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Home My Public Portal About9108 LAS TUNAS DR_Miscellaneous__ I WORKERS' CUMYhNaA11UlV 1JCIyLHtCH11V1V 20-0063DPWt2/90 !KI-1 =VtJ.`7 f-1rr LL_A .:t-'►It .it - i I hereby affirm that I have..a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION { "insure,or a certifieateof.Wor'kers' Compensation Insurance, or a certified copy thereof (Seo; 3800, Lab. C.) I Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING.ADDRESS aDDREss ❑ Certifiea. d copy.is.hereby furnished. g p LA k LOCALITY ❑ Certified copy is filed with the county building inspection CITYZIP department. `r�M �) C^ f7 ko NEAREST. i T 1 CROSS ST. Date Applicant SIZE OF LOTI NO.OF BLDGS.NOW ON LOT DISTRICT NO. I GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' 4- 6 CONST. 0 TRACT BLOCK LOTN I COMPENSATION INSURANCE O. O � MAP - �rllcHwnY S Z O NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not.be completed if the work involved ASSESSOR WAP BOOK PAGE PA CELI= USE ZONE SPECIAL CONDITIONS 0 I by the permit is for one hundred dollars ($'.100) or less.) 5�g p Z. D r art. er L ceitify that in the performarice.of the work for which this TEL NO. permit is issued:I shall not employ any person in any manner LAM C o l 6 s — Lg491 so as to become subject to the Workers' Compensation Laws. ADDRESS 'Q s- RoAWy TE Rp OCCUPANCY GROUP Z S Date 1oZAppticant . -iHJ - A4 r5A CITY ZIP l NOTICE TO APPLICANT: If; after making this Certificate SbfJ G C 0, l OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the.Labor Code,you must forthwith EXIT HARDWARE: comply with such provisions or,this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) i 9(commencing with Section 7000)of Division 3 of the Business - NO.OF EXITS and Professions Code,and my license is in.full force and effect. :. 3me O uslness PARKING• D License Number Lic. Class 1 WAN G A L � o I )QC SPACES REO'D PROVIDED ) I I Contractor Date LIMITED TIME USE I P - Q FROM: DATE - TO: DATE ❑ I am exempt from the licensing requirements as I am a licensed.architect or a registered professional engineer acting in my professional capacity(Section 7051,Business SIZE OF NO.OF INSPECTOR'S I EXISTING BLDG. I STORIES .SIGNATURE. and Professions Code). - ( LiG Or.Reg. No. '- Date PRESENT USE.OF BUILDING yv l L L 1`4 o V e O Lt p tJ FINAL APPROVAL ? Li o3 R. �r71 Nc ZHo � � �r o . HOME OWNER-BUILDER DECLARATION NO.OF EXIs NG 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, Business and ' I PIofessions Code): NO.PARKING b .SPACES PROVIDED O ' i ❑ I, as owner.of the property, will do the work and'the i L structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING rJ r -I:-� C L— Business and'Professions Code). I CONSTRUCTION LENDING AGENCY . h hereby affirm That there is a construction lending agency for. the performance of the work for which this permit is issued . I (Sec. 3097,Civ. C.).. PROPOSED MAX.OCC. "Lender's Name APPLICANT(Pfj/NT TEL NO. HAo N TC A Lender's Address I.ADDRESS j I certify that I have read this application and state that the SO zA�v �D' S � 4^15KIEL C 5 1 '7 J above information is correct. I agree to comply with all County PERMIT FEE , ordinances and State laws relating to building construction,and " '. I hereby authorize representatives.of,this County to enter upon ISSUANCE FEE the above-mentioned property for inspect,ionpurposes. TOTAL FEE - �Z SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1Vt7RKERS'CO(•1PLNSATIONllECLARATION CE 875 I (11-84) M_�,crELLANEO.US APPLICATION- -' - CE 875 ='I hereby affirm -that.l have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,_or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy,No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy, is hereby furnished. BUILDIrvc — cw.LITY XX ADDRESS ,FJ Certified copy is filed:with the county building inspection LOCALITY NEAREST departmcy, ent. 3 , CROSS ST. ' Date. _Apphca lit - NEAREST /I _ DISTRIC�OQROUP ., .TYPE OCESSED By - - CROSS.ST. ..�O ,-AVsL "- ��''// (��+ CONST.//,, ' CERTIFICATE Or EXEMPTION.FROM WORKERS' LEGwL COMPENSATION INSURANCE' Des E: ALI0N LOT NO. �� BLOCK MAP NwNw Ar NO. (CIRCLE) STATE MAJOR SECOND LOCAL _ - NO. OF`BLDGS, _ (This section need not-be completed if the work. involved TRACT 4 blD_ NOW ON,LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($1.00) or less.) USE OF - SIZE OF LOT , EXISTING BLDG. ,.�..� r 1 certify that in the performance=of the mork for.which this O_ perniit is,issiied, 1 shall not employ any.person in any ma`nneKX OWNER of -buildin So as.lo become subject to the\YorkeQ( ) ensation Laws. MAIL OCCUPANCY-GROUP C, --LI I'/ ADDRESS � S, UL Date 1!L Applicant L� bard A TEL OCCUPANT LOAD NOTICE I-O APPLICANT: If, :rel Ala ing Itis .ertificate of circ � � No. �$ �l — ( L� v_ EXemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: C'ompensation'provisions of the Labor Code, you must forth- with coml lv with such--provisions or'-this permit shall be TRAILER USE � � 'G.EO GEOLOGY INSPECTION ❑ deemed revoked. ❑' ❑ No Spec. Knowl. OCCUPANCY INSPECTION p - Panic Devices LIC:[:NSED CONTRACTORSDECLARATION - hereby affirm that I ant licensed under<provisionsof Chapter I SAF ETY.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 an X tt effect. Narnta' Ol business— - PARKING REO'D PROVIDED SPACES. License Number Lic. Class_ E I LIMITED TIME USE Contractor—._ Date _ DATE_ DATE . FROM: FJ 1 nm exempt front the licensing requirements as 1 am a licensed, architect or a registered professional engineer SIZE OF- NO.OFNSPE CTO R'S g p 8 FIE W� acting in my professional capacity (Section 7051, Bus- EXISTING BLDG.- Jl- STORIES SIG TORE .. _ -: iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg. No.__ _ Date f +' till,": HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS a ON LOT AND USE I 1 hereby affirm that I am exempt from the Contractor's License Law for the follpwing,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 7044,Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDINGAGENCY I'hereby affirin 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 1 certify that 1 li;ive 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 25 .00 upon the 11) ve--4,v oned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Xx_ _ XX lxx (�7 n;11'r IniIIvf, Ilatc