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Home My Public Portal About9624 LAS TUNAS DR_Miscellaneous__ .,WORKERS'COMPENSATION DECLARATION CE 875(1 1-84) MISCELLANEOUS APPLICATION CE 875 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. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING 1 ')y LOCALITY , A DRESS �/ ❑ Certified copy is filed with the county building inspectionNEARESr LOCALITY r department. Tbwi2leL� CROSS ST. 1 Date Applicant EAREST � P" � DISTRICT Gd/d/OI�7P TYPE PROC D BY CS {.�_L CON T ROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL u COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE) STATE MAJOR SEC D 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 SI 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 j 1( L 1 1 GIY1 �i�irl I / so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP o ADDRESS ( Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITY n G No� Z — 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 ❑ GEOLO Y 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 effect. PARKING SPACES E:=REQ'O PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: TO: El I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF 5IN IP CTOR•s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES sl wruRE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS � 7.8 A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's # ' ' e 9 8 8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ' ' ' ' ' ' z 0 I, as owner of the property, will do the work and the SPACES PROVIDED c3. 1 6-88—88 structure is not intended or offered for sale (Section 7044,Business and Professions Code). 01 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.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address U 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, . and hereby authorize representatives of this County to enter TOTAL FEE upo t above-mentioned rope for inspection purposes. 3 _, , Flo SEE REVERSE FOR EXPLANATORY LANGUAGE ?` QQ Signature of Permittee Date r WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have 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. u1LDING / /1 v� C LOCALITY ADDRESS !�/7 J ❑ Certified copy is filed with the county building inspection ` �/ C,4 71 NEAREST department. LOCALITY /' CROSS ST. Date Applicant EAREST /1�{�/t // Q/ n DISTRICT N G UP TYPEJPR SSED BY CROSS ST. /Cl//`�� I/ [�`^�/' i /'� •� CONS . CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J v COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NA' HIGHWq } NO. 7 (CIRCLE) STATE MAJOR SEC D LOCAL t1 NO. OF BLDGS. O (This SOChOn 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.) SIZE OF LOT EXISTING BLDG. USE OF Cr I certify that in the performance of the work for which this r 0 permit is issued, I shall not employ any person in any manner NER�'5rdr 14§4 JU so as to become subject to the Workers' Compensation Laws. IL ! OCCUPANCY GROUPa��] W ADDRESS / '� s D/v L, d Date Applicant to p TE NOTICE TO APPLICANT: If, after making this Certificate of clry1 /141 �� / i� NOL. � OCCUPANT LOAD Z 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 ❑ deemed revoked. ❑ No Spec. Knowl. ❑ Panic 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 effect. PARKINGSPACES REO'D O PROVIDED D License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ElI 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 SI NATURE iness and Professions Code). P FINAL APPROVAL ENT USE OF BUILDING Lic.or Reg.No. Date �l U O HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON ON LOT AND USE Y 1•f tf I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- Q 6-85 ness and Professions Code): NO. PARKING SPACES PROVIDED El 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). OSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 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,, Pp TOTAL FEE hereby authorize representatives of this County to enter he above- ntioned property for insp tionuIG� SEE REVERSE FOR EXPLANATORY LANGUAGE I re of mittee Date GG e,Yf 4t4 Zv,i t I WORKERS' COMPENSATION llECLAKA1lUN 20-0063DPW12/90 M1bUt LLANhL)US AI- VLIC:AI IVN I hereby affirm that I have a certificate of consent to self COUNTY OF LO§ 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 BUILDING ADDRESS ADDRESS ❑ Certified copy.is hereby:furnished. x Z�2 L),-;IL LOCALITY ❑ Certified copy is filed with the county building inspection CITY ZIP 1 , {, NEAREST department. C / � CROSS ST. / Date Applicant SIZE OF L T NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST, CERTIFICATE OF EXEMPTION FROM WORKERS' t I BLOCK LOT N COMPENSATION INSURANCE TRACT O. MAP HIGHWAY • No. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less.) USE ZONE SPECIAL CONDITIONS i I certify that in the performance.of the work for which this �4Zy TEL No. I permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws. ADDRESS � o OCCUPANCY GROUP , I Date pplicant CITY ZIP NOTI TO APPLICANT: If, after making this Cefificate 1 �? OCCUPANT LOAD of Exemption, you should become subject to the orkers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE: ( comply with Such provisions OC this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a t I 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS S and Professions Code,and my license is in full force and effect. Name o Bupt es! 4 L.64 PARKING• REO'DD PROVIDED D License Number Lic. Class SPACES y ( I I Contractor Date LIMITED TIME USE ❑ DATE DATE FROM:I am exempt from the licensing requirements as I am a TO: licensed architect or a registered professional engineerSIZE OF NO.OF n t acting in my professional capacity (Section 7051,Business EXISTING BLDG. STORIES INSPECTOR'S TOR'S and Professions Code). Lic or Reg. No. Date PRESENT USE OF BUILDING FINAL APPROVAL 9 v� 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, Business and ( Professions Code): NO.PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING £ f P Business and Professions Code). t I CONSTRUCTION LENDING AGENCY 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.). PROPOSED MAX.OCG Lender's Name APPLICA T(PRINT) TEL NO. a- Lender's Address ADDRESS t I certify that I have read this application and state that the above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and - hereby authorize representatives of this County to enter upon ISSUANCE FEE f I S' the above-mentioned property for ction purposes. I `. TOTAL FEE O - X ��$ 1 ra �- SEE REVERSE FOR EXPLANATORY LANGUAGE Ri Signature of Permittee Date L WORKERS' CUMYhMA11U(V UCt.LAKtk11U1V 20-0063DPWt2/90 IYl l L.C.LLH11l C:V V H i�i�L1�-'t'►i i V l ti 1 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.) - FOR APPLICANT TO FILL IN BUILDING Policy NO. _ Company BUILDING ADDRESS ADDRESS i ❑ Certified copy.is hereby:furnished. X96ZI F . 1-4-S U LOCALITY ❑ Certified copy is filed with the county building inspection CITY ;j zlPq� NEAREST, department. // CROSS ST. r,' SIZE O LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY Date :' � Applicant � - CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' 2 �D O N TRACT BLOCK LOT NO. MAP HIGHWAY V COMPENSATION INSURANCE NO. ,CIRCLE, STATE MAJOR SECOND LOCAL.. (This SCCtIOn need not be completed if the work involved gSSESSOR MAP BOOK PAGE PARCEL USE ZONE =SPECIALDITIONS by the permit is for one hundred dollars ($100) or less.) v rpi�rfy er TEL NO. V L certify that in the performance.of the work for which this U L Z O6-26-44-f-./ /3 UJ permit is issued.I shall not employ any person in any in ADDRESS tL l so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP to ? 2 LoL Date Applicant . uA 1 zIP NOTICE TO APPLICANT: If, after making this Certificate t / O� 7 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.you must forthwith comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Know[. ❑ revoked. ElOCCUPANCY INSPECTION[ Panic Devices LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions Of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) NO.OF EXITS a 9(commencing with Section 7000)of Division 3 of the Business game o usliiess and Professions Code,and my license is in full force and effect. n/ PARKING rI�' PROVIDED SPACES License Number Lic. Class LL��J I LIMITED TIME USE Contractor Date DATE - DATE 1 ❑ I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer INSPECTOR'S actin in my professional capacity (Section 7051,Business SIZE OF NO-OF g EXISTING BLDG. Z Div STORIES SIGNATURE, and Professions Code). 1 - Date PRESENT USE OF BUILDING FINAL APPROVAL Lic. or Reg. No. — 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, Business and Professions Code): NO,PARKING SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING i Business and Professions Code). Li R =T/ i L S To 7�� i CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued PROPOSED MAX.OCC. (Sec. 3097, Civ.Q. i Lender's Name APPLICANT(PRINT) TEL NO. Gt t L14 626-261-3f8 Lender's Address ADDRESS __ I certify that I have read this application and state that the 83 C L'r7 I/=1. N I ( l ER CSI above information is correct. I agree to comply with all County PERMIT FEE .._ ... - .. ordinances and State laws relating to building construction,and . I hereby authorize representatives.of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. -- t '1 TOTAL FEE X SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date