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HomeMy Public PortalAbout8839 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATIONDECLARATION 76M444 87544 (2-80) MISCELLANEOUS- APPLICATION ' I 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.) NG 2 0 Policy No. BV ILOI Company' FOR APPLICANT TO FILL IN wvv RE 3 7 Q r ❑ Certified copy is hereby furnished. .. "'ED I NG 7U/x//}S. aI� .LOCALITY ❑ 'LOCALITY GdJ .G.H , department: is filed with the county building inspect ion T n ^ ,y,.r /� depart menu LOCALITY /�'Mr�E U�L L/.r., �/ 7(�y NEAREST CROSS ST. Date Applicant AREST ^� OISTICy,�O. G VP TYPE PROC Y c ROSS sr. OSE/-fE fT✓, lg�./JG7, rl Ro y _ry T PE CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL - J O EO B COMPENSATION INSURANCE DESCRIPTION LOT NO. elocic MAP „w'ocA No. (CIRCLE) STATE MAJOR SECON °CAL >_(ThIS section need'not be completed IP She workInVOIVCd TRACT NO. OF BLOGi NOW ON LOT - USE ZONE SPECIAL CONDITIONS _ O by the permit is for one hundred dollars (5100) or less.) U USE OF lq� ' SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this /J' J L. !d7/%l.dS permit is issued, I shall not employ any person in any manner ' OWNER SCC /J so as to become subject to the Workers' Compensation Laws. AILP OCCUPANCY GROUP i. ADDR UJ Date - .Applicant CI_NOTICE TO APPLICANT: If, after making this Certificate of TTY -T/Y/P (RTE OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE:. a Compensation provisions of the Labor Code, you must forth-, with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION C]deemed revoked. - No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I ani licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 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 REQ•° E= PRONTO ED' � ' License Number Lic.'Class LIMITED TIME USE Contractor Date DATE DAT I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECT°R's acting in my professional capacity (Section 7051, Bus-. X l iNGaLDe. STORIES IGrvwTDRE iness and Professions Code). 1. FINAL APPROVAL RESENT VSE OF 6UILDING Lic.or Reg.No. Date _ . 1Jtiss- xrt<,S ?ibKts 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- nessand Professions Code): NO. PARKING # a E E E O 8 SPACES PROVIDED OO I, as owner of the property, will do the work and the - structure is not intended or offered,for sale (Section -E•�•E -� 7044, Business and Professions Code). °POSED USE OF BVILDING�I�1(J}Ow�/'/l�' r'I�(, 1 1'27-84 CONSTRUCTION LENDING AGENCY. - ' rva+iLjwlr/Lr- IJV . 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. Dec. , Lender's Address ,PERMIT FEE. " 1 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 buildingconstruction, rorwL FEE - and hereby t horizef re presen[ativ�s of this Countv to enter ' Upon e-n ntio ed prop fry for mspecti n p pose SEE REVERSE FOR EXPLANATORY LANGUAGE SI nature ofTermittee Date 1 WORKERS'COMPENSATIONDECLARATION C CE 875 (2-60) MISCELLANEOUS APPLICATION {� E 875 u I hereby affirm that 1 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 AOBU I.L.D.:NG p�0J Q e SS 0 J ❑ Certified copy is hereby furnished. BUILDING 41��1 �''• �� LOCwuTY ADDRESS V ri.�� E' 1^t�S ()',n> V{�\Y Q+ 7 Certified copy K filed with the county building inspection NEAREST department. LOCALITY � �Lh CROSS ST. Date Applicant N AREST {{{����I DISTRICT NO, GR DP TYPE PROCE SED BY CROSSay. