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Home My Public Portal About9529 1/2, 9531, 9533 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 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 in Ware, or a certificate of WorkersCompensation Insurance,or a certified copy thereof(Sec. 3800,Lab:C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING s� ADDRESS ❑ Certified copy is hereby furnished. uILDEss /5'3L LOCALITY 6 Certified copy is filed with the county building inspection fJ NEAREST department. LOCALITY 1L 4' CROSS ST. Date Applicant NEAREST G DISTRICTf. GROUP TYPE PROC SED BY CROSS ST. �f��. ��? CC NjT/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL BLOCK. �� COMPENSATION INSURANCE DESCRIPTION LOT NOMAP HIGHWAY } NO. 02�0� (CIRCLE) STATE MAJ R`SECOND LOCAL a (Thin section need not be completed if the work involved a NO. OF BLDGS. 7____FIAL CONDITIONS O p TRACT NOW ONLOT by the permit is for one hundred dollars ($100) or less.) USE OF /fDDRESS EXISTINGBLDG. � 1 - tr I certify that in the performance of the work for which this y'� O permit is issued, I shall not employ any person in any mannerNER !/Ir I•' so as.to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP W IL I //jj� i' W5 kee wkr� {�,�.Y1•�� CLDate Applicant.NOTICE TO APPLICANT: If, 'after,making this Certificate ofY Me!: TEL OCCUPANT LOAD Z 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 o No Spec. Knowl. ❑ ,deemed revoked: LICENSED CONTRACTORS DECLARATION OCCUPANCY IrvsPEcrioN Panic.Devices El 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 Busi- ness and Professions Code, and my license is in full force and PARKING effect. SPACES REO'D O I PROVIDED License Number Lic.Class LIMITEIJ TIME USE Contractor Date DATE DATE 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 SIGNATURE iness and Professions Code). O� FINAL APPROVAL r RESENT USE OF BUILDING Lic.or Reg.No. Date-) e EXISTI HOME OWNER-BUILDER DECLARATION No. of AND UNG'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- 3•U1' p ness and.Professions Code): NO. PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and .the #`o,D o 9 4 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). 0 0 0,0 oro 0 RO POSED USE OF BUILDING �� , , CONSTRUCTION LENDING AGENCY 0 5,2.0,-8 1 1 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, Ind her by authorize representatives of this County to enter TOTAL FEE pon e- bove-mention propert for inspection purposes. SEE REVERSX FOR EXPLANATORY LANGUAGE Signature of Permittee Date �!7RKERS'COMPENSATION DECLARATION 7610444 ' a 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 �I ure, 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. BUILDINGS31 LOCALITY ADDRESS - Certified copy is filed with the county building inspection NEAREST department. OCALITY;EC eft 1� CROSS ST. Date *Applicant EAREST ��1 M DISTRICT N��..CA�' G UP TYPE PRO D BY CROSS ST. SE CONST.,/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V COMPENSATION INSURANCE Desc RlPnoN LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECO D'LOCAL ` - NO. OF BLDGS. No. (c IRCLRCLE) � d (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.) 'USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which thist, _ 0 permit is issued, I shall not employ any person in any manner ow E R N p. �c ~ so as to become subject to the Workers' Compensation Laws. AIL ('y OCCUPANCY GROUP LUIJ 10 ADDRESS V • IV Date ApplicantU) NOTICE TO APPLICANT: If, after making this Certificate of CITY ? NO. — 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[] GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic D@VIC@S ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT I-7 (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'D O PROVIDED D License Number Lic.Class 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and PIOfeSSIOnS Code). RESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date G HOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGS ON LOT AND USE I hereby affirm thah 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 - I, as owner