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HomeMy Public PortalAbout9514 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION.DECLARATION 76M444 CE 875 (2-80) MISCELLANEOUS APPLICATION I 'hereby affirm.That I have a certificate of consent to serf 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. uILDING (� P/ LOCALITY / (�J ADDRESS � .� - J /ti/b �V� VG Certified copy is filed with the county building inspectionNEw REsr department. OC ALITY (�/ CROSS ST. aVat Date Applicant N REST /��L•yy� / DISTRICT NQS G OUP TYPE PRO ED BY ROSS ST.. t-%�(�U eI�,L L�(►]( /�J CONST. CERTIFICATE OF EXEMPTION.FROM WORKERS' LEGAL a <lJ(J �,��JJ L/ D,ESCRIPTION 'LOT NO. BLOCK ` COMPENSATION INSURANCE MAP HIGHWAY } NO. - (CIRCLE) STATE MAJOR SECO D LOCAL'NO. OF BLDGS. (TINS SOCtIOn need'.not becompletedif the work involved TRAcrNOW ON LOT - USE ZONE SPECIAL CONDITIONS. 'O by the permit is for one hundred dollars ($100) or less.) U USE OF /^, SIZE OF'LOT - EXISTING BLDG. V.`/ 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 116WNellEN AJ ES EW, so as to become subject.to the Workers' Compensation Laws. [ OCCUPANCY GROUP LU U ' • JA�DDRESSi'/Date Applicant NOTICE TO APPLICANT: If, after making this Certificate ofY ff /� No� 8 7�� �9SQ 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❑ NO Spec. KIIOWI. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OccuawrvcY INSPECTION Pa1lic 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• REQ'D PROVIDED S - SPACE - License Number Lic.Class LIMITED TIME USE Contractor Date. - - DATE D ATE i❑ _ FROM:. TO: , lam 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 IGNATURE iness and Professions Code). FINAL.APPROVAL .. r�� P SENT USE OF BUILDING o 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 the following reason (Section 7031.5, Busi- ;247567A ' ness and Professions Code): NO. PARKING - SPACES PROVIDED - # a Q F1 I, as owner.of the property, will do the work and the © � P88 structure.is not intended or offered for sale (Section 7044, Business and Professions Code). 0 0 o e o 0 o z OPOSED US E, CONSTRUCTION LENDING AGENCY // //� t1 5'''01 =8 6 I hereby affirm that there is a construction lending agencyL 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 �� f r7 - I above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to,enter 7n.wthb -men 'oned property for inspe ion pur SEE REVERSE FOR EXPLANATORY LANGUAGE fG/ e- u Signature of Permittee Date, WORIGERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 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. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. ILDING lJ i LOCALITY. ADDRESS Certified copy is filed with the county building inspection NEAREST department. 1 � 1 CROSS ST. Date Applicant AREST DIS RICT NO. GRO TYPE OC SSED BY LO CROSS ST 52 !'� _� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (/ _ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NO (CIRCLE)Z�-5 (��R�Ej STATE MAJOR SECOND L L 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. SIZE OF LOT EXISTING BLDG. d I certify that in the performance of the work for which this tV 1 N g y permit is issued, I shall not employ any person in any manner WNER c I - so as to become subject to the Workers' Compensation Laws. IL I _ OCCUPANCY GROUP o DDRESS ` j 9 1A Tl.l S j�, Date Applicant TEL OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of ITY NO. _ y Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATI N FOR EXIT HARDWARE: 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 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 effect. PARKING REQ'D D PROVIDED D SPACES License Number Lie. 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 FROM: To: IN acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). FINAL APPROVAL .� PRESENT USE OF BUILDING Lie.or Reg.No. Date u 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 the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING r ,sem ❑ I, as owner of the property, will do the work and theSPACES PROVIDED y structure is not intended or offered for sale (Section r 7044,Business and Professions Code). OP �5 3 S 5 A OSED USE OF BUILDING r• CONSTRUCTION LENDING AGENCY # 0 0 0 0 $8 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 0 0 0 issued(Sec. 3097,Civ.C.). Lender's Name \PROPOSED MAX0 Q 9 3,=8 6 . OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.1 agree to comply with all County ISSUANCE FEE ("" I ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 'upon theabove-mentioned property for inspection purposes. ✓% - SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P rm ttee Date WORKERS'COMPENSATION DECLARATION 76M444 