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HomeMy Public PortalAbout9662 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 CE 875(11-84) MISCELLANEOUS APPLICATION . I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insur.�, or a certificate of Workers'Compensation Insurance,e,or . a ciified copy thereof(Sec.3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING J G(/1'^T, ,� ADDRESS ❑ Certified copy is Hereby furnished. ADORESS LOCALITY `G ❑ Certified copy is filed with the county building inspection LOCALITY department. L-� I NEAREST CROSS ST. Date Applicant NEAREST DISTRICT N G OU YPE PROCESSED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 'IYV COMPENSATION INSURANCE DESCRIPTION LOT NO. � BLOC MAP HIGHWAY STATE MAJOR SEGO LOCAL NO. OF BLDGS. NO. (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 �/E�� SIZE OF LOT EXISTING BLDG. (j D�",•, I certify that in the performance of the work for which this o permit is issued,I shall not employ any person in any manngr OWNER 1* .O I =' so as to become subject to the Workers' Compensation Laws. MAIL o OCCUPANCY GROUP U ADDRESS O r' Date Applicant LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY ` NOL •—� i 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION I No Spec. Knowl. ❑ deemed revoked. i 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 Buri- NO. OF EXITS ness and Professions Code,and my license is in full force and �I effect. PARKING SPACES REq'D D PROVIDED �_ I ' J 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 S GNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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 1, License Law for the following reason (Section 7031.5, Busi 1 4 ness and Professions Code): NO. PARKING property, SPACfiS PROVIDED z 1 2 0.6 A I, as owner of thewill do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). #,0 0'o o 8 8 CONSTRUCTION LENDING AGENCY PROPOSED use OF BUILDING o D o 0 0,0 0 In e. a I hereby affirm that there is a construction lending agency ' 55-v _ 1 1,2-8 8 8 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 � 00 , above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, anhereby authorize representatives of this County to enter TOTAL FEE n the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date i I WORKERS'COMPENSATION DECLARATION 76M444 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 LI insure,,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Policy Na. Company FOR APPLICANT TO FILL IN BADUIDRESSLDING I,, r • Certified copy is hereby furnished. BUILDING ` LOCALITY ADDRESS. f ✓ ':� Certified copy is filed with the county building inspection OCALITY //�� NEAREST f department. ,fig; L-%� ? /7. GJ ceoss ST,.* f Date Applicant EAREST DISTRICT��'iii�{{{OOO G���QQQ UP TYPE PROC SSED BY CROSS ST. `.� '�i�J�i�• �j OV � CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ✓ o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP NO, ' L MlG HWAY STATE MAJOR SE CON LOCAL NO. OF BLDGS. (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 //n1' I certify that in the performance of the work for which this slzE of Lor EXISTING HLD G. V o permit is issued, I shall not employ any person in any mannerOWNER so as to become subject to the Workers' Compensation Laws. p MAIL 7 OCCUPANCY GROUP o ADDRESS Date Applicant LIJ NOTICE TO APPLICANT: If, after making this Certificate of CITY ��, . (-'��� TNoL / �� `(� OCCUPANT LOAD Exemption, you should become subject to the Workers' gppLICATION 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. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busi- SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING SPACES REWD D PROVIDED II��J 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 profbssional engineer I SIZE OF NO.OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SI ATURE inessandProfessionsCode). FINAL APPROVAL PRESENT USE OF BU DING (J r Lic.or Reg.No. Date �� 7r HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE ;2832 I hereby affirm that I am exempt from the Contractor's # 0 0 0 0 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING o 0.0 o D o a 7 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 1 1.1 0-87 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 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 upo •the above-mentioned property for inspection purposes. R SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION �E 875 MISCELLANEOUS APPLICATION ;r• CE 875(11-84) !� .I urrebor afcert that I have a certificate of consent tc 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.