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT NO. BLOCK Y COMPENSATION INSURANCE NOP C�FDO jcGRc�e) STATE MAJOR sEcorvD LOCAL S NO. OF SLOGS- bysection need not he completed if the work involved TRACT t NOW ON LOT USE ZONE $PEC IAL CONDITIONS 0 . by the permit is for one hundred dollars (S100) or less.) - SIZE OF LOT EXISTING BLDG. CJ 0 I^certify that in the performance of the work for which this IUS1 Q permit is issued, 1 shall not employ any person in any mannerwNER I ' / H Ec\ �L\...5 yy U so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP /�- �-• W Date Applicant ¢•/ d U) OCCUPANT LOAD TEL. z NOTICE TO APPLICANT:*if, after making this Certificate of +rrSr 3�rta� TE 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 deemed revoked) .. C] No Spec. KnoWl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ panic Devices ❑ ' I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (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 PARKING REO•O effect. SPACES D PROVIDED License'Number Lic. Class LIMITED TIME USE Contractor - Date - TE DATe - I am exempt from the licensingrequirements as 1 am a ' licensed architect or a registered professional engineer St.E OF NO. OF - INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). - FINAL APPROVAL PRESENT USE OF BUILDING y�(C` el._- k�e / ��Z G' Lie.or Reg.No. Date. 6 -J �YV\ 11 HOME OWNER-BUILDER DECLARATION No. OF ExlsrlrvG 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 2 5Q, rJ A I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section - #,e le e,e 88 7044, Business and Professions Code). _ ' ROPOSED USE OF BUILDING - s e,e s e e e en z CONSTRUCTION LENDING AGENCY I hereby affirm that-there is a construction lending agency `tea- `e •B— J'�. S 4106-82 for the performance of the work for which this permit is a - 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. I agree to comply with all County ISSUANCE FEE ordinances and State-laws relating to building.construction, roraL FEE and hereby authorize repr sen tatives of this County to enter, (a�C/ (^,V . o. the abo e- ntione roperty for inspec[ioI Pur uses. SEE REVERSE FOR EXPLANATORY LANGUAGE 04�90L_/� ,, ., Signalure of Permittee Date - , NGRKERS'L'OMPENSATION DECLARATION aaa CE 875(11-e41 MISCELLANEOUS APPLICATIONZ - CE 1 heo!by affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION IILJII insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANTO FILL IN BUILDING 1 G 07 Certified copy is hereby furnished. BUILDIN 8839 Las T nas Dr. ADDRESS ADORESS LOCH LIT Certified copy is filed with the county building inspection LOCALITY Tem lel Cit Ca. 91780 NEAREST department. p \ y f CROSS ST. Date Applicant NEAREST Rosemea -Blvd. DISTRICT NO. GROUP TYPE R ESSED BY CROSS ST. F '� (/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1 O COMPENSATION INSURANCE DESCRIPnoN Lor No. BLocK mRw A. (CIRCLE) STATE MAJOR SECOND LOCAL IN 0 (This section need not be completed If the work involved TRACT NOW WOO S SE ZO E SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) USE oP //�, SIZE OF LOT EXISTING SLOG. — 3 z-7-0 I certify that in the performance of the work for which thiso permit is issued, I shall not employ any person in any manner OWNERD'( Thomas Fann so as to become subject to the Workers' Compensation Laws. MAIL y. OCCUPANCY GROUP �_� o ADORE Ef�, 362 W. G rvey rr100 a Date Applicant w NOTICE TO APPLICANT: If, after making this Certificate of CITY Monterey Park NO 280-0281 OCCUPANT LOAD Exemption, you should become subject to the 1Vorkers' 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 INSPECTID Panic Devices 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 and effect. PARKING SPACES REO'O � PROVIDED License Number Lic. Class FUTUREKIDS of Temple City/ LIMITED TIME USE San Gabriel Contractor Date PATE DATE 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer slzE OF rvo. of INSPECTOR'S acting in my professional capacity (Section 7051, Bus- SIZE OF BLDG. sroRlEs �. @ 4SIGNREiness and Professions Code). ,4compu ter center FINAL APPROVAL _yjAJ� 21PRESENT USE OF BUILDING yZ LLica or Reg.Na. Date 1IHOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGSD � µ th_1 j llj,% l!7''r'1! ON LOT AND USE L• Y 1 hereby affirm that I am exempt from the Contractor's ,r Ap ^-1=4 Fri 1. License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING - ElI, 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). PROPOSED USE OF BUILOINIgI providing computer CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency information systems for children ages for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 212 t0 12 years Lender's Name PROPOSED MAX. Dec. 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 e]Siesentatives of this County to enter TOTAL FEE U fie above-me ned property for inspection pur oses. - SEE REVERSE FOR EXPLANATOR LANGUAGE �,�ctizet/ /o y 90 Sign V ' q /� I \A'OaILRSCOMPENSATION DECLARATION - 26i`'1d46 r„-841 MISCELLANEOUS APPLICATION 76 144 I I,erebv affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING .AND SAFETY DIVISION insure, or a certificate ofWorkers Compensation Insurance,or a certified copy thereat Sec.3800.Lab.C.I. RD Policy No. -CompPoll-DINGy FOR APPLICANT TO FILL IN Poll-DING (}�J ❑ - ADDRESS Certified cope is hereby lonished. auo OlLoRElNG - UT A E LC . � ��� ass I I Certified copy is :fled o'ith dye counts building inspection LOCALIT' Temple Cit ORose PSS, department. P `� Date Anplicant NEAREST DISTRICT NO. GRO}}11P TTPE� CESSEO By CROSS St. � � � CONST./ CERTIFICATE OF ENEMPTION FROM itORRERS� LEGAL D t P I///. 1 COMPENSATION INSL 12_\NCL' CES CPIPT;ON LOT NO. �aLOCK I vier vlG vw wv STATS yAJOR SECOND LOCAL NO. JF aLOG5. (e R -) (This section need not be complered if the (cork involved -PAcr NO w oN Lor us ?ONE1aPECIALCONDITIONS by the permit is for one hundred dollars 1511101 or less.) 'u,E OF . I s,zE OF LOT E%ISTINc eLOG I certify that in the Performance e.' :!:e '.I'od: :I;r 'chich :his - permit is issuer.. I shall not entric, any nerson in an, manner wNEP so as to become subject to tlite 1Corkers Co-naensn tion Laws. OCCUPANCY GROUP - 'AIL AD OREssIR R a r - Date \pohLant _ N'OWL TO APPLICANT: I a;r aklr ''.us Luc - $jC r ��,A�, CN.F� o. Lr'f'UPa.N OdC -- ExemptionI'ou <!tou'd become uni L- 0 h ti I'ke s- I '`^I' ]P o ,�a�.0!' . _ _- Compens. cion -Provisions alite aba 1_..de. . xr must lot h- L! A'L , .-_. l suit comm, Ivith <uch nrovicons .- :Itis _-er-nit ;hail heIL -SEI oEOLOGr :NSP=_c:cN IC�Ct!1 deemed -,tied- �cRA No Suea._ _ICI LASED i'ONTRACTORS DI_CL AR aTIO`: OccuPAN cr IN SPc crloN ga Pan1C DevCes Li I Irerele, a;firn, :hat I am licensed under ormsionsof(i,aoter sAPETv PERmIT I- (usr IT-m5 aELo.�l 9 (commencing Ivith Section ?000) of Uh'ision ' hf the Blasi- `- No. OF E%I-s - ness and P-nfessions Code. and m> license I, in ud :orae and ARCING effect.t. zz� �� _ ES REO'O PROMOE'.] License Number Lie Casa LIMITED TIME USE Contractor !)are-- I are I am asempt Ilona tile WnaNHIV reQUIlignicn:q :is I am 1 ❑ licensed archoeci or 9 7ernsaerej p e,sio al Lrurineer ;rzE OF M. OP Ira SPECTOR'S z actin. :n In, pret.:.tonal a..._ _ .. ,L.. 0 Bus ._ NG L.G.aGF-_5 SI uRE mess and I':ofessicrs Cadet. Evr use OF aulLolNG FINAL A??ROV AL Lic-orRef. No. Dare_ PR i UI_In yf HOME OR'N P.R-BCILUER DEC LI K.\full\' No. OF AauILDINcs A'. us.NG oN LOT ND IL I hereby afirm that l am exempt from the Contractor's License Lah. for the follo,in_e reason (Section -1131... Busi- ness and Professions Codel'. NO. PARKING SPACES PROVIOEo I, as olvner of the property, will Jo the .cork :and the structure is not intended or offered int ::.Ie Section 7041-Business and Professions Code). CONSTRUCTION LENDING AGI'NC 1 X PROPOSED USE Or aulLolNG I hereby affirm that there is :I construction ending veno T ( for the pertornumce of the (,cork for Much this permit is issued(Sec. 3097,Civ. C.). Lender's N:une PROPOSED mA%. 