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HomeMy Public PortalAbout9402, 9404 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 111-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,,or or a certified copy thereof(Sec. 3800,Lab.C.). C� j C Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ( Certified copy is hereby furnished. BUILDING ADDRESS © (%'I `�-S tl/tlI6 LOCALITY DCertified copy is filed with the county building inspection LOCALITYTQ �� t 1f-� NEAREST eS S department. ` 'G� m ! i CROSS ST. Date Applicant NEAREST DISTRICT N ROUP TYPE P CESSED BY CROSS ST. (�G SS i/ . Q CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL007 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL 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 permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL UG" G h E'h OCCUPANCY GROUP fj-� p ADDRESS 8 Date Applicant I„ rEL. OCCUPANT LOAD C NOTICE TO APPLICANT: If, after making this Certificate of CITY r2 b401 M NO. 9 f�! Exemption, you should become subject to the Workers' z 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. F] deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 -h /� 13�}� SJ ���rf Fln�( CO. PARKING effect. 'I REq D D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE I 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. s STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL !/l� �� PRESENT USE OF BUILDING T' Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE „/]^ I hereby affirm that I am exempt from the Contractor's VN 7UI 111 �. License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING. F1 _SPACESPROVIDEDIs.- I, 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). 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.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address S / 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, and hereby authorize rep r ,entatives of this County to enter TOTAL FEE 2� upon t e a cy�menti ed rty for pection purposes. a`p/)_ ?/SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date( T WORKERS'COMPENSATION DECLARATION CE 87755 (1 7-84) MISCELLANEOUS APPLICATION {� CE LI t 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 celtified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN SS BUILDING ADDRE ^'�+ 5 U FICertified copy is hereby furnished. BUILDING o C�' LOCALITY / [E c Certified copy is filed with the county building inspection LOCALITY ` /4 9'/,,O NEAREST department. CROSS ST. Date Applicant NEARESTDIR1 Old TYPE PR ES D BY CROSS ST. _^ / ' .( CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL `J v V COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SE CO D 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 slzE of Lor EXISTING BLDG. I certify that in the performance of the work for which this � permit is issued, I shall not employ any person in any manner OWNER o U JJ so as to become subject to the Workers' Compensation Laws. MAIL ("44n OCCUPANCY GROUP p ADDRESS-,L,&O ,mold ,�yl�/J �� � Date ApplicantuJ NOTICE TO APPLICANT: If, after making this Certificate of CITY /�/���ta /,,,,TN OL _ 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. E 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 C � effect. PARKING REQ'D PROVIDED SPACES IBJ License Number Lie. Class IC4n2PIT 777LIMITED 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 engineerSIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES IGNATURE iness and Professions Code). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION O. OF EXISTING BUI DINGS D / ON LOT AND USE I hereby affirm that I am exempt from the Contractor's _ License Law for the followingreason Section 7031.5, Busi- 'f2L U it ness and Professions Code): NO. PARKING . ❑ I, as owner of the property, will do the work and the SPACES PROVIDED / AM I'nYi w structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN \ 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, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mention d prop rty for inspection purposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of VerKttee ate 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 APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. B DILDING LOCALITY DRESS C.� C ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT NO. G OUP TYPE 1R.CJfSSED BY CROSS ST. af/ /Q_•'I CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL fJ<_ DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE NOP (CI LE) 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 0 by the permit is for one hundred dollars ($100) or less.) USE OF (r SIZE OF LOT � N BLDG. 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 so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP0Fr LU -40 ADDRESS - rJA `A IA—CLA L Date Applicant TE NOTICE TO APPLICANT: If, after making this Certificate of CITY i^ NoL OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICA N 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 IR] Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) ❑ NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness I Call effect and Professions Code, and my license is in full force and 1 t I s Name SPACRKING r ACES- License I PROVIDED O License Number Lic.Class Home.Address - S�IREEJI L J LIMITED TIME USE Contractor Date DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a, Flione — 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 NO. OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION 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 z'2 31.5 A ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section # • • • • 40 7044, Business and Professions Code). ROPOSED USE OF BUILDING 14 n • • o e • • • SSP CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 09,2 6—80 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, and hereby authorize representatives of this County to enter TOTAL FEE uppn the above-mentioned property for inspection purposes. SEE REVERSE F R EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 8754 (2-g0) 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 r i7 Certified copy is hereby furnished. uILDING 9402 East las Tunas Dr. LOCALITY ❑ DRESS C•- - ` Certified copy is filed with the county building inspection NEAREST LOCALITY 1 department. *" t'„'Q rity Ca- CROSS ST. �y�J Date Applicant NEAREST � DISTRICT NO. GRO P ;jkSSED BY CROSS ST. Rosemead Blvd. dam" CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. STATE MAJOR SECOND LOCAL BLOCK MAP HIGHWAY d NO. OF CL BLDGS. NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 O by the permit is for one hundred dollars ($100) or less.) V U USE OF SIZE OF LOT EXISTING BLDG. �.