The URL can be used to link to this page

Home My Public Portal About9508 LAS TUNAS DR_Miscellaneous__ WORjCERS'COMPENSATION DECLARATION CE 875(11-84) M I SC E L Li`l N E O x.11 APPLICATION S - CE 875 I'&reby,affitm that i have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, pr a certificate of Workers'Compensation Insurance,or a cerfuied copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING _ %/1 LOCALITY ADDRESS nt El Certified copy is filed with the county building inspection LOCALITY (�1y(J/� NEARES 6 f / T department. V. (J CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP ITY PEI PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP HIGHWAY NO.NO. F SLOGS. (CIRCLE) STATE MAJOR SECOND LOCAL (This Section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.)• usE OF SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this _ CD permit is issued, I shall not employ any person in any manner OWNER OF LDP '7'1 — '�,` =' so as to become subject to the Workers' Compensation Laws. MAIL CuPi1NCY GROUP a ADDRESS L% Date Applicant L uJ TEL' S OCCUPANT LOAD °- NOTICE TO APPLICANT: If, after making this Certificate of CITY � j No. �s Exemption, you should become subject to the Workers' ( APP ATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No. OF EXITS ness and Professions Code,and my license is in full force an JV &HE IC E�$ effect. PARKING REO�D PROVIDED i License Number Lic. Class ear SPACES•(tom LIMITED TIME USE Contractor Date DATE DAT E FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF rvO. OF INSPECTOR S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). U77j FINAL APPROVAL /� ` PRESENT USE OF BUILDING Lic.or Reg.No: Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUIL INGS 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 0 I, as owner of the property, will do the work and the SPACES PROVIDED NI I FEE structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 0000-0001 10/20/89 I hereby affirm that there is a construction lending agency A-L- t G 6328 1 PM 2=31-1 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 u e-mentioned roperty f r inspection purposes. `c i�r/ � SEE REVERSE FOR EXPLANATORY LANGUAGE _ 6 Signature of Permi Date WORKERS'COMPENSATIONDECLARATION 76874(2-80) MISCELLANEOUS APPLICATION hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND*SAFETY DIVISION insure, or a certificate of Workers' r's'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) Policy No. CompanBUILDIN y FOR APPLICANT TO FILL IN G /�/� J/ ADDRESS (f� 4 �, ❑ Certified copy is hereby furnished. BUILDING LOCALITY —� Certified copy is filed with the county building inspection NEAREST department. OCALITY, CROSS ST. .��f'-•�/ Date Applicant NEAREST B DISTRICT NO. G UP TYPE PROC SED B, 'OSS ST. ,� C24 eONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �� Z .COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP 00 HIGH WAv STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved NO. OF BLDGS. USE ZONE SPECIAL CONDITIONS' a l p , TRACT NOW ON LOT O by the permit is for one hundred dollars ($100) or less.) ^ U USE'OF SIZE OF LOT EXISTING 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' 0 so as to become.subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP CL W AD DR _ Date -Applicant TEL. NOTICE TO APPLICANT: If,after making this Certificate of lc5i Tr NO. OCCUPANT LOAD Z Exemption, you should become subject to the Workers' 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 deemed revoked. C3 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) 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 PARKING. effect. SPACES REQ'i) PROVIDED License Number Lic.Class LL��JJ LIMITED TIME USE Contractor Date DATE D A r E FROM: TO: ❑ I am exempt from the licensing requirements as d 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 �'PRESE NT USE OF'BUILDING - Lic.or Reg.No. Date p HOMEOW DECLARATION NO.OF E S ING BUILDINGS ON LOT A D USE z2508A I hereby affirm that, I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- # o 0 0 o t3 8. ness and Professions Code): NO. PARKING SPACES PROVIDED .0 ❑ 1, as owner of the property, will do the work and the o 0 0 0'o 0 o z .structure is not intended or offered for sale (Section },,04-82 7044, Business and Professions Code). 0 . - OPOSED USE OF BUILDING , CONSTRUCTION LENDING.AGENCY c 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, D LAZ TOTAL FEE.,:? �q and hereby authorize representatives of this County to enterry 4po �tabo�ve-mentioned property or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �—Signature of P rmittee Date 1 > EiKERS'COMPr NSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirj; that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION inure, or a certificate of Workers'Compensation Insurance,or a certi�ied copy thereof(Sec. 3800,Lab.C.) Policy No. CompanyFOR APPLICANTAO FILL IN BUILDING Cr/1'tr • - ADDRESS �Vjt(/lQO ❑ Certified copy is hereby furnished. LDING fi� LOCALITY ADDRESS (J44 ❑ Certified copy is filed with the county building inspection NEAREST department. /0eCALIT CROSS ST. Date Applicant AR EST DISTRICT NO. G OU TYPE �PROCE D By CROSS ST. P, ^ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL � DESCRIPTION LOT NO. BLOCK. MAP H,GHwwv COMPENSATION INSURANCE No, (CIRCLE) STATE MAJOR SECOND L AL >. NO. OF BLDGS. (This Section need not be completed if..the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS OU by the permit is for one hundred dollars ($100) or. less.) USE OF .SIZE OF LOT EXISTING BLDG. Q I certify that in the performance of the work for which this ' permit is issued, I-shall riot employ any person in any manner VIE I" so as to become subject to the Workers' Compensation Laws. M IL - OCCUPANCY GROUP. Ek� � LLLI DRESS r .