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HomeMy Public PortalAbout9627, 9627 1/2 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION {� � CE 875 LI I 7iereby 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 cop thereof(Sec. 3800aU �.). 3 Policy No.1LQ Company IS�1 �^ 6L FOR APPLICANT TO FI LL IN BUILDING ...... Certified copy is hereby furnished. BUILDING 962 kO 'o %4 LOCALITY ADDRESS Certified copy is filed with the county building inspection LOCALITY^ NEAREST art ent. �Mn1 G G!� C7� U CROSS ST. Date Apphca NEAREST DISTRICT NO. G OUP TYPE PR CE SED BY CROSS ST. —{�� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �l COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) 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 SIZE OF LOT EXISTING BLDG. Cr- t 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 so as to become subject to the Workers' Compensation Laws. MAIL 1 '] OCCUPANCY GROUP —� C I= Date Applicant ADDRESS jrw N.�� ~ o LLTE . NOTICE TO APPLICANT: If, after making this Certificate of CITY NO `�j' 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 INSPECTIONNo❑ Spec. Knowl El deemed revoked. . LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El 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. B PARKING REQ'D PROVIDED SPACES License Number Lic. Class 717v 2 b -?CU S SAL, Af 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. OF INSPECTORE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI NATURE iness and Professions Code). FINAL APPROVAL l)_ /1 PRESENT USE OF BUILDING tt �! Lic.or Reg.No. Date � q D vN a ti 1-4 0 EE HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE J' C I hereby affirm that I am exempt from the Contractor's 77 C/ ; License Law for the following reason (Section 7031.5, Busi- 01,131313-1300 iL ness and Professions Code): NO. PARKING1 71; f'i 1, as owner of the property, will do the work and the SPACES PROVIDED 6563 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 agencyA -M O Of C 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 GO above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, r and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigubure of Permittee Date f ORK1iRS'COMPENSATION DECLARATION CE 875(11-84) 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 certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING /`/ LOCALITYADDRESS /( 7Y 1 N , ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST r department. CROSS ST. Date Applicant NEAREST DISTRICT! , OV NO. GROUP TYPE P ESSED BY CROSS ST. CONST. /• CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 7VVV�" — CO MPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (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 (5100) or less.) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. o permit is issued, I shall not employ any person in any manner 0WNER` //��L�LC.t-�Gee���rr�/� , so as to become subject to the Workers' Compensation Laws. aooREss /03J KLLLJ�y/�C.C, c�Id/ OCCUPANCY GROUP o Date Applicant LUL, NOTICE TO APPLICANT: If, after making this Certificate of CITY `�� NO. 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. Know]. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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 REQ O PROVIDED O SPACES License Number Lie. 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 slzE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES S15NATURE i iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUIL, INGS 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 u I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is (j issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address n O c� I certify that I have read this application and state that the PERMIT FEE above information is correct.1 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 i upon the above- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that 1 have a certificate of consent to sell 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. BUILDING LOCALITY ADDRESS � (-!•T.�E' ❑ Certified copy iiifiled with the county building inspection NEAREST department. LOCALITY C CROSS ST. Date Applicant NEAREST ff)) DISTRICT NO. GRO P TYPE PR CESSED BY CROSS ST. (�/✓ /� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL CJ DESCRIPTION OO. BLOCK COMPENSATION INSURANCE LT NMAP �ry HIGHWAY } HO. O 4� (CIRCLE) STATE MAJOR SECOND LOCAL tl NO. OF SLOGS. (This SCCtIOn need not be completed if the work involved TRACT NOW ON LOT USE ZONE I SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. cc I certify that in the performance of the work for which this C� O permit is issued, I shall not employ any person in any manner OWNER H so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP W ADDRESS /� 0. Date Applicant TE NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. 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. ❑ pDeviceseC. Knowl. Pani NOS ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT 1 (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. effe��. SPACES REO'D PROVIDED License Number Lic.Class LIMITED TIME USE Con*actor Date DATE DATE I am exempt from the licensing requirements as I am a FROM To. INSPECTOR'S licensed architect or a registered professional engineer slzE of No. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ESFINAL APPROVAL ENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION ON LOT AND USSEE NO. XISTIBUILDINGS I hereby affirm that I am exempt from the Contractor's =7 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED - 1, as owner of the-property, will do the work and the r r structure is not intended or offered for sale (Section a c• s e c• r _, 7044, Business and Professions Code). ROPOSED 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 inform on is correct. 1 agree to comply with all County ISSUANCE FEE ordinances d State laws elating to building construction, TOTAL FEE and re autho ' rep sent iv of this County to.enter up t b eI d pr for inspectio /rpdses. SEE REVERSE FOR EXPLANATORY LANGUAGE ature f e ittee ate �� WORKERS'COMPENSATION DECLARATION CE 875 (2-80) MISCELLANEOUS APPLICATION CE 875 e I hereby affirm that 1 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 FILL IN BUILDING ADDRESS El Certified copy is hereby furnished. io uILDIN G 1 LOCALITY ADDRESS G Certified copy is filed with the county building inspection NEAREST department. LOCALITY pro,,,. 