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Home My Public Portal About9534-9536 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATIONDECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING. ADDRESS Certified copy is hereby furnished. BUILDING ��7y c� !�N �n TG- Pc&C/ ADDRESS LOCALITY ` Certified copy is filed with the county building inspection LOCALITY T�� PCL . G('ry NEAREST department. CROSS ST. ' Date Applicant NEAREST �^ �� D�T DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. '�/[ {{.•ii CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 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 SIZE OF LOT EXISTING BLDG. O permit is issued, I shall not employ any person in any manner OWNER ;.� so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ` o ADDRESS Z3 Date Applicant WJ NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. OCCUPANT LOAD L. 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 ❑ .No Spec. Knowl. EJ deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Ihereby affirm that I am licensed under provisions of Chapter SAFETY PERMI ❑ 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 SPACES II�� License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE F1I am exempt from the licensing requirements as I am a PROM" TO. 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). PRESENT USE OF BUILDING FINAL APPROVAL Lie.or Reg.No. Date SVD AJ C— -- 0 C-0 C�i(�i—/ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's FE License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ❑ SPACES PROVIDED a-a -- I, as owner of the property, will do the work and the 1) _-;•-I ;j structure is not intended or offered for sale (Section °-1=1'-E 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ' jPROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency S J for the performance of the work for which this permit is (J issued(Sec. 3097,Civ.C.). 1 Lender's Name " PROPOSED MAX. OCC. Lender's Address AV I I certify that.I 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 laws relating to building construction,frd . hereby authorize representatives of this County to enter TOTAL FEE __iilabove-mentiorled prop rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �I. ture of Permittei Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLIC `TI®1 V 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. // BUILDIN /j. LOCALITY / /�^,[,I• , i J Certified copy is filed with the coADDRES S unty buil ng inspection NEAREST . department. LOCALITY CROSS ST. Date - Applicant NEAREST DISTRICT NO. GROUP TYPE / ROCESSED BY CROSS ST. �� O �- rJ_ CONST CERTIFICATE OF EXEMPTION FR WORKERS' LEGAL a / COMPENSATION INSUR NCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE AJOR SECOND LOCAL NO. (CIRCLE) IL NO. OF,SLOGS. (This section need not be completed if the work involved TRACT NOW ON,LOT US/�ZONE SPECIAL CONDITIONS by the permit is for one hundred ollazs ($100) or less.) usE of i ! i SIZE OF LOT -- EXISTING BLDG. v I certify that in the performance o the work for which this permit is issued, I shall not employ any person in any manner owNER a G -� U so as to become subject to the W rkers' Compensation Laws. MAIL OCCUPANCY GROUP LU ADDRESS �� d Date Applicant r) NOTICE TO APPLICANT: if, fter making this Certificate of cliY Li NEL ) OCCUPANT LOAD Z Exemption,. you should bel me subject. to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such prdVlslons or this permit shall.be TRAILER USE E GEOLOGY INSPECTIONNO Spec. Howl. ❑ deemed revoked. El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic De ices I hereby affirmthat I alicensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF E ITS 9 (commencing with Se ion 7000) of Division 3 of the Busi- ness and Professions Co e, and my license is in full force and C-�-� SPARKING. effect. REQ'D O PROVIDED O PACES License-Number ! Lic.Class LIMITED TIME USE /� D, Contractor Date �/ lu 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 mit professional capacity (Section 7051, Bus- EXISTING BLDG. STORIE'S SIG TORE ]ness and Prdfessions Code). PRESENT USE OF BUILDING „ FINAL APPROVAL. Lic.or Reg.N.] Date- _! u 3--E E HOM9 OWNER-BUILDER DECLARATION ON No. of EXISLOT AND UAND INGUSE SE BUIL ING I hereby affix that, I am exempt from the Contractor's License Lawdor the following reason (Section 7031.5, Busi- NO. PARKING ) SPACES c �_ .L i•V i :i.0 z ness and Professions Code SPP.0 ES PROVIDED t I, as o Her of the property, will do the work and the structur Is not intended or offered for sale (Section 7044, l�siness and Professions Code). \" 1 PROPOSED 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 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 St•to laws relating to building construction, TOTAL FEE . and hereby autho Ize representatives of this County to enter u on thea ove- e o ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit Date WORKERS'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;.ora 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 Certified copy is hereby furnished. .L.ING ` � �/ IL ADDRESS LOCALIT ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST �A��f� DISTRICT NO. GROUP IT ,,,YPE CESSED BY CROSS ST. CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ( r COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NOF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL . (This section need not be completed if the-work involved TRACT NOOW ON LOT ;1USE::ZZ]0NE: 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 permit is issued, I shall not employ any person in any manner OWNER �C �` y so as to ec me subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP ® o r ADDRESS ^L7 , �Q• �L i3 Date VV Applicant I„ TEL'' OCCUPANT LOAD NOTICE TO'APPLICANT: If, after making this Certificate of CITY �r4-fes/ _ Q_,�No. .-2aj C/3 Exemption, you should become subject to the Workers' 2- Compensation Compensation provisions of the Labor Code,you must forth- P,PLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know[. ID deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El 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. ASS`��Q�it�� PARKING ' SPACES REQ'D PROVIDED License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: El I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineerSIZE OF NO. OF INSPECTOR'S acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO: OF EXISTING BUILDINGS D I I ON LOT AND USE I hereby affirm that I am exempt from the Contractor's elli License Law for the following reason (Section 7031.5, Busi- 33 y ness and Professions Code): NO. PARKING •,8rLl96 - - ' 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-m ntioned pro pert inspection purposes. +�� ✓ SEE REVERSE.FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (1 7-84) MISCELLANEOUS APPLICATION CE 875 I hereby e cert that I have certificate of consent t' self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDINGQ p5 ADDRESS Certified copy is hereby furnished. BUILDING l�- ADDRESS S ^, LOCALITY ( t Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST I� 1 dJ� DISTRICT NO. 4ggqOU TYPE PR ESSED Y CROSS ST. lJJ CONST. f`11 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECONTV 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 SIZE OF LOT EXISTING BLDG. y. 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 OWNER c� so as to become subject to the Workers' Compensation Laws. MAIL ` OCCUPANCY GROUP _J o Date Applicant ADDRESS Q w ��, TEL. ,_ �-27 OCCUPANT LOAD CL. NOTICETO APPLICANT: If, after making this Certificate of CITY o. Exemption, you should become subject to the Workers' z 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. 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, 9 PARKING SP p CES REQ.D D PROVIDED D License Number Lic. Class a LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES GNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE PT I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 3741 ( ;y structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I 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 PROPOSED MAX. OCC. I Lender's Address t, 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 as upon the e-me Toned cperty for inspection puposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i Signature of Permittee Date i