HomeMy Public PortalAbout9470 LAS TUNAS DR_Miscellaneous__ MI;-1 MISCELLANEOUS APPI 11CAT 110-N
,V0KKLRS' (OM P ENSAII 10N DB I-ARA 11()IN
I hereby alTirm that I have ii certiliciiie oI scut I" 'Ch COLINTY 01- LOS ANGELES BUILDING AND SAFETY DIVISION
I insure.ur ,I certificate III' Workers' Comimiszition InswmicL!. of II
.t certil'ied cop) thereol" (Sec. 3800, Lab. C.)
Policy No. Collipilm FOR APPLICANT TO FILL IN BUILDING
Bill DING ADDR ES ADDRESS
El Certil'ied copy is here h)' hilluslIC&
A41 GLos ms_D-t- LOCALITY
El Certif'ied copy is Filed With the county buildingllspcclioil CI ZIP
department. CROSS NEARESSTT.
Date Applicant SIZE OF LO NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY
ERIII WAII: OF I XI:Ml"ll()N I RoNl \VORK1,1\11" CONST.
TRACT BLOCK NO.
CONIPLNSNFION INSURANCE HIGHWAY
NO. iCIRCLEI STATE MAJOR SECOND LOCAL
(This seciiiin need noi be completed If tile "milk imol%ed 'ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS
by the permit is fur one hundred dollars (ti 100) of less.)
I ccrlil") tll:ll in the perl'(jinance of the %koik hw which illis G
O5 W ER
permit is issued. I shall not employ an) person iij w� milillwl —
— a-6
so its to become subject to the Workers" (oiripen,mion Lim's. ADD R p GROUP c— u OCCUPANCY
Date Applicant CI YC -T (JD\/1_NA
NOTICE TO APPLICANT: If'. allei making 111P, (citil)(ille OCCUPANT LOAD
of EXernpti0n, VOLI S1101-11d become SUbject to the Workers' APPLICATION FOR
Compensation pro\inions of the Labor Code.you must I')I III%\it 11 EXIT HARDWARE:
comply with such provisions or this PCI-Illit "llidl bC (ICC111CCI TRAILER USC LJ GEOLOGY INSPECTION No Spec.Knowl.
revoked.
LICENSED CONTRACIORS DIJ I_ARAI'()N ❑
OCCUPANCY INSPECTIONi_� Panic Devices ❑
provisions ol' hlipm
I hereby aft that I alit licensed Linder SAFETY PERMIT LIST ITEMS BELOV,,I
9(commencing with Section 7000)of Di%ision ',of'the BLISIVICSS NO.OF EXITS
and Professions('ode.and my license is in full force and effect. F
PARKING-
Number Lic. (11�� SPACES REQ1D PROVIDED
Contractor LIMITED TIME USE
DATE DATE
and exempt Irian the licensing requirements its I aill it FROM:
TO:
licensed architect or a registered professional engineer
–
acting in 111) Pr0I'CSSi0lIld CapilCil) ISL'Clion 7(15], Business S S
lzl-OF 1 .1 INSP
BLDG- SI E
and Prolessions Codc).
EXisriNG IG
PRESENT USE OF BUILDING
Lic. or Reg. No. EFINAL APPROVAL
00 1 i(JV
Qetj ?Mme acasgoy(eS X,
HOME OWNER-131111 DER DIA LARAHON NO of CXIbIiNGBUILDINGS � \b1
ON LOT AND USE
I hereby iflTimi that I itin c\cnipt hoin the('o,itmcto,'.s I icolse
. c Ise
Law for the following reason (Section 7031.5. Business and
Professions Code): NO.PARKING
j'
S :\C LS PROVIDED
❑ I. as owner ol, the property. \\III III' IIIL! k :i1ld 111L
structme'is not intended or ol.lCled 1*01 side (Scciloll ,/n11, PROPOSED USE OF BUILDING
Business and ProCessions Code).
Ph� -( ,
CONSTRUCTION I.FNI)IN(i .%61:N("I
I hCrCh\' AI'llill lillit UICIC is it C011"IHIC11011 lelidilig wcflo 1.)l
the perlorinimcc of the \\oik Ioi which (his pelmil is issued
(Sec. 3097, Civ. (.). PROPOSED MAX.OCC.
Lender's Name __ - _ , I —
APPLICANT,PIW11
TEL NO
Lender's Address0692
I certify (hat I have read this application and state111;11 the 2-f 4— pel (nuoRL ra r I 4-rmn-_ CA 17 F2
above information is correct. I agree to comply with all County PERMIT FEE
ordinances and State laws relating to building construction,and
hereby authorize representatives of. this County 10 ClItcr LII)oIl ISSUANCE FEE
the �Iliolled property I'or inspection IlLIIp0Sk:',,.
'one" pro,
TOTAL FEE
2_�zv
x SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perlimice