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Home My Public Portal About5011 ENCINITA AVE_Miscellaneous__ I ,•` OR.KERS'COMPENSATION DECL11Z,1TION 76 875111 841 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent-to self COUNTY OF LOS :ANGELES BUILDING AND SAFETY DIVISION un sure- or a certificate of Workers'Compensation Insurance,or r , a certified copy thereof(Sec. 3800, Lab C) Policv No Company FOR APPLICANT TO FILL IN BUA.DR�sD. NG S Certified xpy is hereby furnished- g BUILDING �V l �' �` d LOCALITY AOOR 355 l��- I FCertified copy Is tiled With the county building Inspection'X LOCALITY �/ /y /^/ NEAREST department �/�(//e ` / CROSS ST Date Ippliwnt NEAREST DISTRICT NOI GROUPTYPE P ESSED BY CROSS ST �OV CERTiFiCaTE OF E CE�IPTiOV FROM 110RIC-ERS' LEGAL CONS CONIPENSATION 1NSLRINCE - DESCRIPTION LOT NO BLOCK MOAP ;cep`Qi STATE MAJOR SECOND LOCAL NO OF BLDGS (This section need not he completed If the ,York involved TRACT NOW ON LOT Use ZONE SPECIAL CONDITIONS by the,. permit Is for line,hundred dull!rs ISM) or less )I r USE OF ' - I SIZE OF LOT �'/�. EXISTING BLDG I _ertifv that in he Der-ormancc 'ht -lie \nrK :or 't Iitch his ' permit is issued. I shall nut employ any person .n Inv manner V OWNER /J I SO as to become cublect -o the 'Norkers Compensation Laws AIL OCCUPANCY GROUP i A , '.� �� , IE Date \orlliant g '...ESS NOTICETO aPPLIC INT If, •iter mak.m_ :his ::atuicate,of x CITI ronjj�,4 �) moo- OCCUPANT LOAD Exemption, you >hould become subject -o :he )1•omers V, APPLICATION FOR EXIT HARCWARE Compensation Drottsions 3t the Laoor Coae au must forth- • ! %%It" cOmDly 'till' 'I"" OrotlsiUnS " rt) `ernhil ,tiall I:e -RAIL=R JSE '1 GEOLOGY INSPEC-'ON - INo Spec Knowl ' E deemed retoked — — LICENSED I O\TRaCTORS DE(-:L \R ITIO's occvPAvc r+sPEcnoN B Panic Devices El I fie rebv ar`irm :hat f am licensed under provisions of Uiaptcr - SAFETY PERMIT LIST ITEMS BELOW) a 9 (commencing with Section'7000) of Dnision 3 of the Busi- i NO OF EXITS ness Ind Protessiuns Code, and mt license is in -till •urce Ind ARKING e.feLt )SPPACES REO'D �_ PROVIDED License Number L:L Class LIMITED TIME USE •i ContraLtor Date DArc on rE - JJ I un empt roil he '!Lensuhg ;euuuemencs :, ; ani 1 i hLensed lrchittL: Or t :es_tster,.d -notessioria1 2n_!n_-_ ;IZE OF o OF NSPE CTOR s z 1c:mg In ^ts DTUte SlUn11 aDaL:[ Se-ion 'I., SII S- =•CIS +G 3LDG STCRIES SIGNATVRE 5 mess and Professions Codel ' =RESENFINAL APPROVALT 'JSE OF 3UILDING 14011E OWNER-BLILDER-DECLIR IFIO\ NO of EXISTING BUILDINGS O ON LOT'AND USE 1 lierebv affirm flat I im exempt •mm alio Conti Ltor s l� L!Lense La,.% fo Pror :lie 'L flu's uv -e.uon 'Se.:wn 031 -4Buso- Busi- ness and tessionsC odes NO PARKING .3PACES -ROVIOEO I 1, as owner of :he Dropert •vlll do he tori. Ind he structure is not intended or offered Or aie Se,:-,ion, Oa-) Business,Ind Proiessions C)del C ONSTRLCTION I-EVDI\G IIJEWst PROPOSED USE OF BUILDING I hereby- atfum that ;here is I LonstruLtion lending uzency ! for the performance of the work fur which this permit is issued (Sec 309-.Cis C i t Lender's N.inie — I� - PROPOSED MAX OCC Lender s Iddress S I"J 1 - PERMIT FEE 25.00 1 certify that I Iha%e read this application and stare that the �9R abote information is correct l agree to Lomplv;tuh all