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Home My Public Portal About9546 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 MISCELLANEOUS APPLICATION fl CE 875 (11-84) I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES:"! BUILDING AND SAFETY DIVISION insure, of a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). t Policy No- Company FOR APPLICANT TO FILL IN BUILDING ADDRESS 5 e FICertified copy is hereby furnished. BUILDING ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY c NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE P CESSED BY pp CROs sT. PLO p _a CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Q 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 SIZE OF LOT EXISTING BLDG. �jP I certify that in the performance of the work for which this t! '..+�� o permit is issued, I shall not employ any person in any mannerOWNER ` �� — f/V�7 k� y o so as to become subject to the Workers' Compensation Laws. MAILt�c—:� OCCUPANCY GROUP I 6f— I ADDRESS D�fT�� h„I)� O' �3 IIE�=� F_ Date Applicant `-3 rEL. OCCUPANT LOAD w NOTICE TO APPLICANT: If, after making this Certificate of CITY Clf, No. v, 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 OI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ EJE] No Spec. Knowl. 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. 2/ ?/J PARKINGREp'D PROVIDED SPACES License Number Lie. 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. J SIFT STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING t Lie.or Reg.No. Date WIN N17FEE HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS — ON LOT AND USE /y/ s I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usi jj •-,,.:� ness and Professions Code): NO. PARKING ,r,, ❑ I, as owner of the property, will do the work and the SPACES PROVIDED i�4•i y MH ;l,c5M, 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, e U and hereby authorize representatives of this County to enter TOTAL. FEE upon the bove-mentioned property for-i4spection purposes. 1� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitte Date ( _ WORKERS'COMPENSATION DECLARATION CE 875(11-84) M ISCELLANEOUS 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. BUILDING 1 J (( ' / J�/ / Xh ADDRESS L19"J 7Vl/V VK, 7E�'1 ��`J LOCALITY Certified copy is filed with the county building inspectt`' LOCALITY NEAREST department. % 3tX CROSS ST. 67 Date Applicant NEAREST / JJ //// DISTRI T NO,. GROUP TYPE CESSED BY CROSS ST. r (,Zo5C- (2�F}'�� /, �/ `� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL G o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF HLDGS. (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. �� 5-- 1 certify that in the performance of the work for which this -1 °o permit is issued, I shall not employ any person many manneRX ioWNER of buildingF1 -Z `j'l,� so as to become subject to the Workers' Compensation La�Vs. MAIL OCCUPANCY GROUP ® o Date Applicant Ac �� ADDRESS f (f 17U�2T(- #l1P U TEL.�JZ y(�_p 933 o_ NOTICE TO APPLICANT: If, after ing this Certificate of CITY A (ZC/,�(�((4N0 OCCUPANT LOAD 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 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 Busies NO. OF EXITS ness and Professions Code,and my license is in full force aX effect. Name of business PARKING REp'D PROVIDED License Number Lic. Class -1 t C Oitl C zPT TAI G SPACES LIMITED TIME USE Contractor Date 10P UIIRQ iC71 ;t'7_ DATE DATE;-7 1-1 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. y1 D v S t STORIES SI ATURE ;' inessand Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date #' HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS b (` 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 -�Av F1I, 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 [ certify that 1 have read this application and state that the PERMIT FEE 25 - 00 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-mentioned property for inspection purposes. \ SEE REVERSE FOR EXPLANATORY LANGUAGE XX Signature of P nrittee Date i WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C.A.T[O N i CE 875 i1 t-84) 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 �Ij I j a certified copy thereof(Sec. 3800,Lab.C.). J SU I LD IN G Policy No. Company t. FOR APPLICJ�{A1�jNT TbQFI LL IN ADDRESS Certified copy is hereby furnished. ADDRESS S 14S NA.5 YID LOCALITY i i Certified copy is filed with the county building inspection LOCALITY NEAREST 1. department. CROSS ST. Date Applicant NEAREST DISTRI NOD�. TYPE // P ESSED BY CROSS ST. �'} CONST. I CERTIFICATE OF EXEI4PTION FROM WORKERS' LEGAL I COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHw Av No. (CIRCLET STATE MAJOR SECOND LOCAL NO. OF BI-DGS. (This section need not be completed if the work involved TRACT NOW ON LOT USEZEJSPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USE OF I SIZE OF LOT ��/�, ISTIfB�j G. I certify that in the performance of the work for which this R permit is issued, I shall not employ any person in any manner owNER U 1Lp1116 so as to become subject to the Workers' Compensation Laws. aoORCSS �(lAla85 AeOCCU�FiN�Y