of the property, will do the work and theVU structure is not intended or offered for sale (Section 1 7044, Business and Professions Code). p� J PROPOSED USE OF BUILDING O ri CONSTRUCTION LENDING AGENCY � l e,o 0 0 • 9 e I hereby affirm that there is a construction lending agency 061 ,0-86 ' 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, TOTAL FEE and hereby authorize representatives of this County to enter u o the above-mentioned property for i spection purposes. SEE REVERSE FOR EXPLANATORY'LANGUAGE iU-1 �d(o signeo,4f ee Date WOR K LR S' (ON1 I'L.NSAI[ON DE( 1.A R Al ION MISCELLANEOUS APPLICATION I hereby alTrrIII that 'I have it ccilil'icalc ol, collcm to scil COUNT 111 OF LOS /kNGI--I..I--.S BUILDING AND SAFETY DIVISION IJ insure, or it certil"icale of Workers' Compensation lllsilmkn'-C. ol it certified copy thereol' (Sec. 3800. Lah. C.) Policy No. Compam FOR APPLICANT TO FILL.IN BUILDING BUIL DING ADDRESS ADDRESS FCertihcd cop) is helch% furnished. I LOCAFiry ❑ Certified cope is I iled � I(h the CoiitV hkIIdilu I Iill CITYY zIP NEAREST department. 70Cl �/i CROSS ST. Date Applicant SIZE OF 1-6T 1 NO.OF BLDGS.NOW ON LOT DISTRICT NO, GROUP]TYPE PROCESSED BY Cj6 0 CONST. LOT NO. (1:8111 1( Al 1: OF FX l:M I"I[ON FROM WOR K 1 1, 1 PAC r BLOCK IIII—AY (ON/lITNSAIION INSURANI, 11 N., CIRCLE, STATE MAJOR SECOND LOCAL ('rilis section need iiiii be completed if the vioik im-lihed by (lie permil is lot- one bundled dollars (.'sIOM orless.)by MAP BOOK PAGE PARCEL it SE ZONE SPECIAL CONDITIONS ON OWNER TEL NO. I certify that in the perlormaricc (it ilic \kork 1,,i \khiell lllis permit is issued. I shall not cmplo-% all� Verson ill �111\ lt�oll klws� ADDRESS so its to become SLlbjCCI to the kkloikeis' (ompcn,i I OCCUPANCY GROUP I cul Dilic Applicant CITY ZIP NO FICF '10 A PIT K AN I: ll*. alter iiuikiii-, lllis ( CIIIIIL.alc OC,('(JPA-N-I-LOAD of Excillptioll. .\oil should hecollic subject lo [Ilk: APPLICAI 10N 1:01 1 XI F HARDWARE Compensimoll proNisionsol [lie Lziboi (odc.koti mti�t hiii1midi conipl) \%ith Stich prmi�iolls or Hli, pellml he dC--'IlICd TRAILER GEOLOGY INSPECT ION No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTIONXI Panic Devices ❑ I.ICENSI-1) CONTRACTORS DH I.ARAI I()N 1 lietehy all irm that I am licensed under piovisions of ( li;ll)te[ SAFETY PERMIT' LIST ITEMS BELOW. 9(commenchiL with Section 7000)(ll'[)I\ision I of'the BLIsilleSs NO.OF EXITS F and Prol'essions Code,and my license is in kill force and el'tect. PARKING: REO PROVIDED SPACES License Number Lic. CklS,� LIMITED TIME USE Contractor Date DATE DATE ❑ 1 arn exempt Troth the IiCCrIShIL1 rcqtiirciIIciItS as I ;1111 it FROM: TO: licensed architect or it registered professional cni- cer 5 SIZE OF 1 actilig ill nIN professional capacit\ (Scciion 70 1. lft2FCSS EXISI INNO.OF INSPECTOR'S G BLDG. SIORIL. SIGNATURE and Prolicssions Code). LIC. or Reg. No. PRESENT�USEnOF BUILDING� FINAL APPROVAL 110ML OWNER-BUILDI.R DI.( I.ARAIION N0.0[31 >1lNI b ON LOT AND USE I hereby alTimi that I itin c,\cmp1 ITOTII the('Olitrlctolr,s License Law for the following reason (Section 7031.x. Business, and Professions Code): NO.PARKING SPACES PROVIDED 1, its owner of the proper) \\ill do the N%oik and Ilic .---_-__---__- S11110111C is 110( 1111CIlded 0111flexedI'-I S;IIC (SVC 111111 ?ILII.X PROPOSED USE OF BUILDING Business and Professions ('oder. zl/ CONSTRUCTION LENDING \(il:N( Y I herchy alTimi that there is it consmiction lenditip wctic) Ilii the perl'ormance of the v,oik for which Illis licl-II'lit Is isslicki PROPOSED MAX,OCC. (Sec. 3097. ('iv. C'.). Lender's Name APPLICANT WfAW) JO. Lender's Addiess ADDRESS 4ff7y 62 —C/,S?D I certify that I have lead this al)JIliCati011 and SIMI: Ilial [Ile -3 3 Z474L- C above information is correct. I agree to Comply \6111 1111 ( OL1111V PERMIT FEE ordinances and State laws relating to construction.and hereby authorize representatives ol' this County to clitcl upon ISSUANCE FEE the above-mentioned property for inspection plilpOses. TOTAL FEL X SET RIATIRSE FOR EXPLANATORY LANGLJAGF 0 Signature ol' I"erinmee [)fit,