HomeMy Public PortalAbout9020 ACASO DR_Miscellaneous_7/26/1989_bedroom and enlarge kitchenWORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self
insure, ora :ertifrcate of Workers' Compensation Insurance, or
a certified copy hereof (Sec. 3800, Lab. C.).
POBiy No. Company
Certified copy is hereby furnished.
Certified copy is filed with the county building inspection
department.
Date Applicant
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the work involved
by the permit is for one hundred dollars ($100) or less.)
I certify that in the performance of the work for which this 15
permit is issued, I shall not employ any person in any manner 10
as to becorpe subject to the Workers' Compe ti V1 aws.
ate I74 Applies i1.414 Z09 A
NOTI T LICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be
deemed revoked.
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter
9 (commencing with Section 7000) of Division 3 of the Busi-
ness and Professions Code, and my license is in full force and
effect.
License Number Lia Class
I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code).
Lic. or Reg. No. Date
HOME OWNER -BUILDER DECLARATION
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):
I, 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).
76M444 MISCELLANEOUS APPLICATION {�
CE 875 (11-84) LI
COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL INADDRO J
SOLOCALITY
CALITY �� /r J NEAREST
rvEAREST UROSSSTLTAN C' CROSS
SRI NST. GDESCRIAYIO°
LED L
�� DX�s o �d �-
ELO o`�I�� �HWAY
(C`RCLE) STATE MAJOR SECOND LOCAL
N j L OF B ryACT 1 NOW ON LOT E ZONE SPECIAL CONDITIONS
rE OF LOT 7 EX S° NO BLOO. fid c P
DDRB D>A Ara
O Ess
SAFETY PERMIT � (LIST ITEMS BELOW)
Ex 9TIxG eID G.
ESENT
PR
USE of BUILD IrvG
F Ex OTIrvG BUILDINGS
USE
gvtyjty 4'0. PARKING
SPACES PROVIDED L
CONSTRUCTION LENDING AGENCY - osED USE OF BUILDING
I hereby affirm that there is a constmction lending agency
for the performance of the work for which this permit is
issued (Sec. 3097, Civ. C.).
Lender's Name
F
OSED M
STORIES
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 -mention yy,,d pr erty for inspection purposes.
�
&I SEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatureof Permittee D e
OCCUPANCYG
OCCUPANT LOAD
EXIT HARDWARE:
No Spec. Knowl.
Panic Devices
NO. OF EXITS F
SPACESING REOD PROVIDED
LIMITED TIME USE
DAVE TO: DAVE I
NAL APPROVAL
E
ACCT.•.
3x07 80.50
I ITEMS
TOTAL 80.50
. DO
0000-17001 7/26/89
s6i4 1 AM 8314
APPLICATION FOR
TRAILER
USE
❑
GEOLOGY
INSPECTION
p
SAFETY PERMIT � (LIST ITEMS BELOW)
Ex 9TIxG eID G.
ESENT
PR
USE of BUILD IrvG
F Ex OTIrvG BUILDINGS
USE
gvtyjty 4'0. PARKING
SPACES PROVIDED L
CONSTRUCTION LENDING AGENCY - osED USE OF BUILDING
I hereby affirm that there is a constmction lending agency
for the performance of the work for which this permit is
issued (Sec. 3097, Civ. C.).
Lender's Name
F
OSED M
STORIES
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 -mention yy,,d pr erty for inspection purposes.
�
&I SEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatureof Permittee D e
OCCUPANCYG
OCCUPANT LOAD
EXIT HARDWARE:
No Spec. Knowl.
Panic Devices
NO. OF EXITS F
SPACESING REOD PROVIDED
LIMITED TIME USE
DAVE TO: DAVE I
NAL APPROVAL
E
ACCT.•.
3x07 80.50
I ITEMS
TOTAL 80.50
. DO
0000-17001 7/26/89
s6i4 1 AM 8314