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Home My Public Portal About9569 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 76M444 (2-80) MISCELLANEOUS APPLICATION I here,y 'affirmthat I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msUre, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ` y//�/n/ 0 Certified copy is hereby furnished. BUILDING /) ADD RE35 ` � , 1e OC ALITY /// D Certified copy is filed with the county building Inspection 7 LOCALITY NEAREST department CROSS ST Date Applicant NEAREST p `m` 1/� DISTRICT NO. GRPUP TYPE PR ESSED BY CROSS ST. l` l �IY,p. / n� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J COMPENSATION INSURANCE DESCRIPTION LOT NO BLocK Mpp HIGH WpY } NO (CIRCLE) STATE MAJOR SECOND LOCAL d (This section need not be completed if the work involved TRACT JC } 7 Now F BLor S. O by the permit is for one hundred dollars ($100) or less.) USE ZONESPECIAL CONDITIONS 5a USE OF SIZE OF LOT /4C 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 OWNER N U so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP 1L ADDRESS ,Z,�j p �/l. a Ee��] Date Applicant to TE NOTICE TO APPLICANT If, after making this Certificate of CITY A LcaJI'A' NOL R-0) �`6D OCCUPANT LOAD Z 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 or this permit shall be TRAILER USE GEOLOGY INSPECTION NO Spec. Knowl. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 PARKrNG effect SPACES REO'D O PROVIDED D License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE El I am exempt from the licensing requirements as I am a FROM T licensed architect or a registered professional engineer SIZE OFNO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. �� SF-t STORIES NATURE mess and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg No Date X HOME OWNER-BUILDER DECLARATION NO OF E ]STING 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- V l a-r! ness and Professions Code) NO PARKING /2-0 EJ1, 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) PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY Se v 1 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. Lendeds Address PERMIT FEE Q� I certify that I have read this application and state that the CCV77VVV above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, T6TAL FEE and hereby authorize representatives of this County to enter upon th b .rrtyr{gy(g property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SI f Permittee Date J J ?VOR KERS'COMPENSATION DECLARATION a CE 875 (11-84) MISCELLANEOUS APPLICATION CE 87 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 a--4 • ADDRESS Certified copy is hereby furnished. ADBUIDRLDIG 441._rLJV S �R. Tbh �Cl LOCALITY C ENSS G Certified copy is filed with the county building inspection LOCALITY NEAREST }� department cRoss ST. Date Applicant NEAREST T l D DISTRICT NO. RO P TYPE ROCESSED BY CROSS ST.( � T �`�r � ^ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NMAOP ' J HIGHWAY (CIRCH) 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 n SIZE OF LOT EXISTING BLDG. K 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 WEIV T—AIV \ v so as to become subject to the Workers' Compensation Laws. MAIL � OCCUPANCY G lOUP A y AD DR 638 i® \. i{ 06 �7y C7 V Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of k CITY :Uv I ,&A J Aj-V NoL , T Da 7 OCCUPANT LOAD Dr,-, 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. 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 and effect. PARKING REQ'D D PROVIDED D SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE 1 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 S I,9kNATURE iness and Professions Code) e. /� {� PRESENT USE OF BUILDING �'r 'L � FINAL APPROVAL ��0 Lic.or Reg.No. Date L• V U �� 11 n - i HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS -J1_` — i•_ 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- ill, __ ness and Professions Code) NO. PARKING --I-1- 0 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 "FIANIT486 -5,109& 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 A,5, 1 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 auth rize representatives of this County to enter TOTAL FEE on pon the a e-i enti ie pro erty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature of Perini e Date WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION {� CE 875 u I heA by affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Insure, or a':;Ttlficate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800, Lab C.) Policy No Company FOR APPLICANT TO FILL IN BUILDINGADDRESS ❑ Certified copy is hereby furnished BUILDINGL j- OCALITY ADDRESS 1 Cl ❑ Certified copy Is filed with the county building Inspection "NEAREST department LOCALITY CROSS ST Date Applicant NEAREST 7 DISTRICT NO GROLW TYPE (0 CFS ED BY CROSS ST ON3T Tv CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP/�� HIGHWAY STATE MAJOR SECOND LOCAL NO OF BLDGS NO X10 (CIRCLE) d (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 SIZE OF LOT EXISTING BLDG Cr 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 so as to become subject to the Workers' Compensation Laws MAIL n�J�'_�Dp OCCUPANCY GROUP y U1 ADDRESS C'7 ai (�Q,rsJf, - /Jlvp� Date Applicant �i-� NOTICE TO APPLICANT If, after making this Certificate of CITY NOL x —�� — OCCUPANT LOAD z 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 or this permit shall be TRAILER USE GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revokedPanic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION, 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- ness and Professions Code, and my license Is In full force and PARKING effect SPACES REQ'D D PROVIDED D License Number Lic Class 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 JIGNATURE iness and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL Lic,or Reg.No Date AV HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's Q License Law for the following reason,(Section 7031 5, Busi- NO ness and Professions Code) SP 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). PROPOSED USE OF BUILDING �\ 5 7 3,5 A CONSTRUCTION LENDING AGENCY # • • • • I hereby affirm that there Is a construction lending agency (��1 " for the performance of the work for which this permit Ise o 0 0 • • • `\ 1 z issued (Sec 3097,Civ C) Lender's Name PROPOSAD MAX OCC 1� 1 G22-86 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, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE efa�&z ,!�Xnatq&of Permit a Date