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Home My Public Portal About9071 LAS TUNAS DR_Miscellaneous__ WOIRKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS A PPL'ICAT IO N 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) Policy No CompanyFOR APPLICANT TO FILL IN BUILDING �� uu ADDRESS �{J ❑ Certified copy Is hereby furnished BUILDING 7/S LOCALITY ADDRESS71 (,j Certified copy Is filed with the county building Inspection NEAREST c �/1',` department LO ALITY JQ / CROSS ST. 6UL I AKS Date Applicant EAREST V DISTRICT NO G-WITYPE PRO SED BY CROSS ST. �I/'.� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (� \ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP xIG.WAY STATE MAJOR SECO LOCAL } - Q. NO OF BLDGS. NO (CIRCLE) (THIS section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS - Qt, LOT the permit is for one hundred dollars ($100) or less.) USE T �' M SIZE OF OT EXISTING BLDG. I certify that in the performance of the woik for which this O permit�is Issued, I shall not employ any person In any manner OWNER f' so as to become subject to the,Workers' Compensation Laws MAIL OCCUPANCY GROUPEUI LU ADDRESS u to Date Applicant • TEL OCCUPANT LOAD NOTICE TO,APPLICANT If, after making this Certificate of clr Z L� rvo "' �� Exemption, you should become subject to the Workers41JAPPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor,,Code, you must forth- with comply' with such provisions or this permit shall be TRAILER USE C GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked ❑ 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 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'D D PROVIDED D License Number LIc Class LIMITED TIME USE Contractor Date DATE DATE FROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- ;XIS G BLDG. STORIES SI ATURE mess and Professions Code) LTA PRESENT USE OF BUILDING 11 G� FINAL APPROVAL Lic.or Reg No Date V A HOME OWNER-BUILDER DECLARATION rvo OF EXISTING BUILDINGS 1 6 1 5 S ON LOT AND USE # O's 0 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) SP 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) ROPOSED USE OF BUILDING to 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 PROPOSED MAX OCC. ' Lender's Address PERMIT FEE I certify that I h e read this application and state that,the above informat >s correct.I agree to coin y with all County ISSUANCE FEE ordinances a :th.r.e tate lawding construction, TOTAL FEE and herb s •ounty to enter upo ection p�rpos SEF,-REVERSE FOR EXPLANATORY LANGUAGE g lure of Permittee Da e WORKERS'COMPENSATION DECLARATION CE 875 (11-84)4 =' CE 87M I SC E L LA N E O U S APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIV SIGN 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 BUILDINGo71 ADDRESS A Certified copy is hereby furnished. BUILDING/?O7) 5 Tuns V6 LOCALITY REBS `7 0 Certified copy is filed with the county building inspection Loc LITY i In LNO ST department le, ST. Date Applicant EAREST //�� I NO GROUP TYPE OC SED BY pp CROSS ST. Su.i+a n✓V CONST. SED, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O9 �' —� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK `D'/� 2 HIG NW AY STATE MAJOR SECOND LO (J G`5 (CIRCLE)NO. OF BLDGS.(This section need not be completed if the work involved TRACT NOW ON LOT NE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) useOF SIZE OF LOT EXISTING BLDG. � I certify that in the performance of the work for which this C!) permit is issued,I shall not employ any person in any manner O E s� so as to become subject to the Workers' Compensation Laws. /p OCCUPANCY GROUP CD Date Applicant MCD D RESS 5 - hua I�Qi t''�a(.e U TEL OCCUPANT LOAD UJ NOTICE TO APPLICANT: If, after making this Certificate of ITY Q m r No. la 3 7-22n� z Exemption, you should become subject to the Workers' b _ Compensation provisions of the Labor Code,you must forth- AVPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. 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. PARKING REq D O PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPEC ORAS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ruRE mess and Professions Code). n ^1 1 PRESENT USE OF BUILDING � �'1` FINAL APPROVAL v Lic.or Reg No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 1 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 I, as owner of the property, will do the work and the SPACES PROVIDED ;2 6,0 Q 2.A structure is not intended or offered for sale (Section # o • o • $$ 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1l o e o o • o • I hereby affirm that there is a construction lending agency >°wP�r Q�e55 r1�S 1.2-1 86 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 I 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 u on t above- entioned prope or ins ion purposes. 