HomeMy Public PortalAbout6358 BARELA AVE_Miscellaneous__ WORKERS'COMPENSATIONDECLARATION
CE 8715 (114) MISCELLANEOUS APPLICATION
CE 876
I hereby &M m that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure dr a certificate of Workers'Compensation Insurance,or
a oopy thereof(Sec. 3800,Lab.C.).
Policy No. Company FOR APPLICANT TO FILL IN AD DR■DDRKHSG
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Certified copy Is hereby furnished. BUILDING
LO CALiTY C, '
A13DRKSS
Certified copy Is filed with the county building inspection LOCALITYNKARKST �o
department. GI CROSS ST. l� L
Date Applicant Ni ARK■T G �� D1/T�IICT O TY►i PRO i iD ■Y
CRO■S 1T. / CONST. 1 J
CERTIFICATE OF FMP i90N FROM WORKERS' LKGAL V
COMPENSATION INSURANCE DKf cRIPrlon I LOT No. ■LocK �. r w IR Ar
Ro. (DlwaLt) 1TATi MAJOR fi COHD LOCAL
(This
NO. OF ■EDGE.
(This section need not be COm feted If the work involved TRACT NO1t OX LOT U■ %ONi R►KCIAL CONDITIONS
by the permit is for one hundred dollm ($100) or•leu.) u,i of
■IZK OF LOT Z i7C1/TING ILD 6. {/
I certffy that in the performance of the work for which this CD
permit is issued, I shall not employ any person fn any man= O.NKR G _ 1 5J.
so as toOT
bject to the Workers' Comp on Lawtl MAIL `� �A�E� OCCUPANCY GROUP o
ADDRKSf G ~
DateAppllmnt TiL D_
NO CE TICANT: after making this of CITY �M L& G NO. OCCUPANT LOAD
Exemption, you should become subject to the Wo
I a:E4
Compensation provisions of the Labor Code,you must rth- APPLICATION FOR EXIT HARDWARE:
with comply with such provisions or this permit shall be ❑ ❑ No Spec. Knowl. E
deemed revoked. TR A1LiR U/i 6K0 LO GY INaPi CTION
LICENSED CONTRACTORS DECLARATION OCCUPANCY IN/PKCTION ❑ Panic Devices El
Ihereby sf$rm that I am licensed under provisions of Chapter /AFKTY PKRMIT ❑ (LIST rrKM/ ■KLow)
9 (commencing with Section 7000) of Division 3 of the Bud- NO. of KxIT■
now and Professions Code, and my lig Is in full forge and
effoct Q I ►ARKIX6 RigD ►ROVIO iD
License Number Luc Clara S►A CM2
LIMITED TIME USE
Contractor Date A411C Ic D AT K DATZ
El I s.m exempt from the licensing requirements as I cm a
w �1
licensed architect or a registered profbasional engineer SUCK OF No. OF PKCTURK
acting in my professional capacity (Section 7051, But Kxi/TING BLDG. FO. Oprf NATURi
inemandProfeasionsCode). PRKSKNT USK OF BUILDING FINAL APPROV
Lia or Reg.No. Date
HOME OWNER-BUILDER DECLARATION No. OF Kx IST ING BUILDINGS
OX LOT AND USX ACCT1T
I hereby affirm that I am exempt from the Contractor's v �
License Law for the following reason (Section 7031.5, Bual- , n 37 80,50
nen and Professions Code): NO.PARKING {f�- ,
I, as owner of the property, will do the Aeric and the f►wcK/ PRovrDKn 1 IT
structure Is not Intended or offered for sale (Section TOTAL 90.50
7044,Business and Professions Code). �.y �{y
CONSTRUCTION LENDING AGENCY ►wo►ofKD u/K of ■UILDIN6 0 1 (j4h GV.
50
I hereby affirm that there is a construction lending agency MANGE ■00
for the performance of the work for which thL permit is
Issued(Sec. 3097,Civ.C.).
Lender's Name ODD&-OOO1 6/27/89
PROPO■KD MAX. OCC.
Lender's Address Z-v> (�51 4204 1 AM 9:12
PERMIT FHE �
I cm-tify that I have read this application and state that the
above information is correct I agree to comply with all County ISSUANCE FeK b S O
ordinances and State laws relating to building construction,
and hereby author)ze representatives of this County to enter TOTAL PK¢ rj
upon the 34ve-Illmd9�9 property for inspection pvrpopm
g SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date