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Home My Public Portal About9406 LAS TUNAS DR_Miscellaneous__ j WORKERS'COMPENSATION DECLARATION CE 8454 (, MISCELLANEOUS APPLICATION t Hereby= cert 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,cr i � i I _ a certified copy thereof(Sec. 3800,Lab.C.). — = 11 Poliev No. Company FOR APPLICANT TO FILL 1N BUILDING /'//� � 7 Certified copy is hereby furnished. BUILDING / ADDRESS TT / 1 ADDRESS ?q,06 `- L�5 I V/y9-�� LOCALITY } ` ❑ Certified copy is.filed with the county building inspection 7NE aR EST - depaItment. OCAL:TY Temple (✓.mr,le City .CROSS ST. Date- Applicant NEAREST r f�,�/'� / r DISTRICT NO. GROUP TYPE' ESSED BY CROSS ST. 'ALCss,,IvDR.O AV CONST,J/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL aD v �" v } COMPENSATION INSURANCE ❑e SCRIPT 7oN LOT No. BLOCK {MAP HIG MW AY NO. N (clR.c t,e) STATE MAJOR SECOND LOCAL O'. OF BLDGS. (This section need not be completed If the work involved iTRACT - INOW ON LOT - - •USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (5100) or less.) I USE OF j SI'<EOF LOT EXISTING SLOG. I certify that in the performance of the work for which thisUp= = Ly permit is issued. I shall not employ any person in any manner ---E:' IXI(2AII!rr 'JET �{ S®V —, so as to become subject to the Workers' Compensation Laws. �/J OCCUPANCY GROUP ))(fAS //jj — AIL LI Y VAe DR E Date applicant _ NOTICE TO APPLICANT: If, after making this Certificate of 1T _ �.�� o� � OCCUPANT LOAD Exemption. you should become' subject to the. Workers' I APPLICATION FOR EXIT HARD`PJARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be -RAILER USE l_I GEOLOGY INSPECTION 1No Spec. Knowl. - � deemed revoked. DECLARATION r� OCCUPANCY INSPECTION LICENSED CONTRACTORS Dl Panic Devices I N L.. [ hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEi+1S SELO Vf) ` 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 �� at feet. 4! {f [�T�jli PARKING REQ•D PROVIDED 'PACES License Number Lic. Class LIMITED TIME USE w Contractor Date o A-E ATE Z ❑ am exempt from_ m _ FROM: ?G; - rom the licensing -equireents as I am a Licensed architect or a-registered professionals engineer SIZE OF NC. OF INSPECTOR'S z actlnY to ?nv protessional capacity (Section 7051. Bus- EXISTING SLOG. TO SIGNATURE ° iness and Professions Code). oFINAL APPROVAL + PRESENT USE: OF BUILDING Lic.or-Rea. No. Date s t HOIs'lE OWNER-BliILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I,/ /r eit,ill I I I +•� � I hereby affirm that I am exempt from the Contractor's :•E -'• _ j License Law for the following reason (Section 7031.5. Busi is=7 ness and Professions Code): No. PARKING LSPACES PROVIDED"as owner of the property, will do the work and the. structure is not intended or offered or sale (Secti!--� 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY g �ROPosED USE OF BUILDING I hereby affirm that there is a construction lending agency; ��`of��_ C5`7 .LJ)Q/-3-,4 j 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 j 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 25.00 ! upon-the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of tttee Date i i _ . 'WORKERS'COMPENSATION DECLARATION CE 8754(2-80) I SC E L LA � E O US APPLICATION I-hereby affirm that I have Iv ceriific6te 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:) jj Policy No. Company FOR APPLICANT TO FILL*IN ADDRESS • h Tu ❑ Certified copy is hereby furnished. 4UILDING D C J'fZ LOCALITY `TY'•(.•Gs Vj ' - - - � '. ADDRESS Gr ��/ 1/ '• Certified.copy is filed with the county building inspection NEAREST department. L OCALITY i— / f CI ( �`' cRoss ST. '��L�-5s A�u a P. Date - Applicant EAREsT rte— I p DISTRICT NO.' G�QUP TYPE / PROCE SED'BY ROSS ST. •. V A .VC, [" x( y CONST.V CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL I rVl VV - DESCRIPTION LOT NO.' BLOCK MAP- p .) HIGHWAY COMPENSATION,INSURANCE•: / /f�� { } rl o. J>�yII��ScIRCLE) STATE MAJOR S�ECO D LOCAL Q. (Thts section_ NO. OF BLDGS.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.) U SE'.OF //� O • SIZE OF LOT EXISTING BLDG. t ,� - I certify that in the performance of the•work for which this..' V permit is issued, I shall not employ any person in any manner NER �— so as to become subject to the Workers' Compensation Laws. nl� OCCUPANCY GROUP rt. W ADDRESS. _ .r i ...! _ Date Applicant. c AVC fl jC NOTICE'TO APPLICANT: If, after making this Certificate of c TYM—! L �� NoL-Z Z� OCCUPANT LOAD 3 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 0 No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANC YI NSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) 9 (commencing with Section 700 0) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and effect. PARKING "REO'D PACES. SO PROVIDED. O License Number1 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 m my professional capacity(Section 7051, Bus- EXISTING BLDG.: STORIES - SI NATURE iness and Professions Code). B j / FINAL APPROVAL RESENT USE OF BUILDING C..� N z_ , Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION No. oP EXISTINGSE BUILDINGS • �4� S 4 ON LOT.AND USE. I hereby affirm that,,l am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- o 0 0 m 0 o z nessand Professions Code): No. PARKING ' SPACES PROVIDED I,.as owner of the property,will do the work and the Q G 2 2 8 5 structure is not intended'-or offered for sale (Section 7044, Business and Professions Code): OPOSED USE: BUILDING C5 - - 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 Statelaws relating to building construction,. TOTAL FEE V\ and her authoriz representatives of this County to enter " upon.the a cNcaie one property fo inspec purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE y� Signature of Permittee Date.