The URL can be used to link to this page

Home My Public Portal About9208, 9210, 9212, 9212 1/2 LAS TUNAS DR_Miscellaneous__ L WORKERS'COMPENSATION DECLARATION CE 876(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' rs'Compensation Insurance, e,or a certified copy thereof(Sec 3800, Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING v ADDRESS F1Certified copy is hereby furnished ABUILDING DDRESS LOCALITY Certified copy is filed with the county building inspection NEAREST department OCALITY CROSS ST Date ApplicantAREST DIST ICT NO GR TYPE R S S E D BY CROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGALAzz COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY } NO ,?jv(�,♦� (CIRCLE) STATE MAJOR SECOND LOCAL > NO OF BLDGS. (This section 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 I certify that in the performance of the work for which thisQ permit Is Issued, I shall not employ any person in any manner 4�1OWNER , U so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP III ADDRESS CL Date Applicant z TEL. NOTICE TO APPLICANT If, after making this Certificate of CITY No. OCCUPANT LOAD Exemption, you should become subject to the WorkersAPPLICATION 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 INSPECTIONEl deemed revoked ❑ ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION occuPArvcY INSPECTION Panic Devices 1 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 REQ'D ==T-R--.DE- License = PROVIDEDLicense Number Lic Class LIMITED TIME USE Contractor Date DATE DATE ❑ FROM TO I am exempt from the licensing requirements as [ 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 SoIGNATURE mess and Professions Code). I N A L APPROVAL RESENT USE OF BUILDING Lic or Reg No Date HOME OWNER-BUILDER DECLARATION OF EXISTING BUILDINGS ON LOT AND USE 7 ON 1 hereby affirm that I am exempt from the Contractor's 08 2 3 A License Law for the following reason'(Section 7031 5, Busi- ness and Professions Code) NO. PARKING SPACES PROVIDED # • • • • 88 1, as owner of the property, will do the work and the structureis not intended or offered for sale (Section • • • • • • • z 7044, Business and Professions Code) 40 OPOSED USE OF BUILDING Q 0 4"8 4 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 have read this application and state that the above information is correct I agree to comply with all County ISSUANCE FEE ordinances and St ws rel g to building construction, TOTAL FEE and hereb rite repres ryes of this County to enter zpo t ��c -mention perty for inspe Ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ittee Date i WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 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 BbI`LDING ANL7"SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab.C). Policy No Company FOR APPLICANT TO FI LL IN BUILDING ' /T ADDRESS Certified copy is hereby furnished. ADDRESS G � J /, �� LOCALITY �i / ` 0 Certified copy is filed with the county building inspection OCALITY NEAREST department. CROSS ST Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. (^ a CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �� 'f Ad {/ !� COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY NO OF BLDGS NO (CIRCLE) STATE MAJOR SECOND LOCAL (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 �.. I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG.� D_ permit is issued, I shall not employ any person in any manner OWNERy - o so as to become subject to the Workers' Compensation Laws. MAIL 4V OCCUPANCY GROUP � o �� ADDRESS Date Applicant �r LU NOTICE TO APPLICANT• If, after making this Certificate of CITY N 9fy 7133 OCCUPANT LOAD N 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 Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] 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. PARKIN GREQ' SPACES D D PROVIDED �J License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI 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 SIG TURF mess and Professions Code) FINAL APPROVAL �� z(—1,?PRESENT USE OF BUILDING / Lic.or Reg.No Date L46�� 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 � I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section /J 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSE USE OF UILDI G 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 I certify that I have read this application and state that the PERMIT FEE p-U' above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby auth rize representatives of this County to enter TOTAL FEE & upon the o`e- entionedAro arty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 7� Signature of Permittee / Date III\ WKERS'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 FOR APPLICANT TO FILL IN BUILDING ! c ADDRESS /v/'J J ❑ Certified copy is hereby furnished ABUILDING