GROUP i Date applicantTE (�n, _ NOTICE TO APPLICANT: If, after making this Certificate of CITY { L ��T NOI C`+lV�� 0{� OCCUPANT LOAD =- Exemption, you should become subject to the Workers' APPLICATIONFOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- ❑ t with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ! No Spec. Knowl. deemed revoked. t OCCUPANCY INSPECTION ❑ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS �ELOW) - f 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 ^ ///� C//{�/�> effect. T„l� (/� 6so e5 PARKING SPACES REQ'D PROVIDED I(�I I L� License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ FROM: TO: I am exempt from the licensing requirements as 1 am a INSPECTORS i licensed architect or a registered professional engineer SIZE OF NO. OF SI ATURE actin° in my professional capacity (Section 7051. Bus- EXISTING BLDG. STORIES 9 inessand ProfessionsCode). FINAL APPROVAL PRESENT USE OF BUILDING v Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO, OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's ;•1.... + License Law for the following reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING A. I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 1044,Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I lterebv affirm that there is a construction lending agency 1 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 c 0119( 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, and hereby authorize representatives of this County to enter TOTAL FEE 2,!5 6Q ` upon the above- ntioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of. rmittee ` Date ' r "'°R1:ERS C0\1PENSAI,I)NDLILAKAtIU.` 'u1V1MISCELLANEOUS APPLICATION .E 87575 (11-84) hereby affirm that I have a certificate of consent self COUNTY OF LOS ANGELES B.UILGING ANI) SAFETY DIVISION (sure, or a certificicate of Workers'Compensation Insurance, e,or certified copy th reo�ft�(Sec. 3800.Lab.C.). ""`� � ` I� olicy No. S mpany SLi®P.fl�r- 1yGc�l OUlu� FOR APPLICANT TO FI LL IN ADDREN / S� L• Certified copy is hereby furnished. ,} SU ILDINGi,� L4 Ina ADDRESS I[ LOCALITY Certified copy is filed w" t the cou s bt i n LOCALITY NEAREST 10, d p rtm 11 / , X CROSS ST. )ate Applic t NEAREST DISTRI NO, GRO��JJJP TYPE p ESSED BY CROSS ST, ( ' D(l VI CONST. Pr A rfe CERTIFICATE OF EXEMPTION FROM\YORK S' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP IGRWAY ND. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. rhls section need not be completed if the Nvork involved TRACT NOW ON LOT USE ZONEISPECIAL CONDITIONS ly the permit is for one hundred dollars (SI00) or less.) USE OF - SIZE OF LOT EXISTING BLDG. certify that in the performance of the work for which this - ermit is issued, I shall not employ any person in any mJ manner OWNER l e- as to become subject to the Workers' Compensation Laws G MAIL OCCUPANCY GROUP 1t,, xADDRESS )ate Applicant L. (� IOTICE TO APPLICANT: If, alter makine this CerTEOCCUPANT LOAD tificate of CITY S NO. �j� 42c � aemption, you should,become subiect to the Workers' �� _. ompensation provisions of the Labor Code, you must forth APPLICA ION FOR EXIT HARDWARE. .,ith comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ eemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION LN Panic Devices hereby affirm that I am licensed under provisions of Chapter r� I SAFETY PERMIT LJ (LIST ITEMS BELOW) (commencing with Section 7000) of Division 3 of the Bust- No. OF EXITS less and Professions Code, and my license is in full force and ffect. PARKING SPACES REQ D � PROVIDED .icense Number Lic. Class LIMITED TIME USE ontractor Date DATE DATE re FRDM11: - : 1 am exempt from the licensing requirements as 1 am a TO licensed architect or a re_yistered professional engineer SIZE OFNO. OF INSPECTORS acting In In)` professional capacity ISeitlon 051. Bus- EXISTING BLDG. ZZ�O S -�-. STORIES ' SIE.GNA R iness and Professions C.o:i:). PP.ESE t:T USE FINAL PPROVAL OF BUILDING o ��. _ic. or ReL. No. Dater\ HOME OWNER-BUILDER DECLARATION No. DF EXISTING BUILDINGS Q 1\ 1 {- � °3 3 ON LOT AND USE '\�` .'.'1' = �--�' hereby affirm that 1 :I n'. exempt from the Conu:Ictor s .icense Law for the follo%�m reason I Section 7,031.5. busi- less and Professions Code r: NO. PARKING SPACES PROVIDED I, as owner of the property', \sill do the worl: ;Ind the — structure is not intended or offered fnr Sale (Secaion 7044,Business and Prof essiuns Code). --------------------- CONSTRUCTION LENDING .-VGLNC1 PROPOSED USE OF BUILDING herebv affirm that there is a construction lendine aLcncv Y or the performance o; the work for which this permit is ;sued(Sec. 3097.Civ.C.). .ender's Name— PROPOSED MAX. OCC. .ender's.Address PERMIT FEE certify that I have read this application and state that the Ibove 4itformation is correct. I agree to comply with all County ISSUANCE FEE )rdinances a d State laws .relating to building construction. nd he'r y autt iz represe ativ o? this County to enter TOTAL FEE GZ pc n t) me ti 1 op m.pectinn purposes. sla Izl:�'l.lar 1:()I: r�PLnN:\fc)I:v LAvGUAGI Sienature of Permittee ll:uc C-e:O -1 CO(,- ( (l"C