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Home My Public Portal About8835 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION 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.) 2 Policy Nn. BUILDING Company FOR APPLICANT TO FILL IN ADDRESS 3 r ❑ Certified copy is hereby furnished. LDIrvG p G3 3 F,i• �S /� s ODPE55 O o LOCALITY ❑ Certified copy is filed with the county building inspection y� NEAREST y \ department. CALITY �y'YI•,/ /[ • CROSS ST. f� Date Applicant N REST Y"��'�/ r•�/ DISTRICT NO. GROUP TYPE PROC SSEO BY Ross sT.�S�/77Efi IJjj4JLry¢�El..., Q / �L CONST. 2 -CERTIFICATE'OF EXEMPTION FROM WORKERS` LEcaL - I qq �/ !/ .J COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK Nov pC QUY1 AiGwwA. - Y (owc�E) 'STATE MAJOR SECO LOCAL ' a NO. OF SLOGS. (This $eC[IOn need not be completed If the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS ' O by the permit is for one hundred dollars ($100) or less.) ! V USE 0 SIZE OF LOT EXISTITING_BLDG. C.� ir 1 certify that in the performance,of the work for which this n Q permit is issued, I shall not employ any person in any manner ER/C•,C]OL( S Cl A / LTD' I (r ��7 I V so as to become subject to lhe'Workers' Compensation Laws. M��p(J L - OCCUPANCY PANCV GROUP I� W ;: DRESS 10O CL Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of v TEL 8j g � S O /�}S OCCUPANT LOAD Z 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 SEE] GEOLOGY INSPECTION NO SpeC.'Knowl. Eldeemed revoked. LICENSED CONTRACTORS DECLARATION, OCCUPANCY INSPECTION Is Panic Devices ❑ �1 hereby 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:eff2cl. SPACES REO'O D PROVIDED License Number Lie.Class LIMITED TIME USE Contractor Date ..TE ..Te ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF No. OF INSPE cro R's acting in my professional capacity (Section 7051, Bus- EXISTING NG BLDG. sro RIES sl NATURE iness and Professions Code). �f= FINAL APPROVAL SENT USE OF BUILDING /IV S (�F�/L,� -6 Lie,or Reg. No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTINGBUILDINGS _ ON LOT AND USE 1 4 6 2 A 1 hereby affirm that I am exempt from the Contractor's , License Law for the following reason (Section 7031.5, Busi- E.E 88 - ness and Professions Code): No. PARKING _ noSPACES PROVIDED • O O , ❑ I, as owner net the property. will the work and the structure is t intended or offered for sale (Section 0,205-85, 7044, Business and Professions Code). SED USE OF BUILDING /.)S CONSTRUCTION LENDING AGENCY _ V C, 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 state that the above information is correct. 1 agree to comply with all County ISSUANCE FEE - Ordinances and Slate laws rel' Ing t0 bUll dlllg construction, TOTAL FEE an rebv auth ize represe atives of this County to enter u on he abo a-m ntioned operty for-inspection purposes. EE REVERSE FOR EXPLANATORY LANGUAGE /- .2 i e f e" ttee Date t -:WOR1iERS'COMPENSATIONDECLARATION CE 875 (11-84)44 M ISCELLANEOUS APPLICATION {� CE LI 1 hereby affirm that I have 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[hereof(Sec. 3800, Lab.C.). _ PolicyNo.—Company BUILDING P FOR APPLICANT TO FILL IN ADDRESS G d Certified copy is hereby furnished. D eess 283S [—H-S Tv�vf LOCALITY 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. GC ej Ty cRoss sT. Dale Applicant RAREST ��jj ��('`�,/ / DISTR,CTONO. Gpq TYPE PRO ESSEO BY CROSSSY. /�-V JCry`-�O �r•.YD t/A/ ov b^// CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOr NO. BLOCKP HIGHWAY n,D (C,RCLe) STATE MAJOR SECOND LOCAL NO. OF BLOCS. (This section need not be completed If the Work involved TRACT NOW ON LOT USE ZONE SPE C,AL CONDITIONS by the permit is for one hundred dollars ($100) or less.) p usa OF I certify that in the performance of the work for which this s,zE OF Lor 3p QUO ExsT,rvG BLDG. o permit is issued, I shall not employ any person in any manner owNERF yiLO/ 6 c.D so as to become subject to the Workers' Compensation Laws. MAIL /� OCCUPANCY GROUP �, o Date Applicant DREss LSI U NOTICE TO APPLICANT: If, after making this Certificate of CITY /,�(rfo� ��f 1,3)_f6-- 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 ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices ' 1 hereby affirm that I am licensed under provisions of 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 /.