� d Date Applicant rA NOTICE TO APPLICANT: If, after making this Certificate of ITY , INE L OCCUPANT LOAD z Exemption, you 'should become subject to. the Workers' Is Compensation provisions of the Labor Code,,you must forth- . PLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION d ❑ No SpeC..Knowl. deemed revoked. ❑ LICENSED CONTRACTORS DECLARATION occurwrvcY INSPECTION P3nIC Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 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 effect. PARKING SPACES REO'D O PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ' FROM: TO: ❑ I am exempt from the licensing requirements as I am a: INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STO IES OGNATURJE iness an -Professions Code). SENT USOF BUILDING FINAL APPROVAL E Lic.or Reg.No. Date . HOME OWNER-BUILDER DECLARATION NO.O T EXISTING BUILDINGS $ r ON LOT AND USE - 1 /r Ihereby affirm that• I am exempt from the Contractor'sd� License Law.for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING . SPACES PROVIDED - ❑ 1, as owner of the property, will do the work and the Q V1 A ' structure is not intended or offered for sale (Section 7044, Business and Professions Code). 9-115�OSED USE of BUILDING Jt # o'.0 o 0 8.8 CONSTRUCTION LENDING AGENCY; 0 0 0 0 0 0 o z 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.). 0 1.2 5'8 5 Lender's Name - PROPOSED.MAX. OCC. Lender's Address PERMIT FEE I.certify that.1 have read this application and state that the above• formation is correct. I agree to comply with all County ISSUANCE FEE ordi a es and State laws. relating to building construction, TOTAL Fee an he eby authorize 'presentatives of this County to enter u n e abpve-me ned property for inspect' n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE . SI ure of Per tee Date WORKERS'COMPENSATION.DECLARATION 76 44 (2-80) MISCELLANEOUS, A PPL)CAT I®'N I" CEI hereby affirm that I have a certificate of consent to selfCOUN COUNTY OF LOS ANGELES BUILDING ND SAF'ET'Y DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec'. 3800,Lab.C.) Policy No. CompanyFOR APPLICANT TO FILL IN, BUILDING ADDRESS D Certified copy is hereby furnished. BUILDING J^/ JI, /) •—//^ w LOCALITY - ADDRESS Certified copy is filed with,the county building inspection NEAREST OV department. LOCALITY ' CROSS'ST: Date Applicant NEAREST a - DISTRICT NO. GROUP TYPE OC ED BY CROSS ST. 6 �r CONST. CERTIFICATE OF EXEMPTION`FROM WORKERS.' LEGAL DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE "AP "'�"" 61 NO.. OF BLDGS. NO. (CIRCLE) CL STATE MA"J R SECOND LOCAL (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.) 0 USE OF ' SIZE,OF LOT EXISTING BLDG. CC I certify that in the performance of.the work for which this 0 permit is issued, I.shall not employ any person in any manner OWNER1A 11A lad so as to become subject to the Workers' Com_peiisation Laws. MAIL OCCUPANCY GROUP V _ ADDRESS' y�„ 0- Date Applicant TEL. NOTICE TO APPLICANT: If, after making this Certificate of CITY rvo. J y OCCUPANT LOAD Exemption, you should become subject. :to the Workers' Compensation provisions of•the Labor Code, you must forth- PLICATION FOR EXIT HARDWARE: with comply with .such provisions or this ,permit shall be TRAILER USE o - GEOLOGY INSPECTION 0 No Spec._Knowl. deemed revoked.; Panic �eVICBS ❑ OCCUPANCY INSPECTION. LICENSED CONTRACTORS DECLARATION ❑ 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 BusiEl - ness and Professions Code, and my license is in:full force and PARKING. of^J�Ct. - - SPACES REQ'D PROVIDED License Number Lic.Class LIMITED TAME USE LL��JJ 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 in my professional capacity (Section,7051, BUs- EXISTING BLDG. STORIES SIG NATORE 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 ani exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- z 94 4, 1 A ness and Professions Code): NO. PARKING ^ - SPACES PROVIDED' •. ❑ I, as owner of the property,.will-do the work and the #k* o'o o 88. structure is, not intended or offered for sale (Section 7044,Business and'Professions.Code . 0 0 0 0 0 0 0.m _ ) PROPOSED USE OF.BUILDING CONSTRUCTION LENDING.AGENCY 0 1.2-8—'8'3 I hereby affirm that there is a construction lending agency b for the performance of the work for which,this permit is ' issued(Sec. 3097,Civ.C.). Lender's Name PRoaoseD 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 Issu ANCE FEE ordinances and State laws relating to building construction, TOTAL,FEE and hereby authorize representatives of this County to enter upop he a ove-mentioned petty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Date