1� CROSS ST. Date Applicant EAREST \LSI► DISTRIC NO. G OUP TYPE PROC ED BY CROSS ST. rn, CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP MIGR WAV NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NO. OF NOW ON LLOT USE ZONE SPECIAL CONDITIONS 0 l OT by the permit is for one hundred dollars ($100) or less.) USE OF Q SIZE OF LOT EXISTING BLDG. cc I certify that in the performance of the work for which this � permit is issued, I shall not employ any person in any manner WNER J� V11!' `i Woe, 1 0 so as to become subject to the Workers'Compensation Laws. AILOCCUPANCY GROUPX9_1 to S 1(0 L 7� W ADDRESS W CL Date Applicant -- o0 TEL. NOTICE TO APPLICANT: If, after making this Certificate of P CITY No. Z g 8 Q'L 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 ❑ ❑ No Spec. Knowl. deemed revoked. Panic DeVICBS LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I 4..reby 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 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. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE inessand Professions Code). FINAL APPROVAL ESENT USE OF BUILDING 0.` ��Z S /y /1 f Lic.or Reg.No. Date Gam/ HOME OWNER-BUILDER DECLARATION NO. OF ANDXISUS IL Gs 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 SPACES PROVIDED El I, as owner of the property, will do the work and the 9 7 S 4 A structure is not intended or offered for sale (Section 89 7044,Business and Professions Code). PROPOSED 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 0 2 1 4—8 3 issul:d(Sec. 3097,Civ.C.). -% rto_,�V_ 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, TOTAL FEE noorize�re&presentativeses of this County to enter .. I Q�ve for i:7ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE /I nature of Permittee Date WORKER'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I herebor afcert tate 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.). 42 Policy No. Company FOR APPLICANT TO FI L� IN BUILDING ADDRESS 1:1Certified copy is hereby furnished. u ILD I N G LOCALITY �` 5- �!'�LS ADDRESS d Certified copy is filed with the county building inspection LOCALITY n NEAREST department. �� (� C-/ !Y , cRCISS ST. Date Applicant NEAREST DISTRICT I GROUP TYPE ESSED BY CROSS ST. �� �� CONST. eka CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rvo. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be completed if the work involved TRACT NOW. ON LOT EPANCY 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 permit is issued, I shall not employ any person in any manner OWNERLIr I114so as to become subject to the Workers' Compensation Laws. MAIL GROUP o ADDRESS U Date Applicant I„ NOTICE TO APPLICANT: If, after making this Certificate of CITY�/QC� TEL. p/ 1 OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- with comply With such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ E] No Spec. Know]. 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 tarn 6 jnQj effect. PARKING REQ'D D PROVIDED D �/ SPACES License Number Lie. Class /v A S t 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. of INSPECTOR S acting in my professional capacity (Section 7051, Bus' EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL `© PRESENT USE OF BUILDING / Lic.or Reg.No. Date iii ��� FEff HOME OWNER-BUILDER DECLARATION NO. OF EXISTING UILDINGS 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- PC '/� ) (jQl —� i�1 ��,` ;''7 ness and Professions Code): NO. PARKING 1G 1 Q�y� 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 4 PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency t LLQ for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name Lender's Address PROPOSED MAX. OCC.I certify that I have read this application and state that the PERMIT FEE Q above information is correct.I agree to immply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and here authorize re reseptative of this County to enter TOTAL FEE Dv upon t a ove-ment' d ert f in pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �• Signature Permittee 0" kDjate WORKERS'COMPENSATION DECLARATION PEB75(11-84) MISCELLANEOUS APPLICATION •�• "' CE 675 • I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES ~ BLJItDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or •I a certified copy thereof(Sec.3800,Lab.Q. I Policy No. Company FOR APPLICANT TO FILL IN BAUILDING C��a 7 y DDRESS / Certified copy is hereby furnished. BUILDING y6d/ Lild l uN LOCAL- Y XX ADDRESS P/J7 Certified copy is filed with the county building inspection ' LOCALITY -70 tCpl_4- C/TyNEAkEST OSS ST. department. 3CX Date Applicant NEAREST DISTRICTy7. GROUP CONST. P GESSED BY CROSS ST. `..71•r^•CS L-(N .!/ ITYPKV 7 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 U36 ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) IU OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this. '� o permit is issued,I shanot employ any person in any manne%rr OWNER of buildin m as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP2. ADDRESS r Date Applicant o3 NOTICE TO APPLICANT: If,after making this Certificate of CITY NOL DOG 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 oI 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- ness and Professions Code,and my license is in full force an r� effect. NaS112 of business PARKING SPACES REWD 1 1 PROVIDED �• LL __JJ License Number Lic. Class IM(P .tl' 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.OF e—NSPECTUR6 131 acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIESl"11 iness and Professions Code). PRESENT USE OR BUILDING FINAL APPROVAL 1f Lic.or Reg.No. Date d HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ®® 7J `� t ON LOT AND USE 1 a 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 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.Q. Lender's Name /rr PROPOSED MAX.OCC. Lender's Address I � ' I certify that I have read this application and state that the PERMIT FEE I 1/ above information is correct.I agree to comply with all County I, ISSUANCE FEE ordinances and State laws relating to building construction, I and hereby authorize representatives of this County to enter TOTAL FEE \\ 25.09 upon the above-mentioned property for inspection purposes. !SEE REVERSE FOR-EXPLANATj RY LANGUAGE ;CX XX 1 Signature of Permittee Date