� ��// effect. /1h7E �� )Yilf S� • PARKING REO•D E PROVIDED SPADES LIMITED TIME USE License Number Lia Class (J FIM Contractor Date ..Y. AT. 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SrzE OF No. oP INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. sro R,Es SIG RE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date C.-)14 e—,C[C_4L- HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS D N E FEE N ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor's Z License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDEDL!.YIf 1, as owner of the property, will do the work and the �, !v l,t i r' Z; structure is not intended or offered for sale (Section �) - 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING - - I hereby affirm that there is a construction lending agency I C 4 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 �-�,J , 1 certify that f 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, my and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE / ✓ , Signature of Permittee Date WORKERS' CUMYLNJArtUw llCl.LHttHrrVtV 200063DPN12/90 1VL1D4C,LLH1VGVl1D 1A r L_I%a'f 01Y I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS ANGELES - BUILDING AND SAFETY DIVISION - insura or a certificate of Worlers'Compensation Insurance, or- - - - a certified copy thereof (Set.:3800, Lab Q, Policy No. - Company FOR APPLICANT TO FILL'IN BUILDING ' BUILDING ADDRESS ADDRESS - ❑ Certified copy.is hereby.furnished. �I;S Ti1/Vyg pR, LoeAUTY ❑ Certified copy is filed with the county building inspectio CITYZIP department. e/T G�- q/'J�v NEAREST CROSS ST. Dale %' Applicant SIZE OF LOT NO.OF SLOGS.NOW ON LOT DISTRICT NO. GRDUP TYPE PROCESS EO BY OL CERTIFICATE OF-EXEMPTION FROM WORKERS,' CYPE Q TRACT BLOCK LOT NO. I - COMPENSATION INSURANCE RICKwAY (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL No leIRf1E1 STATE MAJOR SECOND LOCAL.. by the permit is for one hundred dollars ($Ito)) Or less.) USEZONE SPECIAL CONDITIONS .T'!?p&LEy er IT'ELNO. I. certify that in the performance.of the work for which thi 5. per. •203-0 S W so mit is issued: subject not theemployW any person in any mann pe m to become subject to the Workers' Compensation Law. ADDRESS bh 353-6'frF N . ct 65"Y' (,�,yp�—'� /fes D - OCCUPANCY GROUP Date Applicant . a>�� L& CIT �� zIP ry/i26 o Z NOTICE TO APPLICANT: If. after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR . Compensation provisions of the-Latior Code.you must forthwith EXIT HARDWARE: comply with such provisions or'this permit shalt be deemed TRAILER USE F-1 GEOLOGY INSPECTION C1 No Spec.Knowl. - ❑ ' revoked. - LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter- SAFETYPERMIT❑ (LIST ITEMS BELOW) i 9(commencing with Section 7000)of Division 3 of the Busines NO.OF EXITS and Professions Code,and my license is in.full force and effec e o HI els /1 CH/UU 7/3X /TC GO Ute%?