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Home My Public Portal About9666 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 7SM444 ` CE 875(2=80) MMCELLANEOUS APPLICATION I hereby affirm that 1 nate a certificate of consent to self COUNTY OF LOS ANbt L]ES- BU�ILI)ING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or I i a certified copy thereof(Sec..3800;Lab.C.) ) Policy No. Company I•. ILBUILDING. . • FOR APP�LICANTTO FL IN � .,;:.,• ADDRESS ❑"_Certified copy is'hereby furnished. 01BUILDING i'�'" I 1 ADDRESS LOCALITY F1 Certified copy is filed with the county building inspection'•. NEAREST department. . if OCALITY CROSS ST. Date Applicant EAREST DI S T,R I C T-Vq� G UP TYPE PROCESSED ROSS ST. CONST. CERTIFICATE OF.EXEMPTION FROM WORKERS' LEGAL DESCRIPTION LOT NO. BLOCK MAP HIGHWAY COMPENSATION INSURANCE I• (CIRCLE) STATE MAJOR SEC46 Local O}. N D. (This section. need not be completed if the WOIk InVO1Ved NO. OF SLOGS. TRACT • NOW ON LOT ; USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred.dollars ($100) or less.) C) USE OF SIZE OF LOT EXISTING BLDG. I �. I certify. that in the performance of the,work for which this permit is issued, I shall not employ any person,in any manner OWNER S. JCk� ! 4' so as to become subject to the Workers' Compensation Laws. TAIL 9 C U RANG��(;G R OUP- W ADDRESSe- .a Date Applicant U) TEL' OCCUPANT LOAD 2 NOTICE TO APPLICANT: If, after making this Certificate'o CIT NO. ,�) Exemption, you should become subject to the Workers APPLIC TION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth-'l with comply with such provisions or this permit shall bq TRAILER USE. GEOLOGY-INSPECTION I ,'deemed revoked. ❑ NO Spec. Knowl. ❑. • Panic Devices LICENSED CONTRACTORS.DECLARATION i OCCUPANCY INSPECTION 1 I hereby affirm that I am licensed under provisions of Chapter' SAFETY PERM I Q- (LIST ITEMS BELOW.) NO. OF EXITS 9 (commencing.with Sectioh 7000)of Division 3 of the BUSIt I 'nese and Professions Code., and my license is in full force andPAR . effect. SPACES REQ'D PROVIDED License Number Lic.Class E LIMITED TIME USE Contractor ` Date. I DATE DATE F1 _ - I _ FROM: TO: .. I am exempt from the licensing requirements as Earl a licensed architect. or a registered professional engineer SIZE OF NO. OF I, INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXIS'rfNC+ BLD 6: STORIES G A TURF iness and Professions Code). P _` FINAL APPROVAL { �Q RESENT USE OF BUILDING 1� J Lfc.or Reg.No: Date. I. iSLOTIA 10 117 SoLinat.A& • 1 NC.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ) ' ON LOT AND USE I' I-hereby affirm that- 1 am eiempt from the Contractors License Law for the following reason (Section 7031.5, Busi- ness and.Profession's Code): 1' NO..PARKING SPACES PROVIDED VVV QQ � ❑ I, as owner-of the property, will do the work and'th>e V' ;295 1.5 A structure is not intended or offered for sale (Sectioli I I w�. 1%� D o p O,8' 7044,Business and Professions Code). +V\ IUW C7 . y PROPOSED USE OF BUILDING � + CONSTRUCTION LENDING AGENCY I / ,oio o 0.0 o'o 1 I hereby affirm that there is a construction lending agencI sJ for the performance of the-work for which 'this permit is !- issued(Sec.309.7,Civ.C.). , C 0 3 Lender's Name PIROPOSED MAX. OCG. Lender's Address PERMIT FEE 6Q� �( I certify that I'have read this applicati n and state that tfie { + ♦ `�y Lam. b u above information is ct.I agree to c m,ply with all County ISSUANCE FEE ' ordinances and t ws ting to uilding construction, TOTAL FEE' d I V1 and he au repre atives this County to enter J I /I �• on ov e ioned Rr perty spection�(p�u�rpbsds. SEE REVERSE FOR EXPL INATORY LANGUAGE �/--�bl�=— � 1 Signature errhittee bate 1 i Vaffirm RS'COMPENSATION DECLARATION CE 876(11-84) MISCELLANEOL�S APPLICATION that I have a certificate o£ consent tc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION rtificate of Workers'Compensation Insurance,or Iy thereof(Sec.3800,Lab.C.). Company FOR APPLICANT TO FILL IN BUILDING �ADDRESS copy is hereby furnished. BUILDING L h 1 /1S ADDRESS �II�'7 LOCALITY L ❑ Certified copy is filed with the county building inspection LOCALITY �� 5bl-ty NEAREST department. CROSS ST. Date Applicant NEAREST F�ISTICT NLLLj�j. G U TYPE PR CESS BY CROSS ST. (/ CONSCERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK HIGHWAY STATE MAJOR SECOND LOCAL(CIRCLE) NO. OF BLDG9.