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Home My Public Portal About9549 GIDLEY ST_Miscellaneous_11/29/2000_>r r WORT:ERS'Coh1PENSATIONDECLARATION j 7t.M444 MISCELLANEOUS,�FPLICATION _;F: 675 I11-841 ECOUNTY I hereby affirm that I have a certificate of consent to self OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3900, Lab. C.). LLJJ Policy No. Company FOR APP LI CANT TO FILL IN aD AESS �—L` AOr.7E55 � 7 L , Certified copy is hereby furnished. l / Burp'"G /15. p %�rev 51 --I ,4 .! LOCA1_;TY z ApDR E55 `;I c� err -e4_ i Certified copy is filed with the county building inspectionLDcaLaTv Temple Cit / } CROSS T department. P y ✓ f/ Date Applicant pp NEAREST ` /� NEAR sT- rt' /SCE L./ ,61 uc�. DISTRICT NO, ## GROUP TYPE _j� y ESSED BY CDII{Ejii r I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL LOT NO. � �BLO GK ��C�' i MA+ <S I Y IG HwwY COMPENSATION INSURANCE DESCRIPTION STATE MA OR SECOND LOCAL i No, [CIA CLE( (This section need not be completed If the work involved �+]� 4 NO. OF 13 LOGS. I TRACT / .2 ! (NOW ON LOT 11SC ZONEI5PECIAL CONDI7ICNS I by the permit is for one hundred dollars (5100) or less.) ! -'IF I i I certify that in the performance of the work for which this SIZE OF LOT I EXISTING BLDG. I I permit is issued, I shall not employ any person in any manner .LJLU#JCLLy �,,J OWN ER PA5 � D Kira A P_ 1U fff so as to become subject to the Workers' Compensation Laws. �f MAIL11 OCCUPANCY GROUP o d' AO DR ktrArAil d •r i e f - J I Date .applicant l �J NOTICE TO APPLICANT: If, after makine this Certificate of `- �!' GIrY C� Ail G lrlbri a yo� +C� 3Cy� OCCUPANT LOAD - Exemption, you should become subject to the Workers' 9 Compensation provisions of the Labor Code, you must forth ApPLICgTION FOR EXIT HARDWARE: I with comply with such provisions or this permit shall be TRA,LER USE — GEOLOGY INSPEC-10N ` p n IIS, Flo Spec. KJ. deemed revoked. — Panic Devices LICENSED CONTRACTORS DECLARATION I OCCUPANCY INSPECTICN$$ n { I hereby affirm that I am licensed under provisions of Chaplet I 9 (commencing with Section 7000) of Division 3 of the Busi SAFE-Ty PERMIT NO- aP Exlrs �J ness and Professions Code. and my license is in full forcc anci eItect. / L4 /�f/G/� 1j_/- PARKING I I it SPACES RECD f PROV]❑EO License Number L;c. glass I LIMITED TIME USE Contractor Date _ __ - O.arS once i 1 am exempt from the iicensine-eq as I am ., I i licensed architect or a rezister'ed n_ rof-ssional enginee- I S,tE q� N q. +INSPECTOR'S SIZE i RC �l actino in m} professional apacitr ISec.ion 70_1. Bus NG TLD G. STORIES 1 i SIG NA7U inose and Professions Code1. PRESENT VSE DF auILDING CF�rIFItVr1L )t('r APPROVAL Lic. or Reg. ti� Da.' I HOME OWNER-BUILDER DECLARATION I NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that [ am zxemnt :rem the Cantracror's I License Lars- for the following reason (Section "031.3. Busi- I �+ ness and Professions Codev I NO. PARKING I 1, as owner Of The property. will do the work and rhe I SPACES PROVIDED structure is not intended or offered for sale (Section [ 7044, Business and Professions Code). y r� / a PROPOSED U5E OF BUILDING CONSTRUCTION LENDING AGENCY—T-�- 1 taffirm that there is a construction phis a aeenc ( farr thehe u-h performance of the work for iCh this permit is � - issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address PROPOSED MAX. OCG. [ certify that I e read appticatio and state that the PERMIT FEE 25.00 above infor is correct. I a