/.v PARKING i License Number Lic. Class SPACES REO'D PaovIDED . Contractor Date LIMITED TIME USE I - - DATE DATE ❑ I am'exempt,from the licensing requirements as I am a - licensed.architect or a registered professional engineer FROM: To: acting in my professional capacity (Section 7051, Business SIZE OFNO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. STORIES .SIGNATURE. Lic or Reg. No. - Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS I ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): NO.PARKING . ❑ '1, as owner, of the property, will do me work and th PACES PROVIDED structure is not intended or offered for sale(Section 704 )OPOSEO USE OF BUILOING Business and Professions Code), y SL-ldsr t CONSTRUCTION LENDING AGENCY 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.).. PROPOSED MAX.OCC. Lender's Name PPLICANTIM,W) /' TEL NO..� Lender's AddressDORES. I certify that'I have read this 'application and state that the - - above information is.correct. I agree to comply with all County PERMIT FEE - - ordinances and State laws relating to building,construction,and - hereby authorize representatives.of this County to enter upon ISSUA NCE FEE -S. 1 the above-mentioned property for inspection purposes. ." -<- TOTAL FEE I� _ _ SEE REVERSETOR EXPLANATORY LANGUAGE $ ) Sienamre of Permittee Date _ WORKERS' CUMPLNSA11U N LR1 .LAEIIVIr 20-0053OPWIV90 I E. A I hereby affirm that I have_a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION `:insure, or a cert[ficateof Workers' Compensation Insurance, or - [f a certified copy thereof (See:3800, Lab.C.) - - PoLcy:Na Company - FOR APPLICANT TO FILL IN BUILDINGBUILDING ADDRESS - - 'ADDRESS ❑ Certified copy.is hereby;furnished. . g gQt?pj Ej_ (.{t<! ~t%FkPfi Locnurr - - ❑ Certified copy is filed with the county building inspection CITYcnoss sr. "- zIP a I department. '�r-,R'F( cn Q NEAREST. Date - Applicant - SIZE OF LOT NO.OF BLDGS.NOW ON LOT 015TRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OFEXEMPTIONFROM WORKERS' CONST. TRACT BLOCK LOT NO. B�cewnv O COMPENSATION INSURANCE U o. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be Completed if the work involved- ASSESSOR MAP BOOK PAGE PARCEL N - Q USEZONE SPECIAL CONDITIONS � by the permit is for one hundred dollars ($-I00) or less.) .r._@r€y OWne TEL No. ` I certify that in the performance,Of the work for which this { ��11 U permit Is issued.l shall not employ any person in any manner A-I1�5 I TA[•) -0cf1fa G 301- { a so as to become subject to the Workers' Compensation Laws. ADDRESS O &I Z('$j a ({� - OCCUPANCY GROUP Date b1 Zl 09 Applicant - C17Y ZIP NOTIC TO APPL[CAN : [f. after making this Certificate �� CA �1700 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you mus[forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE EJ GEOLOGY INSPECTION 71 revoked. - - - No Spec.Know]. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter- SAFETY PERMIT❑ (LIST ITCMSBELOW) 9(commencing with Section 7000)of Division 3 of the Business - - - NO.OF EXITS and Professions Code,and my license is in.full force and effect. Name int Bus1ness PARKING• REQ-0 PROVIDED License Number - Lie. Class SPACES Contractor Date LIMITED TIME USE ❑ I DATE DATE am exempt.from the licensing requirements as I am a - - - FROMTo: licensed architect or a registered professional engineer : acting in my professional capacity (Section 7051, Business SIZE OF NO.OF INSPECTOR'S and Professions Code). EXISTING BLDG. sroRlEs { slGNwruRE. LiG or Reg. Na -- Date PRESENT USE OF BUILDING ZA:5TAL L FINAL APPROVAL 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 fallowing reason (Section 7031.5, Business and - Professions Cade): - No.PARKING ❑ I. as owner. of the property, will do the work and the SPACES PROVIDED �c - structure is nor intended or offered for sale(Section 7044,3 PROPOSED USE OF BUILDING 'F-�'� •L ��L i•S I l F� Business and Professions Code). . 1 { CONSTRUCTION LENDING AGENCY 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.)