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Home My Public Portal About9516 LAS TUNAS DR_Miscellaneous__ i WORKERS'COMPENSATIONDECL.ARATION CE 875 (11-84)- MISCELLANEOUS APPLICATION CE 875 hereby affirm that 1 have certificate of consent to if COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,,or ®G�I a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS 12- Certified copy is hereby furnished. g BUILDING �, rJ i i Z ClS �(il Qt S LOCALITY ADDRESS /-� i 0 Certified copy is filed with the county building inspection X LOCALITY ,} / NEAREST department. 1.12 V11n t2 CROSS ST. Date ,Applicant NEAREST DIST R IC NO. GROIJP ITYPEED BY CROSS ST. O G CONST. �/ i CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J' COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOC. MAP HIGHWAY vo. (CIRCLE) STATE MAJOR SECOND LOCAL 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 (5100) or less.) use OF I certify that in the performance of the work for which 'his SIZE OF LOT EXISTING BLDG. permit is issued, I shall not employ any person in any manner X OWNER &4-Ce_ , uci2 & "+(e so as to become subject to the Workers' Compensation Lavas. gOCCUPANCY GROUP Date applicant ,I MAIL 4 I �G II'�tu ✓Lv"'ADDRESS - grEL. OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY ` J�l� _ TELLC, t NO. 56Z_��_�g� Exemption, you sltould 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 1 GEOLOGY INSPECTION No Spec. Knowl. deemed revoked. - LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION (� Panic Devices 1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT LIST ITEMS BELOW) 9 (commencine with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code. and my license is in full force and /} //I ' effect. C_ Gam[/ PARKING REO'D C� PROVIDED i I 'SPACES �Jl LLJJ r License Number Lie. Class LIMITED TIME USE Contractor Date — DATE DATE F 90M: TO: [ am exempt from :he !icensina requirements as I am a f licensed architect or a ree_istered professional engineer 31ZE OF No. of INSPECTOR'S Z acting to my professional capacity �.Secrion �-L. IS-+.ts- EXIS'.ING 3L�]G. STORIES SIGNATU inessand Professions Cude). �_ FINAL APPROVAL Lie.oI Reg. No. Date PRESENT USE OF BUILDINGVaca yL /lea Z } HOtifE OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that i am exempt from the Contractor's i License Law for the following reason (Section 7031.5. Busi- ness and Professions Code): NO. PARKING El [, as owner of the property, will do the •.vork and the SPACES PROVIDED structure is not intended or offered for ;ale i Section 7044.Business and Professions Code). CONSTRUCTION LENDING .AGENCY g PROPOSED USE: of BUILDING I hereby affirm that there is a construction lending aaer.cy 4oil 1'1-1,001 t np;s" 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 25.00 i I certify that 1 have read this application and state that The PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State lags relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 l upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE X SiLTnatur of°-r-nit-Lee Da ,vOltla.RS'(:O:\1PLNSAIIUN bt(,.t-AI:AItUiN :675 (11 84) I CL 875 MISCELLANEOUS APPLICATION hereby affirm that l have a certificate of consent to sell COUNTY OF LOS :ANGELES 13UILI)7'NG ANI) SAI E'I Y I)IVISION ,sure, or a certificate o2 Workers'Compensation Insurance,or certified copy the;egf(See. 3800.Lab. C.). _ _ olicyNo.' Company FOR APPLICANT TO FILL IN BUILDING / • ADDRESS Certified copy is hereby furnished. A BOILDING 916 G¢S 7f//1 a S' JL ADDRESS LOCALITY Certified Copy is filed with the counts' building inspection' \ LOCALITY NEAREST department. y CROSS ST. 13te Applicant NEAREST.. DISTRICT NO. GR�gq��1111P TYPE CE: BY CROSS ST. -/" � CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL / a COMPENSATION INSURANCE i)E S CR I P T ION LOT NO. BLOCK AlHIGHWAY rvoP (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. Chis section need not be completed if the work involved" TRACT NOW ON LOT USE ZONE >PECIAL CONDITIONS y the permit is for one hundred dollars (S100) or less.) uSE OF SIZE OF LOT EXISTING BLDG. certify that in the performance of the work for which this - ermit is issued, I shall not employ any person in any manner OWNER4/�o.CrJ J�i7V//)sop 7l'�1�$TF� as to become