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HomeMy Public PortalAbout9050 LAS TUNAS DR_Miscellaneous__ WORKERS',COMPENSATION DECLARATION CE 875(11-84) M I SQ E L LA N EO U S APPLICATION CE 875 I hereby,aflthat I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msure, or a certficate of Workers'Compensation Insurance, e,or a cert ificeri ed copy thereof(Sec. 3800,Lab.C.). 'fl Policy No Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS i Certified copy is hereby furnished. BUILDING O L �,c G DDRESS J LOCALITY Certified copy is filed with the county building inspection LOCALIT� �� C 1 NEAREST department. CROSS ST. Date Applicant NEAREST DISTRIC NO. GROUP TYPE PR ESSED BY CROSS ST. u LlIkft- _� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. R BLDGS. NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) US e OF SIZE OF LOT EXISTING BLDG. >0-- 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 Q.0 $W��i ( Axon y so as to become subject to.the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a 0 Date Applicant DOR ESS I— U pp TEL' OCCUPANT LOAD CL_ NOTICE TO APPLICANT If, after making this Certificate of CITY No. C/, Exemption, you should become subject to the Workers' ? Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE with comply with such provisions oI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. of EXITS ness,and Professions Code, and my license is in full force and effect manw a tksi Q$S: PARKING SPACES REQ•D O PROVIDED D License Number Lic Class L'—�e!" G° 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 PROM: TO INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code). FINAL APPROVAL _1� /�*� PR SENT USE OF BUILDING `) Lic or Reg.No. Date HOME OWNER-BUILDER DECLARATION N OF EXISTING ®�B �� . ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busr 1,;11313-1]0!01 7{y1;_ ness and Professions Code): NO PARKING F1 -F1I, as owner of the property, will do the work and the SPACES PROVIDED , \ '574 1 PM 4:4om structure is not intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING � G S 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.Q. 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 cro Yi�e aboove-me ti ned roperty for inspection purposes. 11n` ���/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date \oR1:cRs c-oMrcNS\TION DELL\KaC10` CE 875 t� aa1 M ISCELLANEOiIS APPLICATION n - ass � I hereby affirm that I have a certificate of cor3ent to Self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure. or a certificate of \\orkers Compensation Insurance or a certified copy thereof +Sec 3801) Lab C I I �I Pollct No _C omn.tn% - PP I T FI BUILDING ❑ ADDRESS Lam/ Certified copy is hereb} turnisheaBUILDING I ADDRESS V Q �r ALO CA LITY I ❑ Certified copy IS filed\\Ith the Lount\ building impectio i LOCALITY ! NEAREST department Temple City CROSS ST Date APrhicant _ NEARESTDI`T T N GRO TYPE GESSED BY CROSS 5T �� CONST I CERTIEiC ATE Of CSENIPTfON FROM '\OR1:ER5 LEGAL r v , t OWENS\TinN 1NSL R\Nt IE DESCRI1T'O1-,I LOT NO BLOCK A (cCRCLEI STATE MAJOR SECOND LOCAL NO OF BLDGS uo (Tills section need not he comeieted if the l%Urk Involve,] 'RAC' NOW ON LOT USE ?ONE SPECIAL CONDITIONS by the permit Is for one hundred dollars iS1001 or less 1 i USE OF SIZE OF LOT I EXISTING BLDG ' I certtfv that in file perrorman,e of -]:e \ort. `0- \bich -111Spermit Is issued. I ,hall not emplm am n am manner OWNER0— �— so as to hecome subiect to the \\orker,z I-oinvensauor !.a«, XI �If rgln.eGL MAIL I� �NGt��L,. n- _ I OCCUP4NC" CROUP II _ ADDRESS zip- ANA- - Date \pnccant _ r,, - r NOTICE TO ,kPPLI(-\NT If .0*e, m.,kinc -lis (-----21L Ile r $]CIT-- �e r L vO` ��((�l�Cty3 �- j OCCUPe.N-LOAD E\emptlo t \ou 'honld become ,uoiect -o •Iia \\n*her I. lompenshton em•tsrons of the Labia- .sue \ou Inuu rorth_ AP-LICA C�F =\(I- aFZr_", \-E 1 \\Itis comm «Ith uI.h ^rc,Ni awn, ,- hr. •erfiir ;hall I,_ n -A AILEA JSE GEOLOGY NFPECT'CN ,_ No Soec �;1C-11 �J deemed :e\o ed. J P3nic Dewces ❑ LKENSEDCONZR\CTORSDECL-\RaTIO\ OCCUPANCY INSPEC-IOvgS hereb} affirm :hat 1 am hcen_sed under nrcvmons of Chacter - — ., I 9 (commenLIn£ kiith Section 000) of Dnlslon 3 ,it the BuF.