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Home My Public Portal About9621 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 8754(11-84) MISCELLANEOUS APPLICATION a€firm that I havea 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 l V1� 5 ADDRESS /� 'v�V Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS I Certified copy is filed with the county building inspection LOCALITY G• �' �� caoss sT. department. Date Applicant NEAREST DISTRICT NO. GROUP 7Y PE PROCESSED BY CROSS ST. ITL � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) 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 slzE OF LOT EXISTING BLDG. O permit is issued,I shall not employ any person in any manner OWNER =' so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS r-' Date Applicant -7 Z3 NOTICE TO APPLICANT: If, after making this Certificate of L. CITY -E. 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 ❑ 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 PE`MI ❑ (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 0 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- XISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL 117,1n / , f� 4� I Lic.or Reg.No. Date PRESENT USE OF BUILDING o ' ols HOME OWNER-BUILDER DECLARATION NO. OF RXISTimb BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from'the Contractor's 0000-0001 9/26/89 License Law for the following reason (Section 7031.5, Busi- ness usiness and Professions Code): , NO. PARKING 06111 1 �� e � F-1 I, as owner of the property, will do the work and the SPACES PROVIDED 5 16' 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 D for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name i PROPOSED MAX. OCC. Lender's Address O 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 relat' to building construction, and h1by auah .' e repres nta of this County to enter TOTAL FEE u o tovee r inspect urp ses. �/J : SEE REVERSE FOR EXPLANATORY LANGUAGE IMA Signatur of Permittee Dat WORKERS'('CIRIPENSAfION DECLARATION 20-UUfi" 0063DPW 12•'IJ(I MI5C:t,LLANt:.UUtP AF'1 LIC:AI IUN hereby affirm that i have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION I insure,or a certificate of Workers'Compensation Insurance.or a certified copy thereof(Sec. 3800, Lab.C.) fi Policy No.._. Company FOR APPLICANT TO FILL IN ! BUILDING - ❑ � BUILDING ADDRESS ADDRESS �� Certified copy is hereby furnished. �(oZ1 QRS T_UW 5 O(1-• I LOCALITY ! ❑ Certified copy is filed with the county building ins)Codon 'C ZIP ZIP `•1 department. \1`"eue G 1 Ty 1+B0 l CROSS ST. Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY .-----. .. - .. .- i CONST. 1 CERTIFICATE OF EXEMPTION FROM WORKL:RS' C COMPENSATION INSURANCE TRACT BLOCK LOT NO. i MAP HIGHWAY NO. ICINCLEI STATE MAJOR SECOND LOCAL (This section need not Ile completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL I USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (1+100) or less.) OWNER TEL NO. —� certify that in the performance of the work Iilr whl"eh this — 1 permit is issued. I shall not employ any person in any 4118111t'r so as to become subject to the Workers' Coin pen;aIiln� Laws. ADDRESS OCCUPANCY GROUP tI I = X. Date_ _- _ Applicant CITY ZIP NOTICE TO APPLICANT: If, alter making this C'er,ificate OCCUPANT LOAD of Exemption, you should become subject to the 1r(orkers' APPLICATION FOR 1 EXIT HARDWARE: I Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be C eemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ irevoked. .' E]OCCUPANCY INSPECTIONS I Panic Devices LICENSED*CONTR ACTORS DEC'LARAT'ION 1 hereby affirm that 1 am licensed under provision ul' Il;lt)lCr SAFETY PERMIT❑ ILIST ITEMS BELO l I 9(commencing with Section 7000)of Division 3 of the Business No.of EXITS a J I and Professions Code.and my license is in full three and effect. Q�(��LNtcSerj _ PARKING• REWD PROVIDED License Number Lie. Class 0 SPACES I I Contractor Date LIMITED TIME USE I I - DATE DATE ' El am exempt from the licensing requirements its I Tont a i FROM: TO: licensed architect or a registered professional engineer f I acting in in)' protcsslonal capacity (Section 7051, Business SIZE OF NO.OF---�—.