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Home My Public Portal About9674 LAS TUNAS DR_Miscellaneous__ WORKERS'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 ADDRESS E] G Certified copy is hereby furnished. BUILDING —� / LOCALITY ADDRESS � � �• /CQ � � y S ❑ Certified copy is filed with the county building inspection NEAREST department. LecALITv /E �� cRoss sT. L{� Date Applicant NEAREST / DISTRICT NO. ROUPY PROCESSED BY CROSS ST. (�� A� I�r/f(Y C ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VQ COMPENSATION INSURANCE DESCRIPTION I LOT NO. 3 BLOCK MAP HIGHWAY } rvo. —,,Y'7( (CIRCLE) STATE MAJOR SECOND LOCAL d NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ONE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE OF //� /J 0 SIZE OF LOT �" �� (� EXISTING BLDGGAA,,/e V�1 X I certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner OWNER t ��, U so as to become subject to the Workers' Compensation Laws. MAIL _ OCCUPANCY GROUP /2r W ADDRESS 7 C �J T V/ �-/ 0. Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY ,� �� NOI OCCUPANT LOAD Z Exemption, you should become subject to the WorkersAPPLI 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❑ GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONig I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT L--1 (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 E= PROVIDED 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- E ISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING Lic.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 5 0 9, 1 A License Law for the following 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 0.0 40 structure is not intended or offered for sale (Section 0,0 0 0 0 0 0 7044, Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 0504-81 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.). O Q 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 •nd ereb authorize representatives of thi , ounty to enter u n t above eMioned pr t fo i lection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE r S' nature o Permitte a e :3/�� WORKERS'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 ❑ ADDRESS Certified copy is hereby furnished. BUILDING 1 �+ LOCALITY ADDRESS V J IDCertifiedcopy is filed with the county building inspection NEAREST department. 4LOCALITY L L (�� S CROSS ST. Date Applicant RAREST /r , f DISTRICT NO. GR P T PROCESSED BY CROSS ST. 1J-,Fv F FIN ON /511 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL f✓ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY } No. (CIRCLE) STMAJOR SECOND LOCAL ATE a (This section need not be completed if the work involved NO. OF BLDGS. P TRACT NOW ON LOT USE ZONE 71AL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) USE OF U SIZE OF LOT EXISTING BLDG. M 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 D• �Q OL's I— so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP E��A W Date Applicant ADDRESS Po G� � N �T— T E L. z NOTICE TO APPLICANT: If, after making this Certificate of Tv V �'m�L� C_/( NO. S- �' 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 E] GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS a 9 4,commencing with Section 7000) of Division 3 of the Busi- nctss and Professions Code, and my license is in full force and PARKING efjfect. SPACES REO'D O PROVIDED 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL ESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON 0 Z 4 A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's # • • • • 40 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING • • • • • • • (p SPACES PROVIDED +, ❑ 1, as owner of the property, will do the work and the / 9—8 2 structure is not intended or offered for sale (Section 7044, Business and Professions Code). f-41oPosED USE of BUILDING CONSTRUCTION LENDING AGENCY p c U l 1 I hereby affirm that there is a construction lending agency V for the performance of the work for which this permit is issued (Sec. 3097,Civ.t..). 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 /�-? 1 �� the above-menti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY GUAGE Sign ure Permit >! �l Date WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C AT I O N 9 1 hereby affirm that I have certificate of consent to self CE 875 (2-80)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, 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 BUILDING ADDRESS ❑ Certified copy is hereby furnished. ILDING 7 s LOCALITY ESS Certified copy is filed with the county building inspection El Certified NEAREST department. LOCALITY CROSS ST. Uate Applicant NEAREST DISTRI T NO. GR UP TYPE PRO SED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL0 42 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY (CIRCLE) STATE MAJOR SECOND LOCAL '• (This section need not be completed if the work involved NO. CO BLDGS. USE ZONE SPECIAL CONDITIONS tZ P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) pr less.) Q USE OF SIZE OF LOT EXISTING BLDG. cc certify that in the performance of the work for which this O permit is issued, I shall not employ any person in any manner1, TEIN3 NER so as to become subject to the Workers' Compensation Laws. IL � �� OCCUPANCY GROUP I I 0 Date Applicant DRESS Y E(�E 1 / ..Y� III fff��J V 0. NOTICE TO APPLICANT: If, after making this Certificate of zgf-116.1$3 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 provisionsor this permit shall be TRAILER USE GEOLOGY 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. &ffeCt. SPACES REO'D E= PROVIDED License Number Lie.Class LIMITED TIME USE Contractor Date ATE DATE ❑ To: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus- E [STING BLDG. STORIES SIGNATURE iness and Professions Code). XqES..T usE of BUILDING FINAL APPROVAL Lie.or Reg.No. Date Y T --—-- / HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LO7' AND USE I hereby affirm that, I am exempt from the Contractor's '33 7 5 A License Law for the following reason (Section 7031.5, Bus;- #'.