0 �� / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 -(2-80) MISCELLANEOUS APPLICATION {� CE 875 U I 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,br a certified copy thereof(Sec. 3800, Lab C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS l�.J ❑ Certified copy is hereby furnished. Bu1LDING LOCALITY LC OADDRESS Certified copy is filed with the county building inspectionNEAREST department LOCALITY CROSS ST Date Applicant NEAREST DIST ICT O. GR P TYPE PRO SED BY CROSS ST25i 04 1 42 /i CONST. r./ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v V - COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK_ MAP HIGHWAY } ' NO. (CIRCLE) STATE MAJOR SEC D LOCAL tl LOT NO OF S* (This SOCtIOn 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.) USE OF SIZE OF LOT EXISTING BLDG. tL I certify that in the performance of the work for which this Q 'permit is issued, I shall not employ any person in any manner OWN S I— so as to become subject to the Workers' Compensation Laws AIL OCCUPANCY GROUP i2 W ADDRESS ��V `p CL Date Applicant NOTICE TO APPLICANT If, after making this Certificate of c.Tr Nol. OCCUPANT LOAD ,7` 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 DeVICBS ❑ LICENSED CONTRACTORS DECLARATION occuPArvcv INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (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 effect SPACES REO'D PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ - FROM 1 TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG STORIES SIGNATURE mess and Professions-Code). i FINAL APPROVAL • ESENT USE OF BUILDING Lic.or,Reg No. Date R 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 ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section eslu 7044, Business and Professions Code). • / 6/ ROPOSED USE OF BUILDINGCL .,C CONSTRUCTION LENDING AGENCY — •i N 4 81.6 A I•hereby affirm that there is a construction lending-agency _ for-the performance of the work for wjiich this permit is # 88 issued(Sec. 3097,Civ C) Lender's Name PROPOSED MAX. OCC. �• O O O O{• O Z Lender's Address PERMIT FEE O L 13-!-86 Z i L I certify that I have read this application and state that the UL �vJ Cv7 VV above information Is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE �� d anj hereby authorize representatives of thi County to enter u on the ab entio ed opert f i ecti n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE J 2_ Signature o ermittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I 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 thereof(Sec. 3800,Lab C) / Policy No. Company APPLICANT TO FILL IN ABOILDING DDRESS 0 Certified copy is hereby furnished UILDIN- LOCALITY .OADDRESS Certified copy is filed with the county building Inspection i NEAREST department L ALITY / CROSS ST Date Applicant 10NEAREST /v� / DISTRI T NO G P TYPE PROC SED BY - CROSS ST Vl (�, v CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 4mm COMPENSATION INSURANCE DESCRIPTION I LOT No BLOCK p HIGHWAY No (CIRCLE STATE MAJOR SECOND LOCAL >_NO. OF BLDGS. ) d (This section need not be completed if the work involved TRACT - NOW ON L'OT USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) U - USE OF /� SIZE OF LOT EXISTING BLDG. /�; �I ' I certify that in the performance of the work for which this tip , permit is issued, I shall not employ any person in any manner WNER Q so as to become subject to the W ker Compensati awsAIL OCC"UPANCY GROUP U ADDRESS O w Dataj��7—&Applicanta TEL. NOTICE TO APPLICANT If, after making this ertificate of CITY rvo. r 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 USEGEOLOGY INSPECTION deemed revoked ❑ C] No Spec. KnOWi. ❑❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of ChapterswFETY PERMIT ❑ (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 PpeKINe. erffect REO'D O PROVIDED O SPACES ' License Number Lie Class i LIMITED TIME USE Contractor Date DATE DATE FROM" TD I am exempt from the licensing requirements as I am licensed architect or a registered professional engineer SIZE OF ND OF ma INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code) ESFINAL APPROVAL ENT USE OF BUILDING Lie or Reg.No Date HOME OWNER-BUILDER DECLARATION NO OF EXIST4NG 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 SPACES PROVIDED I, as owner of the property, will do the work and the # o'o 8,8. l I structure is not intended or offered for sale (Section 2 " 7044, Busmess and Professions Code). P OPosED USE of BUILDING io o,o olo`D'o, CONSTRUCTION LENDING AGENCY =S IO 3.2 9—8'4 I hereby affirm that there is a construction lending agency for the performanceof 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, TOTAL FEE and her by authorize representatives of this County to enter ypon e a ve-mentio ope:ty for Ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION '16M444_ CE 875(11-84) MISCELLANEOUS APPLICATION Ll ` 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 BUILDING f ADDRESS � /J Certified copy is hereby furnished BUILDING Lj� - A I LOCALITY � XX ADDRESS `v 0 Certified copy is filed with the county building inspection LOCALITY "T� rJ NEAREST department. 