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Home My Public Portal About9441 LAS TUNAS DR_Building_12/29/1988_Subway illuminated wall sign and 3 window signs 64 v WORKERS' COMPENSATION DECLARATION hereby affirm that 1 have a certificate of consent to self: APPLICATION. FOR :�U I L D I N G PERMIT insure, or a certificate of Workers' Compensation Insurance, or a'certified copy thereof (Sec. 3800, Lab. C ) ` �' COUNTY OF LOS-ANGELES BUILDING AND{SAFETY. Policy N 7 -?— Company' �_ T41 e;P1 ❑ copy y "FOR APPLICANT TO FILL IN BUILDING �� r Certified co is hereby furnished. ADDRESS '(� .Certified copy is filed with a county building inspec- BUILDING /J�� / ' D ,.�` do/n deportm(enr ADDRESS �T`�1� /1 S /��///�lIs iC/�' / (tel , Date / � —h?�Applican CITY /P (rG1/ZIP LOCALITY CERTIFICATE OF EXE 10 FROM WORKERS' NO. OF BLDGS. NEAREST. COMPENS ION SURANCE SIZE OF LOT NOW ON LOT CROSS ST. �Q (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 717 ,-J- TENOL. USE ZONE MAP I certify that in the performance of the work for which this OWNER f,I . NO. permit is issued, I shall not employ any person in any manner �P / � SPECIAL so as to become su ct to-the Workers'Compensation Laws. ADDRESS• �Ry S � /!//r('- D. t-! CONDITIONS 0 CITY zIP U � � L�rt� Date Applicant /_ ARCHITECT OR. �� TEL. NOTICE TO APPLICANT: If, after m ing this Certificcite of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROC SED BY 0 Exemption, you' should become subject to the Workers' CONST. E I" Compensation provisions of the Labor Code, you must-forth- ADDRESS -� with comply with such provisions or this permit. shall be / TEL. STATISTICAL CLASSIFICATION T. CONDO. deemed revoked. CONTRACTOR iC �j /i/��/!/ NO. �r LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/X, 6,�? S�� ©�l� . 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 �; oZ Q/1, CLA55 BK VALIDATION �J �s[��! SQ. FT. NO. OF NO.OF CHECK �S License Number �� Lic.Class li SIZE STORIES FAMILIES. ONE ' VALUATION Contractor �06� Ale 04date ! -�c4� DESCRIPTION OF WORK �� NEW ❑ s ❑ ADD ❑ I am exempt under Sec. /VP N S (Z//W/*? ❑ - #f 1.g / ALTER ) o a 4 9,8 1' B.BP.C. for this reason NclaIt) ,d REPAIR .❑ $ x Dat®: USE OF DEMOL ❑ a o a 4.9, 8 8 EXISTING BLDG. ` e �� A 2 2 9 $8 Signature APPLICANT TEL. FINAL" Me O R-BUILDER DECLARATION' PRINTv(� //J� NO. DATE I:hereby affirm that I am exempt from the Contractor's License ADDRES n�N �l�l�S�` 1,a vt'. FI Law for the following ieasan (Section 7031.5, Business and Professions Code):' p j J ❑ BUILDING 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING. TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION'LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L: (Sec. 3097, Civ. C.).. SIDE P.L. Lender's Name LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address g I.certify that I,have read this application and state that the Issuance Fee 0 LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee44?_09LDMA Perm:# and hereb uthorize representatives of this County to enter m upon the o e-men 'oned proper y for inspection purposes. - PSEE REVERSE FOR EXPLANATORY LANGUAGE nat a of Applicant or Agent. Date - -