subject to the \\orkersCompensation Laws. /� OCCUPANCY GROUP - MAIL )ate Applicant ADDRESS � � /e-Cf OSG TEL OCCUPANT LOAD dOTICE TO APPLICANT: If, after making this Certificate of ITY �,� s} No. `(°�Ta g' - xemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: "onlpensltion provisions of the Labor Code, you must forth- itll comply with such provisions,or this permit shall be ❑ .eemed revoked. TRAILER USE EJ GEOLOGY INSPECTION E] No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ® Panic Devices El hereby affirm that I ant licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) (commencing with Section 7000) of Division 3 of the Buss- NO. OF EXITS less and Professions Code. and mN' license is in full force and (feet. PARKING SPACE5 REO•D PROVIDED .icense Number Lic. Class LIMITED TIME USE ' ontractor Date DATE PATE - 1 am exempt from the licensing requirements as I :un :I FROM: TO: licensed architect or a registered professional engineer SIZE OFNO. OF INSPECT -S aCtnlg In my professional capacity 1"Seltion 7(_)51. Bus- EXISTING BLDG. STORIES SIGNAT RE mess and Professions Co — PFINAL APPROVAL�ESEr:T USE OF BUILDING ic.or Reg. No. Date HOME OWNER-BUILDER DEC LAl:\Ti0N r o. of EXISTING BUILDINGS CN LOT AND USE hereby affirm that I :tnl exempt from the Contractor"s ✓^I .icense Law for the following reason I Section 7031.5. Busi- ess and ProfessionsCodel: No. F•ARKING SPACES PROVIDED 1, as owner of the property, \till do thr tr'orl: and the ---- structure is not intended or offered for sale tScction 7044,Business and Professions Code). - rc • PROPOSED USE OF BUILDING - CONS"I RU( II ON LI NDINI, \I;FNCI - --- — --- —_ ..- ---- ------ -- ------- hereby affirm that there is a Consuuruon lendutg agent} or the performance o; the work for which this permit is ;sued (Sec. 3097,Cit'.C.). <,i' r=I .ender'sName PROPOSED MAX. OCC. SA.y. 1I .enders Address PERMIT FEE certify that 1 have read this application and state that the — :hove information is correct. I agree to compl with all County ISSUANCE FEE rdlnances and State laws relating to building construction. I :Rd hereby authorize representatives O? this County to enter 7 0TAL FEE ipon the above-mentioned property for nnpection purposes. ✓1 I?• SI:F RI:A` I:Sl I:OR EXPLANATORY LA*7,U.4GE �Mlr} feirl It , Ii:o MISCELLANEOUS LLANEOU APPLICATION WORKERS' CONIPL.NSAHON DLC'LARAIION ` ?0-bUG;5DPw 1;'lrt) 2� �� I hereby affirm that I ha\c a ccrul'icate of consent to Sell' COON' Y OF LOS ANGEIA'S BUILDING AND SAFETY DIVISION Ij insure,or a certificate of Workers'Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C.) J Policy No. Company FOR APPLICANT TO FILL IN BUILDING y BUII.�M�V�I'rjC11QESS— / � dCADDRESS ❑ Certified copy is hereby furnished. (/%'��(//�J- N J 61- -,,-5 LOCALITY G ❑ Certified copy is filed with the county building inspection ]' nom+/ NEAREST department. �/� L/� t/ / v� CROSS ST. Date _ Applicant SIZE OF LOT NO.OF DGS.NOW ON LOT DISTRICT NO. GR O TYPE CESSED BY CERTII IC'AII- OF EXEMPTION FROM WORKI.RS — B . �� CONST. d' TRACT BLOCK LOT NO. COMPLNSAIION INSURANC E NAP HIGHWAY ✓ ko. IciRC�EI STATE MAJOR SECOND LOCAL (This section need not be completed If the Nork 111\III\'Cd ASSESSOR MAP BOOK PAGE PARCEL 115E ZONE SPECIAL CONDITIONS by the permit is for one hundred dolls is 1S 11)111 ur Icss.) - OW TEL NO. YC - i certify that in the perfornuulcc of the \kork for whichthis permit is Issued. I shall not employ any peISon In an)' manner So as to become subject to the Workers' (ompen>ation Lims. ;ADD4Ess OCCUPANCY GROUP t" Date- --- Applicant :CITE/ .� /_0.7 NOTICE TO APPLICANT: II. :Illcr making this CertifirllcV' :6L (fJ OCCUPANT LOAD of EXentplion, you should become Subject to the Wnrkers' APPLICATION FOR — Compensation provisions of the Labor Code.yOU must G\rth\\'ith EXIT HARDWARE: Com Ply With Such provisions lir this pl'IIIIIt Shall he deemed) fRR TAILELISE D GEOLOGY INSPECTION�_.� revoked. f. No Spec.Know). ❑ OCCUPANCY INSPECTIONN Panic Devices ❑ LICENSED CONTRACTORS DECLARMION I--I i I hereby affirm that I all) licensed under provision- lot (,hapter SAFETY PERMIT IJ (LIST ITEMS BELOW, 9(commencing with Section 7000)of DI\'Idol 3 Of the Business NO.OF EXITS and Professions('ode.and my license is in full force and effect. 