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HomeMy Public PortalAbout8841-41 1/2 LAS TUNAS DR_Miscellaneous__ I WORKERS' COMPENSAITUNUrCLAKAIIUN 20-0063DPW:1/90 MIbC.�,LLANEOUS APPLICATION I. hereby affirm that I have.a certificate of consent tD self COUNTY OF LOS ANGELES .BUILDING.AND SAFETY DIVISION I Yihsure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sed. 3800. Lab.CJS - - - Policy:No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING 1 ADDRESS 8p S>;t T /-ITr� S (�/� ADDRESS " I, ❑ Certified copy.is hereby.furnished. g p 71 ,C I VNfI'S ❑ Certified copy is filed with the county building inspection clry t� - ZIP LOCALITY departmenL 7EM1 L� ci � 1 5 NEAREST NEARECROSS ST. ,. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY 1 CONST. n CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. _ `C I COMPENSATION INSURANCE (CIRCLED STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL NR by the permit is for one hundred dollars ($100) or less.) USEZONE SPECIAL CONDITIONS C I.certify that in the performance.of the work For which this TSD`Q yAS ANN b �tI-�.�-�d)� permit is issued.I shall not employ any person in any manner 7 Ut so as to become subject to the Workers' Compensation Laws. ADDRESS ©� W. NADM rvC OCCUPANCY GROUP Z Date Applicant . CITY NOTICE TO APPLICANT: If. after making this Certificate 0131A 0—prZipq io DDD�4 . .of Exemption. you should become subject to the Workers' APPLICATION FOR OCCUPANT LOAD ' Compensation provisions of[he.Labor Cade you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. El' revoked. P LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Ej Panic Devices El I hereby affirm that 1 am licensed under provisions of Chapter SAFETYPERMIT❑ (LIST ITEMS BELOW, f�l 9(commencing with Section 7000)of Division.3 of the Business ame o Business NO.OF EXITS and Professions Code.and my license is in full force and effect. n PARKING REO•D PROVIDED License Number Lic. Class Po Tr`REE d i RFST,4UR49/Dt SPACES I Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer FROM: TO: acting in my professional capacity (Section 7051, Business SIZETo1NG BLDG. STOROF IES INSPECTOR'S and Professions Code). �r Lic or Rep 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 ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044J PROPOSED USE of BUILDING RfSTA��AM B�s'Y Ntrs Business and Professions Code). — I CONSTRUCTION LENDING AGENCY ._.. - Ihereby affirm that there is a construction lending agency for - the performance of the work for which this permit is issued ' (Sec. 3097,Civ. Q. PROPOSED MAX.OCC Lender's Name - APPLICANT(PRINT EL NO v 4t7uNG .., 6al4 8x66 Lender's Address _ZDRESS I certify that I have read this application and state that the /AAS. M0117C/>" Sf RLNPMOR,) CfRq/gol _ above information is correct. I agree to comply with all County PERMIT FEE - � ordinances and Stale laws relating to building construction,and -- -. hereby authorize rtipresentatives.of this County to enter upon ISSUANCE FEE - 5;;� the above-mentioned property for inspection . TOTAL FEE - �// 1� ^ ' WA T0J v SEE REVERSE FOR EXPLANATORY LANGUAGE- - t Signature of Pennine Dam WORKERS'COMPENSATION DECLARATION 8 C76:M444 75 12-801 MISCELLANEOUS 1PO`ICATIOY 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.) ' UILDING Policy No. Company FOR APPLICANT TO FILL IN ADDRESS f It /T ADDRESS '7 ❑ Certlfle d Copy IS hereby'furnished. BUILDING �0 IAS / LOCALITY ADDRESS (/1VLL. P �/( ' Certified copy is filed with the county building inspection NEAREST department. LOCALITY �' ` CROSS ST. Date Applicant NEAREST - DISTRICT NO. G�OU TYPE PRO ESSED BY • CRO55 ST. / —,% CONST. CERTIFICATE OF'EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE OEscRIPnoN Lor No. ewcK ,cRw. X. � /��' STATE MAJOR SECOND LOCAL NO. OF SLOGS. - rvo. j/�/ (cw CLE) a (This section need not be completed If the work involved TRACT NOW ON LOT USE ZONE 50 EC IAL CONDITIONS O mit by the peris for one hundred dollars ($100) or less.) U USE OF ' SIZE OF LOT EXISTING BLDG. �. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner OWNER so as to become subjecttothe Workers' Compensation Laws. MAIL O OX/,R y OCCUPANCY GROUP WU ADDRESS /=M PLE C/T r/ 917p0 W Date Applicant - NOTICE TO APPLICANT: If, after making this Certificate of CITYT . TEMPLE C1 NELo. dO OCCUPANT LOAD Z/HS Exemption, you should become subject 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 El No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I Perebv affirm that i am licensed under provisions of Chapter SAFETY PERMIT LJ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division'3 of the Busi- ess and Professions Code, and my license is in full force and PARKING. rfect. REO'D D PROVIDED D , SPACES ' icense Number - Lic.Class LIMITED TIME USE Contractor Date DATE DATE .❑ I am exempt from the licensing requirements as I am a- licensed architect or a registered professional engineer slzE of rvo. OF INse Ecro R's acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 0 fsIG NATU RE 'Riess and Professions Code). PRESENT USE OF BUILDING - FINAL APPROVAL Lic.or Reg.No. Date r 11 Lf- W - , I NO. OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE 0112 7�—8'4 I hereby affirm that- 1 am exempt from the Contractor's - License Law for.the following reason (Section 7031.5, Busi- nes.,and Professions Code): f NO. PARKING SPACES PROVIDED ❑ I, 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). J ' / PROPOSED USE OF BUILDING "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.). Lender's Name J. . PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that 1 have read this application and state that the” " above information is correct. Lagree to comply with all County ISSUANCE FEE _ ordinances and State laws relating to building construction, TOTAL FEE .