1 C I cRDss sr. Date Applicant NEAREST I A 1� ,1 DISTRICT NO I-2P TYPE CESSED BY CROSS 5 L `v ILAS 'y �� y CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1J COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NO OF SLOGS. (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.) USE OF SIZE OF LOT EXISTING BLDG. r I certify that in the performance of the work for which thiso permit is issued, I shall not employ any person in any manned OWNER of buildin — =' so as to become subject to the Workers' Compensation Laws MAILOCCUPANCY GROUP o ADDR E 2::] S r Date Applicant 2— �� w NOTICE TO APPLICANT If, after making this Certificate of CITY C�jnoL�6S' 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 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ ( ST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS El ness and Professions Code,and my license is in full force anX effect. Name of business 'E Z PARKING SPACES READ O PROVIDED License Number Lic. Class - LL = LIMITED TIME USE Contractor Date DATE E DATE PROM' TO: El I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF _ S S11I SIGNATURE- acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES `• t." - i.' mess and Professions Code). FIINAL APPROVAL Lic or Reg No Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS U C� f� 1 hereby affirm that 1 am exempt from the Contractor's ON LOT AND USE G' License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED �/ n structure is not intended or offered 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 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 1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, end hereby authorize repr tatives of this County to enter TOTAL FEE 25- 00 upon 1p bove-mention o erW- or inspection rpos s. I �� SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX Signature of Permittee Date I RORI:LRS'COMPENSATION DCCL\RATION CE 875 11 t 841 4 CE MISCELLANEOUS APPLICATION I` 87 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 tin a certified copy thereof(Sec. 3800, Lab C If "—J Policy No CompanyBUILD nc FOR APPLICANT TO FILL IN 5�71 ❑ � AD DR 55 Certified .ropy is hereby furnished v BUILDING 7-�.. A ADDRESS Q LOCALITY I 0 Certified copy is tiled with the county building Inspection X LOCALITY NEAREST department. C,`!: CROSS ST Date apolncint NEAREST DISTRICT NO GROUP TYPE ESSED BY CROSS ST CONST i CERTIFIC ITE OF EXEMPTION FROM 110RURS' LEGAL COMPENSATION INSl;RA1�CE DESCRIPTION LCT VO BLOCK cww wr ro (CIRCLE) STATE MAJOR SECOND LOCAL NO OF SLOGS (This section need not he completed If the Work in,,olved TRAC- NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit Is for one hundred dollirs ISI00) or less USE OF SIZE OF LOT EXISTING BLDG I erttfv that it 'fie oer!urmanLe nt 'Ile •snrK :ur 'khtc.h 'his permit is issued.ffI shall ❑ot employ dm pe--,on :n inv manner OWNER ,a�,q/� � t so as to eco eI ubhect o the tborkers Comcensation Laus g J � OCCUPANCY GROUP 'A AIL n07/ ♦ `T � i Date 3 1 1orhLant R AD / //� NOTICE rO aPPL1C�`T [f, atter maks'. ' is _auicate Iii clTr vo 1�S7—�eJgl7 OCCUPANT LOAD E%emption, you shouia become subject -o the �Vorxers A LICA TION FOR EX IT HARCbVARE Como_ensation orm isiens of the Labor Coae , ou must forth ,lith comnly pith �u.0 pro,iswns 'r 1'15 -ermit .nail be — ,� -RAILER dSE G20 LD GY INSPEC"ON _ NJO Spec KnoWl deemed :esokzd - LICENSED I O`TR.aCCORS DELL \R \ilo'. OccUPAac NSPECTION % Panic Devices I lierebv atflrm :hat I am licensed under provisions of Chaoter 9 Icommenctne '%Ith Section 7000) of Dnislon 3 of the Busi- SAFETY PERMIT �115T ITEMS BELOW) NO OF EXITS ness ana Professions Code. and ms license is :n 'till 'once and effect PARKING n �� SPACES REOD _ L• PROVIDED I I License Number L Cldss °� �— _ LIMITED TIME USE n CintraLtor Date owTE owre J I Jm e,evipt rort he 'i4.ensnn2 :eauuemenis ., 1 dia d IILznsed archileL: Jr n e21stered -imtessronal =n_tnae: ,IZE OF No of INSPECTOR s ? actin_ in 111% oruiess1Und1 .;dodL:I �eLtiUll 'I.i l3ll S- ZXIS- NG 3LOG 3TCRIES SIGNATURE mess and P:ofessiensCodei FINAL APPROVAL �.�_��, •' �4 ESE•IT 'ISE OF 3UILD1`!G Lic or Rei V., —_--- -- Ddlc __— --- ` I , HO%IC o SCR-RLLDCR DECLaR 1f10`. VO OF USE BUILDINGS �t F 009= - }fir-1 ON LOT AND SE 1 �1 `Z �'H I lierebv atfirni :hat i iin e%empt 'rnm :he ContraLtor, �r ( LLense Lassfor the ',•llo s in^_ :e.tson Se,:ion -031 -4 31[1s1- ness and Professionst odel NO PARKING 1, as o%sner of :he onspern •Itll do -lie ,ern. Ind -he SPAC25 IROVIDED structure is not intended or otte:ed or lie Se,:-,ion 7044 Business mil Proiesslons C)del p A PROPOSED USE OF BUILDING CONSTRLCTION I-LVDI\G kGEV-`i I hercbl affirm that :Isere is n Lrmstruction lending •ieency i � G��e�G S Q2•Nary- SYozQ j for the performanLe of the work for s611iL11 dus permit is issued (Sec 309-•Cn C.) µ'10µ,eJr Lender's Ndnne ` PROPOSED MAX OCC lV Lender s lddress 25.00. j I certify that l tease read this application and state that the PERMIT FE. abo%e information is correct I agree to comply n till all County ISSUANCE FEE ordinances and State Iasis relatme to buddme construction. and lierebv authorize represent atnes of this County to enter TOTAL FEE 25.00 1 upon the abuse-mentioned property lir inspeLtton purpos•s SCE RLQ FRSE FOR ECPL.aNaTORI' LANGUAGE g I