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� NORK}.RS (.O!a1Pl� _:1TI0'dDIClARATCOti . 76,V1444 �ypsS���������� ,�pPI.eICATION � \
- CE 875(2-80)
� t n�r�bv u tinn h � � ��a e �c titic t� ot conticn « s�!i . LOUIVTY OF LOS AN�'i�LES BUILDING AND SAFETY DIVISION �
insu .o� a certrf�i.d[e ut 1V I;�Gy (.cim�>ens,�t��in Ins irancu,��r �
a cc�[ificd cnpy therenV'(tinc.3800,l.ab.(:.)
P��licy Nrit�TC]_�.�,.$�F,�inpany-_�.g�GlOtLTn�1Ya���i, FOR APPLICANTTO FILL IN aui�o�Nc �/ / / ' �I ��9 �/
w�owEss �✓'Y�J e��, �tt�-vs-e'la,r�i��?.h.,e/!JL'�PGC-
C� Cerlified copy is'hereb9 furni;l�ied. Qu�o�� .1347 Diamond Bar Blvd. �oeaur+ '
� r� a�ss .(�c-�.-a.,.�.._�,�, .�-a.�c..i
i:r,rrRfrd c pr ss rilc.d.+�itn thP cr.in1>�b�t�d�n cpecnon --- --- "
�, �� �� LQGAI!TY NFAREST
���faa � Dian,ona Bar �Rosy�T. /� k.�' .c.���t>
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nac� ___ .aE n� ,,,� - -- �r Diairond Bar Blvd. & Grand ��Ta"T" GR�"P �` �eY
-- EcHoss s /� pbs ..
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oescrsivriorv �o�rvo.
1��717.'�.���1�)�V����Ij]t1;��F. 9 ���40972 �'aP (crsc�) STATEMAJORSECO 040CAL (�qe
. . y NO.OF BLpGS.
�T�73S SeC}IOSI IiCi'.(� I!()i°.CL C(Ri}�efe({ iF ti1C WOY� II1V(JtVC(� �RA ,� 40972 NOW ON LOT �Q� dUSE ZONE SPECIAL CON ITIDNS �
by I�P pe mt �s for one iu ndr u (IOIf1T3 (5160) u Lc.ns.) . ------ ._ ....--..
f U3E OP ��
5 Z£ F L�r t:(IET:Nc�JL[l�. , J '_Y � R-
I ce f�� lh.�t m tlia pe for �.nce u Iti ��a k foi rvIi cl [h s - - .. — . ..-'— —� _ _ �� � �
� �,r� c . ,.��,�d,i�n��:n�� „ui , :��,�r s��,�< � m,�n�r � PY'esley of Southern California �
so as CG Lecome subjec+ tu Ih�4Verkerc�.:anpen.s.iuun i�iws. - ---� � OCCUPANCV GROUP u�
�aoo��ss P.O. Box 2200 _.__.... —. . __._— n
� DAte _ .1T plican[� ._ _. _ _ �
} hoi�c�ro.atri�c arvz rt �r«,�»,,u ,K�i,�, ce�t�r,�ac�<�r ���r�N Fiaa h ��� �p�C p5�Q OCCUPANT LOAD
I F;xemphun, S�i shculd bc�o ie ,uUt ct to h \N k�s' _ -�•� ."�,•'� ' �•�'! x`�'�- . —.. _____ —.._ .___—.. .n•
� Comper.;aLr,n . .i-;,;of th.L b��r . a �n i cf furtn- �� ' yP?!ICA710N FOR EXIT HARDWRRE:
�Yith cam�ly ��t[i s�cn pr�v.�,o ie nr tnn penn i ,t u71 Fe 7 ���F p5E GEOLOGY irvsPECT�oH� No Spec.Knowl. ❑
dcc d vn6ed . ❑
' ° Panic Devices
5 OCCUPH� NS�ECTION •
i I I(. \SLD C.O�-T'R�1(TO}2 UT�CI UcA1'iO4 �Y--_ __�—_— _._ . .__ ___ _—__
i [h.rrl tt rm�I�,�t i am I ced undcr pr>}itiions rf U q t Y SAI'ETY PERMIT� (usr irems aewwl �
) (�nmrie.inne �..il� Srciion �OUO)of U.�.ii un 3 0.t.i�Rui.,i _ __ rvo or cz�rs
ne;s and Prufesair,ns Cude;anci my liccnse i;in fuu turce and �gd�.2S trailer for Tr. 41305 Pp.RKING• f�
�fEV'lI. --- --'-- -- CES • REQ�D �� PROVi�E� u
�.i�:tnse�:umncr 289274_ �.;;..c���ss__ 8-�- -- -- LIMITEO TIME USE
,-
,
c�����rr�� Presle��f 5�,�<Ca'._1/21 82� i _____— o�rE — __ �,art
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�� I ilm .-en�, fr�m i i��ns�fi� �r��ients a5 I am a � �
�� ii ��ed ir 1 e t u i regi.le d � �fess nzi rnY,����r.er � ¢t nF �.oF ��+sPeeroe's
( nihaa .r. � y hrouvi� �I � >>i..� i5e...�r,i�^051. 13u.� . srm anc., erss : __
� SIGNATURE
1 —... . ._— . ..
� �cssandlrofc,�om,(ode) tFINALAPPROVAL •
� RESENT USE OF IIILDING
I.iL o It.� hn __.. ... _.—DaLe —._ �
__ _——__ .._ ,.. . ..
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.OIV LOT N SE �
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1 h��>� iff tl_ t I a n c� mpc tm i t6 C-�fr�<tor, �
�:._ •��s���en�cr ot the io c�:� �w � ', �suar - �� ��'�M V
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ness anJ Protcssions C'odz) �rvo rne
srac�, o roeo r r F',� 3',�A
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srructure , nol m(emlta o� ff �d f� stile (Se�uon . � �o a
i(144,$usmasti vnn]'rnfetiai�m Cude). � aoPosko usE...or au����rve �� � �
coNsrftocrr:cN�.::uut�c,�cr�r..v ! �-- - --~ ' I a •4 8.5�
I 112�EJ1 11 i[�tl'1 1 Jil I.`IIC�I]� t 'I1t�Y i---_"".._... ....._..—____' � � o O tl�
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for [he pu�iorntancc I'th� �tork nr �h h tl�iis � t is � � ���Jr.�e=i
�ss��on�sr�.3os�,c�o.c.�. i=--- 0 1,r b`-8'2
Lcn�icr's piame none___.._.__ _ � �� vwocosEo max.occ. ,
� Lende��'s.lddress _ —__. �pEenni7t°EE �� G��.' ,'�"��"��
� 1 c�r[ily lh;it 1 liave read [his:qiplic:ation and state thnt the '� �� �.f �. �
nr�ve infnrinnYion is coreect.f agree ku comply wi�h ail Councy ��. �ssuarvee FSF � ��'
dinancos a�ud ,qtate Im.va rcla¢ing to buildin� cunstructiun, �
� aiad Itrrehy :�Thorv.^,repi�.+entn[ives ut ehis Count�t� enter �TOTAL FCE ;j�✓,l'� .. _
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uposi I n �u�e �it �ip tv !o n p:ution pur��ose.a. � .;Lli REVF�251�,:I�OIt lXPLANA'PORY I.ANGI.IAGb:
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