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Home My Public Portal About8806-8808 LAS TUNAS DR_Miscellaneous__ N,0RKERS,COFIPENSATIO';�``-CLARATION CE 875 MI...CELLANEOUS APPLICATION {� � CE 875(t t-641 � LJ 1 hereby alfirm-th:.I.I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure, 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 ADDRESS Certified copy is hereby furnished. K. I BUILDING V_ AODfl ESS LOCALITY ❑ Certified copy is filed with the county building inspection LOc ALITY `_ r/_ /,, _ NEAREST department. d'(!7L /Mvr��'�'I CROSS ST. Date Applicant NEAREST GIBS T+{�'I CIN. G TYPE ....��PP P E55 BY CROSS ST, r-T OV -� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL GGc..../// Q STATE MAJOR SEGO LOCAL COMPENSATION INSURANCE DEscRIPnoN Lor No. BLocK IDRwA NO. OF SLOGS. US by t sectionprm need not be completed If the work involved TRACT NOW ON LOT ) USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE TIN 1 certify that in the performance of the work for which this SIZE of Lor EXISIrvG BLDG. o permit is issued, I shall not employ any person in any manse[ OWNER t T so as to become subject to the Workers' Compensation Laws, MDDAILRE55 Z3 OCCUPANCY GROUP o A Date Applicant �S �� - u'-1 NOTICE TO APPLICANT: If, after making this Certificate of crry no� �l��Z$S'_Z7�� OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: With comply with such provisions or this permit shall be TRAILER USE ❑ cEO Lo cY INSPE CT1oN ❑ No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 4B,�-- Panic Devices 1 hereby affirm that I am licensed under provisionsof Chapter SAFETY PERMIT ❑ (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 1: /) effect. IKAM /,/ PARKING ARED PROVIDED SPCES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No. OF NSF E SPE croft's acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL ? /x PRESENT USE OF BUILDING Lic.orReg. No.� Date V oM L HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUIL OINCS t li-i FE I ON LOT AND USE 1 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 0000-110101 4/ •5/ =0 I, as owner of the property, will the work and the [99721 A�11s_7a3? structure is not intended or offered SPACES PROVIDED 9972d for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING r 6 �(�1 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 Jyy^I PROPOSED MAX. OCC. /I• Lender's Address DO I certify that 1 have mad this application and state that the PERMIT FEE above information is correct. I agree to comply with all County ISSUANCE FEE ordina ccs and State laws relating to building construction, and ' eby authorize represe tatives of this County to enter TOTAL FEE upi c above-menti ed pr •ei 'on purposes. ^ or ins SEE REVERSE FOR EXPLANATORY LANGUAGE r j�(% Signature of Permittee j Date WORKERS'COMPENSATION DECLARATION 7GM444 CE 875 (2-80) MISCELLANEOUS APPLICATION {I I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION u ir&ure, or a certifiEate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800, Lab-, C.) Policy No. Company FOR APPLICANT TO FILL IN - BUILDING yAr/ ADDRESS / ❑ Certified copy is hereby furnished. cult.I,NG r4 2 OG 1-AS T (VAS.a V i LOCALITY QADDRESS D O .1 Certified copy is filed with the county building inspection NEAREST department LooALITY / KP_('r / 1 `T eaoss ST. Date- Applicant NEAREST O l� DISTRICT NO. G UP TYPE PRO D BY CRO55 sT. ML)S G TC L C /fI� ��I CONST., CERTIFICATE'OF EXEMPTION FROM WORKERS' BEsc wairnoN LOT No. BLocX ryoJl fSJoO 1 „(WDA V Y' COMPENSATION INSURANCE / (oRCLE) STATE MAJOR sw D Local d (This section need not be completed if the work involved NO. OF SLOGS. USE zorvE SPECIAL CON.mons 0 p TRACT HOW ON LOT 0 by the permit is for one hundred dollars (5100) or less.) USE OF SIZE OF LOT EXISTITI NG BLDG. 1 certify that in the performance of the work for which this � 0 permit is issued, I shall not employ any person in any manner - V /f so as to become subject to the Workers' Compensation Laws. MAIL t L oO E OCCUPANCY GROUP (/t^� W OWNER ADDRESS 4106 L S1 JN145 DQ ,✓ a Date Applicant �t ,..p/� p _ N NOTICE TO APPLICANT: If, after making this Certificate of c-TYSp� t78 t(;L ��`1447. 7 325- OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- With comply with such provisions or this permit Shall be TRAILER USE 0 GEOLOGY INSPECTION C] No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION0 Panic Devices ❑ 1 herebv•affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3.of the Busi, ness and Professions Code, and my license is in full force and PARKING. effect SPACES REDO D PROVIDED License Number Lie.Class LIMITED TIME USE Contractor Date - DATE DATE ❑ 1 am exempt from the licensing requirements as I am a licensed architect or a registered pfofessional engineer SIZE OFNO. OF I.SPECTOR'S acting in my professional capacity (Section 7051, Bos- EXISTING BLDG. STORIES sl NATURE mess and Professions Code). PRESENT USE OF BUILDING p/c(J IE FINAL APPROVAL Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BmLDINGS ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Susi-. ness,and Professions Code): NO. DARNING SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ((�� 7044, Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDINGGAG17NCY __ •� L VA \�ereby affirm that there is a construction lending agency 1 I L A fon'he performance of the work for which this permit is issued(Sec. 3097.Civ.C.). 