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Home My Public Portal About8837 LAS TUNAS DR_Miscellaneous__ R'ORKERS'COMPENSATION DECLARATION 768444 - SAPPLICATION {� CE 875 (11 84) M ISCELLANEOULJ 1 hereby affirm that IWo 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 BUILDINssG ADOR EO D / ri ln'Lzt� L-,- Certified copy is hereby furnished. BUILDING - XX ADDRESS8837 E . Las Tunas TcC LOCALITY Certified copy is filed with the county building inspection LOCALITYNE AResT department. 3Cy. Temple City , CA 9 1780CROSS sr. Date Applicant NEAREST 9IsT.ICT NO GROUP TYPE ' CESSEO BY CROSS ST. g Blvd . - �o� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DEsc RIPnoN Lor xo. BLOCKMAP1..WA IC ,-el STATE MAJOR SECOND LOCAL NO. OF BLDcs. 1 c (This section need not be completed If the work involved TRACT NOW ON LOT USE SONE 5PECIAL CONOITIO.S by the permit is for one hundred dollars ($100) or less.) 512E OF LOT EXISTING BLO G. I certify that d, rise performance of the work for which this o permit is issued, 1 shall not employ any person many mOWNER of building Th Fariri Laws. so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP :;DRESS 8835 E . Las Tunas '✓ Date Applicant w NOTICE TO APPLICANT: If, after making this Certificate of CITY Temple City „o`' 285-9266 OCCUPANT LORI] h Exemption, you should become subject to the Workers' 7 PPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- A with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. KnoWl. deemed revoked. OCCUPANCY INSPECTION ❑ Panic Devices LICENSED CONTRACTORS DECLARATION 1 I 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 anX effect. Name of business PARKING REO'D PROVIDE. SPACES License Number Lic. Class Jon ke Bair CPA LIMITED TIME USE Contractor Date .ATe SATS 1 am exempt from the licensing requirements as 1 am a RO• licensed architect or a registered professional engineer eet SIZE OF msTR's SIGNATURE acting N my professional capacity (Section 7051. Bus- EXISTING BLDG. iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL _/Q //� Lie.or Reg.No. Date DrI 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. PARKING 1, 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). CONSTRUCTION LENDING AGENCY PROPOSED U5E OP 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 25 . 00 I certify that I have read this application and state that the PERMIT FEE above information is correct. 1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, fl and hereby authorize representatives of this County to enter TOTAL FEE 25 .00 _r upon the above-mentioned property for inspection XX XX 3/31/95 SEE REVERSE FOR EXPLANATORY LANGUAGE - = rl Signature of Permittee Datei WORKERS'COMPENSATIONDECLARATION CE 875 (t1-841 M ISCELLANEOUS APPLICATION CE 875 inhereby affirm that I have a certificate of consent 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 FI LL IN ISU.LDING AOOR ESS Certified copy is hereby furnished. ulLVIrvG n 47 AD DRE55 b b U E I a LOCALITY Certified copy is filed with the county building inspectionOCALITY NEAREST department. cRDss sr. VILA Date - Applicant EAREST ' OISTjtICTONQ' OIIP CONST. 6Y CRO55 ST. PROC SSED wQUT/ 3 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK 3L .'c.I Ej naP STATE MAJOR SECOND LOCAL (This section need not be completed If the \VOIk InVO1VCd TRACT NOW ON LOT USE'ZONE SPECIAL CONDITIONS ' by the permit is for one hundred dollars ($100) or less.) I USE OF I(� 5 ZE OF LOT EXISTING BE I certify that m the performance of the work for which this J o permit is issued, I shall not employ any person in any manner owNER ,�. :\ ^. \: .nn y so as to become subject to the Workers' Compensation Laws. mAeL + �OCCUPANCY.GROUP I- LAC, ` s ADDRESS O \ . � ,A\`l ..L YY=====»�� U Date Applicant - - - r , 5\' OCCUPANT LOAD W NOTICE TO APPLICANT: If, after making this Certificate of CITY y ENemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- PLICATION FOR EXIT HARDWARE: with comply with such provisions Or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ ❑ ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INS PE cr1oN Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ (LIST ITEMS aELowj 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 REO•D PROVIO EO SPACES License Number Lie. Class LIMITED TIME USE _ Contractor Date DATE DATE 1 am'exempt from the licensing requirements as 1 am a Licensed architect or a registered professional engineer slzE OF No. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. sroRlEs sl NATURE iness and Professions Code). FINAL APPROV AL Lie.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS FEE 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. PARKING - El I, as owner of the property, will the work and the �u 1 ( 100y structure is not intended or offered SPACES PROVIDED 4508d for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 hereby affirm that there is a construction lending agency o for the performance of the work for whichthis permit is issued(Sec. 3097,Civ.C.).- , PERMIT FEE Lender's Name d,6PROP SED MAX. Dec. Lender's Address 0 6 ' 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 State laws relating to building construction. TT and ereby authorize representatives of this County to enter TOTAL FEE Qty11 the above-mentioned grope I inspect n o S. SEE REVERSE FOR EXPLANATORY LANGUAGE Signat re of Pen t e Date -WORKERS'COMPENSAT[ONDECLARATION 76 87CE 8745111-84) MISCELLANEOUS APPLICATION {� - LI 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 BD ILD ING ABU Certified copy is hereby furnished. BUILm Ne (13 E �f11uaS pl^I LOCALITY A OGRESS E IwV Certified copy is filed with the county building inspection LOCALITY NEAREST department. GROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. GQ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE' DESCRIPTION Lor rv0. BLOCK .GRW. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLOGS. (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.) UE of 1 certify that in the performance of the work for which this slzE of LOT Ex ISTING BLDG. o permit is issued, 1 shall not employ any person in any manner OWNERI)k%sv S vrt wa =' so as to bec9me subject to the Workers' Compensation Laws. MAIL IDV OCCUPANCY GROUP o '3(, ADORES' Z w U Date � Applicant u+ - w NOTIC T APPLICANT: If, after making this Certificate of CITY. 0f� L GAIL zIC1�7 1 HDL. �d-'�81 s-,96-,76p), OCCUPANT LOAD Exemption, you should become subject to the Workers' IAPPLICATION 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 INSPECTIO R§ 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- V NO. OF EXITS ness and Professions Code,and my license is in full force and by C, ,�/�• effect. \` PARKING REOD E= PROVIO ED SPACES License Number Lie. Class LIMITED TIME USE Contractor Date oATE o.TE I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF Iry SPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG wTVRE iness and Professions Code). PRESENT USE OF BUILDIN FINAL APPROVAL11 Lie.or Reg.No. Date 1 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS E ON LOT AND USE 1'1'—� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Bdsi- ' ness and Professions Code): NO. PARKING OCIO+�-CIUU1 911'19i.1 EJI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for We (Section 2261 1 ON 1:117 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN 1 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. 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 15 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE igna[ of Pet t ----y�—