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Home My Public Portal About9664 LAS TUNAS DR_Miscellaneous__ I WORKERS'COMPENSATION DECLARATION 1 76M444 p /� �p APPLICATION.T A� ` CE 875(2-80) MISCELLANEOOS APPLICA 1 ION I hereby affiirn •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.) ! 1 Policy No. Company I FOR APPLICANT TO FILL IN Bu1LDING ❑ ADDRESS — Certified copy is'hereby furnished. tAUDDRE's I—LDIs (�� LOCALITY Certified copy is filed with the county building inspection NEAREST Jr department. LOCALITY CROSS ST. Date ApplicantEAREST DISTRICT NO. GROUP TYPE P OCESE D BY 1 CROSS ST. S 4 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL •D` 'd-0Z COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY } No. (CIRCLE)' STATE MAJOR SECOND LOCAL tl (This section need not be completed if the work involved NO. OF BLDGS. USE ZONE SPECIAL CONDITIONS V b the p TRACT NOW ON LOT y permit is for one hundred dollars ($100) or less.) USE OF I certifythat in the , SIZE OF LOT EXISTIN BLDG. tX performance of the work for which this Q permit is issued, I shall not employ any person in any manner O NER sA;;!/ U so as to become subject to the Workers' Compensation Laws. • AIL � / I , OCCUPANCY GROUP LU ) DRESS N?S I IL Date Applicant r. I Z NOTICE TO APPLICANT: If, after making this Certificate of clTv L OCCUPANT LOAD Exemption, you should become subject to the Workers' qpp IC TION 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❑ I No Spec. Knowl. ❑ deemed revoked. Panic DEVILeS ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (41ST 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. , SPdC ES RRQ'D D PROVIDED �. License Number Lic.Class s 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 I SIG NATURE iness and Professions Code). FINAL APPROVAL /r, RESENT USE OF BUILDING J% r``' Lic.or Reg.No. Date I. , i 2 HOME OWNER-BUILDER DECLARATION NO.OF rmXIS7fING BIJILDINGS `,I ON LOT AND USE I ul l� j I hereby affirm that- I am exempt from the Contractor's 7 License Law for the following reason (Section 7031.5, Busi- : I 7t r:: i ''M 7•'1_I' ness and Professions Code): NO. PARKING I I , t!�1+= - `-1 T SPACES PROVIDED I, 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). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm-that there is a construction lending agency for the performanceof the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCG. I Lender's Address (PERMIT FEE a_,;p,O V I certify that I have read this application and state that the v ; above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter �/ry n he above-me tied property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE w &--- 99 Signature R Permitt a Date • I i WORKERS'COMPENSATION DECLARATION 76 CE 875(11-84) M I SC E L LA N EO U S APPLICATION 'fl I,)xareby affirm that I have a certificate of consent to self I 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 BU AUILDING ` DDRESS Certified copy is hereby furnished. FISUILDING 0q �"0NIKK Or LOCALITY DRESS 'f" / \f /� y Q ❑ Certified copy is filed with the county building inspection LOCALITY - PC�e T/ r,�`� 9� /Q U NEAREST department. CROSS ST. / Date Applicant NEAREST `meq ,/Lj/1/ / DISTRICT IqD/ G CONIX PROCESSED BY CROSS 57. �(1Y, 4 /f i71/ IL�(J �1�,lw US `[[[��,///' iV/ (� CERTIFICATE OF EXEMPTION FROM WORKERS' TYPE LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR OND 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.) !(^y�J USE OF vjl IZE OF LOT f a yV EXISTING BLDG. a 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 O NER /(/. ) ST,*Cx1.LC� so as to become subject to the Workers' Compensation Laws. AIL d , OCCUPANCY GROUP IZa A RESS -7D r nr Date Applicant `� LLl NOTICE TO APPLICANT: If,after making this Certificate of CITY ,erg/ C'/� ®gp,oL 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 ❑ GEO OGY INSPECTION ❑ No Spec. Knowl. dedmed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY FERMI ❑ (LIST ITEMS ]BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- No, of Exlrs ness and Professions Code,and my license is in full force and effect. PARKING SPACES REQ D D PROVIDED D License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing.requirements as I am a FROM. TOC licensed architect or a registered professional engineer SIZE OF NO.OFOR S IN IP ATURE acting in my professional capacity (Section 7051, Bus- EX TING BLDG. STORIES inessand Professions Code). FINAL APPROVAL t RESENT USE OF BUILDING I / �' Lic.or Reg.No. Date PP29 oHOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS / a 7 A ON LOT AND USE I-hereby affirm that I am exempt from the Contractor's V o D o o 8 8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING O a O D 010 O z I, as owner of the property, will do the work and the SPACES PROVIDED 0 '1;11 7'71.8 8 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.C.). Lender's Name PROPOSED MAX.OCC. Lender's Address 22}} � � V 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 �ok Aieve-m7entii e' p mer inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE \ 1) Signat re of Per ' tee' Date i WORKERS'COMPENSATION