• • • • 8 8 ness and Professions Code): NO. PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the • • • • • • • z structure is not intended or offered for sale (Section 7044, Business and Professions Code). -POSED USE OF BUILDING 07. 05783 CONSTRUCTION LENDING AGENCY agency _ r,/V ,/��+ f_ Al` I herebyaffirm that there is a construction lendinga enc /� 1/ /� �-� for the performanceof 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 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 relating to building construction, TOTAL FEE and lWfey authoriz r ese tatives of this County to enter o above• on d erty or insp��2, 205 ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature r ttee Da de ,I WORKERS'COMPENSATION DECLARATION C 8754(2 80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or i certified copy thereof(Sec.3800,Lab.C.) Policy No. Company I FOR APPLICANT TO FILL IN BUILDING !f7 / e2� �u PDD REBS (P / n.iT Certified copy is hereby furnished. ILDING 'w /t� DDRESS V �AS V aEJ14PL.EG, LOCALITY ��LE Certified copy is filed with the county building inspection NEAREST department. OCALITY �� 19 B / r CROSS ST. F'y A-AJ Date Applicant AREST �"�—�' DISTRICT NO. G§§��OUP TYPE PRO ED BY CROSS ST. 5�0f[-)- CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' , LEGAL U COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAF /�/1 ��/j //)) HIGHWAY } Ho: pI�V IJ (CIRCLE) STATE MAJOR ECO LOCAL CL 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 (5100) or less.) U USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this !!! O permit is issued, I shall not employ any person in any manner I NER OIaLIigM A tkq so as to become subject to the Workers' Compensation Laws. IL OCCUPANCY GROUP _ V W •!►DDRESS Date Applicant I �� - W TEL. NOTICE TO APPLICANT: If, after making this Certificate of ITY �FREMO'"r' No. OCCUPANT LOAD — Exemption, you should become subject to the Workers' 1. 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. ❑ ElI No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION29 OCCUPANCY INSPECTION 'I Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter I 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. REQ'D O PROVIDED D SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ElFROM: TO: - I am exempt from the licensing requirements as I am a: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXI TING BLDG. STORIES SI NATURE iness and Professions Code). RESENT USE OF BUILDING FINAL APPROVAL / EXISTING Lic.or Reg.No. Date /// HOME OWNER-BUILDER DECLARATION No, of ON LOT AND USE AND USE BUILDIN s - I hereby affirm that, I am exempt from the Contractor's :2 1 7 Q,O A License Law for the following reason (Section 7031.5,Busi- ness and Professions Code): • - NO.PARKING # O O O O I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 0 0 0 0 0 0 o z' 7044,Business and Professions Code). oPosED USE OF BUILDING 15_8S CONSTRUCTION LENDING AGENCY •'-�� AQ� !�' 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 represent tives of this County to enter ugon the above-mention e ert for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE j Signature of Permittee Date 1 WORKERS'COMPENSATION DECLARATION I CE 875(11-84) M I SC E L LA N E®U S APPLICATION I hereby affirm hat 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 (- FICertified copy is hereby furnished. nUILDIN 67 � "f 71A/Wf ZV, LOCALITY 1:1Certified copy is filed with the county building inspection 4 LNEAREST dLOCALITYar CROSS ST. Date Applicant EAREST / //�/ DISTRICT NO. TYPE O ESSED BY Pp CROSS ST. ��Lfr�HI�J�+ /17� �. ^ CONST.i' '4 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 6G-a6 COMPENSATION INSURANCE IDESCRIPTION LOT NO. BLOCK MAP/6D_,,, HIGHWAY wv STATE MAJOR SECOND LOCAL NO. (CIRCLE) • NO. OF BLDGS. (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 SIZE OF LOT EXISTING BLDG. C'�'/ I certify that in,the performance of the work for which this CD permit is issued,'I shall not employ any person in any manner owNER 01,/R,4v (//zy/ S> so as to become.subject to the Workers' Compensation Laws. AIL �`-� �A (� OCCUPANCY�GROGF.:• �. o ADDRESS /03.3 J e SG►�IVIA .JTI � •1 ��'. 1 Date Applicant I - I,,.J NOTICE TO APPLICANT: If,after making this Certificate of CITY 1�i9-LE Cy! No. CFI V/'"M7 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El 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. PARKING REQ'D =—T PROVIDED D SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a ROM: 07 licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, BUS EXISTING BLDG. STORIES S G,NATURE iness and Professions Code). � �� FINAL APPROVAL / RESENT USE OF BUILDING Lie.or Reg.No. Date "cp 00, 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 0 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). b O 6 A CONSTRUCTION LENDING AGENCY . RRoPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency /�E T.4iG– — c j�i�L i�.r 0 0 0 0 for the performance of the work for which this permit is o 0 0 0 0 0 o y issued(Sec. 3097,Civ.Q. ? Lender's Name R PROPOSED MAX. OCC. I 204-" Lender's Address PERMIT FEE T certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE c ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE e o to above mentioned property for inspection purposes. up v��✓td e ® r/– –� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per ittee Date