HomeMy Public PortalAbout9441 1/2 - 9445 1/2 LAS TUNAS DR_Building_2/9/1988_New bldg retail shops S'.COMPENSATION DECLARATION
6y rrri fhat h have ' Cicpte of consent to self �i � L ICI T I®IV FOR' �lJ I.L,D 16V G PERMIT �]
e;.or e
o' ertificate of Workers'
Compensation Insurance,
certified copy thereof (Sec. 3800, Lab. C.) ! ✓
COUNTY OF LOS ANGELES BUILDING AND SAFETY
olicy No. Company
�. Certified:copy is hereby furnished: FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUILDING (f)
tion deportment. ADDRESS • 7 I— v
Date Applican,�k I CiTlgmjtr 6 ZIP LOCALITY JAI
ERTIFI ATE OF EXEMPTION FROM WORKERS' NO: OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT ' CROSS,ST'
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars'($100)or less.) TRACT BLOCK LOT NO. MAP'BOOK. PAGE PARCEL
OWNER a V: NO. USE ZONE MAP �/ C
I certify that in the performance of the work for which this O. •t(7.3
permit is issued,.l shall not employ any person in any manner t . , (/�s SPECIALS
so as to become subject to the Workers'Compensation Laws. ADDRES/y/. E • v V CONDITIONS 0
CITY ZIP
Date Applicant D=
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL, DISTRIC G UP TYPE FIRE PROCESSED BY O
ENGINEER A^ NO. CONST. ZONE V
Exemption, you -should become subject.to the Workers' . ' )
Compensation provisions of the Labor Code, you must forth- ADDRESS MkZe
with.-comply with such provisions orthis permit shall be.: TEL, STATISTICAL CLASSIFICATION APT. C NDO.
deemed revoked. CONTRACTOR NO.
LICENSED CONTRACTORS DECLARATION LIC. ,. CLASS NO. ' DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of Division.3 of the Business and LIC. SEWER MAP '
Professions Code, and my license is in full,force and effect. CITY CLASSBK /6 / VALIDATION
SQ. FT. NO.OF NO.OF CHECK
License Number Lic.Class SIZE STORIES FAMILIES ONE
/1 VALUATION m®
Contractor 6YZ'1ei4�A--" Date DESCRIPTION OF WORK NEW- $ j
ADD
DI am exempt under Sec. ,
ALTER ;2 8 9 U..O.A
B.BP.C. for this reason REPAIR $
D tUSE OF. OL -#:o °.o;o 2 3
EXISTING BLDG.
10,
Gt teQ APPLICANT TEL
Signat'ur' FINAL E1,(G 4 3,.9 4. •,
NER-BUILDECLARATION DATE
EPRINT N
I.hereby affirm that I am exempt from the,Contractor's License --- AA
Law for the following reason (Section.7031.5, Business and. ADD COTsr7 FI
Professions Code): R
B 1.443947
BUILDING
I, as owner of the property, or my employees with 2 Q 9,y 8 8
wages as their sale compensation,will do the.work and
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code): MOVING TEL. ..
' CONTRACTOR NO.
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- % - t,
tion 7044, Business and Professions Code). ADDRESS r
CONSTRUCTION LENDING AGENCY REQUIRED YARD -HWY TOTAL SETBACK
t �'9 9 G 5 A '
SET BACK PROP. LINE WIDTH -z
I hereby affirm that there is a construction lending agency-for FRONT N, # o 0.0 o.0 1
the performance of the work for which this permit is-issued' • •- P.L.
(Sec. 3097, Civ: C.'). SIDE I X1.7 4 5.25
P.L. t'•
..Lender's Name _
LDMA Ref:,#- �.7 4 5 2 5
P.C. Fee$ Permit Fee
Lender's Address 0 6 2 3:�8 8
I certify that.I have read this application and.state that;the Issuance Fee ,�V Ptp/c fi .'
g above information is correct. I agree to comply with all County Investigation Fee w
o -ordinances and State laws relating to building construction, _ Total Fee ..J LDMA Perm. # -
R and hereby authorize representatives of this County to enter
on the above-mention pro rty for inspection purposes._
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of pplic6nt or Agent - b6te
i ,