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Home My Public Portal About9112-9114 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION ; 'CE 876(2-80) M I S C:E L LA N E O U S`.'A.P P L''1 C A T I O N I hereby affirm that'I have a certificate of consent to self 'insure, or a certificate of workers'' ' Compensation Insurance,or COUNTY'OF LOS ANGELES BUILDING AND SAFFTY'D.IVISION a certlfied'copy thereof(Sec.3860"Lab C.)'. Policy No Company: FOR APPLICANT TO FILL IN. BUILDING ADDRESS El • LOCALITY Certlfied,co y is hereby,furnlshe 01 2' : S' '...T nN r I ADDRESS Certified copy is filed with the county building inspection-- NEAREST 00, LOCALITY _ CROSS ST. 'department.. TEM f' L E G 'Date Applicant EARES T' I �,� - - DISTRICO GROUP - TY'PE PRO C SSED BY. CROSS ST. (� _ NS CERTIFICATE OF EXEMPTION FROM WORKERS' DescRlPn � ��/ CO T LEGAL' �'� - COMPENSATION;INSURANCE B�o NOP (CIRCLE) ON LOT NO. CK - I } - - .STATE MAJOR SECOND LOCAL CL NO. 6F BLOGS. ` (This section'need riot-be completed if the,mork involved TRACT ,- NOW:ON LOT USE ZONE SPECIAL CONDITIONS by the permif' is for',one�hundred''dollars ($100). or less.)• - USE OF - Q _ SIZE OF LOT EXISTING BLDG. - - -' I certify that'In'the'performance of the work for which this -0 permit is issued, I shall not.employ any person in any manner wNER 1;`L S(� Ems/£ G� 0 • so as to'beconie subject.to the Workers' Compensation Laws..'. OCCUPANCY GROUP �' �,: AIL .. ADDRESS. Date Applicant TEL. ` NOTICE TO.APPLICANT: If, after-making.'this'Certificate of irY i�dN �q G� NO. ��? �y 2' 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 rovislons or this`permit shall .be INSPECTION 0 NO Spec. Knowl.: deemed revoked. . P.Y P P TRAILER U OCCUPANCY INSPECj10N GEOLOGY INSPE panic DeViCes ❑ -LICENSED'CONTRACTORS'DECLARATION hereby affirm that I am licensed under provisions of Cbapter- SAFETY PERMIT [ (Liss ITEMS BELow) ` F (commencing`.witWSe'ction 7000),of Division 3 of the Busi- ness and Professions Code, and my.license'is in,.full force and PARIciNG: ..effect. -'. + - SPACES ROVIDED .. License,Number -Lic.Class LIMITED TIME USE Contractor - Date DATE DATe ..�,. TO: .. I am exempt from the licensing,requirements as.i am a'. INSPECTOR'S licensed architect'bi a registered professional”engineer. SIZE OF - _ � NO. OE - acting In my professional.,capacity '(Section 7051, BUS- EXISTING BLDG.. STORIES SIGNATURE iness and-Professions Code). E FINAL APPROVAL R ESENT.USE OF BUILDING Plt Lic.or,Reg:No. •Date HOME OWNER-BUILDER DEC LARATIONNo'.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,l'r'ofessions Code): No. PARKING SPACES.PROVIDED, [:).'s' as owner of the property, will do the work and the =' z 9`4 q,0 A' ".structure''is not" intended,or offered,for.sale (Section ' -7044, Business•arid Professions Code). , • - ROPOSED USE OF BUILDING• a X88 o' s a Plcn CONSTRUCTION LENDING AGENCY' a e o e't I hereby ,affirm .that:there is a construction lending agency for the performance of-the work for which ;this permit is ; 0-2-0 1 8.3' issued-(Seci3097,Civ.C.). ' "Lender's Name.' PROPosED M nx.'occ. " Lender's"Address ,. PERMIT FEE _ I certify that 1 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 relatingto.building Construction, TOTAL FEE �j O and hereby