HomeMy Public PortalAbout9416, 9418, 9418 1/2 LAS TUNAS DR_Miscellaneous__ ...... ._..._........ ._... •� r� i-V i `at 16—%.0 a..J Y't H I- i—1`i 1-% 1 i t/1 Y -
j I hereby affirm that I have a certificate Of' consent al sellCOUN'FY OF LOS ANGELES BUILDING AND SAFETY DIVISION I�I
insure, or a certificate of Workers Compensation Insur:utcc, or �l
a certified copy thereof (Sec. 3800. Lab. C.)
>a Policy No.— Company FOR APPLICANT TO FILL IN BUILDING
BUILDING ADDESpSG � 1 ADDRESS
ElCertified copy is hereby furnished. 0,4119 �/ J TONAS p1/• LOCALITY
❑ Certified copy is filed with the count} building insilCCtIOn CITY ZIP
' department. 1M 21e C,(� Cg g17Fj`O NEAREST
CROSS ST. ,
Date _ — Applicant . SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY
_ ._._. . .......... ... CONST.
CERTIFICATE OF EXEMPTION FROM WORKER,"
f COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY C:
No. (CIRCLE) STATE MAJOR SECOND LOCAL
(This section need not be Completed If [lie work inS'olled ASSESSOR MAP BOOK PAGE PARCEL -USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars (sI00) or less.)
OWNER L .TEL NO. /
I certify that in the performance of the work for which this J�2j7 CD 6 760 t�30- 6?j -- f
permit is issued. I shall not emploc any person in any manner n_
so as to become subject to the Workers Compensation Laws. ADDRESS
160-3 1/e h 1r0 Y- J 0 m a S OCCUPANCY GROUP
Date Applicant---- — ------- -- CITY 17O h JCt�l T //ZIP Cp`\ 6?-), �j-
- NOTICE TO APPLICANT: If. after making this Certificate /a OCCUPANT LOAD
of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code.you must forthwith
comply With such provisions or this perinit shall be dt'enled TRAILER USE❑ GEOLOGY INSPECTION❑ NO Spec.Know[. ❑
revoked. ❑
LICENSED CONTRACTORS-DECLARATION OCCUPANCY INSPECTIONX Panic Devices
I hereb; affirm that I am licensed Under provisions o) Chapter SAFETY PERMIT❑ (LIST ITEMS'BELOW,
9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS
and Professions Code.and my license is in full force and effect. r.tiG ,r tet,�Iti�S�
PARKING
License Number _ .._ -_ _. LIC. Class ,�/ —��n -., f�� SPACES REO'D PROVIDED
i I Contractor .. .-- _ - .._. .. Dale •CJ(`� LIMITED TIME USE
DATE DATE
Ellam exempt from the licensine requirements as i am t FROM: TO:
a licensed architect or it registered professional ell Cineer INSPECTOR'S
acting in my professional capacity (Section 701, liusincss SIZE OF NO.Or
-
SIGNATURE
and Professions Code). EXISTING BLDG. STORIES
Lie. or Ree. No. Date PRESENT USE OF BUILDING �-Q � FINAL APPROVAL `j Q�p DI
I — —
HOME OWNER-BUILDER DI:('l.AI:AII()N NO.OF EXISTING BUILDINGS
ON LOT AND USE
I hereby affirm that I am exempt from the Contractor's 1J,cose
Law for the following reason (Section 7031.5. Business and
Professions Code): NO.PARKING
❑ Las owner of the properlt. Will /il� the �rllrk :nt�-I tllr SPACES PROVIDED --
structure is 1101 intended lir UI ICrid-I01 S:1IC (SCei IUII 7144, PROPOSED USE OF BUILDING
Business and Professions Code). r r
r Ce
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a consu'uction lCildioU acencc fnr _
the performance of the work for which this permit is issued
f (Sec. 3097• Civ. C.). PROPOSED MAX.OCC. /
Lender's Name __--- X �-�TrPPLICA_/� T fPRIN-,SHv TEL NO
a
Lenders Address ..--_------.__-- .-- .. _ _ ADDRESS
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County PERMIT FEE
ordinances and State laws relating to building construction,and
hereby autliori'41 representatives Of this County.to enter upon ISSUANCE FEE
the aboVmeno propefrty for inspection purposes. .
TOTAL FEE
^. SEE REVERSE FOR EXPLANATORY LANGUAGE
re of Penni lee Date