2429.7A Lender's Name PROPOSED MAX. OCC. # • 88 r(� Lender's Address PERMIT FEE .10 0 0 . 0 2 I certify that I have read this application and state that the py above information is correct. I agree to comply with all County ISSUANCE FEE 0 J 2 6�-8 6 ordinances and State laws relating to building construction, TOTAL FEE and herebv authorize representatives of this County to enter - upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Man_. % ' 'r,JV.� 3_Igjf. Signature of Permittee Date - WORKERS'COMPENSATION DECLARATION ,76M444 J7 CE 875 (2-80) MISCELLANEOUS APPLICATION 7'LJII 1 hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES - BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN❑ BUaLDING wDORE as Certified copy is hereby furnished.❑ BUILDING —wwv� LOCALITY AD DRE55 G Certified copy is filed with the county building inspection I NEAREST department. LocwurY �� cw OSS ST. Date Applicant NEAREST �y TY DISTRICT NO. GROUP PE PROCESSED BY CR 033 ST. / OSQ-41 D CONST. ' CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 21 COMPENSATION INSURANCE DESC RI PTrON LOT rvo. BLOCK Mao ICI„CLE) STATE MAJOR SECOND LOCAL Y (This section need not be completed if the Work involved No. of BLOGs. USE 20NE SPECIAL CONDITIONS a P TRACT NOW ON LOT O by the permit is for one hundred dollars ($100) or less.) - U USE OF TI SIZE OF LOT EXISTING BLDG. Q. 1 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 PI as to become subject to the Workers' Compensation Laws. AIL woolec- CYOCCUPANGROUP - ~ J P ADDRESS SSbb E, L+1S /t,(, ' CL Date Applicant to N EL. NOTICE TO APPLICANT: If, after making this Certificate of ory �� TNo. OCCUPANT LOAD Z Exemption, you should become subject to the WorkersAPPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit Shall be TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) No. OF EXITS a 9 (commencing with Section 7000) of Division 3 of the Busi- - ness and Professions Code, and my license is in full force and effect. - PARXIrve RED'D 0 PR oven ED SPACES Lice;Ise Number Lic.Class ” 'LIMITED TIME USE Contractor Date DATE DATE L{ I am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE OF ND. OF INSPECTOR'S acting in my professional capacity (Sectioli 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING / -�� ,! ^ S FINAL APPROVAL D 7/ �/A Lic.or Reg.No. Date V^MIV T J V��•� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 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. PARKINGx'616 9.0 A ❑ I, as owner of the property, will do the work and the SPACES PROVIDED - structure is not intended or offered for sale (Section ,# 8 8 7044, Business and Professions Code). ROPOSED USE OF BUILDING \..%7�L � ,O O e,e e•e1e Z CONSTRUCTION LENDING AGENCY 10.06J-82 1 hereby affirm that there is a construction lending agency 1?W VATE;� for the performance of the work for which this permit is CGT issued (Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 1 certify that I have read this application and state that the - above information is correct. 1 agree to comply with all County ISSUANCE PEE ordinances and State laws relating to building C0uStTUCtlOn, TOTAL FEE Q� and hereby authorize representatives of this County to enter up the above--au.at�roperty for inspection p rpos SEE REVERSE FOR EXPLANATORY LANGUAGE ln.nc� _9 L4 Signature of Permittee to OIORKERS'COb1PENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS APPLICATION l� CE 875 r ' I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANSELS BUILDING AND SAFETY DIVISION ,ILII insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). \ Policy No.—Company FOR APPLICANT TO FI LL IN BUILDING BDORE55 D Certified copy is hereby furnished. BUILVIrvG LOCALITY' AD OR E55 Certified copy is filed with the county building inspection /� � '''T NEAREST •( department. LocwLITY �� ..f Q %A �I fiCROS$ ST. ONST Date Applicant NEAREST DISTRICT N/pO. GR UP TYPE E P SSED BY CR095 ST. C .- �y CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLODX rvov (ci cLel 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.) ND.M OF a I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG... o permit is issued, 1 shall not employ any person in any manner OWNER U t (� , n y so as to become subject to the.Workers'Compensation Laws. MAIL OCCUPANCY GROUP ADD. Date Applicant rEL. NOTICE TO APPLICANT: If, after making this Certificate of CITY OCCUPANT LOAD'7� rvo. .8S— Z� y Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions Or this permit Shall be TRAILER USE❑ GEOLOGY INSPECTION ❑ No Spec. Know) deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PgRMIT ❑ (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 es effect. In PARKING SPACES REO'D E� PROVIDE- License Number Lie. Class ��[.� LIMITED TIME USE Contractor Date DATE DAT. I am exempt from the licensing requirements as I am a Bus- licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. s'roRlEs SIGNATURE iness and Professions Code). Lie.or Reg.No. Date PREs SE OF BUILDING FINAL APPROV AL I HOME OWNER-BUILDER DECLARATION ND. OF ANDEXISTINGUSE BUILDINGS tin FEE- ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING • _. /V:,L-,^ SPACES PROVIDED 1 1'IIIi"�i' I, as owner of the property, will do the work and the s*^ structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROP 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 PERMIT FEE I certify that I have read this application and statethat the above information is correct. I agree to co g-w#tarathCounty ISSUANCE FEE ordinances and State, laws r o building construction, and hereby at or` e ntatives of this County to enter TOTAL FEE 00 upon the ab e- Ione operty for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date R'ORKERS'COMPENSATION DECLARATION 75M444 CE 875 (11-84) MISCELLANEOUS APPLICATION 1 I hereby affirm that I have a certificate of consent to self COUNTY OF r GELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or .�+-„� .-ci+ L ' a certified copy thereof(Sec, 3800,Lab.Q. L Policy olic Vo.—Company - D�ILpINc lj G�c YFOR APPLICANT TO FILL IN ADDRESS 00 D Certified copy is hereby furnished. AppR BUILDE5ING 5 F V f/ 7u�'yI/C S'/t�- LOCALITY I 6 �� f 1 1 Certified copy is filed with the county building inspection LocwurY �/^J/ /C1 ` NEAREST department. � �/4Al ��✓ /(� CROSS ST. Date—Applicant NEAREST _ rr-,. pISTR ON� G P TYPE _2 E$$ED BY GEAR ST. u-O lI E1� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL RAA COMPENSATION INSURANCE OES CRIPTION LOT NO. BLOCK STATE MAJOR SECOND LOCAL NO. OF BLOCS. I (Tills section need not be completed If the work involved TRACT NOW ON LOT VSE ZONE SPECIA LRCONDITIONS by the permit is for one hundred dollars (SIOO) or less.) a Q� VSE OF 1 SIZE OF LOT I certify that in the performance of the work for which this EXISTING BLp G. � '/ T/�^. permit is issued, I shall not employ any person in any manner OWNER ( 4-4114 o j LtL so as to become subject to the Workers Compensation Laws. OCCUPANCY GROUP — NAIL Ap OR E55 VV K N — 1 Date Applicant //�� C�>''/�{_./lAp2-2-61,11" — NOTICE TO APPLICANT: If. after making :his Certificate of CITY Sew C�,t jL.GL u R IY ITVY OCCUPANT LOAD Exemption, you should become subject to the Workers APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- I with comply with such provisions or this Permit shall L ne RAILER USE GEOLOGY INSPECTION No Spec. Know . deemed revoked. T p I 17 Panic Devices LICENSED CONTRACTORS DECLARATION oc cp Pa Ncr INSPECTION _ I hereby affirm that I am Licensed under provisions of Chanter � SAF cTY PERMIT a (LIST ITEMS aELOw) I 9 (commencing with Section 7000) of Division 3 of the Busi- �T '/'/I NO. of ExITs - ness and Professions Code. and my license is in null force and effect. EC ASPACES P SPACES REOD I I PROMOEO ' I License Number Uc. Class LIMITED TIME USE Contractor Date DATE DATE z h I am exempt from the licensing requirements as I an a I licensed architect or a registered professional engineer SAE OF - /"� Tao. of INSF=_ETOR'E '= acting n my professional Capacity (Secclon i0. 1. Bus- I =xISiING 9LO G. �3bZ� S JTJ (STORIES / SIGNATURE iness and Professions Code). - E.v FINAL APPROVAL -' s'- - V_ PR Lie.or Reg. NO, Date EEE NT USE OF 3VIL.ING A J A e HOME OWNER-BUILDER DECLARATION NO. OF ExISTING BUILDINGS O �{ I In I,'- 1"i - ON LOT AND USE 1 1 hereby affirm that I am exempt from the Contractor's -• .L` I License Law for she following reason (Section 70315, Busi- ness and Professions Code): No. PARKING I, as owner of the property. willdo the work and ;he y-PAcES PROVIDED structure is not intended or offered for sale iSection j 7044,Business and Professions Code). ( CONSTRUCTION LENDING,AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a constmcdon lending agency /'o.vls?'•�k(� ,� i/G.✓=T3i 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 ,he PERMIT FEE En Sr Q above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby a)rfiqrrizg itpresentatives of this County to enter TOTAL FEE a 1 upo the ab enti ed property for inspectioJJll Durgosex. SEE REVERSE FOR EXPLANATORY LANGUAGE iynatu e o ermiltee Date