e t ply with all County I ISSUANCE FEE ordinanc n ate laws reo uilding construction, and h th ize Rtes t s fthis County to enter I TOTAL. FEE 25.00 t. I upo the bo e- ent r inspection purposes. j SEE REVERSE FOR EXPLANATORY LANGL AGE ignatuP641f Pe ee Date 'ORKG.RS'COhiPENSATIONE)ECLARATION 16M444 CE 875 (11-841 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' Compensation Insurance, or FINAL APPROVAL a certified copy thereof {sec. 3900, Lab. C.). Polley No. —C:anlpanYBUILDING FOR APPLICANT TO FILL IN ADDRESS ��J ❑ Certified copy IS hereby furnish xx BUILDING rY 1' LOCALITY ' ��' ADDR536 Q54q r7-91 rSTREET Certified copy is filed with the county building inspection LOCALITY NEAREST department. YY. T� LTV PA _ 1)-LW CROSSsT. Date Applicant NEAREST CROSS ST. DISTRICT NO. GROUP ITYPE ,Sl r� CONST• l� Pp �10ESSRD 13Y p � ��r`� XX CERTIFICATE OF EXEMPTION FROM WORKERS' LE GIIL c� COMPfNSAIION INSURANCE, DESCRIPTION LOT N0.5 u BLOCK MAP IG Wwv NO, tCIRCLEI STATE MAJOR SECOND LOCAL (Chis section need not be completed if the work involved TRACT 1 ,7ggk OF BLDGS. NOW ON LOT 9 USE ZONEISPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) SIZE OF LOT .�nTk4 USE OF / 1 that in the the work for which this �fl �. EXISTING HLDGGARAGE certify performance of permit is issued, I shall not employ any person in any manneXX ow--- Of building RANDY GENE NAG8V so m to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP Elatc-9_2-0..=.9-5—Applicantf7V C;FA1E A"GBY MAIL ADDRESS 9548 GTaLEy ST. '� NOTICE TO APPLICANT: If,1' :. irt�akfZ EllisI[6rfdfi¢/ate of CITYr�MpLE czr�.cA. �rNOL�-��-Soar OCCUPANT LOAD Exempt: n, you should become subject to the Workers' C'nmpencition provisions of the Labor Code, you must forth APPLICATION FOR EXIT HARDWARE: with comply With suds provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION ❑ No Spec. Knowl. ❑ deemed revoked. OCCUPANCY INSPECTION 12 Panic Devices l,l('I(NSF.0 ('ON FRAC"FORS DECLARATION 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 anix Name of business effect. REQ'D I I SPAC SPA CESS I PROMOED License Number Lic. Class RANDY GENE NAGRV Contractor_ (late I ani exempt from the licensing requirements as 1 am a license([ architect or a registered professional engineer SIZE OF NO. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. r 8x20 it. STORIES 0 iness and Professions Code). Lic. or Reg. No. Date PRESENT USE OF BUILDING GARAGE HOME OWNER -111111 -DER DECLARATION I hereby affirm that I and exempt from the Contractor's License 1,aw for Illc following reason (Section 7031.5, Busi- ness and Professions Code): F11, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the perfornumce of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name - �- NO. OF EXISTING BUILDINGS ON LOT AND USE 9-0 v;AtiN0—J-414–, fA0 NO. PARKING SPACES PROVIDED none teq.tuked PROPOSED USE OF BUILDING TO MANUFACTURE WOODEN AOUARTUM STANDS. PROPOSED MAX *OCC, Lenders Address 1 certily that I have read 1ltis application and state that the PERMtT FEE 25.00 above infornwtiml is correct. l '19TCC to comply with all County ISSUANCE FEE ordinances and State lams relating to building construction, and hereby authorve representatives of this County to enter TOTAL FEE 25-00 rialotl the above-nlerltiun(!d pmperty for inspection purposes. SFE REVERSE FOR EXPLANATORY LANGUAGE x xx —9 1995 I Willi—..... - -- )hitt. LIMITED TIME USE DATE FROM: TO: oAic INSPECTOR'S FINAL APPROVAL S1.NATURE