00C. Lender's Address ( 1 sertif}' that 1 have read this apptiLa tion and elate that the PERMIT FEE 25 above information is correct. I agree to comply fill all County ISSUANCE FEE ordinances and State laws relating to building construction. � dl and herelev authorize representatives of this County to enter TOTAL FEE 25.00 1 upon t p above-me tinned property for inspection purposes. SEL REVERS[ FOR EXPLANATORY LANGU:AGI. Sienatur of Permittee Date I ,., WORKERS'COMPENSATION DECLARATION 76 8]5 CE 875 (1184) MISCELLANEOUS APPLICATION hereby affirm that 1 have certificate of consent to self iN insure, or a certificate I Workers' rs'Compensation Insurance, if COUNTY OF LOS ANGELES DUILnINr AASrIFETY UI V ISION a certified copy thereof(Sec. 3600,Lab.C.). Policy No. Company 1FOR APP'LICAFP7TO FILL IN BUILDING 1 •DDRE9s O O Certified copy is hereby furnished. XX' tBUILDING AOORES: L—�7 Certified copy is filed with the county building inspeclion�'. LOC.LIrY NEAREST department. ][y, 1 CROSS ST. Date Applicant `I NEAREST �— ' /y�� /'/�. DISTRICT NO. aR P TYPE CESSEO By CROSS ST. C+/r'/�l/Jr �jr� D /�) CONST; CER I'IFICAI F,OF EXEMPTION FROM WORKERS' LEGAL �G� COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK • wNw+. wGv lC LAI STATE MAJOR SECOND LOCAL NO. OF SLOGS. (lilts 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.) I use or slzE of LOT EX.EYING BLDG. 1 certify that in the performance of the work for which this'\ o_ omit is issued, I shall not employ an person in any manse p' r y y p xX OWNER of building .98 so as to become subject to the Workers' Compensation l.awi, .MAIL OCCUPANCY GROUP wD DREss Date Applicant— �� u NOTICE '10 APPLICANT: If, after making this CeltMiCale of CIT JAL _ eoL OCCUPANT LOAD Exemption, you should become subject to the Workers' APPL ATION 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. LI C'ENSf:U CON'fIiACTOKS UECLARA'CION OCCUPANCY INSPECTION ❑ Panic Devices 1 hereby ;dfhon that I am licensed under provisionsof Chapter I SAFETY PERMIT E] (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the B6f1 NO. OF EXITS ED ness and Protessions Code, and my license is in full force anndd r effect. `R� Name of It G PLRKING REQ-D pFOV1D ED License Number _ ____...__ Lia Class �` U//�"— z�G- LIMITED TIME USE Contractor _ Date— DATE 1 am exempt from the licensing requirements as 1 am a licensed architect or a registered professional engineer 517E OF No. or INSPECTOR'S acting, in my professional capacity (Section 7051, Bus- EXISTING BLDG. sroRlEs SIGNATURE iness and Professions Code). FINAL APPROVAL 1O-2q Lic. or Keg. No.-- Date— PRESENT USE or BUILDINGFINALHOME OWINFli-BUILDER DECLARATION No. OF EXISTING BUILDINGS O I p h ON LOT AND USE V I hereby affirm that I :Un exempt train 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). C'CINSIRUC-IION LENDING AGENCY PROPOSED USK Or BUILDING I hereby affirm that there is a construction lending agencyfor the performance of the work for which this permit issued (Sec. 3097,Civ.CA. Lender's Name ._ PROPOSED MAX. OCC. Lender's Address.______.. _ I I I cerlily that I have read Ihix applicn limb :Ina state that the PERMIT FEE TS -- ahove information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and herebyllorize-l—e— sentatives o his County to enter TOTAL FEE 25.001_ifu -- u nAunled propsN inspection purposes. ZSEE REVERSE FOR EXPLANATORY LANGUAGE ..