- SAFETY P RMIT `. (LIST ITEMS BELOW) NO OF EXITS ness and P-otessionS Code and m\ licence is in 'fill torte and effect PARKING y SPACES REO'D I I �R O`J ID ED i Licen,e Numher _ L,c C!a„ LIMITED TIME USE H Contractor----- Date----- GATE DA-E w Z ❑ �o To � I am exempt from the licensing reauuements Is t am t _ licensed architect or a registered r" ,w rniesslonaI enizinetr ;IZE OF ao OF NSPECTO R'S Z actin" m nL protc,ston.d ari- �e:,rot I\51 hill`- EXISTING BLDG S'OAI=S S1,qj4ATURE 9 iness..na P-ote,sicn,1,odzl — - - U ,"RESENT USE OF BUILDING .FINAL APPROVAL HOME O\\NI R-RLILDER DECLAR\TIONNO OF EXISTING BUILDINGS t ON LOT AND USE I hereb} affuni that I ant exempt from the Contractor s i License La\\ for the follo%%nig reason ISelnun -'i31 Bu,,- ne❑ss and ok%n r of the NO. PARKING i SPA CES PROVIDED 1, as , Ater of the property «ill do the work and tie I structure w not intended or offered for Ile ISeLiar,- ; 7044 Itu,ine„and Protessions(ode) t CONSTRLCTION LENDING AGENCI y PROPOSED USE OF BUILDING 1 hereb_\ affirm that there is a constriction bending ,Lecncv ' l for the performance of the %ork for \\bich this permit s issued (Sec 3097•Civ C 1 Lender 3 Ndnie _ PROPOSED MAX OCC Lender's Address _ ( cerntt that I have reed this apphLSuon and state that t:e PERMIT FEE 25.00 above Information IS Lorrecl I agree to Loinply \%illi all(olintty ISSUANCE FEE ordinances and State la\\, relaune ti; building constrU0101. and herebv authorize representatities of this County to enter TOTAL FEE 25.00 upon the,ibo%c-me tioned property for inspection purpose, SEL REVERSE FOR EXPLANATORY LANGU \GE — Signature I ' t tee Date I WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 : hereby affirm that 1 havea certificate of.coto self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insuralns'u nce,or • a certified copy thereof(Sec.3800,Lab.,CJ s .:' , tr r _ , ALJ Policy•No. Company FOR APPLICANT TO FILL IN Bv1iDINa. �j . Py y furnished: ;• sIJILDINGN ' p Certified.co is hereb c, w1ioRE>o 5 i.-0$-n11Jr�Cn 1ZJn 12 C\ I I F� Certified copy is filed withthe county building inspections, ^LOCAUITIC:. , z NaAREST. department. cwoa$sT: Date Applicant atwREST' alsrle tg NoJ ?up TYPB � P'CESSCD BY CROSS'ST " Gjj �L'j CONST. I CERTIFICATE OF EXEMPTION FROM WORKERS' L66AL: / ! COMPENSATION INSURANCE DESCRIPTIONLOT No. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. Of(This section need not be completed If the work Involved TRACT NOW ONBLOT LD0$ U86 ZONE SPACIAL CONDITIONS i by the permit is for one hundred dollars ($100) or less.) USK of I SIZE OF, LOT EXISTING BLDG. a 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 O's j 1.\" so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP DDR['ss55 5 �\Ca��� t� CC �p�VY1©ZT� F Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of TEL' '� Clrr �\m 5�2c� Na. �(plq) °^\\3OCCUPANT LOAD c� c 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. ❑ Panic Devices I ' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter sAF¢ry.PERMIT ❑ (LIST ITEMS BELOW) ! 9 (commencing with Section 7000) of Division 3 of the Busi- NO, of EXITS i ness and Professions Code,and my license is in full force and Qty effect. PARKING R6q'D PROViD 6D SPACES ! License Number Lic. Class ) Ce LIMITED TIME USE Contractor Date " DATE DATE s.. PHOM: To: ❑ I am exempt from the licensing requirements as I am a E licensed architect or a registered professional. engineer SIZE OF NO.OF INSPecroi:'s ? 6 g y p capacity (Section 7051, Bus- EXISTING BLDG. STORIES 8 6NATURE actin in m professional ca aci inessand Professions Code). s. FINAL APPROVAL Date PRESENT,USI —q LIC.Or Reg.NO. E OP BUILDING I HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I II hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ?a':.i(ll.'"(.'i.+l_!.' " ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED ":•j'LI structure is not intended or offered for sale (Section ! 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY LPROPOSSD USE OF BUILDING I hereby affirm that there is a construction lending agency cly, ! 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 - CO 1 certify that I 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, and hereby authorize representatives of this County to enter TOTAL FEE Qa ! upon the above-mentioned property for inspection purposes. • :'� �_--�� SEE REVERSE FOR EXPLANATORY LANGUAGE Sion of PerIII it t cc &S��� }`( 7 9 � I �