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HomeMy Public PortalAbout9657 LAS TUNAS DR_Miscellaneous__ '�I "",'ERS'COMPENSATION DECLARATION I 76M444 i c5 875(11-84) lid ISCELLANEQUS APPLICATION _.t,1 affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION or a certificate of Workers'Compensation Insurance,or tified copy thereof(Sec.3800,Lab.Q. -Company BUILDING icy No. P Y FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. I VORRSS / 6l L1i� p ILDIN fJ �f1� t) LOCALITY Certified copy is filed with the county building inspection v NEAREST department. LOCALITY 1 i •� CA lIe CROSS ST. Date Applicant EAREST -TEMPLE- E L / i' DISTRICT NO. GROUP TYPE PROCESSED BY CROSS ST. T MrL� �V CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCEI DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NOOF BLD GS. Ho.•. (CIRCLE) . (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 IZE OF LOT EXISTING BLDG, a I certify that in the performance of the work for which this ��P n�y j o permit is issued,I shall not employ any person in any manner OWNER i,/ SII' lit! IDI S' so as to become subject to the Workers' Compensation Laws. 'VV 'v OCCUPANCY GROUP Date Applicant AooREss �yf �� �jt91fQ`L� <f C/9 ootAl C=) v TEL. LV NOTICE TO APPLICANT: If, after making this Certificate of -TY L�} No. y� )y ^/�'�L OCCUPANT LOAD y Exemption, you should become subject to the Workers' z 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 ❑ ' deemed revoked. ❑ ❑ No Spec. Knowl. El LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (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. © u IYA,1 VA ( I PARKING REWD PROVIDED License Number Lie. Class 6 �� ! SPACES '}( �I �/.J- , LIMITED TIME USE Contractor Date I , • `�• DATE DATE ❑.I am exempt from.the licensing requirements as I am a licensed architect or a registered professional engineer SIZE o NO. OF FROM: To: INSPECTOR'S acting in my professional capacity (Section 7051, Bus- E STING BLDG. STORIES SI NATURE iness and Professions Code). aG '� FINAL.APPROVAL RESENT USE OF BUILDING /, &A f, Lie.or Reg.No. Date ;g9862A HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE O G o,O 8 8 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- G G o D G o G z ness and Professions Code): NO. PARKING ' ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 0 61 0--88 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY I PROPOSED USE OF BUILDINGL-A jL FUNV ITUA&I 1.a I hereby affirm that there is a constriction lending agency, for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). .N' Lender's Name \ PROPOSED MAX. OCG. Lender's Address UU I certify that I have read this application and state that the PERMIT FEE E above information is correct.I agree to comply with all County I ISSUANCE FEE ordinances and State laws relating to building construction, d hereby authorize representatives of this County to enter I TOTAL FEE *Uon t abo a-m ntio ed property for inspection purposes. ✓ q SEE REVERSE FOR EXPLANATORY LANGUAGE 0 i 'Xinaturk,4 Perm'tee Date i ri WORKERS'COMPENSATION DECLARATION CE 875(1 1-84) M I SC E L LA N E O l9 S APPLICATION ]terely affirm that I have a certificate of consent to self' insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LLII a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDIADDRESNGS (� / L45 7AJ Certified copy is hereby furnished. BUILDING /(//���� C r / . ADDRESS �� N/I/AS LOCALITY �'!�/)1 o 1 Certified Copy is filed with the county building inspection LOCALITY NEAREST !///L(ii ��/In1- 4 department. 1Z_ (/IT CROSS ST. I V 1 LL ~? IT-V 0L.L1 D . Date Applicant NEAREST ,(,1�/'r� yf �J DISTRICT NO. G UP TYPE PR�ESSED BY CROSS Sr. r1Y-"`� 1 l��• 1 y� '1 CONS'It./ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �f(v v COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SE OND LOCAL NO. OF BLDGS. NO. (CIRCLE) (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 LOT EXISTING BLDG. I a 0 permit is issued,I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL �LC)PC Jam_ I OCCUPANCY GROUP o ADDRESS /�7 ZA A4 _G� 1 EL. V Date App cant L1.7 NOTICE TO APPLICANT: If, after making this Certificate of CITY! 2ti TNO. �37 I OCCUPANT LOAD JkDExemption, you should become subject to the Workers' APPLICATION FOR IT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions oI this permit shall be TRAILER USE GEOLOGY INSPECTION , Eldeemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIOPanic Devices El N I hereby affirm that I am licensed under provisions of Chapter SAFETY PER IT ❑ (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 REq'D O PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor Date DATE OA TE FROM: TO: I am exempt from the licensing requirements as I am-a licensed architect or a registered professional engineer SIZE OF NO.OP INS PE roR s acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIG ATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date 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 1 cpf S I, as owner of the property, will do the work and the SPACES PROVIDED #4 structure is not intended or offered for sale (Section (n 7044,Business and Professions Code). o G a o D D o z CONSTRUCTION LENDING AGENCYY_ PROPOSED USE OF BUILDING OU I .1. 