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.) BUILDING Policy No. Company FOR APPLICANT TO FILL IN, wDDRE G ' 'Certified copy is hereby furnished: `.BUILDING 47/'/ /dam vAI 5 �. LOCALITY r. ADDRESS _ Certified copy is filed with the county building inspection' _ NEAREST department. LOCALITY ��2' P7 CROSS ST. Date Applicant. NEAREST .. DISTRICT NO. GROUP TYPE PROC E.D BY' 'CROSS ST. CONST. - ..J CERTIFICATE OF EXEMPTION FROM WORKERS' i.EGAL COMPENSATION•INSURANCE DEsc RIPTION LOT NO. BLOCK mnP HIGHWAY NO. Z STATE MAJOR SECOND LOCAL d' NO. OF B19 O (CIRCLE)LDGS. _ (This section need nC riot be completed if the.work involved TRACT NOW ON LOT USE ZONE S IAL CONDITIONS O by the permit is for one hundred dollars'(000) or less.) 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 L U 'so as to become subject to,the Workers'Compensation Laws. MAIL �y�q OCCUPANCY.GROUP r LU- .. "ADDRESS a Date Applicant to TEL Z OCCUPANT LOAD NOTICE TO^APPLICANT: If, after making this Certificate of c I T D No. 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 proyislons or this permit shall be TRAILER USE E] GEOLOGY INSPECTION❑ No Spec. Kriowl. 0 deemed revoked. Panic Devices ET LICENSED CONTRACTORS DECLARATION. OCCUPANCY INSPECTION I9 (commencing with Section 7000) of Division 3 of the Busi- hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) - NO. OF,EXITS nss and Professions Code, and my license is in full force and PARKING effect. SPACES REO'D PROVIDED D License Number Lic. Class LIMITEDTIME 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 SIGNATURE iness and Professions Code).. PRESENT USE OF BUILDING F[NAL-APPROV ALj� Lic.or Reg.No. Date' �z a7_4 r --" .0 'o o.o NO. OF EXISTING BUILDINGS' - 1 ! ' HOME OWNER-BUILDER DECLARATION ON LOT AND USE o 0 0 a o o'o Z 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 - OI, 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). PROP OSED-U SEOFBUILDING - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency' I' 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-mentioned 'property for'i ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - val ­7 Signature of Permittee Da e WORKERS'COMPENSATION DECLARATION 76M444 ,_14 CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION irrsure� or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS /J Certified copy is hereby furnished. BUILDING T LOCALITY ADDRESS 0 Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. �o p CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLOGS. (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 SIZE OF LOT- ��t 7 l` EXISTING BLDG. �Lf�h I certify that in the performance of the work,for which this :J permit is issued, I shall not employ any persori in any manner OWNER y so as to become subject to the Workers' C mpensation Laws. MAIL _ OCCUPANCY GROUP [�E�] o ADDRESS}- � `(Z,t/Y�IA/a Oy� I— Date Applicant `S TEL' OCCUPANT LOAD a NOTICE TO APPLICANT: If, after m ing this Certificate of CITY ( G No. �CD ► Exemption, you should become bject to the Workers' z Compensation provisions of the La or Code, you must forth- APPLICATION FOR EXIT HARDWARE: With comply with such provlslo s OI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec. K owl. deemed revoked. LICENSED CONTRAC ORS DECLARATION occuawNCY INSPECTIO Panic Dev' es I hereby affirm that I am Iice sed under provisions of Chapter SAFETY PERMIT (LISTATEMS BELOW) 9 (commencing with Section 000) of Division 3 of the Busi- NO. OF XITs ness and Professions Code, d my license is in full force and 1■w�/�/�ryJ7 effect. PARKING RE D PROVIDED SPACES License Number Lic. Class n LIMITED TIME USE Contractor Date DATE DATE I am exempt fro the licensing requirements as I am a PROM. TD. licensed archite or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my p ofessional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Profe ions Code). PRESENT USE OF BUILDING FINAL APPROVALLic.or Reg.No. Date 16_e�Zid HOME O ER-BUILDER DECLARATION No. OF EXISTING BUILDINGS 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 Profess ns Code): NO. PARKING SPACES PROVIDED "F";::`,.-•;;: i PM s; 0 1, 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 agencyI for the performance of the work for which this permit is ✓ issued(Sec. 3097,Civ.C.). Lender's Name f PROPOSED MAX. OCC. / ✓ ` Lender's Address I certify that I have read this application and state that the PERMIT FEE above infor tion is correct.I agree to comply with all County ISSUANCE FEE ordinances d State laws relating to building onstruction, and here uthorize representatives of t my toe TOTAL FEE upon the ve mentioned r perty for' spe n Pur S. SEE REVERSE FOR EXPLANATORY LANGUAGE t / ignature of Permittee ate