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Home My Public Portal About9520 LAS TUNAS DR_Miscellaneous__ �VORKEx,,s'COMPENSATION DECLARATION CE 875 (11-84) M 0 S l�E L LA N E®U S 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. Company FOR APP LICANTTO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDINGLOCALITY ADORES G� J DCertified copy is filed with the county building inspection LOCALITY NEAREST department. ca I/ cRoss ST. Date Applicant NEAREST DISTRICT NO. I GROUP ITYPEROCESSEDPBY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF SLOGS. (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 o permit is issued, I shall not employ any person in any manner OWNERS y so as to become subject to the Workers' Compensation Laws. MAIL O �\ rz OCCUPANCY GROUP o ESS S7 S� I~j Date AO DR S Applicant TEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY P S' 7,o 0. z Exemption, you should become subject to the Workers' APPLICATION FOR c�!^ EXIT HARDWARE: _ Compensation provisions of the Labor Code,you must forth- o? —'SS with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] 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 SPACES REQ'D PROVIDED License Number Lic. Class %PIS d 66 f ° C - LIMITED TIME 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 / NSPE TUR,E acting in my professional capacity (Section 7051, Bus EXISTING BLDG. ((�(L/ STORIES iness and Professions Code). FINAL. APPROVAL �/y� ' PRESENT USE OF BUILDING ?\' 1:," Lic.or Reg.No. Date �1 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS -y _ fi 1'` ON LOT AND USE _} w7.I l'''s -- 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 F11, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDIN I hereby affirm that there is a construction lending agency — S O for the performance of the work for which this permit is fA issued(Sec. 3097,Civ.Q. Lender's Name V 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 entioned property for ins ection purposes. r`r�A��'"�'^ / •�ff�j SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1VORKERS'COMPENSATION DECLARATION CE 875 111-84) MISCELLANEOUS APPLICATION CE 875 e.. o affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES. BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or it certified copy thereof(Sec. 3800,Lab.C.). Policy No.. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. ABUILDING DDRESS XX ADDRSS9520 E . LAS TUNAS DR LOCALITY CsG ❑ Certified copy is filed with the county building inspection _ NEAREST LOCALITY department. 3CY. Ci CROSS ST. Date Applicant NEAREST DISTRICT NO. GROIJ�P TYPE P CESSED BY CROSS ST. - `p /E3( CONST. CERTIEICATF,OF EXEMPTION EROM WORKERS' < LEGAL (fO �j/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MwP HIGHWAY NO. F BLDGS. NO. IC.—LEI STATE MAJOR SECOND LOCAL _ (this $eCtl(1n 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.) USEOF SIZE OF LOT EXISTING BLDG. 44 I certify that in the performance of the work for which this _ c-_ permit is issued, I shall not employ any person in any manneXX, OWNER of buildin so is to become subject to the Workers' Compensation Laws. MAIL I OCCUPANCY GROUP of ADDRESS9520 E . LAS TUNAS DR . r 'v Date-___ Applicant___—__ — u, NOTICI: l0 APPLICANT: If, after making this Certificate of CITY TEMPLE CITY No`(.818 ) 285-9090 OCCUPANT LOAD V) 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 GEOLOGY INSPECTION ❑ - No Spec. Knowl. deemed revoked. f-- OCCUPANCY INSPECTION ❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 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 a effect. IxXName of business PARKING REO'D License Number Lic. PROVIDED SPACES �� J Class 1. It�l S E ear I 1 if', — LL LIMITED TIME USE Contractor_—_______ Date DATE DATE El I am exempt from the licensing requirements as I am a FROM: To. licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessand Professions Code)• FINAL APPROVAL PRESENT USE OF BUILDING Lic. or Reg. No. _ Date— HOME ate HOME:OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE `� Q 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 ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OR BUILDING 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 Nanie ice! I PROPOSED MAR.*OCC. Lender's Address-_— I ddress certify that I have rend this application and slate that the PERMIT FEE 25 . 00 7l 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 I TOTAL FEE 2.5 . 00 Upon tie above-menti tied�J)Zroprty for inspection pi rposes. XX XXj S SEE REVERSE FOR EXPLANATORY LANGUAGE -' — -- -- a•. fir 111–I'1-I'CIIII itIce Dale =• t V. WORKERS'COMPENSATION IfECL•AR kTION 75Ma44 _ CE 875(11-84) M 9SCELLANEOUS APPLICATION I hereby affirm that i have a certifcaCt of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISI 'insure, or as certificate of Workers'Compensation Insurance,or . a certified'copy thereof(Sec. 3800,Lab.C.). Policy No.-- Company FOR APPLICANT TO FILL IN BUILDING ' �� \ ADDRESS F Certified copy is hereby furnished. BUILDING ADDRESS _✓ �, G '! LOCALITY Certified copy is filed with the county building inspectionLOCALITY NEAREST department. . CROSS'ST.. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY CROSS ST. - i,.0 L _ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL OGtA � Gt COMPENSATION INSURANCE DESCRIPTION LOT NO: BLOCK MAP HIGHWAY ' NO. (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 ($100) or less.) - USE of I certify that in the performance of the work for which this slzE of LOT 1 EXISTING BLDG: permit is issued, I shall not employ any person in any manner OWNERLLj so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP } ADDRESS , ! Date Applicant - Q NOTICE TO APPLICANT: If, after-making this Certificate of CITY /' � ~NOL /� y �-per. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Q_ Compensation provisions of the Labor Code, you must forth El with comply with such provisions or-this permit R shall!be TRAILEUSE ElElGEOLOGY INSPECTION No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION; 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 r effect. li/v PARKING REq'D- ' PROVIDED SPACES 11�� License Number Lie. Class LIMITED TIME USE Contractor Date �" '��v DATE t PATE' - '�/'/ j .. / F -%/L�i�j � FROM: TO: h �'I am exempt from the licensing requirements as I am a �e 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 TURE inessand Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING' / Lie.or Reg.No. ,Date HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS✓` V� O f/ 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 I, as owner of the property, will do the work and the SPACES PROVIDED 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 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, ,••.and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date