(This section need not be completed if the work involved TRACT NOW ON LOT INESPECIAL CONDITIONS by the permit is Por one hundred dollars ($100) or less.) USE OF I I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. dU G lg� permit is issued,I shall not employ any person in any manner OWNER F (y y so as to become subject to the Workers' Compensation Laws. MAIL n OCCUPANCY GROUP o ADDRESS S kK/ U Date Applicant til NOTICE TO APPLICANT: If, after making this Certificate of CITY r o� �D OCCUPANT LOAD y Exemption, you should become subject to the Workers' a Compensation provisions of the Labor Code,you must forth- APPLI 'ATI N FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ • ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONVA I Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMI 9 (commencing with Section 7000) of Division 3 of the Busi- ness ❑ (LIST ITEMS BELOW) No. of Exlrs and Professions Code,and my license is in full force and x effect. W PARKING (� SPACES REq'D D PROVIDED D License Number Lia Blass u G r}; e&I 0 r"�� L ( I f6/�V�f1 M A,.9�l � 0 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 SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. f J 0 sroR..S iness and Professions Code). _-.1 FINAL APPROVAL PRESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS O FEE 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 0,000'-0001 4/+7+SLI SPACES PROVIDED I, as owner of thero erty, will do the work and the structure is not intended or offered for sale (Section i 015.1i1�3°�0 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING.(r YV^ 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 \ t,' PROPOSED MAX. OCC. Ler's Address 0PERMIT FEE 5,C�QIcfy that I have read this application and state that theaboinformatin iscorrect.Iagree to complywithall County ISSUANCE FEE ordnces and State laws relating to building construction, and hereby autho ' e representatives of this County to enter TOTAL FEE e pon the above- t' ned property fo inspection pu pos SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Permittee 15he WORKERS'COMPENSATION DECLARATION CE 8754(1 1-e4) MISCELLANEOUS APPLICATION Thereby affirm that II e a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a cels+.ificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). Policy.No. Company FOR APPLICAIrf TO FILL IN ADBUILDING DRESS IQIZ(t F Certified copy is hereby furnished. ILDING (76 6 G s -Z(,�a�S LOCALITY ✓`f j t4 ADDRESS (P Certified copy is filed with the county building inspection OCALITY /J✓/� L(j / /I / (x NEAREST �J/ M department. �� I• • 1 - f�/� CROSS ST. Ci�I Date Applicant NEAREST 1[,/I /.1�� DISTRICT NO. G UP ITYPE9SSED BY CROSS ST. �N`'/,//" /; CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY OP BLD GS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This sedion need not be completed If the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS NO. by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT EXISTING BLDG. a I certify that in the performance of the work for which this C� permit is issued, I shall not employ any person in any manner OWNS s� so as to ecome subject to the Workers' Compenlsd�al'ti/oJ/n L S. MAIL L ��n6 —/ViOCCUPANCY GROUP p� o Dat Applicant P. MCA) �/' I r ADDRESS /I V W NO E T APPLICANT: If, after making this Certificate of CITY lj AlTNo. Uld 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 ❑ ❑ No Spec. Knowl. deemed revoked. TRAILER USE GEOLOGY INSPECTION 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 Rfiq'D PROVIDED License Number Lic. Class !