No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. V uc;gP55 • PARKING REq'D PROVIDED License Number Lic. Class -G SPACES 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. STORI SIGNATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.NDate PRESENT USE OF BUILDING 1 I o. r HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS NO FEE/I/,� ON LOT AND USE V 1 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 Z PM 1:44 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 �7 I certify that I have read this application and state that the PERMIT FEE V� above information is correct.I agree to comply with all County ISSUANCE FEE ordinanA and State laws relating to building construction, and her b authorize reprepntatives of Is County to enter TOTAL.FEE Gd upon th a ove-mer�tione roperty fo nspection purposes. r 9P SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature of Permitte Date WORKERS'SCOMPENSATION DECLARATION a CE 875(11-84) MISCELLANEOUS APPLICATION CE 87 I hereby affirm -that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,, c!i a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyLDIN BUIG FOR APPLICANT TO FILL IN �'/��j ADDRESS 7 d Certified copy is hereby furnished. UII-DING 9448 Woodruff Ave LOCALITY ADDRESS FICertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. �f� Date Applicant NEAREST DISTRICT N9. G UP TYPE P ESSED BY CROSS ST. Oak I j� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a s COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLC) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT U&ONE SPECIAL CONDITIONS SIZE OF LOT EXISTING BLDG. 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 o permit is issued,I shall not employ any person in any manner OWNER o w a r d C h e u n q `9' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o Date Applicant ADDRES 410 S. Comd vor St. -� w Pp NOTICE TO APPLICANT: If, after making this Certificate of CITY Alhambra NOLTE * _ OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth ❑ with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ® Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. A-,"' PARKIN SPACES G REQ'D D PROVIDED License Number Lic. Class American- , inese Service Center LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: O: licensed architect or a registered professional engineer slzE of NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNA iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING _ r Lic.or Reg.No. Date `- r HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS r E`I_;-_ y 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 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 PERMIT FEE ��•�� I certify that I have read this application and state that the 'above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-m ntioned property for inspection purposes. ✓ �� fl g r (� SEE REVERSE FOR EXPLANATORY LANGUAGE / Sign• ure of Perr ittee Date