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HomeMy Public PortalAbout9530 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) MISCELANEOUS APPLICATION . ' I.Fccoy afrirm that I have a certificate of consent to self' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, ora certificate of Workers'Compensation Insurance,or a certified, copy thereof,(Sec.3800,Lab.C.) Policy No. Company " FOR APPLICANT TO FILL IN BUILDING r2 � ADDRESS J J ❑ Certified copy is hereby furnished. OPUILDING �' ADDRESS 3 LOCALITY _/ / / ❑ Certified copy is filed with the county building inspection NEAREST l_ department. OCALITY �. / l7 CROSS ST. " Date Applicant NEAREST L� DISTRICT N99 GR UP TYPE PROCESSED BY CROSS ST. ^ I CONST. CERTIFICATE OF EXEMPTION'FROM WORKERS' LEGA. COMPENSATION INSURANCE "DESCRIPTION LOT NO. BLOCK MAP HIGHWAY N0. (CIRCLE) STATE MAJOR SECOND LOCAL CL NO. OF BLDGS. (This section need not be completed if the work Involved. TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS" O by the permit,is for one hundred dollars ($100) or less.) - USE'OF E OF LOT -EXISTING BLDG. " 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 • rl // .so as to become subject to the Workers'"Compensation Laws. OWNER G�` �TT OCCUPANCY.GROUP W. ADDRESS o O U) Date Applicant p NOTICE TO APPLICANT: If, after making-this Certificate of Girt �� TEL �/3 �ip3 7?3710 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 (NSPECTfON ' deemed reyoked. ❑ NO.Spec. KnOW�. ❑ LICENSED CONTRACTORS DECLARATION. ,occuawrvcY INSPECTIONEJ' 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- nessand Professions Code, and my license is in full force and PARKING. effect. SPACES REO'D PROVIDED License Number Lic. Class, J LIMITED TIME USE Contractor Date DATE DATE ❑ TO: I am exempt from the licensing requirements as I am licensed architect or a registered professional engineer SIZE OF NO. OF Peon a INSP CTOR'S acting.in my professional capacity (Section 7051, Bus E ISTING BLDG. STORIES ^^ SI ATURE iness and Professions Code). V PRESENT USE OF BUILDING FINAL APPROVAL ��/ Lic.or Reg.No. Date Ci o M G r NO. OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON DoT AND USE I hereby "affirm that, I. am exempt- from the Contractor's 9.7.7 6-7 A '• License Law for the following reason (Section 7031.5, Busi- M.0 0 0`®.8.8 ness and Professions Code): No. PARKING SPACES PROVIDED _ 'O"O 0 O O- 0 U) ❑ I, as owner of the property, will do the work and.the &27-8.7 structure is not intended or offered for sale (Section. 7044, Business and ProfessionsCode). ROPoseo.use of BUILDING CONSTRUCTION LENDING AGENCY 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 U �� 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 on the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee Date WORKERS'COMPENSATION DECLARATION 76 44 (2-801 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. j,06UILDING ADDRESS 9530 East Las Tunas Drive LOCALITY �s ❑ Certified copy is filed with the county building inspection NEAREST C department. _ LOCALITY West of Temple CityBlvdCROSS ST. OF Date Applicant EAREST DRI ISTCT N d. GRO TYPE PROC SSED BY CROSS ST. CONST. • CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT NO.. BLOCK MAP,' HIGHWAY } COMPENSATION INSURANCE STATE d MAJOR SECOND LOCAL NO. OF BLDGS. No. (CIRCLE) (This section need not be completed.if the work involved TRACT NOW ON LOT USE ZONE• SP CIAL CONDITIONS 0 by,the permit is for one hundred dollars ($100) or less.) USE OF /J� SIZE OF LOT EXISTING BLDG. �•�(- I certify that in the performance of the work for which this I219estffiellt6' 0 permit is issued, I shall not-employ any person in'any manner OWNER H so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP W ADDRESS 14 4 Victory Blvd Ste. 406 Date Applicant Cn TEL. 0. NOTICE TO APPLICANT: If, after making this Certificate of CITY V rvo. OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTIONNO Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION occurwrvcY wsPEcnory Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter 1 9 (commencing with Section 7000) of Division 3 of the BUST- SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS ❑ ness and Professions Code, and my license is,in full force and, PARKING- Ir�I effect. SPACES REO'D PROVIDED l� License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: :❑ I am exempt'from the licensing requirements as I am a ' licensed architect or a' registered professional'engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ' FINAL APPROVAL �{p RESENT USE OF BUILDING Vacant �5�¢ �'Y`•�6®.� Lic.or Reg.No. Date HOMEOWNER-BUILDER DECLARATION No'.