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Home My Public Portal About9677 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I herebyaffirm.that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or .ser eicate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). _ Polis No.—Company BUILDING y� 5r Y P FOR APPLICANT TO FI LL,IN ADDRESS �� Certified copy is hereby furnished. nU LD.INS. LXTUNAS DR. Tr-, CA•Ql7 LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE �/y CESSED BY CROSS ST. � O' CONST. -// G� �J CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (} il/� COMPENSATION INSURANCE DESCRIPTION LOT NO. HLO CK MAP NIC(CIRMWAYCLE) STATE MAJOR SECOND LOCAL NO. 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. d I certify that in the performance of the work for which this CD permit is issued,I shall not employ any person in any mannerWNER I so as to become subject to the Workers' Compensation Laws. tADDRESS1-'=C?I9. AIL c^.c,GZ L TOE OCCUPANCY GROUP a o 5 A E;Date ApplicantLULL NOTICE TO APPLICANT: If,after making this Certificate of CITY 1A .(A, 41006 NOL gig — 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 ❑ 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 ❑ (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 SPACES effect. ��J� 1 - LQ/Y! PARKING REQ'D = PROVIDED License Number Lic. Class ITY ACAVEMY 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 OLDGe STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE CD I�� 3—� �� I hereby affirm that I am exempt from the Contractor's I O License Law for the following reason (Section 7031.5, Busi- ness and PIOfeSSlOns Code): NO. PARKING �)CC Ji.�ii= V!J 1 r i SPACES PROVIDED El I, as owner of the property, will do the work and the 9"32 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 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.Q. Lender's Name Lender's Address PROPOSED MAX. OCC. I certify that I have read this application and state that the PERMIT FEE 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 �tupon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 6 190 Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS.ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or a certified copy thereof(Sec.3800,Lab.Q. 4 BUILDI /{ Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. uILDING 9677 ADDRESS 1- E. Las Tunas Drive LOCALITY Certified copy is filed with the county building inspection J46CALITY Temple City, Ca. 91780 NEAREST department. ceoss ST. WL Date Applicant N REST DISTRICT N TYPE / PRO ESSED BY ROSS ST. Kauffman D CONST. V CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP NI6HVVAY NO. (CIRCLE) STATE MAJOR SE/ ND LOCAL 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. 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 Robert J. Fryer ;� so as to become subject to the Workers' Compensation Laws. �fIAIL OCCUPANCY GROUP o Date Applicant ool ADDRESS 9677 Z.E. Las Tunas Drive E5 TEL LLI NOTICE TO APPLICANT: If, after making this Certificate of ITYTem l e City, Ca. NO. 818) 285-3102 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 USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. k Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ (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 SPACES REQ'D PROVIDED LL��JJ License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE El i I am exempt from the licensing requirements as I am a PROM: 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 SA NATURE mess and PIofessions Code). PRESENT USE OF BUaIL.%G� repairs & service FINAL APPROVAL Lic.or Reg.No. Date o D 0 HOME OWNER-BUILDER DECLARATION -NO. OF EXISTING BUILDINGS 0 0 0 0 0•o 02 ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 01-1 2"87 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ElI, 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). �� U CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING Sales, Repairs, Sery 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.