> M cc I certify that in the performance of the work for which this u O permit is issued, I shall not employ any person in any manner WNER Arthur Stewart ~ so as to become subject to the Workers' Compensation Laws.tA,L 6830 N Rosemead B 1 Blvd.. #�0 OCCUPANCY GROUP /�'�� L3 U RESS `� WS! WDate ApplicantTEL. Z NOTICE TO APPLICANT: If, after making this Certificate of No. _ 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 USEGEOLOGY 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) a NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- nr�,ss and Professions Code, and my license is in full force and PARKING. effect. SPACES REO'D E== PROVIDED License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 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 Printi.ng Busi . HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's r b 0 0..6 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKINGSPACES PROVIDED i,. O O O O 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section c o c o v o c to 7044, Business and Professions Code). ^� ROPOSED USE OF BUILDING_P.1 � }G ' � 1 ��.�.J 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 State laws relating to building construction, TOTAL FEE it 2uizx� his County to enternspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 1D— 3-$3 S gnature of Permi4rfee 4011 Date WORI:ERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION -• CE 875 hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION h�;;sure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TOdd-., BUILD NG ADDRESS /�D Certified copy is hereby furnished. X}: ✓BUILDING py�� L�r f �U�Al �R��/E LOCALITY ADDRESS Certified copy is filed with the county building inspect LOCALITY NEAREST department. CROSS ST. Date _Applicant NEAREST /�/ /� DISTRICT NQQQ. GR�O UpP TYPE P ESSED By CROSS ST. //VEXAJPPD y G"! CONS CERTIFICATE Oh EXEMPTION FROM WORKERS' LEGAL G��7 a cam) v� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP LID Hw AY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF SLOGS. (fills 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 1000 EXISTING BLDG. Ile I certify that in the performance of the work for which this c� permit is issued, I shall not employ any person in any manneXX owNER of building SO as to heconle subject to the Workers' Compensation Laws. Q OCCUPANCY GROUPMAIL ® n Date— Applicant— ADUREss�0yRANGy Rd CR9/oo3TEL RIP•4'11 /i�Q� OCCUPANT LOAD NOTICE TO APPLICANT: If, after makingthis Certificate of CITY G,4DlA NO.0`6 T JJ v_� Exemption, you should become subject to the Workers' Compensation provisions,of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with stich provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION E] No Spec. Knowl. deemed revoked. ❑ OCCUPANCY INSPECTION ❑ Panic Devices I.I('ENSEU CONTRACTORS DECLARATION 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 anix effect. Name of business PARKING PROVIDED P ,I!E1r�RE /,.lc SPACES REO'D E::= License Number __ __ __ Lie. Class LIMITED TIME USE Contractor-- _____ Date DATE DATE ElI am exempt from the licensing requirements as 1 am a PPO.: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTO S acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES SI Tu e iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg. No. - ----_--- _-- Date 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 (he 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 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONS"I R11C"1'ION LENDING AGENCY PROPOSED usE of BUILDING I hereby ;affirm that there is a construction lending agency -7 fur 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, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 Upon the ve-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX WORKERS' CUMYhNJAlIUIV LtILHKAIiV(V 20-0063DPWi2/90 IY1i��.GL.Lf�1�l�;Vlr� HI�C"L1<.Hl 1tJl1l 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,Wtirkers' Compensation Insurance, or a certified copy thereof (Sec.3800, Lab.C.) ; Policy No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING DDRESS p �C �(�� yt��QJ ADDRESS - ❑ Certified copy.is hereby;furnished. g d C LJA 7 Z PIP LOCALITY ❑ Certified copy is filed with the county building inspection CITY ZIP {,�-D NEAREST department. P L l I • (J CROSS ST. Date Applicant slzE oP�oT a D 5 e '^^L NO.OF BCDGS`NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT tt BLOCK LOT NO. CONST. 0 COMPENSATION INSURANCE AY I NOP CIRCHIGHLE ) 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 (S 100) or less.) USEZONE SPECIAL CONDITIONS O T orfLAMa TEL N c. I certify that in the performance.of the work for which this 1__1k46;L �� _has w " I permit is issued.I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. ADDRESS a- 1 S4-S �, ACV'�ff OCCUPANCY GROUP Z Date Applicant CITY` C>� Zlp I b NOTICE TO APPLICANT: [f: after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of theLaborCode.you must forthwith EXIT HARDWARE: comply with such provisions or this permit shalt be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[ Panic Devices ❑ I hereby affirm that I am licensed under pCOVI$IORS Of Chapter SAFETY PERMIT O (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business NO. EXITS and Professions Code.and my license is in full force and effect. Name o usiyam ness &AC :PARKING I� License Number LIC. Class !! rSPACES REQ'D C� PROVIDED �" I Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer FROM: TO: acting in my professional capacity (Section 7051, Business SIZE OF NO.OF INSPECTOR'S ! EXISTING BLDG. STORIES / SIGNATURE, and Professions Code). _ R PESENT USE OF BUILDING 1 I FINAL APPROVAL 2 oL Lic. or Reg. No. - - Date - HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS I ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Code): NO.PARKING SPACES PROVIDED a— ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING "({ Business and Professions Code). 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.). PROPOSED MAX.OCC. Lender's Name APPLI NT JPRIN1) TEL N - Lender's Address ADDRESS I certify that I have read this application and state that the above information is correct. I agree to comply with at,County PERMIT FEE ordinances and Stat aws relating to building construction,and - hereby authorize re esentatives.of this County to enter upon ISSUANCE FEE i the above-mention property for inspection purposes. TOTAL FEE X ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee Date