� INSPECTOR'S I EXISrING BLDG. STORIES SIGNATURE and Pnll'cssions C'ude).: ^y' _ _ Lie.or Reg. Not. Date PRESENT USE OF BUILDING yR7�E s 1 p 1 Q I FINAL APPROVAL 011.9-01 f� HOME OWNER-11UILDER DEULARAI•ION NO.OF EXISTING BUILDINGS I ON LOT AND USE ' I hereby affirm that I ani exempt from the C'ontractor's License Law for the following reason (Section 7031.5. Business and Professions Code): NO.PARKING ' � El Las owner of the property, will tit, the 11ork ;:nSPACES PROVIDEDd the ` /l structure is Iwo intended or ol'I'cred fill sale(SeCnon 7144. PROPOSED USE OF BUILDING b"ce ST'UQ(O� �I I Business and Professions Code). I CONSTRIA"NON LENDING AGENCY i I hereby affirm that tiiere is a construction lending;14Cnc):11(11- the i1rthe performance tit' the work Air which this permit is issued 1 (Sec.3097,Civ.C.). PROPOSED MAX.OCC. . Lender's Name —_.---.___—_-_.._._.-. .. _.. _.. .. .___.. . APPLICANT(PRINT Lender's Address ___-. .. X SH'l) C 1 ZI�UL) rn�'E /' Q 1 certify that I have read this application and state mai the ADDRESS �I R „„ T(JNPVS V R_• TcA1(.e (.._(��c&. . '1 Tao above information is correct. I agree to comply with all County �1D PERMIT FEE I ordinances and State laws relating to building construction.;111d hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes.I �t•. TOTAL FEE c IX VI�vv ° ro SEE REVERSE FOR EXPLANATORY LANGUAGE j Id Signature of Permittee p;i:c i I ' �1) r • iiuK1�L►c� �u91rL'I�JrtiliV,. ui�LAi�rallUf� �ii::CEiIV8 175(11-84) IViSCELL EUS _ �LICATION I=Hereby-affirm--that--I-have-a--certificate-of consent to self----I = - - - ----- insure, or a certificate of workers'Compensation Insurance,or +, COUNTY'OF LOS ANGELES-- — -BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company Bu1LD,N'3 FOR APP ANT TO FILL IN pPORE 51 Certified copy is hereby furnished. BUILDING 2/` AD OR ESS LOCALIT. ❑ Certified copy is filed with the county building inspection LOCALITY NEAR EST department. CROSS ST. Date Applicant NEAREST DISTRICTNO. G UP TYPE PR ESSED BY CP.OSS ST. 4— F % CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL a f COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLDGS. NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT ;��ONE SPECIAL CONDITIONS by the permit is for one hundred dollars (SI00) or less.) USE OF i ,SIZE OF LOT EXISTING BLDG. ,1f 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 1 y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP E:K] oDate Applicant (ADDRESSqk�z L041 W ITEL' OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY (� NO. ern Exemption, you should become subject to the Workers' APPLI TION FOR EXITr ARDWARE: z Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be RAILER USE GEOLOGY INSPECTION ❑ deemed revoked. • IT ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT [] (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- i , NO. OF EXITS ness and Professions Code,and my license is in full force and effect. I PARKIN d ( SPACES I REQ'D D PROVIDED D License Number Lic. Class I LIMITED TIME USE Contractor Date I DATE DATE j I ❑ 1 am exempt from the licensing requirements as I am a I FROM: TO: licensed architect or a registered professional engineerSIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FIN AL,..p1PPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION !No. OF EXISTIN BUILDINGS r I� 1�� SON LOT AND USE i- /'t f I hereby affirm that I am exempt from the Contractor's { i� License Law for the following reason (Section 7031.5, Busi- I fil, ness and Professions Code): O. PARKING { sPA CES PROVIDED _ v�+.I`�VLIL13 y{ 6/93 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section f 7483 1 PH 3911 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING 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.C.). Lender's Name PROPOSED MAX. OCC. I _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 ,SSUANCE FEE ordinances and State laws relating to building construction, and hereby author' a representatives of this County to enter � rAL FEE p� upon the above-m d property for inspection purposes. / E REVERSE FOR EXPLANATORY LANGUAGE Signat a of rmittee Date «'UR(:LRS'CONfPENSATiON DECLARATION i E 875(11.841 (�l 1SC.ELLANEOUS PPLICATiON , 1 hereby affirm that i have a certificate of consent to self �` COUNTY OF LOS ANGELES $UILD{NG AND SAFETY S2IYISI(3N insure, or a certificate of Workers'Compensation Insurance,,or a certified copy thereof(Sec.3800,Lab.Q. (.om an AD ILDISS Policy No. P y FOR APPLICANT TO F1 LL IN - ADDRESS (� Certified copy-is hereby furnished. S au11;DING /a ' As Tu1VI�S 28 LOCALITY -w + otlwEss Certified copy is filed with the county building inspection, LOCALITY4� CAMELLIA T�Mp� GITy S EAREST department. aim V CR09S ST. D•ILC_ --:1pPIiCant , 'NEAREST QQ(STRICT NO. GA P TYPE r CE59E0 BY CROSS 9T. I, •�� CONST ('liR'fll'iC':>TE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NO.MPP w,cwwwY STATE MAJOR SECOND LOCAL (C1R CL6) NO. OF SLOGS. (This section need not be completed if the work involved TRACT NOW ON LOT S'E ZONEI SPfi CIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this Perriiit is issued. I shall not employ any person in any manners li— of building 6E `14 S1 EH i OCCUPANCY GROUP %I as it) become ),sub Let to the Workers' Compensation Laws. MAIL ` /µI '�■■II ADORESS 53 •'�� v` ' Uaie_— — Applicant TEL. / a OCCUPANT LOAD NOTICE rO APPLICANT: If, after making this Certificate of CITYN1011ITft No• g 8-A6—969 i•:xemption, you should become subject to the Workers' i APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply µ'1t11 melt provisions or this permit shall be I TRAILER USE C] GEOLOGY INSPECTION � No Spec. Knowl. deemed rooked. i Panic Devices CONTRACTORS DECLARATION OCCUPANCY INSPECTION � i I hereby affirin that I ata 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('ride, and my license is in full force•an� BARKING L ri'l'ed ' Xi aine of business REOD PROVIDED �PAcss Lir:•nse Ntnnhcr .--•- _ -- —• Lic. ('lass _ WC-3)3)►0 ,S—r6L,D 10 G I LIMITED TiME USE Date— ' IOATK OA TE TO: ❑ I am exempt from the licensing requirements as I am a IN SPTfi CTOR•S licensed architect or a registered professional engineer SIZE OF NO. OR SIG UR acting in illy professional capacity (Section-7051, Bus- I EXISTING BLDG. STORIES inessalid l'rofessiuns("ode). Fit1NAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. __..._ .—__ _ Date 4 Ii01NII:OWN!.R-BUILDER DECLARATION No. OF EXISTING BUILDINGS �1 -� '{i-E ON LOT AND USE I hereby affirm that I all, exempt from the Contractor's ( License I.aw fur the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING l {,, i SPACES PROVIDED t 5 1 15 FIN 4'-•1 ' I, as owner of tlne property, will do the work and the structure is not intended or offered for sale (Section ( I' 7044.Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY • I hereby affirin that there is a construction lending agency for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). i Lender's Name ____.._.------ PROPOSED MAX. OCC. i Lender's Address' _..---• _ - - • PERMIT FEE 25 .00 I certify Ilrat 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, 25-00 ' and Hereby a thoriZe repre live of this o ty`to enter TOTAL FEE ' II -upon tl h e-Iinentim d y or ins urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE i