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Home My Public Portal About9536 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (11-84) ll_M I SC E p LA N E O 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 APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BU ILDINZ �— LOCALITY ADDRES ECertified copy is filed with the county building inspection LocALlry NEAREST department. Y CROSS ST. Date - Applicant NEAREST DISTRICT NO. G§tOUP T �/ PROCESSED BY CROSS ST. CONS � y _ /zAe CERTIFICATE OF EXEMPTION FROMWORKERS' LEGAL !J (f 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. CD 0 permit is issued, I shall not employ any person in any manner OWNER a0t, so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP. .L o ADDRESS Date Applicant O LTJ NOTICE TO APPLICANT: If, after making this Certificate of clrY A� To� _ OCCUPANT LOAD z Exemption, you should become subject to the Workers' PPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions oI 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- ness and Professions Code, and my license is in full force and NQrnE a� sAPARKING Us��/�Ss effect. �T �✓ SPACES REQ'D PROVIDED License Number Lic. Class � �� LIMITED TIME-USE Contractor Date DATE DAT E FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF f� NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. app SA I STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date -sem;° HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS r/1� V --f ii �%7,: ON LOT AND USE (" L 83 { PM 4n j'7 I hereby affirm that I am exempt from the Contractor's V ' i}�=1�' 1 I-I =L License Law for the following reason (Section 7031.5, Busi- ��1' 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 XRT �' •" I hereby affirm that there is a construction lending agency c, for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 4+V1S Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE �a 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 a5 upon the above-mentioned property for inspection purposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE X' T,r/��y C�ldb�G�► G J �`� i Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION 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./��4 Company FOR APPLICANT TO FILL IN BUILDING ADDRESSeoIti no Certified copy is hereby furnished. FSU ILD I N G -1 / I „ .%�h k►r v� ADDRESS b UJ3 LOCALITY / Certified copy is filed with the county building inspection LOCALITY 7Z 1 NEAREST lJ department. � LF �/ LI) Ci� / ffQ CROSS ST. Date Applicant NEAREST DIST@ICT NO ® ^�OUP TYPE CONST• PRO SS D BY CROSS ST. ✓ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I RV` COMPENSATION INSURANCE DESCRIPTION LOT NO, BLOCK MAP IGMWAV NO. OF LDGS. rvD.` O CIRCLE) STATE MAJOR SECOND LOCAL (This section .need not be completed if the work involved TRACT NOW ONBLOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I USE OF 1 I certify that in the performance of the work for which this IZE OF LOT EXISTING BLDG. C- �� o permit is issued, I shall not employ any person in any manner ,OWNER 5tfF14tVtA Liu Qc Yl.;VnYvl 14,C, W D/V4 so as to become subject to the Workers' Compensation Laws. OCCUPANCY°GROUP. . MAIL TT ADDRESS ,�36 � LAS �1vl 0.10lO .b RIVE y`' Date Applicant _ UJ j �� TEL. /Q /.Q 232 ,OCCUPANT LOAD O_ NOTICE TO APPLICANT: If, after making this Certificate of CITY I.e-. NO. (T J / 93 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 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 SPACES REQ�D � PROVIDED License Number Lic. Class �!(�{Is g L LF-0? ��JJ 1Ml'� 1- e : W04 LIMITED TIME USE Contractor Date ) / DATE DATE ElMr 5'T� I q I I I I FROM: TO: I am exempt from the licensing requirements as I am a � I cIV.1/1 !�— ` u licensed architect or•a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). 00r, 01FINAL APPROVAL ))) PRESENT USE OF BUILDING Lic.or Reg.No. Date / HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS a_ E --• a= _. _. ON LOT AND USE .... .. I hereby affirm that I am exempt from the Contractor's r License Law for the following reason (Section 7031.5, Busi- 00M-0001 7/13/839 ness and Professions Code): NO. PARKING ElI, as owner SPACES PROVIDED of the property, will do the work and the 4471 1 FM12:03 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 kE j&-1 L E for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address � I certify that I have read this application and state that the PERMIT FEE 1, 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 pon the above-me tioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE --f 3 Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION y. 