DDRESS LOCALITY /r ITT 1:1 Certified copy is filed with the county building Inspection / NEAREST department LOCALIT CROSS ST �/�•��/�/ Date Applicant NEAREST DISTRICT NO OUP TYPE PRO ED BY CROSS ST. ^ (� S�a� E CONST . CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAP 1&6 ;IGNWA; } No /C(/�J CIRCLE STATE MAJOR SE OND LOCAL a NO. OF SLOGS (This section need not be,completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one'hundred dollars ($100) or less.) USE OF 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 OWNER _ 1-- so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP 0 LU AODRESS�� 0- Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CITY N'(2-1 NO. 4L 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 USE❑ GEOLOGY INSPECTION deemed revoked ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION R1Panic Devices 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 PARKING. effect. SPACES REQ'D O 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 INS ECTO R'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES GNATURE iness and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No Date r G ,X HOME OWNER-BUILDER DECLARATION No of EXISTING BUILDINGS ON LOT AND USE ;2 3 5 9.4 A , I hereby affirm that I am exempt from the Contractor's = License Law for the following reason (Section 7031 5, Busi- # • • • • 8 8 ' ness and Professions Code) NO PARKING SPACES PROVIDED El1, as owner of the property, will do the work and the 0 0 ° 0 0 0 0 structure Is not intended or offered for sale (Section � 7044, Business and Professions Code). 1204=85 &" Ep PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY �v 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 Is correct I agree to comply with all County ISSUANCE FEE \(� ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon �=e-mentiod property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE a r' 1�7 -_,I--Z_S SI ure f Permit ee Date �WORKEJjS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I herebo' affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or�certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BADDRESS • �� DRESS FICertified copy is hereby furnished BUILDING, ( o ADDRES ( �� LOCALITY 0 Certified copy is filed with the county building in ion LOCALITY- -~ NEAREST department. I -e M –Q CJ CROSS ST. Date Applicant NEAREST DISTRICT NO I GROUP ITYPE ROCESSED BY CROSS ST YX G r,. n CONST. CERTIFICATE OF EXEMPTION FR/NCE RS' LEGAL COMPENSATION INSURDESCRIPTION Lor NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MA OR SECOND LOCAL NO OF BLDGS. This section need not be completed Iinvolved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS bythe permit Is for one hundred door less.) USE OF SIZE OF LOT EXISTING BLDG.I certify that in the performance of thehich this ✓� C�permit is issued, I shall not employ any manner OWNER U 1`so as to become subject to the Workersn Laws MAIL {_n OCCUPANCY GROUP _ o AD DRES� U E3 Date Applicant L,, NOTICE TO APVu If, after ma ing this Certificate of CIT NOL 3 OCCUPANT LOAD Exemption, you become su Iect to the Workers' APPLICATION FOR EXIT HARDWARE Compensation pof the Labo Code, you must forth- with comply wprovisions r this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSERALTO DECLARATIONOCCUPANCY INSPECTION( Panic Devices I hereby affirm tlicensed nderprovisionsofChapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing tion 700 of Division 3 of the Busi- NO OF EXITS ness and Professie, and license is in full force andY 1 Qom„ `n ��effect. e-OF S PARKINGLicense NumberLic. Class A G ✓,5 iJ� SPACESREq'D PROVIDED LI TED TIME USE ContractorDate DATE DATE FROM: TO I am exempt from the lcensing requirements as I am a licensed architect or registered professional engineer SIZE OF NO m . OF INSPECTOR S +, acting in my professi nal capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions de) PRESENT USE OF BUILDING1C FINAL APPROVAL 0 // Lic or Reg No. Date HOME/RUC1TI0( UILDER DECLARATION NO OF EXISTING BUILDINGS MCI ON LOT AND USE figI FEE I hereby affirmm exempt from the Contractor's License Law fowing reason (Section 7031 5, Busi- ness and Profess ) NO. PARKING r SPACES PROVIDED 0 Fl,)ll�t I, as owneroperty, will do the work and the structure iended or offered for sale (Section 531,4 1 AN i i'. 7044,Busiofessions Code). CONON LENDING AGENCY PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency 7 C for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. G1 Lender's Name PROPOSED MAX. OCC. yU, Lender's Address (� PERMIT FEE 5` 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, and hereby authorize representatives of this County to enter TOTAL FEE �— upon the above-mentioned property f r in pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si ature of Permittee ate