The URL can be used to link to this page

Home My Public Portal About9679 LAS TUNAS DR_Miscellaneous__ W0.9q.ERS'COMPENSATIN 76M444ODECLARATION 1 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 I a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANTTO FILL IN BUILDING ❑ pD,D RESS Certified copy is hereby furnished. BUILDING ADDRESS LOCALITY ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST ` / DISTRICT NO GROUP TYPE PR ESSED BY CROSS ST. IvQ y ; CONST.( CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK Mpp HIGHWAY } No. (CIRCLE) STATE MAJOR SECOND LOCAL a NO. OF BLDGSO . (This section need not be completed if the Work involved TRACT NOW ON LOT U$E ZONE SPECIAL CONDITIONS V 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 OF U so as to becom6 subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL W AD DRESS,;.. ' tl Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate of CITY NOL 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 NO Spec. Knowl. ❑ deemed revoked. ' Panic D6VICeS ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS El (commencing with Section 7000) of Division.3 of the Busi- i ness and Professions Code, and my license is-in full force and effect. S PARKING REq'D PROVIDED SPACES License Number Lic,Class LIMITED TIME USE Contractor Date DATE DATE El - 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 R iness and Professions Code). PRESENT USE OF BUILDING./ F1 N' AL APPROVAL ' Lic.or Reg.No. Date NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that• I am exempt from the Contractor's 9644 tl � ;� 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 structureis not intended or offered. for sale (Section 7044, Business and Professions Code). PROPOSED USE OF BUILDING 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 6 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 T6TAL FEE I upon the above-mentioned property for inspection purposes. „,SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee .Date WORKERS'COMPENSATION DECL'AFtATION CE 875 W DSO E L LSA N EO C.A i APPLICATION ' � CE 875 (2-80) z I hereby':0li cert that. i have a certificate of consent to self ,. COUNTY OF ]LOS• ANGEILES IJIL,DING AND SAFETY DIVISION insure,or a certificate of Workers'Compensation Insurance,or , a c�.i5fied copy thereof(Sec.3800,Lab.C.) I' Policy No. Company FOR APPLICANT TO FILL IN Bu1LDINEs3G 7 9 pD,DR ❑ Certified-copy is hereby.furnished. J o Bess 96 LO,CALITY Certified copy is filed with'the county building.inspection /� { /�J� NEAREST department. - CALITY Tem 1e Ci 1. fill CROSS ST.Date, Applicant AREST DISTRICT yup G UP YPE PROC SSEC BY CROSS sr. Kauffman � ° NS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' DESCRIPTION LOT No. BLOCK COMPENSATION INSURANCE NOP HIGHWAY S'�•ATE MAJOR SECAD LOCAL C NO. OF BLOGS. '' (This Section need not be completed if the,work•involved r TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS V by the;permit is for" one hundred"dollars ($100) or less.) USE OF ! S E OF LOT EXISTING BLDG. I. I certify that in the Performance of the work for which this '1 permit is issued, I shall not employ any person in any manner ' o, ER William BILI 1 ottli FWi�]. Vso asto become subject to the Workers' Compensation Laws.. s TAIL , OCCUPANCY GROUPW A' DRESS P•O. Box -884' - r• .a Date__Applicant • i•'., Z TEL. NOTICE TO APPLICANT: If, after making this Certificate of ! Cirr Corni.n a NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT'HARDWARE: Compensation provisions of the Labor Code, you must forth- , Wdeemed revoked.ith comply,with such provisions or this permit shallC]be I TRAILER USE❑ GEOLOGY INSPECTION �.' NOS eC. Knowl. ,❑ li P El'�• ' CCACY INSPECTION Panic Devices �' ' OUPN LICENSED CONTRACTORS DECLARATION• � ❑ - I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 '(c(?mmencing with Section 7.00,0)of Division 3 of the Busi- ness and.Professions Code, and my license is in full force and effect• - PARKING SPACES RE Q'D PROVIDED License Number Lic.Class. LIMITED TIME USE Contractor Date. _ DATE DAT•!s ❑ I.am exempt from the licensing.reyuirements as I am a PROM: TO: licensed architect or a registered professional engineerslz OF NO. OF I INSPECTOR'S acting in my professional capacity (Section 7051, Bus- E. TING BLDG. STORIES NGATURS iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING pizza Parlor I .Lic.or Reg.No." Date j. HOMEOWNER-BUILDER.DECLARAIION No.of ExisrING'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• ! A 7 5 311 A ness and'Professions Code): 'No. PARKING SPACES PROVIDED "#.O.0 0 0'8 8 _ I, as owner of the property, will do the work(Section the structure is not intended or, offered-for sale Section 7044, Business and Professions Code). ROPOSED USE OF BUILDING, 'J 7 2 7 t 8 7 IN Pizza Parlor /) I (r CONSTRUCTION LENDING AGENCY I hereby affirm that.there is a cohstruction lending agency. I for the performance of the work for which this permit is ! ' issued (Sec. 3097,Civ.C.). r Lender's Name • , PROPOSED.MAX. OCG. Lender's Add 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 cohstruction, TOTAL' FEE i and hereby authorize representatives of this County to enter I u n the ove-mentioned property for i s tion purposes. $EE REVERSE FOR EXPLANATORY LANGUAGE 7-13—$L? SignatureofPeGrm ttee Fi Date ' I WORKERS"COMPENSATION DECLARATION 76M444L I C A T I®N CE 875 (2-80) WSCELLANEOUS APP I hereby affirm that I have certificate of consent self COUN'T'Y OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C:) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS y / ❑ Cbrtified copy is'hereby furnished. I BUILDING S L 6ALITY / ADDRESS �� N• ❑ Certified copy is filed with the county building inspection ( NEAREST department. LOCALITY / C 0 CROSS ST. Date + Applicant NEAREST KKK ' 7 .Yf ��11 DISTRICT NO. G UP TYPE PROLES ED BY CROSS ST. K !