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE 00 above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, l- and hereby authorize representatives of this County to enter TOTAL FEE M. arbntloned property for inspection purposes. l i _!ry SEE REVERSE FOR EXPLANATORY LANGUAGE of Pe ittee Date '1� i WORKERS'COMPENSATION DECLARATION cE 875(11-841 MISCELLANEOUS APPLICATION SCE 875 -� I hereby affirm that I have a certificate of consent to self lul insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING 94 77112— Certified 1 a. ADDRESS a�G Certified copy is hereby furnished. BUILDING /7//�(- �r.Iirgs �� XX ADDRESS ('/ 'fj r" 4 LAL;1,e &'�� LOCALITY Certified copy is filed with the county building inspection 1 LOCALITY NEAREST department. XY. 6vtZ ce0ss ST. Date Applicant NEAREST DISTRICT NO. G OUP TYPE CESSED BY CROSS ST. p 1,0C CON :r CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I C/� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO.OF SLOGS. No. (e1w eLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESP EXISTING BECIAL CONDITIONS by- the permit is for one hundred dollars ($100) or less.) USE oSIZE OF LOT f �r � (IJ I certify that in the performance of the work for which this C� permit is issued,I shall not employ any person in any mannekX OWNER of building "-av k, --i ..P so as to become subject to the Workers' Compensation Laws. MAIL �? /j� OCCUPANCY GROUP ADDRESS'. .7, YJY-e I-- Date Applicant LO NOTICE TO APPLICANT: If,after making this Certificate of CITY NO. •C�[ — .:+�FiJ 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 I ❑ 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) 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 an effect. ix !Name of business PARKING R60•D ROVIDED• ! SPACES � D �r;'•-F �.;•_::.•�"_c...• License Number Lic.Class I ( w' S v I CA 9, ', u e 1 -•• '... LIMITED TIME USE Contractor Date DATE PNiM: TD. I am exempt from the licensing requirements as i am a INSPECTORS licensed architect or a registered professional engineer SIZE OF NO.OF SIG TURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. (�j(^ STORIES iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date 'PRESENT USE OF BUILDING ' –s, , / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS - ON LOT AND USE I hereby affirm that I am exempt from the Contractor's I 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 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I Hereby affirm that there is a construction lending agency for the performance of the work for which this permit fs issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX.OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE 25.00 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 ZJr QQ a upon the above-mentioned propeMfins;pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I S466ture of Permittee Date i WORKERS'COMPENSATION DECLARATION ! zo-UUcsUPVJtz'uu MISCELLANEOUS �4 PLICATION - I hereby affirm that I have a certificate of consent to sell' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure.or a certificate of Workers'Compensation Insurance, or f l� a certified copy thereof(Sec. 3800. Lab.C.) ��ppp ` Policy No. __-.• Compan}'_ _ _ FOR APPLICANT TO FILL IN BUILDING 0(O,/ J' F X BU D NG ADDRESS ADDRESS �(� ❑ -certified copy is hereby furnished. . LOCALITY ❑ Certified copy is filed with the county building inspection + CITNEAREST. !�QVdepartment. E CROSS>T +Av Date Applicant __ ! SIZE OF LOT NO.OF BLDGS.NOW ON LOT DIST C:T NO. GRO TYP G SSED BY 1 CONS CERTIFICATE OF EXEMPTION FROM WORKERS' I TRACT I BLOCK LOT NO. '45-14f ' COMPENSATION INSURANCE I • MAP HIGHWAY NO. CIRC,E, STATE MAJOR SECOND LOCAL (This section need not be completed if the %%ork involved I ASSESSOR MAP BOOK PAGE PARCEL -- b) the permit is for one hundred dollars -S 1001 or less.) usE zorf SPECIAL CONDITIONS 1 I certify that in the rfonnarICC of the work for which IhisX OWNER It7N TEL NO. Z pe property 7• ��/ � fv permit is issued. 1 shall not emplu) am person in :uly manner /1'.e so as to become subject tc the 11'clrkers COInpelts:ltiurl L:I�+'s ' hDr°g17 2z 5, � j A'12Cf�arA OCCUPANCY GROUP LZI i Date _ Applicant �r � CIrY �D�� IzIP ��NOTICE TO APPLICANT 1f : g this Cer iiicate}; OCCUPANT LOAD of Exemption. yntl should become subject to the 'orkers' APPLICATION FOR ;,IT HARDWARE: Compensation prov;sions of the Labor Code.yOu must li rthwith comply with sucli provisions or this permit shall be deemed TRAILER USE LJ GEOLOGY INSPECTION�I revoked No Spec Knowl. U OCCUPANCY INSPECTION:) I Panic Devices ❑ LICENSED CONTRACTORS DECLARATION i I herenl affirm that I am licensed under provisions Of Charter SAFETY PERMIT LJ (LIST ITEMS B' OW + I I 9(commencing with Section 7000)of Di%ision -,of the Business NO.OF EXITS _J I and Processions Code.and my license is it-, full Dire:and effect. /�RKI Vi• REC-D I I I PROVIDED 1 I License l\untber .- LIC. C 1:1 a? I SPACES C ontraclrr _. __. _.