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Home My Public Portal About9161, 9161 1/2, 9161 3/4 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(2-80) fel I SC E L LA I v E®6 5 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 FOR APPLICANT TO FILL IN BUILDING / ❑ ADDRESS Certified copy is hereby furnished UILDING r/ � LOCALITY �p ❑ ADDRESS Certified copy is filed with the county building inspection NEAREST department. LOCALITY J j� CROSS ST Date Applicant NEAREST (1 j; DISTRICT NO GROUP TYPE PROC SSED BY CROSS ST L CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lor No BLocK NOP (CIRCLE) } ) STATE MAJOR SECOND LOCAL a (This section need not be Com leted,if the work involved NO OF BLOGS USE ZONE SPECIAL CONDITIONS Q P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) U USE OF SIZE OF LOT EXISTING BLDG (-L� O I certify that in the performance of the work for which this permJq it is Issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUPAAAIL w ADDRESS Date Applicant OCCUPANT LOAD NOTICE TO APPLICANT If, after making this Certificate of L`CITr I �L No. , 09 _ 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 INSPECTIONNo Spec. Knowl. ❑ deemed revoked. Eli LICENSED CONTRACTORS DECLARATION occuvwNcv INSPECTION Panic Devices- ,i hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT 1 (LIST ITEMS BELOW) NO. OF EXITS 19 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect REq'D PROVIDED SPACES License Number Lie Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM TO 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 iness and Professions Code) - RESENT USE OF BUILDING �: FINAL APPROVAL Lie.or Reg.No Date 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 SPACES PROVIDED I, as owner of the property, will do the work and the -4a9 A• structure is not intended or offered for sale (Section 7044, Business and Professions Code) ROPOSED USE OF BUILDING t o o'o o 818 CONSTRUCTION-LENDING AGENCY (- 0 0 0 0 0 0 0�M 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 have read this application and state that the above information correct I agree tcomply with all County ISSUANCE FEE ordinances and State laws relatinto to building construction, TOTAL FEE_;? QQ and here y-aut orize representatives of this County to enter , upon abo -menti ned Wyospectignries� SEE REVERSE FOR EXPLANATO ANGUAG Q(% ignature of Permittee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION {� I_hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION li�are, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800, Lab C) d Policy No BUILDING Company FOR APPLICANT TO FILL IN 6 ADDRESS Certified copy Is hereby furnished ILDING J TE / LOCALITY O ADDRESS Certified copy-Is filed with the county building Inspection NEAREST department OCALITY CROSS ST Date Applicant AR EST DISTRICT N GRAAU TYPE PRO SSED BY ROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP HIGHWAY _O } No (CIRCLE) STATE MAJOR SECO LOCAL a NO OF BLDGS (This section need not be completed if the work involved TRACT NOW ON LOT USE ZQJJE I SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) USE OF //� SIZE OF LOT EXISTING+BLDG 1 .� I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person in any mannerER Z �� so as to become subject to the Workers' Compensation Laws M IL OCCUPANCY GROUP W Date Applicant DDR ESS z s N NOTICE TO APPLICANT If, after making this Certificate of cirY — NOI._ OCCUPANT LOAD z _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 USEGEOLOGY INSPECTION deemed revoked ❑ ❑ No Spec. KnowL ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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 REO'D D PROVIDED O SPACES License Number Llc Class LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM To IrvsPEcroR's licensed architect or a registered professional engineer SIZE OF NO. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES S NATURE /I iness and Professions Code) ESENT use OF BUILDING — FINAL APPROVAL / _g Lic or Reg No. Date d HOME OWNER-BUILDER DECLARATION NO.�OF EXISTING BUILDINGS #4000088 ON LOT AND USE 0 0 0 O'O 0 0 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- nessand Professions Code) NO. PARKING SPACES PROVIDED 1, 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) oPosED USE of BuiLDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency d QV for the performance of the work for wJhjch 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, DO and hereby authorize representatives of this County to enter hbove-mTOTAL FEE /upo the aentione pr erty for inspection SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee D W9,12KERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I b, affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insurere,, o or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C.) Policy No Company FOR APPLICANT TO FILL IN BUILD:NG ADDRESS ❑ Certified copy is hereby furnished BUILDING LOCALITY ADDRESS r_1 Certified copy is filed with the county building inspection department LOC ALIT /P CROSS ST Date Applicant NEAREST [ DISTRICT NO GROUP YO 'N'S E 1PROVSSED1'EIY CROSS ST. C//(,/ (` `,/-,O - � CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1J COMPENSATION INSURANCE DESCRIPTION--FITNO OF BLDGS No. Q BLOCK MAP n'� .1—AY >_ NO lJ (CIRCLE) STATE MAJOR SECOND LOCAL a (TINS SOCtIOn need not be completed if the work involved TRACT NOW ON LOT / USE ZONE SPECIAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) USE OF �/rr�' U r"j C SIZE OF LOT EXISTING BL �i � 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 . IW� �, n16N� SOS so as to become subject to the Workers' Compensation Laws MAIL 1�) OCCUPANCY GROUP w ADDRESS •/ PC �[�J - M Date Applicant fn_ NOTICE TO APPLICANT If, after making_this Certificate of, CIT � 'NOL OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLI ATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION Spec. Knowl. ❑ deemed revoked O Panic No ED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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. REq'D D PROVIDED D SPACES License Number Lie Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM To 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) E QO. l /'" "��•�` �� PRESENT USE: OF BUILDING FINAL APPROVAL pi Lie.or Reg No Date HOME OWNER-BUILDER DECLARATION No O 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 SPACES PROVIDED ❑ I, as'owner of the property, will do the work and the structure is not intended or offered for sale (Section # o o o * 88 7044, Business and Professions Code) PROPOSED USE OF BUILDING • o,o o a o 0 o z CONSTRUCTION LENDING AGENCY j I hereby affirm that there is a construction lending agency Iq 2'07-8 1 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 25 . 00 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, C!% C� and hereby authorize representatives of this County to enter TOTAL FEE 25-. 00 �� . upon the e-mentioned property for inspection ur ses SEE REVERSE FOR EXPLANATORY LANGUAGE Sign7ue-rmittee as of