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Home My Public Portal About9574 LAS TUNAS DR_Miscellaneous__ .:ORKERS'COMPENSATION DECLARATION 76 44 (2-80) 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 ceetificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab.C) Policy No Company FOR APPLICANT TO FILL IN BUILDING i ADDRESS 1 ❑ Certified copy is hereby furnished. BUILDING �1 s �//�AS LOCALITY ADDRESS / ! ❑ Certified copy is filed with the county building inspection t NEAREST department LOCALIT ` CROSS ST Date Applicant NEAREST / I DISTRICT NO GR U TYP PROC D BY CROSS ST /'9 CON T CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J t1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK —P HIGHWAY STATE MAJOR SECON LOCAL tZ NO OF BLOGS. v1�G (CIRCLE) O (This section need not be completed if the Work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) ' USE OF �( � SIZE OF LOT EXISTING BLDG. 1 . O 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 0 so as to become subject to the Workers' Compensation Laws. /�^/ /r!/ / '(/�� O OCCUPANCY GROUP w MAIL �V /16 ✓ V!1S� �✓4� ADDRESS L/ a Date Applicant TEL Z �G NOTICE TO APPLICANT if, after making this Certificate of CITY N . � �'O� —�� OCCUPANT LOAD 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 0 GEOLOGY INSPECTION deemed revoked ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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- ness and Professions Code, and my license Is in full force and PARKING. effect. SPACES REO'D D 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 NO DF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. �OQ + STORIES SIGNATURE iness and Professions Code) PRESENT USE OF BUILDING FINAL APPROVAL i Lic.or Reg No Date it HOME OWNER-BUILDER DECLARATION NO of EXISTING BUILDINGS ON LOT AND USE #4 p p 6 8 6 @ I I hereby affirm that, I am exempt from the Contractor's 0 0 0 0 0 0 0 License Law for the following reason (Section 7031 5, Buss NO PARKING 09.24-85 Hess and Professions Code) SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intendedor offered for sale (Section 7044, Business and Professions Code) PROPOSED SE OF BUILDING It CONSTRUCTION LENDING AGENCYY ) 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 informationis co rr I agree to comply with all County ISSUANCE FEE ordinances and Stat aws relating to building construction, and by aut mIz representatives of this County to enter TOTAL FEE �� k up •Do - e oned propWy for inspect u o SEE REVERSE FOR EXPLANATORY LANGUAGE I� " Signature of�PL5fmittee Da 6 f WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION G CE 875 I hereby a cert that IJ 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 ADDRESS ! Certified copy is hereby furnished. N CE3UILDING 4145 �UrN(�S LOCALITY ADDRESS t Certified copy is filed with the county building inspection OCALITY ' �� I NEAREST. CROSS ST. GCiOVc�i2 Date Applicant NEAREST /! DISTRICT NO G OUP TYPE �/ OC ESSED BY CROSS ST. L- / O a CO NSirT CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o /Y/� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rlo NO OF BLDGS. (CIRCLE) STATE MAJOR SECOND LOCAL (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 wluch this SIZE of LOT EXISTING BLDG. O permit is issued, I shall not employ any person in any manner wNER �Q OCC i C' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP a DDR ESS � C~ Date .7 Applicant w NOTICE TO APPLICANT• If, after making this Certificate of clrY TNOI. 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 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 i effect. tu PARKING REQ'D PROVIDED License Number Lic. Class VXA ✓v SPACES 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 n NO. OF J INSPECTORS acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. ` 2�t� STORIES / SIG TORE iness and Professions Code) RESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg No. Date CLQ — HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's FJI_t- (_—s License Law for the following reason (Section 7031 5, Busi- --r a ec- nessandProfessionsCode): 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 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 I certify that I have read this apphcahon and state that the PERMIT FEE L 7Q 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 ab ve mentioned pro e for inspection pur ose _ L SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION {� CE 875 LI 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 FI LL IN BUILDING ��l Al J ADDRESS f�' Certified copy is hereby furnished. BUILDING fCq if ADDRESS ) LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST Date Applicant NEAREST DISTRICT NO GROUP ITYPEST `��RRYQ�C/E SSED BY CROSS ST. CONii B CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL_ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE AJOR SECOND LOCAL NO OF SLOGS (This section need not be completed if the work Involved TRACT NOW ON LOT USE ZONESPECIAL 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 Lor EXISTING BLDG o permit is issued, I shall not employ any person in any mannerowNER� '' so as to become subject to the Workers' Compensation Laws �j MAIL (� OCCUPANCY GROUP CD wDDREs � �O � r �C✓�U1.Y�Gr�' .L�o � Date Applicant LLI NOTICE TO APPLICANT If, after making this Certificate of CITY NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' nu4L APPL CATION 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. K owl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Dev es El 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 R SPA CES OBD D PROVIDED License Number Lic. Classug S EL Robes ��CtC LIMITED TIME USE Contractor Date �" 1 DATE DATE F] I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR S M acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code). FINAL APPROVAL Z PRESENT USE OF BUILDING Lrc.or Reg No Date /�— 4i, 1' HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 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- 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 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 S 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.represe tives of this County to enter TOTAL FEE upon the abov i ed p e y fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permitte Date WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N EO U S APPLICATION CE 875 f� I hereby affirm that I Have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION `dull 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 FICertified copy is hereby furnished BUILD DR EN.SS L .5 ,� LOCALITY C 51Dy 7 Certified copy is filed with the county building inspection LocALIr NEAREST department. &- CROSS Sr Date Applicant NEARESTDISTRICT 1N 6 U TYPE PROCE SED BY CROSS ST �V � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL t)X COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY NOOF BLDGS NO (CIRCLE) STATE MAJOR SECOND LOCAL (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 o permit is issued, I shall not employ any person in any manner OWNER 4,41, S (1a/ Q y so as to become subject to the Workers' Compensation Laws. M IL OCCUPANCY GROUP o DRESS Date Applicant L TEL' NOTICE TO APPLICANT If, after making this Certificate of clrY No. N OCCUPANT LOAD 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 ❑ GEO OGY INSPECTION ❑ No Spec. Know]. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPEEl CTION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busr SAFETY PERMIT (LIST ITEMS BELOW NO. OF EXITS ness and Professions Code, and my license is in full force and PARKING effect SPACES REO�D D PROVIDED License Number Lie. 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 INSPECTORS acting in my professional capacity (Section 7051, Bus- ISTING BLDG. STORIES SIG ATURE mess and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL ? CJ Lie.or Reg No. Date �T 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 ;201 S 5 structure is not intended or offered for sale (Section # 0 0 o e $ 8 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 0 0 0 0 0 0 o z I hereby affirm that there is a construction lending agency —a 19ae�Z77 for the performance of the work for which this permit is 0 714!88 issued(Sec 3097,Civ.Q Lender's Name PROPOSED MAX OCC Lender's Address PERMIT FEE ov I certify that I have read this application and state that the 5, \�\� above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, d hereby author" s of this County to enter TOTAL FEE r IN on the above-mentioned mpert r rnsp conn pur SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat ' WORKERS'COMPENSATION DECLARATION 76M444 M I SC E L LA N EO U S APPLICATION ~ CE 875 (11-84) I hereby �ffirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION unsure, & 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 7 ADDRESS F1Certified copy is hereby furnished. BUILDINGLOCALITYLOCALITY —f—, C C Certified copy is filed with the county building inspection LOCALITY NEAREST department. E CROSS ST. T C• V a v, Date Applicant NEAREST f DISTRICT NO. GROUPTYPE PROCESSED BY CROSS ST U• CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL NOOF SLOGS. (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. I certify that in the performance of the work for which thisa ` n o permit is issued, I shall not employ any person any manner OWNER so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP CD ADDRESS ~ Date Applicant v` I NOTICE TO APPLICANT• If, after making this Certificate of CITY CI'62 TNOL � �tip'7 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 INSPECTION E] No Spec. Known. 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 N/ �I effect. NMAC / �� PARKING SPACES REQ'D PROVIDED I • � J License Number Lie. Class t, LIMITED TIME USE Contractor Date `�In A) kas;ILDATE 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 INS9 CE 15CTORE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES �. mess and Professions Code) / PRESENT USE OF BUILDING FINAL APPROVAL G�) Lie.or Reg No Date ` / `/ NO F El t 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- !!}!11 l—I l �' 1131f� ness and Professions Code): NO. PARKING 1 �e I, as owner of the property, will do the work and the SPACES PROVIDED 1, ,b 1`�1 _f i j prf1_Iaill structure is not intended or offered for sale (Section V I 7044,Business and Professions Code). vvv 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 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 upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee I Date WORKLRS'COMPENSATIONDECLARATION 76M444 MISCE�.LANEOUS APPLICATION 1 hereby affirm that I have a certificate of consent to self CE 875 (11-84) I-' - j insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec. 3800,Lab C.). BUILDING Policy No Company FOR APPLICANT TO FILL IN ADDRESS%►�� dim � � Certified co is hereby furnished. Bu iLDING , py y XX ADDRESS /rte 7-U/ • LOCALITY Certified copy is filed with the county building inspection LOCALIT NEAREST department. yy, CROSS ST Date Applicant NEAREST DISTRICT NO. GROUP TYPE P OCESSED BY CROSS ST G CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRC Lt) STATE MAJOR SECOND LOCAL F BLDG (This section need not be completed if the work involved TRACT NOWOON LOT S USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE of SIZE OF LOT EXISTING BLDG. p I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manneXX OWNER of building9S7Y L149 T7gP4$ so as to become subject to the Workers' Compensation Laws. MAIOCCUPANCY GROUP L ADDRESS Z Date Applicant T L NOTICE TO APPLICANT If, after making this Certificate of CITY /le n' TEL. OCCUPANT LOAD Exemption, you should become subject to the Workers' A PLICATION 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. 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 Bust NO OF EXITS ness and Professions Code,and my license is in full force anix effect Name of business PARKING SPP CES REQ'D E� I PROVIDED License Number Lic. Class `� /'(FS rn (C�v� d2�STA-VLR,4,JT' LIMITED TIME USE Contractor Date OAT! GATE FROM. TO I am exempt from the licensing requirements as I am a Bus- licensed architect or a registered professional engineer SIZE OF No of— INSPECTOR'S EXISTING BLDG. STORIES nn SIGNATURE acting in my professional capacity (Section 7051, Bus- iness and Professions Code) FINAL APPROVAL Llc or Reg No Date PRESENT USE OF BUILDING HOME,OWNFR-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE 1 hereby affirm that I ant exempt from the Contractor's D IZ Licence Law for the following reason (Section 7031 5, Bust- D ness and Professions Code) NO. PARKING 1, as owner of the property, will do the work and the SPACES PROVIDED structure is not untended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED use of BUILDING 1 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 r PERMIT FEE ,- 1 certify that I have read this application and state that the x above information is correct I agree to comply with all County ISSUANCE FEE ' ordinances and State laws relating to building construction, and hereby authorize reprwiQatives of this County to enter TOTAL FEE 25.00 upo�the.�Oov, mentio ape for inspection pu os SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX Slenature of ' nnillee Date