County ISsuANCE FEE ordinances and State lasts relatina to building"construction, Ind lierebv authorize represent atnes of this County to enter TOTAL FEE 25.00 4 7 upon ie on abov�e/mentione�d pprropert} for inspeLttun purposes R`%/ rl elw (o ,Lr, t % /, SEE REI FRSE FOR EXPLANATORY LANGUAGE � n 'WORK RS'COMPENSATION DECLARATION 76M444 - MISCELLANEOUS- -APPLICATION CE 875 (11-84) I hereby affirm that I have a certificate •o£ consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab C). Policy No —Company FOR APPLICANT TO FILL IN BUILDING �� i ADDRESS /`/'L`�f Certified copy is hereby furnished. BUILDINGl VT LOCALITY ADDRESS- C ��..(�1 ►% 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST1 1- DISTRICT NO. GROUP TYPE CESSED BY CROSS ST. I-. kA ,O / CONST , CERTIFICATE OF EXEMPTION FROM WORKERS'. LEGAL a COMPENSATION INSURANCE DESCRIPTION I Lor No BLOCK MAP HIGHWAY - NO (CIRCLE) STATE MAJOR,SECOND LOCAL ' - NO'-OF BLDGS. (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, t I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner' •OWNER L ` '2-G! bia W_I-1 J so as to become subject to the Workers' Compensation Laws. MAIL ��o OCCUPANCY GROUP, a U ADDRESS ~ Date Applicant LLI NOTICE,TO APPLICANT If, after making this Certificate of cIT �� NO.TELt /S7 lf�j D OCCUPANT LOAD Exemption,' you should become subject to the Workers' g APPLICATION FOR EXIT HARDWARE - Compensation provisions of the Labor Code,you must forth- with comply with Such provisions oI this permit ,shall be - TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know]. deemed revoked. LICENSED CONTRACTORS DECLARATION' OCCUPANCY INSPECTION Panic Devices ill I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LISTiTEMS BELOW) 9 (corrimencing with Section 7000) of Division 3 of the Busi- NO OF EXITS ness and Professions Code, and rimy license is in full force and effect., d ` _ _ SPACESPARKING REQ'D PROVIDED ziu_ License Number Lie. Class — LIMITED TIME USE Contractor Date - DATE DATE ' PROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity'(Section 7051', Bus- EXISTING BLDG STORIES SIGNATURE messand Professions Code) FINAL APPROVAL PRESENT USE OF BUILDING 1 Lic.or Reg No. Date HOME OWNER-BUILDER DECLARATION No. of EXISTING BUILDINGS ' ON LOT AND USE v1 � I hereby affirm that I am exempt from the Contractor's _ License Law for the following reason (Section 7031 5, Busi 0—]1;f' ; ness and Professions Code) NO. PARKING 1�! . f G' dry 07: SPACES PROVIDED �� ,A1 354. �il �e�'� I, as owner of the property, will do the'work and the structure is not intended or offered for sale (Section I 7044,Business and Professions Code). ; CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ; I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ C.) Lender's Name • PROPOSED MAX. OCC Lender's Address I certify that I have read this application and state that the PERMIT FEE 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 ab ve mentioned p perty for inspection purposes. i_ ¢ SEE REVERSE FOR EXPLANATORY LANGUAGE Z11 I _l Signatu of Perini tee bate 1VORKLRS'C'OMPLNSATION DECLARATION CE 875 (11-84) 1 _� FLLANEOUS APPLICATION CE 875 I hereby affirm that 1 have a certificate'Cof consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION - insure, or a