., PROPOSED MAX.OCC. Lender's Name - AP.PLICANTtenINTt� - - TEL NO. Lender's Address AAD�D.RW-Ess ` I certify that-I have read this application and state that the C1, ( �t Lz -vCN. iwgTG ct'* qt jeo above information is correct. I agree to comply with ali County PERMIT FEE - - - ordinances and State laws relating to building construction, hereby authorize-representatives.of this County to enter upon 1ssuANCE FEE the above-mentioned property for inspection purposes. . - - TOTAL FEE ' SEE REVERSE.FOR EXPLANATORY LANGUAGE Sienatmre of Permittee tie WORKERS'COMPENSATION DECLARATION a CE875 It t-841 MISCELLANEOUS APPLICATION CE B] I hereby 9ffirm that 1 have a certificate of consent to selfCOUNTY OF LOS ANGELES BUILDINGAND SAFETY DIVISION J irn' re, or a certificate of Workers'Compensation Insurance,or �r�1 a certified copy thereof(Sec.3800,Lab.C.). �1 Policy No. Company FOR APPLICANT TO FILL IN OU ILD 1Nc p�?� rO y' AUOR E$$O J C ,> �e� Certified copy is hereby furnished. Uu1LO1ND L,p�C�' / u Lc cA ser AUIL ENG :! v -' J LJ+E I Certified copy is filed with the county building inspection LOCALITYT rY Ne AR EET department. Temple City GROSS ST. Date Applicant _ NEAREST GISTR ICT�NO. GROUP TY PE� ESSEO a pp CROSS ST VI // y/' IGR CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL wA COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK STATE MAJOR SECOND LOCAL N° lc Lel rve. OF 6LDGS. (This section need not be completed if the work involved TRAGI Now ON LOT USC ZONE SPECIAL commons by the permit is for one hundred dollars (5100) or less.) u5E OF 1 slzE OF Lor EXISTING SLOG. 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manrex ...ER 7�ff7",G15 so as to become subject to the Workers' Compensation Lax,S. / R J.{//1�JI / ,1}� OCCUPANCY GROUP 3- I V �Py / /' ADDRESS /7S�L I1�V V �/t 4kf,V ,V qi/O I Date r applicant "J C '-*^1 =_ TEL 1 typ2 OCCUPANT LOAD NOTICE TO APPLICANT: If, after making ;his Certificate of mrY rvO.(�T�p"Gj�(j-a i Exemption. you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you MUST .oY+n- I� I with compiv with such provisions or This permit shall be TRAILER VEE OEO LOcv INSPE—,ON No Spec, Knowl. I� deemed re,(ked. — — LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPE CT1oN gra rank Devices I hereby affirm That I am licensed under provisionsof Chante: SAFETY PERMIT — (L,sT IrEru aELOwj I 9 (commencing with Section 7000) of Dr,ision 3 of:he Busi- nessand Professions Code. and my license is in.. :ufl force o.;d �I I eIlec:. PROVIDED ACES � License Number Lie. Class LIMITED TIME USE Contractor— Date-- 1 am exempt from the licensing -equirements as 1 art. Licensed archirece o: a registered professional em-inee: saE of •Ic. O= IN SPEcreR aClln^ 1r1 my processional ::apacii? ISec:ion -0c1. Bu-.- ExISTING 9LO G, S-DRIES SIG Nf TURF mess and Professions Code). PRESENT USE of BUILDING (FINAL APPRCV AL Lic.or Ree. No. Dave _ - V HOME 011'NE R-3lILDER DECL;R.y T:O\, No. of D USE ANaululNcs ///111 O ON LOT AND USE I hereby affirmthat t am exempt -rom :ha Contractor ! I U 1 License Law the following reason ISecTion 7011.5. Busi- ness ness and Proiessions Codec NO. PARKING SPACES PROVIDED L as owner or ;he property. will de :he work and ;he Structure is not intended or offered for sale (Section 7044.Business and Professions Codec. PROPOSED USE OF BUILDING CONSTRUCTION LENDING aGCNC I [[ 1 hereby affirm that there is a constmction lending :izenel: Q•fQj ��f,T�yY,LoflCS FlnJ�t7P' L I for the performance of the work for which this permit is J '" issued(Sec. 3097,Civ. C.). X0 9FG26;N zre,1GO Lender's Name PROPOSED MAX. OCC. Lender's Address ( PERMIT FEE 25.00 I certify that 1 have read this application and stale that the ' above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction. t and hereby authorize representatives of this County to en.er TOTAL. FEE 25-00 S. f upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat fire of Penalties Date 11