�C..� 0 0 ��. and hereby authorize representatives of this County to enter u/pion the bove mentioned property for inspection p rposes. SEE REVERSE FOR EX PLANATO LANGUAGE 0 v Signature of Permittee Dae —WORKEAS'COhIPENSATION DECLARATION 5(11-84) ' MISCELLANEOUS APPLICATION '' CE CE 87875 L I hereby affirm that I 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.Q. Policy No. Company FOR APPLICANT TO FILL IN ADDRESS UU NfJ `1.1 Certified copy is hereby furnished. BILDING ADUL E55 44 _ 44d m, T p LOCALITY. c� 1 Certified copy is filed with the county building inspection LOCALITYNe AREST department. -= 'PLC-- 0-17-Y, C .Q I'7�TJ CROSS ST. OSEYne7��I Dare A llCant NEAREST f� ��//,,TT OISTR CT N{p'y G�jPUP TVpE / FROC O Y Applicant CROS$ ST. D v�V.1J` i �L x („� CONST.I�/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 6 tV V t(/ YYY COMPENSATION INSURANCE DESO RIFTION Lor NO. BLOCKis IJWA NOP (­R.1.) STATE MAJOR SE CO LOCAL NO. OF BLOGE. (This SCChOn 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 1 certify that in the performance of the work for which this`J SIZE of Lor EXISTIRG BLDG. (j o a permit is issued, I shall not employ any person in any manner OWNER cse_—wi•\ I so as to become subject to the Workers' Compensation Laws. MAIL �IIDOREES1_ ^ Q ����CCCUPANCY GROUPI' - L o Date Applicant T NOTICE TO APPLICANT: If, after making this Certificate of clTv I Cl"� �o� \I OCCUPANT LOAD z_ Exemption, you should become subject 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. ❑ � [JNo Spec. KnOWI. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION - Jr..� SGA'1—J 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 ZFfCCI. PARKING REDO PR ONTO EO SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a I licensed architect or a registered professional engineer SIZE OFNO. OF .INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BID.. STORIES ' SIGR�TURE 1neS5 and Professions Code). ^ pAn. FINAL APPROVAL PRESENT USE OF BUILDING �N 0.LiiV � -Lie.or Reg.No. - Date �P Y V. o • 50 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- 1 2.1 7=8,6 ness and Professions Code): NO. PARKING I, 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 USE OF BUILDING �—1 AIQ eR� I lrerebv affirm that there is a construction lending agency for the performance of the work for which this permit is issued(See. 3097,Civ.C.). 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 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'COMPENSATION DECLARATION 76M444 CE 975 (2-30) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to :elf 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 BUILDING — ❑ Certifiedlcopy is hereby furnished. BUILDING(�./71r I 41 /ns TCI h 6(S 6& LOCALITY RE55 S b T I/+ Certified copy is filed with the county buildinginspection - /J NEAREST ' department. LOCALITY (,,.{t cRoss sr. DatC Applicant - NEAREST xp DISTRICT NO. Gia..' TYPE PROCESSED BY CROS ST. V`OC �.R' �IO CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT rvo. aLocK msv Ic,RCLeI STATE MAJOR SECOND LOCAL a NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE ffIAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) 2 USE OF V SIZE OF LOT EXISTING BLDG. - J Q I certify .that in the performance of the work for which this 10 permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. AIL (�j r/•• L OCCUPANCY GROUP W ADORES$ I+�/ Y` Date Applicant I Z NOTICE TO APPLICANT: If, after making this Certificate of CITY CRG2/ cl Nod. 9/q�6 OCCUPANT LOAD 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 deemed revoked. ❑ _ ❑ No Spec. ices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION�H( 2 Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) rvo. of Exlrs a 9 (commencing with-Section 7000) of Division 3 of the Busi- ness p and Professions Code, and my license is in full force and APP I i cant I s Name - P^ effect. 1 Ak0f1 THA9'Wy 4ARKING ^I I Eff2REO'OPROVIDED SPACES License Number Lic. Class Home Address -///d N- :�l eelphe- .9Ye LIMITED TIME USE Contractor Date 1 (� DATEo..c. ❑ I am exempt from the licensing requirements as I am a Phone licensed architect or a registered professional engmeer SIZE OF No. of �J INSPECTOR'S acting in my professional capacity (Section 7051. Bus- EXISTING BLDG. STORIES a SIGNATURE iness and Professions Code).' A L ESE,NT USE OF BUILDING FINAL APP R O V Lic.or Reg.No. Date '•1✓a� h G /4 .HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BmI.OING 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- - nes$and PIOECSSIOnS Code): NO. PARKINGSPACES PROVIDED G ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section /� - #'e e e e 40. 7044, Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY d� /-a (i/Z 49 - I hereby affirm that there is a construction lending agency e! / 1' Q,0 g'=8 0 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 Issues NCE FEE - ordinances and State laws relating to building construction, TOTAL FEE ' and hereby authorize representatives of this County to enter up o .above- entioned roperty f r inspection purposes. SEF. REVERSE I- REXPLANATORY LANGUAGE g��J �o CJS-F 80 gnat.re of Permittee Date _ .