The URL can be used to link to this page

Home My Public Portal About9201 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 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 Insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANTTO FILL IN BUILDING / ADDRESS !G(Y ❑ Certified copy Is hereby furnished 4 OUILDING TvN Q' LOCALITY ADDRESS Certified copy Is filed with the county building inspection - NEAREST department LOCALITY �� /� �� CROSSST Date Applicant NEAREST C DISTRICT NO. ROUP TYPE 1PRO v CROSS ST N iO r / /I CONST./ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL _ OV F//C V COMPENSATION INSURANCE DESCRIPTION LOT NO. 3 BLOCK MAP MIGNWAY } NO (CIRCLE) STATE MAJOR SECOND LOCAL t1 /' NO (This SECtIOn need not be completed if the work involved TRACT �V NOWOF BLDGS ON LOT USE ZONE SPE IAL CON D�ITIONS Q by the permit is for one hundred dollars ($100) or less.) n U USE OF ('/ SIZE OF LOT EXISTING BLDG cc 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 { OWNER �D1rV14 7.b e1^1U so as to become subject to the Workers' Compensation Laws MAIL l�) OCCUPANCY GROUP �_� W ADDRESS 377 .5CMl3 y/� 0• Date Applicant Z r� TEL NOTICE TO APPLICANT If, after making this Certificate of L'-CITY /�Pn/TSJ� /l„ NO. 3 . 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 deemed revoked El NO Spec Knowl. ❑ I\ ❑LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter- SAFETY PERMIT I (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 effect. PARKING. SPACES REO'D PROVIDED License Number Lie Class LIMITED TIME USE Contractor Date DATE DATE El FROM TO I am exempt from the licensing requirements as I m 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 iness and Professions Code). a PRESENT USE OF BUILDING FINAL APPROVAL Lie or Reg No Date (V/ 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- q i �7�l,J2 A' Hess and Professions Code) SP PARKING Z 1 ] SPACES PROVIDED I, as owner of the property, will do the work and the structure Is not Intended or offered for sale (Section #`•'• • • 8 8' 7044; Business and Professions Code) v PROPOSED USE OF BUILDING , � 'O.O • • • • O,Z CONSTRUCTION LENDING AGENCY �7 I hereby affirm that there Is a construction lending agency DJC/✓49 — !Al—.0,4 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 Is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE aQ. hereby authorize representatives of this County to enter , up n the abo -mentioned rope for Inspectio purp ses SEE REVERSE FOR EXPLANATORY LANGUAGE SI ,Mature of mittee ate 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 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 ILDING 9201 Las Tunas Drive, T.C. LOCALITY N ADDRESS Certified copy is filed with the county building mspectio NEAREST IF department LOCALITY CROSS ST Date Applicant NEAREST � T( DISrRICT NO. GROUP TYPE P CES D BY CROSS ST L/yt_��i7�W�� 1J /'1 j CONST V CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Q J L�L1 t/V COMPENSATION INSURANCE DESCRIPTION LOTNOJ 7=J BLOCK IGHWAY No P` `-'v (c R LE) STATE MA SECOND LOCAL } (This section need not be completed if the work involved TRACT�yS tj NO WNO OONBLOT S USE ZONE SPE IAL CONDITIONS n by the permit is for one hundred dollars ($100) or less.) USE OF ty U SIZE OF LOT EXISTING BLDG I certify that in the performance of the work for which this Q permit is issued, I shall rot employ any person any manner OWNER h so as to become subject to the Workers' Compensation LawsMA OCCUPANCY GROUP DRESS O� LU Date Applicant a' NOTICE TO APPLICANT If, after making this Certificate of CITY NOL . OCCUPANT LOAD 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. E] E3 NO Spec. KnOW�. ❑ 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 — Koh Young DO PARKING effect REQ'D E= PROVIDED License Number Lic Class ,_ 911 S . Ki ngsely Dr LIMITED Contractor Date Los Angeles , CA 90006 ATE LIMITED TIME USE DATE I am exempt from the licensing requirements as I am a 387_4360 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) EFINAL APPROVAL SENT USE OF BUILDING Lic or Reg No Date Dai ry 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 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 2 1 9 6 3 A CONSTRUCTION LENDING AGENCY Change of ownership #'• •.• • (a I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is •'o o • e • • issued(Se C. 3097,Civ C) Lender's Name PROPOSED MAX OCC O Q02—, 80_8O Lender's Address PERMIT FEE 1 certify that I have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the labove-mentioned property for Inspection purposes SEE REVERSE FOR EXP NATORY LANGUAGE r Signature of Permittee Date i WORKERS' CUMY;✓NJA11UlV LJCI.LAKHi1ViV 20-0063DPW12/90 L_JL -1I tvl�t I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION 'rinsure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof (Set. 3800, Lab. C) - - - Policy'No- Company FOR APPLICANT TO FILL IN BUILDING UILDING ADDRESSADDRESS - ❑ Certified copy is hereby furnished g LLQ TwlGt 'Dr, mem Gt I---IY ❑ Certified copy is filed with the county building inspectio TY1 ZIP 71 department. P Te—vn ( Cry q 1+ �gV NEAREST 1 CROSS ST" Date Applicant SIZE OF LOT NO.( BLDGS.NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY coNsr CERTIFICATE OF EXEMPTION FROM WORKERS' O TRACT BLOCK LOT NO. V i COMPENSATION INSURANCE MAP - HIGHWAY No (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less.) USE ZONE SPECIAL CONDITIONS I certify that in the performance of the work for which th r{_gr ' er TEL NO. LU permit is issued. I shall not employ any person in any marine N S • Sam —2g� Q"�° so as to become subject to the Workers' Compensation Laws. ADDRESS . OCCUPANCY GROUP Date Applicant CITZIP Y NOTICE TO APPLICANT If, after making this Certificate 6-ic� i G( 9 f OCCUPANT LOAD of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code you must forthwith APPLICATION FOR EXIT HARDWARE- comply comply with such provisions OC this peimit shall be deemed TRAILER USE l, GEOLOGY INSPECTION❑ No Spec Know] ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chaprer SAFETY PERMIT❑ (LIST ITEMS BELOW) I 9(commencing with Section 7000)of Division 3 of the Busines NO OF EXITS and Professions Code, and my license is in full force and effec e o uslness 7 PARKIN License Number Lic Class //�� SPACES G' REQ'D D PROVIDED I A N n � i e- (0 �Gtrr LL�� i Contractor Date LIMITED TIME USE I ❑ I am exempt from the licensing requirements as I am a DATE DATE o licensed architect or a registered professional engineer FROM To ' acting in my professional capacity (Section 7051, Business EXISTING BLDG STORIES INSPECTOR'S SIGNATURE.R 'S and Professions Code) Lic or Reg No - Date PRESENT USE OF BUILDING FINAL APPROVAL 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 70315, Business and ' Professions Code) NO SPACES PRNG OVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044 ROPOSED USE OF BUILDING Business and Professions Code) I I pr ve 4�.r, CONSTRUCTION LENDING AGENCY 4 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) PROPOSED MAX OCC. Lender's Name PPLICANT(PAINT) TEL NO SLAK -V9 61- V Lender's Address ADD}Ess Gi I certify that I have read this application and state that the /V• �� `� above information is correct I agree to comply with all County I� PERMIT FEE i ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mento d p operty for inspection purposes. - - -- - t TOTAL FEE fD 3� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P Ittee Date