7 -_ SPACING REO'D D PR— VIDE-License Number Lir. Class j SPACES — --- Contractor Date — LIMITED TIME USE I � _ - V DATE DATE ElI am exempt front the licensin., requi,ements aS I all) a FROM: TO: z licensed architect or a registered professional engineer -- actin ii.Ill rOfCSSiOIlal Ca 1CIt t ScCIloll 7051. Iltlslll C. SIZE OF NO.OP INSPECTOR'S ! g Iy SIGNATURE and Prole>slon p`s Cudr 1. EX IS rING BLDG. SrORILS-- Lie. or Reg. No. Date PRESENT USE OF BUILDING &Ct FINAL APPROVAL IIOML: OWNER-131 DI:( LARMION No.orcxisnNGBUILOwcS :)N LOT AND USE I hereby affirm that I am exempt fiom the Contractor's License - — - Law for the following reason (Section 7031.5. Business and Professions ("ode): NO.PARKING SPACES PROVIDED L as Owner ol' the properly. will do the owik ;Ind) Ihr — - - _--- structure IS not intended oi-UIICICLI for sale (Section III-t-(, PROPOSED USE OF BUILDING Business and Professions Code). —~�_ /+ CONSTRUCTION LENDING AGI:N( Y /v hereby affirm that there is it construction lending tWCI1C\ fol' the performance of the work for which this permit 'is issued I (Sec. 3097, Civ. C.). PROPOSED MAX.OCC. Lenders Name -- _ _ - A IC NTI(PH1N7J TEL O. 0U 1 , 1C_fTCSn S4 Lender's Address certify that I have read this application and state that the above information is correct. I agree to Comply \kith all County "ERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon iSSUANCE FEE the above-mentioned property for inspection purposes. 'TOTAL.FEE -7 SI:F RfAERSE FOR LXPL_ANATORY LANGUAGE '.i Signature of Permittee Dote - '� i 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.) Policy No. 'Company FOR APPLICANT TO FILL IN ' BUILDING * ADDRESS Certified copy is hereby furnished: UILDING r LOCA�Ir'Y - DRESS 9516 Las 'Tunas Drive. T Certified copy is filed with the county building inspection NEAREST department. LOCALITY Temple .City, Calif. CROSS sT. Date ,Applicant. - NEAREST - 'p' - DISTRICT NO. GR P TYPE PROC SSEn BY .. - CROSS ST. Primrose. - ,�• CONST. - < CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL S" — 2 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP RIGMWAY NO. .a_4 6 / (CIRCLE) STATE MAJOR SECOND LOCAL Q; NO. OF-BLDGS. 0 (This section need not be completed if the work-involved TRACT NOW ON LOTUSE ZONE SPECIAL CONDITIONS' 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 tills ' VVV" permit is issued, I shall not employ any person.in any manner owNER u1 G�1 Hs ,t. Davidson so.as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP W -p MAIL ry. n cQ .T�'1 .6 /{/n /^ t.1,I DDRESS. ..1220 lla c�iment• PZ-! .K/ D" W. Date Applicant TEL. Z NOTICE TO APPLICANT: If, after making this Certificate of cITYltaO'ena No. `�l tg_222 OCCUPANT LOAD 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 0 GEOLOGY INSPECTIONNO Spec. KnOWI. - ' deemed revoked. Q . Panic Devices Q LICENSED CONTRACTORS DECLARATION occuPwrvcY irvsPEcrloN El I hereby affirm that I am licensed under provisions of'Chapter SAFETY PERMIT q (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the'Busi- No. oF.Exlrs ness and Professions Code', and my license is in full force and effect. - PARKING REO'D PROVIDED -- SPACES License Number Lic.Class LIMITED TIME USE . Contractor Date _ DATE' DATE FROM: TO: - I am'exempt from the licensing requirements as I atti'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 lttes5 and PfOfeSS10I1S Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date a tall't,14 Sal HOMEON LOT AND USE DECLARATION No. of EXISTSE Bu1LDIrIGs • 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): rvo. PARKING - SPACES PROVIDED ❑ .. , [, as owner of the property, will do the work and the �` ;941, S 5.A structure is not iniended or offered for sale (Section #'o 0 0 0 [�0 7044,Business and Professions Code). ` PROPOSED USE OF.BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0'2 2 3 8 1 for-the performance of the work'for"which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MA.X. OCC. Lender's Address PERMITFEE 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, TOTAL FEE and hereby authorize representatives of this County to enter pUn _�ie abo -mention d roperty for inspection purposes.. SEE REVERS FOR EXPLE ANATORY LANGUAG .Feb. 15, 1981 '. ignature of Permitt.e Date