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): � f F] 1, as owner of.the property, will do the work and the SPACES PROVIDED 2 structure is not intended or offered for sale (Section �$ a,o 0 0 8 8 'x'044, Business and Professions Code). _ I ' POSED,USE OF BUILDING t0,0'a r0 O,O'O CONSTRUCTION LENDING AGENCY I I.hereby affirm that there is a construction lending agency Retail clothing and gift 0 -3 3 1 —84 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 author�ieep resent Ives of this County to enter pon. abo`-moned o erty r insp ction us. SEE REVERSE FOR EXPLANATORY LANGUAGE r Signature of Permittee -Date WORKERS'COMPENSATION DECLARATION '76M444 ' CE 875 (2-80) MISCELLANEOU.S 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 APPLICANTTO FILL IN ADDR SS A0 ADDRESS Certified copy is hereby furnished. . UILOING `L J 7 - - ¢ ( Loc ALITY ADDRESS �� D �. F- / o �l / 4{..- ✓d ❑ Certified.copy is filed with the county building.inspection NEAREST department. Lo ALITY �nM� CROSS ST. 7 ffA1,45 i Date Applicant &WEAREST �' ✓,/�/✓ (� // S n DISTR C /ytpGR//Q�J�UP TYPE PR SSED BY CROSS ST. -� ILCYI AJ r� "ase_ ✓ ONST. / ,. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT NO. BLOCK - mAP HIGHWAY - COMPENSATION INSURANCE no. "Ir (CIRCLE) STATE MAJOR SE/OND LOCAL a NO. OF BLDGS. -'O (This section need not be completed if the work involved TRACT NOW F LOT USE ZONErIAL CONDITIONS Uby the. permit is for one hundred dollars_($100) or less.) USE OF /SIZE.OF LOT EXISTING BLDG. �J/-' 'I certify thaf in the performance of the'work For which this Q permit is issued, I shall nof'employ any person in any manner OWNERo1p £ 6 OD)f U� r�a� so.as to become subject to the Workers' Compensation Laws. AIL yn OCCUPANCY GROUP LU _ ADDRESS 0 SOX O/ U) Date Applicant �j } NOTICE TO;APPLICANT: If, after making'this-Certificate'of cITY/'/L/Jyr7e Ql/'�� NO� ;2/3, 34,3 3JV OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the LaborCode, you,must forth- with comply with such provisions or this permit shall be .TRAILER USE❑ GEOLOGY INSPECTION CD NO Spec. K11OWI. ❑ - deemed revoked. LICENSED CONTRACTORS DECLARATION occuPArvcy.INSPECTIory Panic DeVIC@S E] I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) No. OF Exlrs ❑ 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- PROVIDED SPACES REq'D O O 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 of a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity.(Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE iness and Professions Code). - FINAL APPROVAL RESENT USE OF BUILDING -/1 /��y,L , Lic.or Reg.No: Date 6� C 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 7031.51 Busi nes§and Professions Code): No. PARKING 2 ' SPACES PROVIDED 4 7 I,. as owner of the property, will do the work.and the 71A 'structure is not intended or offered.for sale (Section', 1 U #'oto '® o 7044, Business and Professions Code). \�. _ PROPOSED.USE OF BUILDING', © c'ID is-0.6'a CONSTRUCTION LENDING.AGENCY ' I hereby affirm that there is a'construction lending agency CA� 0 5"2 9=8.6' 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 C unty to enter u�nntthe above-mentioned property for insp tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ` Date WORKERS'COMPENSATION DECLARATION 76M444.. MISCELLANEOUS A P P L I C AT I O N I hereby affirm that_?:^have a certificate of consent tself CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a cec+.ificaie of Workers'Compensation Insurance,e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFILL IN BUILDING FOR APPLICANT TO ADDRESS Certified copy is hereby furnished. BUILDING q!;— �� / �u�p or LOCALITY XX ADDRESS 1.t� 1/ 0 Certified.copy is filed with the county building inspection LOCALITYt NEAREST department. 3tX Z �-e C� �� CRoss ST. Date Applicant NEAREST DISTRICT NO. GROUP ITYPE OCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (Tills 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. �e } O I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manneyX OWNER Of building UJM Ti'115bL o so as to become subject to the Workers' Comppee�nn�satioon'Laws. MAIL OCCUPANCY GROUP �a o pp Q/-0 DW& C.-�N ADDRESS VC). Date A licant '✓V L/ TEL, LV NOTI E TO APPLICANT: If, after making this Certificate CITY No. �J�, 2'7I3� OCCUPANT LOAD yy 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 oI this permit shall be TRAILER USE ❑ GEOLOGY 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 anix effect. Name of business PARKING SPACES � PROVIDED SPACES E� License Number Lic. Class M M I AJ LIMITED TIME USE Contractor Date DATE GATE F1 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 SI ATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date pp�� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS U ON LOT N AD 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 1, 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.Q'. ��•`: Lender's Name -.. PROP( QED MAX. OCC, Lender's Address - PERMIT FEE I certify that I have read this application and state that the T 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 25.0 upon the above-mentioned property for inspection purposes. I /SEE REVERSE FOR EXPLANATORY LANGUAGE XX 4iY� c U n�XX z , Signature of Permittee -� D•to I