08-88 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 fYd above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, hereby authorize representatives of this County to enter TOTAL FEE 5,0 on the above-mentiproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignature o Permittee Date WORKERS'COMPENSATION DECLARATION I CE 875(11-84) MISCELLANE®US APPLICATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LJ a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDIG —�� /J�� ADDRENSS AS , �/7-I�� Certified copy is hereby furnished. BUILDING ADDRESS LOCALITY I Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRIT TYPE ENS S BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIG XW AY � NO. (CIRCLE) S7A7E MAJOR No.OF BLDGS. CON �LOCAL (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. CD permit is issued,I shall not employ any person in any manner OWNER =' so as to become subject to the Workers' Compensation Laws. MAIL l OCCUPANCY GROUP o ADDRESS � 44 6~.7 Date Applicant LO NOTICE TO APPLICANT: If, after making this Certificate of CITY Tg OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICA ION 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 1 DF NO. OF EXITS ness and Professions Code,and my license is in full force andpa © „e! J effect. SIiIP SS yy IV ' PARKING REq'D PROVIDED SPACES II��J License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ 1 am exempt from the licensing requirements as Iam a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: TO: INSPECTOR' acting in my professional capadity (Section 7051, Bus- EXISTING BLDG. STORIES I NATO iness and Professions Code). FINAL APPROVAL R PRESENT USE OF BUILDING 01 Lic.or Reg.,No. Date , HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE _... _ .. I hereby affirm that I am exempt from the Contractor's T-!.I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code ): NO. PARKING 9 �:.-.:::-.'..:v.::M,.1.':•.-:'..�::;:...�` .esu' B `. !i'-�'r.^!i....;=•iT-�....:�/ I, as owner of the property, will do the work and the SPACES PROVIDED �,� j':'"•`- .�•:''s:�:_ .`T' m structure is not intended or offered for sale (Section 7044,Business and Professions Code). n Aln 7? CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDIN Joc 0,5I 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 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 �J — upon the above- entioned prop rty for inspection pu oses. Q �p SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o rmittee 'Yate WORICEI,S'COMPENSATION DECLARATIONCE 875((11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self 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. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS FlCertified copy is hereby furnished. qr BUILDING LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST CAR department. CROSS ST. Date Applicant NEAREST DIS=RIDGY NO. G$pUP o gT EssER BY ROSS ST. V„fr (p1 j�(Jl CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP ..n�om/ HIGHWAY NO;�--2647 (CIRCLE) STATE MAJOR SECOND AL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SP6 CIAL 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 LOT XISTING BLDG. permit is issued, I shall not employ any person in any manner OWNER' 531 so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP m Date Applicant ADDRESS TICv NOTICE TO APPLICANT: If, after making this Certificate of CITYNOL 1 /Sq OCCUPANT LOAD a Exemption, you should become subject to the Workers' y z 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. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 r� effect. PARKING RSPACES . D = PROVIDED I I License Number Lic. 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 INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL XPRESENT USE OF-BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE �7r. •� I hereby affirm that I am exempt from the Contractor's r! License Law for the following reason (Section 7031.5, Busi- 3NCI G 3E 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 �li!1E—_! j =%iii 7044,Business and Professions Code). 85 CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ,iV17yj I hereby affirm that there is a construction lending agency Ie for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). x�✓y ���j Lender's Name / PROPOSED MAX. OCG. 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, and hereby authorize representatives of this County to enter TOTAL FEE upon:the above-mentioned property for inspection purposes. XSEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1 WORKERS'COMPENSATION DECLARATION[ CE 875(11-84) fel I,�C E L LA N EO U S APPLICATION CE 875 I hereby affirm that I 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.). BUILNG Policy No. Company FOR APP LI CANT TO FILL IN DI ' ADDRESS V7 Certified copy is hereby furnished. BU-0-s , �� ? LOCALITY ~ ❑ Certified copy is filed with the'county building inspectio LOCALITY NEAREST department. CROSS ST. Date• Applicant NEAREST DISTRICT NO. GROUP T P �7 P OC S56D BY CROSS ST. V (�j ONST.rj./ I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �J �/- COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. OF BLDGS. STATE MAJOR SECOND LOCAL NO. w� (CIRCLET (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 y SIZE OF LOT EXISTING BLDG. C I certif that in the pperformance of the work for which this permit is issued, I shrill not employ any person in any mannerOWNER =� so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL Date Applicant ADDRESS nALTtv NOTICE TO APPLICANT: If, after making this Certificate of, CITY NOL --�� � OCCUPANT LOAD O Exemption, you should become subject to the Workers' r Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be deemed revoked. TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM) ❑ )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 �' PROVIDED O License Number Lic. Class SPACES 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- EXISTING BLDG. STORIES SIG ATURB iness and Professions Code). PRESENT USE OF BUILDING _ G FINAL APPROVAL z� / Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT ANO USE AI'•t •?' '+ I hereby affirm that I am exempt from the Contractor's ACM4 'z _ License Law for the following reason (Section 7031.5, Busi- �%0 FLEE 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 '13/23/89 -7044,Business and Professions Code). ' p PROPOSED USE OF BUILDING �J += �J�• + Art a nG 1 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 1/21 p� for the performance of the work for which this permit is O U Jl issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. V Lender's Address 0 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 O u§, he above-mentioned property for inspection purposes. SEE REVERSE FOR O&LANXTORY LANGUAGE i. 01 Signature of Permittee Date