DECLARATION I 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 in'Sure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). BUILDING Policy No. Company FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS NNN Certified copy is filed with the county building inspection CALISS I NEAREST department. flj 1 cRoss ST. Date Applicant NEAREST DIS TgFG'Z G U TYPE PRO E�S�SYALCROSS ST. L1�� (l/1 CONST.6CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Wk COMPENSATIONINSURANCE DESCRIPTION ILOTQJ) BLOCK MAP HIGHWAYNO. (CIRCLE) STATE MAJOR SECO x6. OF BLDGS. I (This section need not be completed if the work involved TRACT C NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100).or less.) USE of ZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this ~I p CD permit is issued, I shall not employ any person in any manner OWNER A p C , j D so as to become subject to the Workers' Compensation Laws. All, OCCUPANCY GROUP o Date Applicant A DRESS (CG 141ti b(. , I LLI NOTICE TO APPLICANT: If, after making this Certificate of CITY CA9AU � NO. U—� — 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 GE: OGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El 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. I SPACES G REQ'D D PROVIDED D License Number Lic. Class LIMITED •TIME USE Contractor Date DATE DATE FROM: TO: F1 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' XISTING BLDG. STORIES SIG TURF inessand Professions Code). . FINAL APPROVAL PRESENT USE OF BUILDING ./ Lic.or Reg.No. Date 9n 4tr6w Lp _NV 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 I, as owner of the property, will do the work and the SPACES PROVIDED z O 6 O•� A structure is not intended or offered for sale (Section 7044,Business and Professions Code). Q Q CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING °o °o °o rd F!z I hereby affirm that there is a construction lending agency 0 9,06-788 for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name PROPOSED MAX. OCG. Lender's Address PERMIT FEE �\ I certify that I have read this application and state that the U above information is correct.I agree to comply with all County ISSUANCE FEE �( ordinances and State laws relating to building'construction, and here authorize presentatives of this County to enter TbTAL. FEE Q �� n the ove-mentio d p perty or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee , QDate I V1'c'SRKERS'COMPENSATION DECLARATION CE 875 . MISCELLANEOUS A P®1 I C A T I®A 1 I. Li'eby affirm that I have a certificate of consent to self CE 875(2-80) M r L� /'1 �I t� ins ,"or a certificate of Workers'compensation insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certit4ed copy thereof(Sec.3800,Lab.C.) Policy No: Company BUILDING FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ❑ ADDRESS j Certifiedpy is filed with the county building inspection l NEAREST department. LOCALITY CROSS ST. Date \Applicant NEAREST DISTRICT GR,QUP TYPE PROC SSED BY CROSS ST. I r /{ CONST. CERTIFICATE'OF EXEMPTION FROM WORKERS' LEGAL IhTJI DESCRIPTION LOT NO. BLOCK ) STATE MAJORS OND LOCAL a COMPENSATION INSURANCE NOP (CIRCLE) } NO. OF BLD GS. (This Section need notbe completed if the work involved TRACT NOW ON LOT U�E ONE SPECIAL CONDITIONS (, by the permit is for orie hundred dollars ($100) or less.) J —lux of t V SIZE OF LOT / EXISTING BLDG. Z I certify that in the performance of the work for which this I O permit is issued, I shall not employ any person in any manner OWNER l I H so as to become subject to the Workers' Compensation Laws. MAIL y y)� ' OCCUPANCY GROUP W ADDRESS / U CL Date Applicant n I I to NOTICE TO APPLICANT: If, after making this Certificate of cITY 7QK P No� �� OCCUPANT LOAD z Exemption, you should become subject to the WorkersAPPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply With such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. ❑❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT ❑ (LIST ITEMS BELOW) I NO. OF EXITS a 9 (commencing with Section 7000)of Division 3 of the Busi- + ness and Professions Code, and my license is in full force and' IRKINGPA . effect. iSPACES REo'D PROVIDED License Number Lic.Class LIMITED TIME USE. Contractor Date y DATE DATE El 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 j J SIP NATURE iness and Professions Code). SENT USE OF BUILDING FIINAL APPROVAL ✓� Lic.or Reg.No. Date Q �� HOME OWNER-BUILDER DECLARATION O.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 SPACES PROVIDED I I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ` aD 4 9 4,G A 7044, Business and Professions Code). �/x,,\) \, # 0 0 0 0 S 8 F} OPOSED USE OF BUILDING I V V CONSTRUCTION LENDING AGENCY I o 0 0 0 0 0 o z I hereby affirm that there is a construction lending agency () 7, 2 8 6 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 1 have read this application and state that the above information is correct.I agree to comply with all-County ISSUANCE FEE ordinances :and ate laws relating to building construction, TOTAL FEE and here a orize representatives of this County to enter upo ve-mentioned o ty for inspec 'on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I 5 r ignature of Permittee Date ` I i WORKERS'CQMPENSATION DECLARATION CE 8754(11-84) MISCELLANEOUS A P P L I C A T I O N I hereby affirm that I have a certificate of consent tself I 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.