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.). BUILDING Policy No. Company FOR APPLICANT TO FILL IN /9- ADDRESS FICertified copy is hereby furnished. `�( BU ILDING / E• S LOCALITY �C �" ADDRESS l7 Certified copy is filed with the county building inspection LOCALITY T�►v ,n ` /'1 Al NEAREST department. 1 ` C CROSS ST. Date Applicant NEARESTDISTRICT NO. G$OUP TYPE PRO SED BY CROSS ST. 16vv1 r✓lam' ,/J - CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �h� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NOP (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be completed if the work involved TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS 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 this a •permit is issued, I shall not employ any person in any manner OWNER Q EA-4 WQ� o U so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP POBO ADDRESS 1/�- 0 ~ Date Applicant p�� L�iJ NOTICE TO APPLICANT: If, after making this Certificate of CITY� fNOL - �J� OCCUPANT LOAD Exemption, you should become subject to the WorkersoZ�7 3 ' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: Wltll comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. 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 and effect. PARKING REq•D SPACES = PROVIDED 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 INC. OF IN PECTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES IGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL I Lic.or Reg.No. Date p_VVL tt ` L ROSS � 0� HOME OWNER-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): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED z 1 .0 2 4 A structure is not intended or offered for sale (Section 7044,Business and Professions Code). # o o o o 8 8 CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING -TF-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. ' 0.28-88 '2 8_8 8 Lender's Name PROPOSED MAX. OCC. Lender's Address 0 + Ob 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, d hereby horize representatives of this County to enter TOTAL FEE o 8n the ab menti n d prWerty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Ign t Date 1VORI:I;RS'CODIPENSATIONllECLARA"f10N 76M444 MISCELLANEOUS APPLICATION - , ►hE 875 (11-84)ereby affirm that I have a certificate of consent self 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.__ CompanyFOR APPLICANT TO FILL IN pDDRE55 Certified copy is hereby furnished. XX BUILD'.r" SS �' �� LOCALITY AD Certified copy is filed with the county building inspection LOCALITY NEAREST department. 3M CROSS ST. Da(e Apphcatit.-_._._ NEAREST DISTRICT NO. GROUP ITYPE I PR CESSED BY CROSS ST. /� CONSTI .-7f CERTIFICATE OF EXEMPTION FROM WORKERS'' T LEGAL C/ COf�1PENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BlDGS. (Tills 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 /�/p SIZE OF LOT EXISTING BLDG. /' p I certify that in the performance of the work for which this �--+ D— permit is issued, I shall not employ any person in any manne5CX OWNER of building WlC.t'LAAA E&— so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP_ ® cr ��++ �� C7 ADDRESS ;Z.> aBO (tel• 9i7 U Date------___—_ Applicant — - -- u, rs� TEL OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of clrY No. 6 / Q Exemption,. you should become subject the WorkersAPPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,, you must forth- wlth COMPIV With SUCII pTOVislons or this permit sliall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CON't RAC).ORS 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 an*X effect. Name of business PARKING . SPACES REO D O PROVIDED License Number Lie. Class /QraAI� LL��JJ LIMITED TIME USE Contractor_--__— __ Date DATE DATE ElI and exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF Jq{ (' NO. OF INSPECTORS acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. a�(/ V STORIES SIGNATURE inessand professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 71 Lie.or Reg. No. _ Date — : IIOMI?OWNER-BUILDER DECLARA"TION NO. OF EXISTING BUILDINGS 9/01 ON LOT AND USEl hereby m affirm that 1 aesempt from the Contractor's t�l�lt—f'jpl;ii = License L,aw for the following reason (Section 7031.5, Busi tress and Professions(.ode): NO. PARKING SPACES PROVIDED 1, as owner of the property, will do the work and the 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. CA Lender's Name PROPOSED MAI.*OCC. Lender's Address---------------.---_---- _-- 25. 00 certify that l have read this application and stale 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, and hereby authorize representatives of this County to enter TOTAL FEE 25. 00 upon the above-menti med 1) )pert lection purposes. � ^^g�SEE REVERSE FOR EXPLANATORY LANGUAGE Cj^II:IIIrr nt Iv['I'111itII`r )):Ile