certificate of Workers'Compensation Insurance,e,or - - a certified copy thereof(Sec. 3800,Lab C.) ! _ I'Miev No Company FOR APPLICANT TO FILL IN BUILDING y� ADDRESS a Certified copy is hereby furnished. BUILDING pp XX ADLOCALITY ` _ Certified copy is filled with the county buflding inspection LOCALITY NEAREST departmentXY• n / V CROSS ST "Date–_ _ApplicantNEAREST DISTRICT NO. GROUP TYPE P CE SSED BY CROSS ST '} j7 G v CONST C'P,RTIFICAFE OP EXEMPTION I ROM WORKERS' LEGAL C/o / C OMPCNSA TION INSURANCE DESCRIPTION LOT NO. BLOCK MHP HIGHWAY NV. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS (fills section=need not be completed if tile work Involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or lees.) USE OF SIZE OF LOT EXISTING BLDG. certify that to the performance of the work for which this permit is issued, I shall not employ an person in an manne - P P Y Y P Y $X) OWNER of buildin - --- CII as, Ili become euhlect to the Workers' Compensation Laws MAIL j OCCUPANCY GROUP c ADDRESS S O{y3Q ,�J Dale____ _-- Applicant ---- - — UL //p LLI NorICI' rO APPLICANT If, after making this Certificate of �� a NOo��" 'Ta SO OCCUPANT LOAD I -'eilptloll, you should become subject to the. Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- \vital comply ked with such provisions or tills permit shall be TRAILER"USE ❑ GEOLOGY INSPECTION E] No Spec. Know 1. deemed rclo " - _ - - ❑ - OCCUPANCY INSPECTION ❑ Panic Devices 1-1( I NS1 D(-0N I RACI ORS DECLARATION - 1-hereby affirm that I am licensed Under provisions of Chapter SAFETY PERMIT ❑ - LIST ITEMS BELOW) t 9 (commencing with Section 7000) of Division 3 Of the Busi- NO OF EXITS" . ties,; and Profession_e(ode, and my-license is in full force anx; m1 effect - Name of business (/j PARKING REq'D �- I PROVIDED SPIA'C ES License Number Lic Class / 0 A LIMITED TIME USE Contrsctur_ __ Date DATE DATE FROM TO El 1 am e\enipt from the licensing requirements as 1 am a - licensed architect or a registered professional engineer j SIZE OF NO. OF ( INSSGE rU 'S acting in my professional Lapacity (Section 7051, Bus- EXISTING BLDG. STORIES mess and Professions Code) LIC OL Reg No Date - - PRESENT USE OF BUILDING FINAL APPROVAL IlOMI.OWNLR-BUILDER DECLARATION NO OF EXISTING BUILDINGS O�GI ON LOT,AND USE - 1 -fierebv- affirm that I and exempt -from-the- Contractor's License Law for the folloxsmg.reason'(Se(.tion7031'5, Busi- ness Jild Professions Code) NO. PARKING El1, as owner of the property, will do the work and the ; SPACES PROVIDED structure is not intended or offered for sale (Section 1 7044,Business and Professions Code). i CONS I-RUCI ION LENDING AGENCY PR OPOSED`U SE OF BUILDING I hereb} affirm that there is a construction lending agency for the performance of the work for leluch this permit is issued(Sec 3097,Civ C I Lender s Name—— PROPOSED MAX.'OCC _ _ - I eider's Address—_-- — -- I I t i PERMIT FEE00 _— -T certliv that l have read this application and state that the 25, above ulfonnatuln Is correct I agree to comply with all County ISSUANCE FEE ordinances and State lad's relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25, OQ Lipo n the v -n nhonei pro crty r inspection purposes E REVERSE FOR EXPLANATORY LANGUAGE L��c — _ - XX XX �Jr ti - Ci�•nitlnrl�l Pcunitlee� DJic - .- -