HomeMy Public PortalAbout9611 LAS TUNAS DR_Miscellaneous__ \JVKIIbKJ �-VIYtYL',1VJH 11 Vlv LIa,LHnHl:V:v io vi•«.."- J� n� � 2 /� v J� + i( �B�B
CE 875 (11-84) 11 1bULLi�T11YL'�L b AFJi LI(,A i IUN '
I hereby affirm that [ have a certificate of eorsent to self
insure, or a certificate of Workers'Compensation lasurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
a certified copy thereof(Sec. 3800,Lab.C.). l
1 Policy No. Company FOR APPLICANT TO FILL IN ABUILDING
DDRESS
Certified copy is hereby furnished. X BUILDINGDn'
ADDRESS �'f IC LOCALITY
1 Certified copy is filed with the county building inspection / �//
department. LOCALITY Temple ity /Z�Q NEAREST
C
CROSS ST.
Date Applicant _ NEAREST /�n,t l{-j/� �f ���h DISTRICT NO. GROUP TYPE PROCESSED BY
CROSS ST. �i,,''l`P6 ^K Y( (� O CONST,
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �V ) J� S
COMPENSATION INSURANCE DESCRIPTION LOT No. U L \111 HLOCK aAa HIGHWAY
rvo. (CIRCLE) STATE MAJOR SECOND LOCAL
NO. OF BLDGS.
(This section need not be completed if the work involved TRACT I NOW ON LOT 81y USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) usE OF R17 2 00 /
SIZE OF LOT EXISTING BLDG. EZ2ggINL
I certify that in the performance of the work :`or which this
permit is issued, I shall not employ any person in any manner y OWNERLL* KQ S(�( —�—�0 y
so as to become subject to the Workers' Compen.;ation Laws. MAIL OCCUPANCY GROUP
0
<< r-
Date �bb Applicant __N-- AD DRE55 �� __
C-3
NOTICE TO APPLICANT: If, after making this "ertificate of X CITY 7pyn NE' l byb _b OCCUPANT LOAD uJ
Exemption, you should become subject to the Workers' APPL CATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code, you must forth-
1 '•Villi comply with SI1Ch DIOV1510RS Or this pCrllllt shall be TRAILER USE GEOLOGY INSPECTION No Spec. Knowl.
deemed revoked. —
LICENSED CONTRACTORS DECLAR.3TION OCCUPANCY INSPECTION$$ Panic Devices (�
I hereby affirm that I am licensed Under provlsicii-,Of Chanter SAFETY PERMIT LIST ITEMS BELC'i ') ^�
- 9 icommencmg with Section 7000) of Division - of the Busi- No. of Exlrs
ness and Professions Code, and my license is in ftal force and
effe
��•'" G�w /"1 L-K I PARKING REO"D �� PRCVID ED
i.
SPACES (
License Number . Lic. Class i ---� LIMITED TIME USE
Contractor Date _ DATE DATE
0
Z I FROM: TO:
C 1 am exempt from the licensing require ineml-s as I am a A_----{{{
i licensed architect or a registered professiU,la1 en freer SIZE OF No. of NSPECTOR'S
Z actin In my professional capacity (Section 70-1, Bus- EXISTING BLDG. +Y(CJ00 _Z�•Nw TORIES Z SIG RE
o iness and Processions Code). I�(
PRESENT USE OF BUILDING -A1 I IF1NAL APPROVAL
Lic.or Reg.No. _Date--_
) i
HOME OWNER-BUILDER DECLARATION No. of EXISTING 3UILDINGS ,
ON LCT AND USE
I hereby affirm that I am exempt from the Contractor's �� /�� I
I License Law for the followin_ reason (Section 7'J31.5, Bus.i-
Hess and Professions Code): NO. PARKING
U^ ��I,I.7{_
I, as owner of the property, will do the work and the SPACES PROVIDED 5��/� pa� �
structure is not intended or offered for _:ale (Section
i 7044,Business and Professions Code).
PROPOSED USE OF BUILDING
CONSTRUCTION LENDING AGENCI _ / /�n_
I hereby affirm that there is a construction lending agency A� (��` /71`
for the performance of the work for which tins per it is --
issued(Sec. 3097,Civ. C.).
Lender's Name _
PROPOSED MAX, OCC.
Lender's Address
' I I certify that [ have read this application and nate 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 re resentatives of this Comity to enter TOTAL, FEE 25.00
} I u thea ove-mention d operty f r inspection purpo es.