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS (ice Certified copy is hereby furnished. BUILDINGLOCALITY i ADDRESS F Certified copy is filed with the county building inspection LOCALITY NEAREST department. nc CROSS ST. Date Applicant NEAREST ' Ll l DISTRICT NO. G OUP TYPE CESSED BY CROSS ST. /J CONST. CERTIFIOATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I 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 ($100) or less.) USE OF, I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. O permit is issued, I shall not employ any person in any manner I OWNER I =' so as to become subject to the Workers' Compensation Laws. MAIL ri C4 �� OCCUPANCY GROUP a ADDRESS —rLi�rS w— V Date Applicant NOTICE TO APPLICANT: If,after making this Certificate of CITY e NOL. gig) 3 .-p OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION E] No Spec. Knowl. deemed revoked. ❑ Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] hereby affirm that I am'licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS ness and Professions Code,and my license is in full force and Ljs effect. W PARKING REq'D D PROVIDED D a SPACES License Number Lic. Class ` 4P r LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or, a registered profbssional engineer SIZE OF NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, BIIS EXISTING BLDG. STORIES FINAL APPR �gy��4�;� ,.. 1c]$IATURE iness and Professions Code). n rr.- OVAL 1 /! A/n_ PRESENT USE OF BUILDING L 6l9 Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS �e q4PM i'=Fft ON LOT AND USE 11�' 'vT:I.} I hereby affirm that I am exempt from the Contractor's I' License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section i 7044,Business and Professions Code). i CONSTRUCTION LENDING AGENCY PROPOSED 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.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address 5,. 00 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 �00 upon the above-mentioned property for inspection purposes. 14_125:N rte, r� I-- SEE REVERSE FOR EXPLANATORY LANGUAGE � 3. SignatureofPermittee Date C I WORKERS'COMPENSATION DECLARATION 76M4"OPW12/90 MISCELLANEOUS APPLICATION 1 d 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 f I a certified copy thereof(Seiw 3800, Lab.C.)-- Policy .) :i•_. + FOR APPLICANT TO FILL IN I BUILDING r` Policy Na Company ..i H •• -:. BUILDIN ADDRESS ADDRESS �, •; Certified copy.is,hereby:furnished I Lps t4 LOCALITY ' Certified copy is filed with the county building inspection CITY ZIP NEAREST 4 department I IOVVI Gt v CROSS ST. Date '' Applicant SIZE OF LOT NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY 1 CONST. - a CERTIFICATE OF EXEMPTION FROM WORKERS' C COMPENSATION INSURANCE !, TRACT BLOCK LAT NO. MAP HIGHWAY (r { I No. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for.one hundred dollars (S 100) or less.) C FITaI.certify that in the performance.of the work for which this _ Cry: er TEL No. U permit is issued;I'shall not emplby'any person in arty mannADDR er e ��S�`}�— U) so as to become subject to the Workers' Compensation Laws. ESS a' OCCUPANCY GROUP ( Date Applicant . CITY ZIP NOTICE TO APPLICANT: If. after making this Certificate �u CaVY�k o� (717S D OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the.I{abor Code,you must forthwith comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ ' revoked. OCCUPANCY 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 t ) 9(commencing with Section 7000)of Division 3 of the Business Name o ns�ness and Professions Code,and my license is in full force and effect.l. + PARKING• REQ'D I PROVIDED License Number Lie Class I - SPACES eo{ I I Contractor Date LIMITED TIME USE ! ' DATE _ DATE i ❑ I am exempt from the licensing requirements as I hm a FROM: TO: licensed architect or a registered professional engineer n acting in my professional capacity(Section 7051,Business SIZE OF NO.OF `� INSPECTOR'S �•- 1 and Professions Code). I EXISTING BLDG. STORIEd SIGNATURE. Lim or Reg.No. - Date PRESENT USE OF BUILDING 'FINAL APPROVAL q7N CIII 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 I I I 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 7044.1 PROPOSED USE OF BUILDING I Business and Professions Code). 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 ' I (Sec. 3097,Civ.Q. I PROPOSED MAX.OCC { Lender's Name APPLICANT(PAINT) TEL NO. (^ tise IX-T 14 Lender's Address ADDRESS I certify that I have read this application and state that the u �' Cu CGWIorn t rt � v ( above information is correct. I agree to comply with all Cohnt y PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives.of this County to enter upon ISSUANCE FEE 41%. the above-mentioned property for inspection purposes. ,•-I • - i I:. S •I TOTAL FEE.-. O SEE REVERSE FOR EXPLANATORY LANGUAGE' Sig-nature of Permittee •Date I