� `i]/ �� CONY CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY } N4.NO. OF BLDG'S; (CIRCLE) STATE MAJOR SECO LOCAL t1 • (This section need not be completed if the work involved ( TRACT NOW ON LOT USIE ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE OF I 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 n so as to become subject to the Workers' Compensation Laws. i MAILER , I • • OCCUPANCY GROUP U /►) W ADDRESS � I N ;] Date Applicant // r� �7 NOTICE TO APPLICANT: If, after making this Certificate of , C.TYa 1"J'/ fJ02f.o P/ 1 ),fZ ' f I OCCUPANT LOAD Z Exemption, you should become subject to the 'Workers' ' '-APPLICATION PV§ 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 I No Spec. Knowl. ❑ _deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices A ❑ I I hereby affirm that I am licensed-under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) I 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 I PARKING effect. PAC ES 1 REO'D PROVIDED II S License Number Lic.Class i LIMITED TIME USE Contractor Date I DATE DATE ' FROM: TO: ❑ I am exempt from the licensing requirements as I am a i licensed architect or a registered professional engineer. SIZE OF NO. OF I INS GNATURE ECTO R'S acting in ,my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING + FINAL APPROVAL, Lic.or Reg.No. Date Z (� i H / _& NO.OF EXISTING BUILDINGS I 1 A HOME OWNER-BUILDER DECLARATION ON LOT AND USE � o o.O O 88 I hereby affirm that- I am exempt from the Contractor's f License Law for the following reason (Section 7031.5, Busi- ' I 'o'0 0 0 0 0 0 4— ness and Professions Code): NO. PARKING i SPACES PROVIDED ❑ I, as owner of the property, will do the work and the 1 010 5-85 structure is not intended or offered for sale (Section 7044, Business and Professions Code). PROPOSED USE OF BUILDING i CONSTRUCTION LENDING AGENCY �G/f I hereby affirm that. there is a construction lending agency for the performance of the work for. which this permit is I I issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCG. ' I Lender's Address PERMIT FEE I certify that I have read this application and state that the i above information is correct.I agree to comply with all County ISSUANCE FEE i ordin ces and State laws r ating to building construction, TOTAL FEE an y authorize repre ntatives of this County to enter I j above-1pentione pipperty r inspection purposes. j SEE REVERSE FOR EXPLANATORY LANGUAGE I cls moi- /r Signature of Per a Date 4 WORKERS'COMPENSATION DECLARATION CE 875(11.84) M I SC E L LA N EO U Si APPLICATION i 875 I hereby affirm that I have a certificate of consent to self I COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUI DLDING ADRESS ��j \SfCiJ�JL.yj Certified copy is hereby furnished. X I ADDRESS 9G�7`/ 5 TL�s�g-s' D t, LOCALITY Certified copy is filed with the county building inspection LOCCR 093 ST. ALITY NEAREST department. XY.' a V AWV' �� RI� C_ „Date Applicant NEAREST NO, DISTRI T NO. I GR UP TYPE P SSED BY CROSS ST. �O CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL y d COMPENSATION INSURANCE DESCRIPTION LOT NO. /4 BLOCK MA9 HIGHWAY ' NO. (CIRCLE) STATE MAJOR SECOND LOCAL , NO.OF BLDGS. (*(This section need not be completed if the work involved TRACT v(a NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I / USE OF SIZE OF LOT Jj 17 % EXISTING BLDG. C� I certify that in the performance of the work for which this r,,' permit is issued,I shall not employ any person in any mannekXi OWNER of buildingbAls &646s% J so as to become subject to the Workers Compensation Laws. I� OCCUPANCY GROUP P .15,kl ADDRESS r Y 6 I MAIL 60& C� Date Applicant //S- - uI NOTICE TO APPLICANT: If,after making this Certicate of clrY A 4ev No� 1] �a p/] OCCUPANT LOAD Exemption, you should become subject to the Workers' ppLICATION 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 ❑ 11 ❑ No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT❑ (LISTATEMS 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 a `r effect. Xf 'Name Of business SPAACHSG REWD � PROVIDED License Number Lic. Class I O ElAJA PIZZA i LIMITED TIME USE Contractor Date I DATE DATE 4 FROM? TO: 01 am exempt from the licensing requirements as I am a licensed architect or a re istered rofbssional en lneer I SIZE OF / NO.OP p INSPECTOR'S acting in my professional capacityp(Section 7051,, Bus- EXISTING BLDG. /��5� }% STORIES i SIG TORE inessandProfessionsCode). -- v - Fit IAL APPROVAL ' PRESENT USE OF BUILDING T d Lic.or Reg.No. Date Ikezg HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �Q ON LOT AND USE 1 _/ I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED F1 I, as owner of the property, will do the work and the 2148 Alf! (+=•' structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I 1 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.OCG. i Lender's Address I certify that I have read this application and state that the PERMIT FEE 5.00I above information is correct.I agree to comply with all County ISSUANCE FEE ordinance$ and State laws relating to building construction, ` and hereby authorize representatives of this County to enter TOTAL FEE 25.00 (TUpon the above-ment' ned property for inspection purposes. I � XX • SEE REVERSE FOR EXPLANATORY LANGUAGE I ' i XX , Signals c of i,er V,itl Date