(` SEE;REVERSE FOR EXPLANATORY LANGUAGE
_ of
ignature of Permit-t, D e
WORKERSCOMPENS,1MON DECLARATIONMISCELLANEOUS APPLICATION
I -00G3L)PV)I',-U0
I her,-h%- affirm that I have a certificate of consent it) s:I:* COUNT)' OF LOS ANGELES BUILDING AND SAFETY DIVISION
insure. or a certificate of Workers'Compensation Insurance or If
a certified copy thereof (Sec. 3800. Lab. C.)
Polic.\ No. Company ;:DP, APPLICANT TO FILL IN BUILDING
ADDRESS
'Certified copy is. hertim furnished. X BUIL N ADDRESS
TmaLOCALITY
❑ Certified cope i; filed with the county building' in-specil";1 cl- ZIP NEAREST
department. utf( �/Zgr') CP SSS.7
Date Applicant NO.OF SLOGS.NOW ON LOT PROCESSED BY
PROCESSED
T'
CONST/
Q
('-ERTlFlC,,4TE OF EXEMPTION.FROM WORKERS' TRA' i BLOCt I LOT NO.
-
CUMPENSATION INSURANCE i E3 STATE P1,-.JOP SECOND LOCAL
(This section need not be completed it the %cork iu\01%(-(l A-SSESSOR'MA=BOOK P;�,GE1� =-R EL USa--ONE SPECIAL CONDITIO15
In.% the permit is for, one hundred dollars 01001 or less.1 %,r&,7—o/9-o 17 A
OWNER TEL NO
crlil'% i)mt in ilie-- .)i :h": koil. i,,�j whih proper
Y,
pc,r.l:!i I, !slued. i simll not e-nifflo, Lirv, pe!.,on in any S;h%- Ho 1c, 6 960731
sic hccon- subjelci to the ��orl "p I D D F �
J/ Tungt,z GPOUP
D:ite
C:I T)'
ZIP
N )TIr"L TO .40P-11C.-�.N'T: mil,mL, ihi� C ertj-. 'Te4note cl,+�
C 917 ED
Of
rxerliniion. %o.i Shouid btCOITC SUbieci to the Vbrkt-� z-X;T HARDV,,,AR)-E
I C 4�T 10 N F D
-)m
ntnsjiion nro%iion�of me Labor Cnde. inusi i0rilwiil-
TRAILER USE GEOLOGY IN-5PEZT;ON 2
DCZDPANZ. Panic Dev;c��
L 1, N SE I) C
_).�TK,V-TOJm:� DL U; :\R.=,T R
1 heitm that am jictns-d movisions o!� hamc— SAFETI PERMIT' LIS;T 17.EN!i�BELOW
9 70f)(,) ): ':)i-,j,iop. of the B
Llmnz. NO.OF EXITS
m\ tic...,_ 1; 111 1 U I; :Inc
C CI i
REO•v
LIMITE0 TIME U S E:
DATE
L F P T C:
INIF:
JIld P10i"'SNIOn: EXISTING BL',, STO.Ri�--
[PRESENT USE OF
N/-0"17T
IMME
ON LOT, AND L!5-- Z?ne
1
hereby affirm thai I ;ini -xtinpi from ihe Conirac!oi,. .Iren>e \�/✓��
Law :-rj.- the follmkim, reason (Seciior 7031.:-, OUSIDLS!, JI1L:
Proftssions Code): NO.PARKING
El1. as oxk,n.-, ol- (tic property. %\ill do III,- v.oik and SPACES PROVIDED <2w Sbqied RrUnci -
structure is not intended or offered for sjit (Section 70-44,.% PROPOSED USE 0-BUILDING
Business and Prof--scions Code 1. I pro V-n 0 te 1doy(d - Pe owe %,- L
VVP
CONSTRUCTION LENDING AC7,LN(')
i herch affirm that there is it construction lendim-, agenc.\ I-():
the performance of the worl: ior \0iich this pci-n-ut is issue
,'Sec. 3097Civ. C.). PROPOSED MAX.OCC.
Lendc''s Name AP- ICA NT(PRIN7• TEL N
Lerider's Address dtl!�I. (,:;17171�-Ho 1(72 �960W�
i certify that I have read this application 1/ 443 14 m Qr- :Rhiok CY,*Y 7M0
cation and stat: Ina: Hit- NORL:�s
above information is correct. I agree I(,comolN with all County PERM.—FEE
ordinances and Stale laws relaiine to huild;n2 construction.mw
hereby authorize representatives of this County In enter ii.pon ISSUANCE FEE:
the above-mentioned propt.!.\ for o, lilsf),-Clioll purposes.
TOTAL FEE
SFE REVERSL FOR f-\P: ANATOM LANGLUV.if-
r--y