authori rep"resenfatides df this County.to'enter. Oe+ upon'the above- boned property',for inspection:purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ofPermittee- bate WORKERS' COMPENSATION DECLARATION 00II6.; MISCELLANEOUS APPLICATION 20-OI2/90 I_hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION II 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 / BUILDING ADDRESS ./ �`- "'� ADDRESS cif El Certified copy is hereby furnished. ��m` /�`* 7t5 ,7,--- LOCALITY ❑ Certified copy is filed with the county building inspection' CITY ZIP /7 department. %C�-u l&- e ! �i 50 NEAREST CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DIS TR �P TYPE CESSED BY / CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. COMPENSATION INSURANCE MAP HIGHWAY NO. ICIR0.E1 STATE MAJOR SECOND LOCAL (This section need not be completed'if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (x'100) or less.) certify that in the performance of the work for which this OWNER TEL NO. { permit is issued, I shall not employ any person in any manner rz 2 Y �/7/LE' . es2 ems' 411 Bleg ' so as to become subject to the Workers' Compensation Laws. ADDRE S >> // OCCUPANCY GROUP r Date Applicant CITY zip !l Z� NOTICE TO APPLICANT: If, after making this Certificate l< <� C G OCCUPANT LOAD ' .f Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ ILIST 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. PARKING• REQ'D D PROVIDED D License Number Lic. Class _ LJ SPACES Contractor _ — Date ____ �J LIMITED TIME USE DATE DATE ❑ I am exempt from the licensing regUil-CulCutS its I am a - FROM: TO: licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Business SIZE OF NO.OF INSP CTOR'S and PTOfe$SIOnS Code). EXISTING BLDG. STORIES ATURE Lic. or Reg. No. D;ue PRESENT USE OF BUILDING FINAL APPROVAL Z .... .. . ' Ucd HOME OWNER-BUILDER DECLARATION Nb.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I and exempt from the Contractor's License Law for the following reason (Section 7031.5. Business and Professions Code): NO.PARKING . El [, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section_ 7.044,X PROPOSED USE OF BUILDING Business and Professions Code).. CONSTRUCTION LENDING AGENCY i 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued OCC. (Sec. 3097, Civ.C.). PROPOSED MAX. __ .. Lender's Name APPLICANT(PAINT) TEL NO. ISI INTI Lender's Address ADDRESS I certify that I have read this application and state that the. 1.-;: :71 above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and I••= '' 'I hereby authorize representatives of this County to enter upon ISSUANCE FEE ptl�t the above-mentioned property for inspection purposes. ` i :.I TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE ;"' Signature of Permittee Date ; i WORKERS t�i,.IPLNSAfION DECLARATION .1 UM1.1a I her affirm that I have it certi�-i(ialc ur consent Sent Ii, Selz � cOUN�� MISCELLANEOUS, BAPPLICATION " =; Y DIVISION insure,or a certil'icate of Workers'Compensation histit, e, it certified copy thereof (Sec.3800. Lah.C.):_ d Policy No Company _FOR APPLICANT TO FILL IN BUILDING - .BUILDING ADDRESSf -ADDREss ,Q 7Z_MA CL El C'er[if Ted copy Is Hereby fol Wished'. ��Z L�.