//� LIMITED TIME USE Contractor Date DATE DATE I am exempt from the licensing requirements as I am a PROM? TO: licensed architect or a registered profbssional engineer SIZE OF NO. OF INSPEC R•S acting in my professional capacity,(Section 7051, Bus- EXISTING BLDG. STORIES SIGN RE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING � I. L Lic.or Reg.No. Date G(lS%p�1 C )NI _ 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 i- ness and Professions Code): NO. PARKING ! ,4 F-1I, as owner of the property, will do the work and the SPACES PROVIDED 1 At.; •;a•-1 J 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 0 ��G f issued(Sec. 3097,Civ.Q. czqs e� Lender's Name U PROPOSED MAX. OCC. Lender's Address PERMIT FEE , co 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 bf this County to enter TOTAL FEE Q( upon the abov entfoned prope y for' ctio purpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I I " w � I , WORKERS*COMPENSATION DECLARATION CEMB 4i„-84) M ISCELLANEOgS APPLICATION 1 hereby affirm that 1 have a certificate of consent to self OF LOS ANGELES BUILDING AND SAFETY DIVISION insure. or a certificate'oi Workers'Compensation Insurance,or ' COUNTY a certified copy thereof(Sec.3800,Lab.C.). BUILDING �/ / / Policy No. Company I FOR APPLICANT TO FILL IN ACORKSs �O(OCO Certified copy is hereby furnished. BUILDING �� s 7liN� LOCALITY C� ADDRESS V 0 Certified copy is filed with the county building inspection �� NEAREST LOCALITY C�. CROSS ST. I department. NEAREST Datc_ --:lpplit:lnt CROSS ST. DISTRICT NO. GRO P IT.-.,.r. YPE P E59ED BY O CONST. t'1:R'i'Ii'i(':1TE OF EXEMPTION FRO%I WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. IBLO CX "'w P. ICIRC wr STATE MAJOR SECOND LOCAL NO. lilA CLi) NO. OF SLOGS. NOW ON LOT USE ZONE(SPECIAL CONDITIONS (TIAs sCCtltln need not Ile completed if the work involved TRACT ' by the permit is for one hundred dollars (S100) or less.) , IusE OR sl3E OF LOT EXISTING BLDG. C� , ! c,:rtify tilat in the performance of :he work for which *,Itis permit is issued, I shall nut employ any person in any manne w otANER Of building ;—cis 1 C�� b ) OCCUPANCY GROUP sn as dl) hctu lie <nbiec: :u the Wrtrkers Compensation Laws: MAIL �q1 C, ADDRESS �� ,dox /w+ -3 I NOTICETO APPLICANT: If,after snaking this Certificate of CITY.5eV ,4.2j No.• 6*- -9/? OCCUPANT LOAD i Exemption, you should become subject to the Workers' L ; ('Ilrttncnsltion provisions of the Labor Code. you mast forth APP (CATION =0R XIT iiARCNlAR=_ ----�� t with crimpiy wall such provisions or this permit shall be I TRAILER USE � GEOLOGY INSPECTION ,rJ' IVC Spec. Knowl. ED ,teemed revoked. I Panic Devices I I('I'NSF•U CONTRACTORS DECLARATION I OCCUPANCY INSPECTION I I hereby affirm that I ail( licensed uncle:provisions of Chapter SAFETY PERMIT [; (LIST ITEMS BELOW) No. of 'EXITS 9 Ictininiencing with Section %000) of Division 3 of the Busi- ness and Proicssion%Cade.and rtn• license is in frill force a Name OfF bUS?ileSS ,PARKINGy^' 'D ' ' PROVIDE] �I iSPACES REO'D I.::. Class _ I G9�A1,ic/Ayio't! LIM1 T ED TIME USE DA iE t Contract7,r -•--�---- •--- Ila le 0WVSOwTC nI1 R90NI TO: ! all( exempt from the licensing requirements as I am a INSPECTOR'S licensed architect or a :egiste:ed professional engineer SIZE OF NO. OF sl TORE acting in my professional Caracity (Section 7051. Bus- EXISTING BLDG. l DSO STORIES inessand Professions Cude:. FINAL APPROVAL I �/1e,q • PRESENT USE OF BUILDING � I-Ic.or Reg.V �Jo. __.. .--- -- Date ir1S/ ' /SIL a HOME OWNFR-III'll—DER DECLARATION NO. OR EXISTING BUILDINGS /f ON LOT AND USE I perch% affirm that I ant exernpt from the Contractor's I.;cense Law for the following reason (Section 7031.5, Busi- ness Anil Pro fessiv ns lode!: NO. PARKING SPACES PROVIDED 1, as owner of the property, will do the work and the i structure is not intended or offered for sale (Section t 1044.Business and Professions Code). I PROPOSED USE OF BUILDING ... ('0NS'i'iZltC`I'I(IN LENDING AGENCY - I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 5 �I issued iSec-3097,Civ.C.). _ Lender's Nalne _-__---- PROPOSED MAX. OCC. Ler deCs:Address PERMIT FEE 25.00 e � j•i I I certify that I have read this application and state that the above information is correct.1 agree to comply with all County ISSUANCE FEE :ty ordinancesId State laces relating to building construction,and ilerep5thorize representatives of this County to enter TOTAL FEE 25 ,�� - upnn t I h -InentIUllet]property RIr'nspeciion purposes. Y� iSEE REVERSE FOR EXPLANATORY LANGUAGE .r j Si Lure: � G�L