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDIADDRESNG S 66L Lal u s FiCertified copy is Hereby furnished. BUILDIIG AD DR ESs 6O? LAS •TV�Y101 S LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST + y(1 !.1yam, department. er- le Ci+ CROSS ST. Carne I f a, d- �A1A f 1 Date Applicant NEAREST �+ 1 DISTR`ICT NO. GROUP TYPE OCESSED BY CROSS ST. C'umellla oI- QUI• man �/f, (�' CONST., CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (6 ale v 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 I certify that in the performance of the work f r which this SIZE OF LOT EXISTING BLDG. permit is issued,I shall not employ any perso any manner OWNER p C- C Z O =' so as to become subject to the or rs' Co sation Laws. MAIL OCCUPANCY GROUP I Z Lt-t— ADDRESS ©� Date —Applicant ,y, NOTICE TO APPLICANT: If, after making this Certificate of CITY �OGI\ NOV T.L' Q ro j03 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. 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.( i effect. PARKIN G ^ SPACES REq'D D PROVIDED D License Number Lic. Class 14� d Ce n e , LIMITED TIME USE Contractor Date DATE DATE 0 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF n�,, No. OF FROM: TD. INSPECTOR'S acting in my professional capacity (Section 7051,-Bus- EXISTING BLDG. OW" STORIES SIG"uRE iness and Professions Code). 7 Lic.or Reg.No. Date PRESENT USE OF BUILDING 6 FINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USEf v� C.t •��l 1012,• V I I !,I?i f1�1—E3t •!r j 0t i I hereby affirm that I am exempt from the Contractor's {�• = - License Law for the following reason (Section 7031.5, Busi- ' O /, FIN�+? ! nese and Professions Code): NO. PARKING i I I, as owner of the property, will do the work and the SPACES PROVIDED 5 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING •s I Hereby affirm that there is a construction lending agency 'i-w+0 r i tri 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 r upon the above-mentioned property for inspection purposes. / ! SEE REVERSE FOR EXPLANATORY LANGUAGE c� Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) V M �S GE L LA N E O p S A P P L I C A T I®N 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. Company FOR APPLICANT TOTILL IN BUILDING F1 Certified Certified copy is hereby furnished. g,' i BUILDING a �� LOCLITY �- ADDRESS IA ❑ Certified copy is filed with the county building inspection //�7� NEARES department. LOCALITY L7_ r- CROSS ST. Date Applicant AREST �� VY DISTRICT NO. `GR UP ROCESSED BY CROSS ST. S (,'�� �� T ST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL .4-0 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK , STATE MA OR SECOND LOCAL MAP WAY } I (CIRCLE) tL . NO. CLE) (This section' need not be completed if the work involved TRACT NNOOW OF BLDGS. (CIR ON LOT USE ZONE FCIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG. �Icc I certify that in the performance of the work for which this GGGGOOss"'I O permit is issued, I shall not employ any person in any manner NER I U so as to become subject to the Workers'Compensation Laws. AIL OCCUPANCY GROUP Lli fCAADDRESSESS -+ a.Date Applicant U) TNOTICE TO APPLICANT: If, after making this Certificate ofITv No. �j I OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR I EXIT HARDWARE: with'comply with such provisions or this permit shall be TRAILER USE - GEOLOGY INSPECTION❑ I NO Spec. KnOWi. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI q (LIST ITEMS BELOW) i 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 , ING effect. PAR; SPACES REQ'D O PROVIDED License Number Lic.Class I LIMITED TIME USE i Cl�htractor Date I ( DATE DATE ai I am exempt from the licensing requirements as I am m licensed architect or a registered professional engineer I SIZE OF NO. OF FROTA: TO: INSPECTOR'S acting In my'professional capacity (Section 7051, BUS- I EXISTING BLDG. STORIES I SIGNATURE iness and Professions Code). ESENT usE of BUILDING FINAL APPROVAL Lic.or Reg.No. Date IO (a I I NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION i ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's I z 2 7. R License Law for the following reason (Section 7031.5, Busi- t� o a D o 88 ness and Professions Code): No.PARKING SP P.CES PROVIDED ❑ I, as owner of the property, will do the work and the I 0 0 0 0,0 0 o z structure is not intended or offered for sale (Section i 7044, Business and Professions Code). i orosED USE OF BUILDING o"6'1 8—8 4 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 7 above information is correct.I agree to comply with sill County I ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned property for inspect' purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE d�ar � d _91Ignature of Permittee Date