� 7)/ 4 LOCALITY Certified copy is.l'iled with the county building Inspection CIS zip . -- department. Cif,l NEAREST: /,SAS/ ,/1lC _. ,_ - CROSS ST: G.f�,�/H /tYl� - DISTRICT- - . GROUP Applicant _ SIZE OF LOT - NO.OF BLDGS.NOW ON - Ivo.- TYPE PROCESSED BYCONST. CERIIFIC'AIE.OF EXEMPTION FROM WORKERS C.,TRACT BLOCK LOT NO. COMPENSATION INSURANCE - - MAP HIGHWAY 1. NO. ICIRCLEI STATE MAJOR SECOND LOCAL (This section'need not be eompleled if the work.invol%cd ASSESSOR MAP BDOK PAGE. PARCEL 115E ZONE SPECIAL•CONDITIONS r" by the.permil is fur. one hundred dollars (S IOO) or less.) •:- I OWNER TEL NO. iler certify that in the performance of-the Work Ior 1+1 i-h (his sorasl tosbecome lsubjectshall lto tl eot plWorkeoy rs' Compcn,pelsoll lluolal'hilws , OCCUPANCY GROUP- t I ADDRESS_ 90, 2. i Date. - Applicant ury -'. ZIP NOTICE TO APPLICANT. If,ilftel m:ik'niE this CL •ific.lte LE L:{T' ko OCCUPANT LOAD of'. Exemption, you "should become subject to the'Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must fo,thwith EXIT HARDWARE: 1 comply With-such provisions or.-this permit Shall he 0eerned TRAILER USE❑ GEOLOGY INSPECTION❑ NO SpeC.:ICnOW1. El revoked. �1 ' I OCCUPANCY INSP-ECTIONXJ Panic Devices LICENSED CONTRACTORS DEC'1_ARAFION ❑ 1 hereby,affirm that I'am licensed Under pl0 ISIOIIS elf t hapler SAFETY PERMIT❑ (LIST ITEMS.BELOWI 1 - 9(comrrlencing with Section 7000)of Division 3 of the Business of Exlr a and Processions Code,and my license is ih Full Puree alai effect. NO S cif' .�t.lSlFi PARKING• . - SPACES. ' -REO'D D . PROVIDED D License Number LIc. Class 11�hN6 ,4UtOMOQ�LE ` '� - - - ----�- "--- --- - =-_--, LIMITED TIME USE t Contractor Date - ,, DATE -DATE . ( ❑. 1 am exempt from• the'licensing`reyun'enients as.1 ain :1 FROM: TO: _-:j• i,.. licensed architect or a registe're'd profession 11 �'ngine'er Qionill capacity(section 71 IslllessSIZE OF _ - - INSPECTOR'S acting in my pR)IeSSEXIS rlNG BLDG. rOR1ES SIGNATURE -f and Professions Code).- — --- Lic.,or Reg. No. Date PRESENT USE OF BUILDING FINAL'APPROVAL , a � r _ � f10ME OWNER-BUILDER 'DI'A LARAIION No__OF;E ISrING_BUILDINGS ON LOT AND USE I hereby affirm tliat.1 ani exempt Boni-the Contractor :icelise - — — - Law for the f�illiiwing reitson (Sectium;7031.5. Business,arid' 'P(OfeS51015 (_Ode): NO.PARKING.- ... -.. SPACES PROVIDED ❑ I. as owner of lhC property will,do lhe. ,clerk and the — =- - structure Is not IlliCllde'd 0r,1111e I*k!d.f01 sille (Seeil;111 04-i. PROPOSED USE OF BUILDING - ? Business"and Pro1(,:ssi6hs'Codc), I I CONSTROi'IION.L'ENDING AG � 05 i' I hereby affirni that thcl"e is it consu'ICH011 lendinp lLcncy for the performance of the work"for which 'this pen'lllt Is issued — �i" (Sec. 3097, Civ. L.). - - PROPOSEDWAX..OCC. - - Lenders Name _ ----. _ .. ... _ _ _�• APPLICANT(PRINT) - _ TEL NO. MiAl - Lender's Address `._..' ., - ADDRESS h - .. lI I' I i'cer[ify that I have read (his application and shite that the a4 ��5 �u 'e �` '-Ordinances Is.correct. I:.agree to Comply With all County 'PERMIT FEE. ordinances and,State laws relating to building cunstrucriun,:and ' lI - j hereby authorize representatives of this County to inter upon ISSUANCE FEE l the above-mentioned property for inspection pilrpou',. TOTAL FEE ' x % 1,fi SEE REVERSE FOR EXPLANATORY LANGUAGE L'0 Y �• m Sioffnature of Permita Vale