HomeMy Public PortalAbout9445 LAS TUNAS DR_Miscellaneous_3/8/1989_occupancy inspection "4KERS'COMPENSATION DECLARATION 76M444
CE 875-(„-84) MISCELLANEOUS APPLICATION {�
I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY .DIVISION LI
insure, or a certificate of Workers'Compensation Insurance,
e,or
a certified copy thereof(Sec. 3800,Lab.C.).
Policy No. CompanyFOR APPLICANT TO FILL IN BUILDIryG
ADDRESS
Certified.copy is hereby furnished. BUADDRIL°'NG' r
LOCALITY
ESS J
Certified copy is filed with the county building inspection LOCALITY g198o NEAREST
department. CROSS ST.
Date Applicant NEAREST
ST. ORk- A0 DISTRICT NO. GROUP 'TYPE P.R SSED BY
CROS ��� �` CONST.
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL
COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP �f -A
NO ) STATE MAJOR SECOND LOCAL
NO. OF BLDGS.'
./JV'—241..R.LE
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) USE OF
SIZE OF LOT EXISTING BLDG.
I certify that in the,performance of the work for which this (,
permit is issued,I shall not employ any person in any manner OWNER o
so as to become subject to the Workers' Compensation Taws. MAIL X70 L �Gb OCCUPANCY,GROUP �
O
ADDRESSN `. O CS
Date' Applicant C-,
TEL• OCCUPANT LOAD
O_
NOTICE TO APPLICANT: If, after making this Certificate of CITY o No. (RI Q �- S ys
Exemption, you should become subject to the Workers' z
Compensation provisions of the Labor Code, you must forth- A&LICATION FOR EXIT HARDWARE:
with comply with such provisions oI this permit shall be TRAILER USE E GEOLOGY INSPECTION'E] No Spec. Knowl. ❑
deemed revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices
El
I hereby affirm that I am licensed under'provisions of ChapterI
SAFETY PERMITIE] (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 and
effect. PARKING
SPACES REQ'D D PROVIDED
License Number Lic. Class LIMITED TIME USE
Contractor Date DATE DATE
DI am exempt from the licensing requirements as I am a FROM: TO:
licensed architect or a registered professional engineer SIZE OF O. OF INSP TORS
acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE
iness and Professions Code). FINAL APPROVAL
Lic.or Reg.No. Date PRESENT USE OF BUILDING
VA%01 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND U.SE
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): NO. PARKING m "`
I, as owner of the property, will do the work and the SPACES PROVIDED
structure is not intended or offered. for sale (Section.
7044,Business and Professions Code). 1�I)( -' =• =.
II PROPOSED USE OF BUILDING •�+^. �k- in
CONSTRUCTION LENDING AGENCY I� " ' - ('-
I hereby affirm that there is a construction lending agency
Ad—
for the performance.of the work for which this permit is
issued(Sec. 3097,Civ.C.).
Lender's Name
PROPOSED AX. OCC.
Lender's Address -
I
PERMIT FEE I
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 TOTA'L.'FEE
up n the above-mentioned property for inspect' n purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE,
Signat of Permittee bale