__ Date LIMITED TIME USE ! l DATE DATE I ! :Inn exempt front the licensing reWllrenients :I., I :Int :I FROM: TO: licensed arcluiect or :I r-ai%iered profes%i nal engil eer IS:ZE OF NC OF INSPECTOR'S acting in nr professional capacio ISccuon 70;1. Business t, EXISTING BLDG. STORIES S URE and Proiessums Code). I !10-z�r ,PRESENT USE OF BUILDING FINAL APPROVAL Lic. or Reg. No. : . t):Ice 1-10ME OWNER-BUILDER DEC'I.4R U101IN 'NO.OF EXISTING BUILUINCS ON LOT AND USE I U 01 I hereby affirm that I ant exempt from the.C'ontractor's License i �0 .0.1 Law for. the followine reason (Scctidn 7031. Business and l •Professions Code):❑ ;'NO.PARKING r�1. as Owner of the: prapert), will do tile work ork and thk )SPACES PROVIDED Structure is not intended or offered for sale(Section 7(14.}, PROPOSED USE OF BUILDING Business and Professions Code). I i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency tier the performance of the work for which this permit iS issued (Sec. 3097.Civ.C.). ! PROPOSED MAX.OCC. Lender's Name ._.___...._. .__ f PPLICA NT rPRINT I TEL NO. , I Lender's Address _---__—. ADDRESS I certify that I have read this application and state that the 1 1 above information is correct. I agree to comply with all C Cunt% PERMIT FEE ordinances and State.laws,relating.to building•construc.t.ion-ana hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. �fOlDOTAL FEE �� ) SEE REVERSE FOR EXPLANATORY LANGUAGE "'►' 11hr.1:ERs'COMPENSATION DECtAlcATtON 76-%4,14AMISCELLANEOUS APPLICATION � I � C5 87575 (11.841 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS :ANGELES: ? BUILDING AND SAFETY DIVISION -400 - insure. or a certificate of Workers'Compensation insurance,or a certified copy thereof(Sec.3800,Lab.C.). I _- Policy No. CompanyFOR APPLICANT TO FILL-IN AS)OR N9 / r �Z AO DR SS Certified:ropy is hereby furnished. BUILDING / —70&& LOCALITY AOORESS Ln (/i 9 1 Certified copy is tiled with the county building inspection g IOCALITY ./+f. / /'%? NEAREST department. /� (� (� / I CROSS ST. Dale Applicant CROSS 5T . ; DISTRICT No, cR uP TYPE cEssED 3Y I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL .J Ori CONST. COMPENSATION INSURANCE 7ESCRIPTI ON LOT NO. BLOCK ' '^AP Ia STATE MAJOR SECOND LOCALI NO. (CIRcLEI YO. OF BLDGS. (Tills section need not he completed If the work involved TRACT NOW ON LOT 1 USE ZONE�SPE C:AL CONDITIONS i by the permit is for one hundred dollars ISM) or less.) usE DF SIZE OF LOT I E:C1571NG SLOG. I certify that in :he performance of :he 'work :or«•liic:i :his permit is issued. ! snail lot employ ant• person n any manner g OWNER r4, IO& I i so as to become'subiecr :o the Workers' Compensaiion Laws. " g 'AAIL OCU'P4NCY GROUP ADORESS `(� I .. t ,Date Applicant % NOTICE TO APPLXANT: If, rite:atakim: :!tis Cenificate of cIT� G ,, pQ6Ne� 9,6-0097 Q11CUP4N7. LOAD Exemption, you should 'become iubjec- :o :he Workers' Combensauon provisions of the Labor Code. you dust :orrh- APPLICATION FOR ;. =:<I-ri.4r=CWr:RE. with Comply With <Ui:: provisions :!-.!s -e:ilit inall be -RAIL=R USE '-' GEOLOGY INSPECT:ON ',Io Spec. Know!. deemed revoked. — —I LICENSED CONTRACTORS DELL.\R.I,TIO` OCCUPANCY Ir+sPECT:oN Panic Devices B � I I hereby at:irm :ha: I um licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS 9E LOlY) ` 9 (commencing With Section 110001 of Division 3 of:he Susi- No. of EXITS ness and Professions Code.and my license is in full .force and ettec-. (I SPACES G RE0 7 1 I I PROVIDED `_ , License Number Lic. Class ! LIMITED TIME USE CJntrac or Date DATE oArE • I am d`•enior ;:pin -Ile licensing :CEillLe:nC:1C:� :.1�! Sfn S + p,��• -� I lioensed archi:ec: or a :e_iszered professional =n;i l=_: 3IZE OF No. of I INSPECTOR'S 2 ac:m8 In -it. proteisional cabal::;• SdC::btl �!_.. JUS- =XIST::lG 3LO G. ST CRIES SIGNATURE ; inessandI oiessionsCodel. I ! IFINAL APPROVAL ' -RESE.17 USE OF 3UILOING Liu.or Re_.No_ — Dare _— HOME OWNER-BUILDER DECLARAMON NO. OF EXO USEISTING BUILDINGS ANd I hereby affirm :hat I um exempt f;nm :Ile CIbntructor's ON LOT License Law :or rile :vllu[['ine :easoil Seu:ton -01.:. Bu,!- I ness and Professions(rode(: I No. PARKING El �, SPACES -ROVIDED 1, as opener of :he property. will do dle •eon:; and Aw structure is not intended or offered for iaig •Section t 11044.BUsiltess and Professions Node). I . CONSTRUCTION [-ENDING.WENT Y PROPOSED USE OF BUILDING �C� .� J ? tie 1 I. hereby affirm that :here is a construction lending agency CC[ pz I for the performance of Elie work for which diis' permit is I CIO Ct� issued(Sec.30911.Civ.C.I. ty I Lender's Name PROPOSED MAX. Dec. Lender's Address I '� I I PERMIT FEE 25.00 l.i` 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. rind herebyauthorize epresentatives of Ellis County to enter TOTAL FEE 25.00 t upon th •bove-me neo p perty for inspection purposes. I Z I SEE REVERSE FOR EXPLANATORY LANGUAGE i