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Home My Public Portal About9667 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self ins le, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION u a certified copy thereof(Sec. 3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ pD06 DR ESS G f•�'1L' Certified copy is hereby furnished. uILDING p S �� LOCALITY �7 DRESS 7 ❑ Certified copy is filed with the county building inspection NEAREST department. LOCALITY CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP T PE PROC SED-RY CROSS ST. .(�, 'D1 ` NS's. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �/ COMPENSATION INSURANCE DESCRIPTION LOT N Zl",? BLOCK MAP ®4HIGHW A; } No. ,,CIRCLE STATE MAJOR SECOND LOCAL d (This section need not be completed if the work involved J NO. OF BL T USEIZONE SPECIAL CONDITIONS O P TRACT t NOW ON LOT by the permit is for one hundred dollars ($100) or less.) USE OF //fes SIZE OF LOT EXISTING BLDG. X I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner OWNER VS U so as to become subject to the Workers' Compensation Laws. C OCCUPANCY GROUP �� W MAIL ✓/•r^ a ADDRESS J� N Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of CITYS' �/� �o NO. `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 D@VIC@S ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (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 D 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 iness and Professions Code). FINAL APPROVAL RESENT USE OF BUILDING / r (►'�/ /' yro� Lic.or Reg.No. Date IP VVV f HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE o 5 3 4,2 A I hereby affirm that I am exempt from the Contractor's ] • • • • 4 0 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKINGrp ❑ SPACES PROVIDED • • • • • • • rp I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 0 5. 2.0—81 7044, Business and Professions Code). RovosED 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 f ! 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 information is correct. 1 agree to comply with all County ISSUANCE FEE ordinances laws relating to building construction, and e y authorir representatives of this County to enter TOTAL FEEkP u n We above- tion roperty rsp?c�yn poses. SEE REVERSE OR EXPLANATORY LANGUAGE Signature of Permittee �.]D e I WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I y reby�jacert that I have a certificate of consent nc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION irl+tllre, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) Policy No. Company - L7& G '/ FOR APPLICANT TO FILL IN BUILDING / / �} v� ADDRESS &(Ff ❑ Certified copy is hereby furnished. ILDING LOCALITY ADDESS RC s ❑ Certified copy is filed with the county building inspection wo NEAREST department. LOCALITY /� cRoss ST. Date Applicant NE qR EST rs� DIST ICT NO. GROUP TYPE PROCESSED BY OSS ST. Off/ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP Cet MIGRWAY NO. •-, (CIRCLE) STATE MAJOR SECOND LOCAL d NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS Q by the permit is for one hundred dollars ($100) or less.) USE OF / U 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 NER L so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP n_ W ADDRESS !� a Date Applicant ) to NOTICE TO APPLICANT: If, after making this Certificate of Y t/ No � / — OCCUPANT LOAD Z Exemption, you should become subject to the Workers' APPLI 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 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 �--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 effect. SPACES REQ'D E== PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a. FROM: INSPECTOR'S licensed architect or a registered professional engineer SIZE OF NO. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). RESENT 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 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). wlQT'OSED USE OF BUILDING F 4 0 S 2 A CONSTRUCTION LENDING AGENCY # o - 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. O S 1 9-82 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 las relating to building construction, TOTAL FEES andAebthorzittrepiresentatives of this County toenterupom i d pelty f inspection ur�ose . SEE REVERSE FOR EXPLANATORY LANGUAGE .0101 Sermee to I ' r WORKERS'COMPENSATION DECLARATION 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 insure,'or a certificate of Workers'Compensation Insurance, e,or a certified cc y the_eof(Sec.3800,Lab.C. Policy�p GCompany, LS �p BUILDING / j p� FOR APPLICANT TO FILL IN ADDRESS_ DR ESS �v Certrfie copy is hereby furor ed. BDDRES �j� LOCALITY i ElCertified copy is filed with the county building inspection L CALITY r G� NSARS sTr. dep rtmen�. qCROS Date 0 g�•— Wpplicant NEAREST DISTRICT�}O. GROJJJ111P J'VPE NST. PROCE§SED BY ' CROSS ST. SI �( / CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL (� ✓ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SE CO LOCAL NO. (CIRCLE) NO. OF BLD GS. (This section need not be completed if the work involved TRACT NOW ON LOT USE SPECI ZONE AL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF // IZE OF LOT EXISTING BLDG. / 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 U OWNER �•/1Qas&/)IF y so as to become subject to the Workers' Compensation Laws. MAIL [J�� /./✓J OCCUPANCY GROUP o �+` DDRESS p�lJ 1 /\� C� � I F• Date Applicant NOTICE TO APPLICANT: If,after making this Certificate of CITY& pIJ/( NO. I OCCUPANT LOAD y Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- 6, APPLICATION 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 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 PARKING effect. SPACES REq'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 P . licensed architect or a registered professional engineer SI OF NO. OF RD TO: M: INSPECTOR'S acting-in my professional capacity (Section 7051, Bus- Z/---TING BLDG. STORIES SIGNURE lnessand Professions Code). n /c �GO./ FINAL APPROVAL PRESENT USE OF BUILDING /" 4S e y G/ Lic.or Reg.No. Date /fir C HOME OWNER-BUILDER DECLARATION NO. OF EXISTING H ILDINGS 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). g. CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency � � G ��Q i 4 FEE for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). i+i0/o:� Lender's Name !]!]!l—i��:Q f Lender's Address Z7vPROPosED MAX. OCC. U� r°i(; I-MI.-z-_. 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 1 ' on the a ve- ntioned prope ty for inspection purposes. 1 a a� SEE REVERSE FOR EXPLANATORY LANGUAGE (� Parilr'e of Perhittee Date I WORKERS'COMPENSATION DECLARATION CE 875(11-Mi MISCELLANEOUS APPLICATION I hereby aftcrm 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.Q. Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS (/C/ Certified copy is hereby furnished. BUILDING / LOCALITY ADDRESS VL I� X 0 Certified copy is filed with the county building inspection V LOCALITY NEAREST department. /� CROSS ST. Date Applicant X NEAREST DISTRICT NO. GROUP TYPEP ESSED BY ! CROSS ST. • D Q q CONST., CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o �I 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 I TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS .by the permit is for one hundred dollars ($100) or less.) USE OF ///� SIZE OF LOT EXISTING BLDG. L— 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 OCCUPANCY GROUP �a a ADDRESS 1•-- Date Applicant u�l NOTICE TO APPLICANT: If, after making this Certificate of CITY ✓ To� OCCUPANT LOAD Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forth APPLICAIQN FOR EXIT HARDWARE: with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ElNo 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 NO. OF EXITS ness and Professions Code,and my license is in full force and I effect. PARKING raREQ'D PROVIDED �_ I ` BJ License Number Lic. Class ces LIMITED TIME USE Contractor Date DATE DATE FROM: TO: El I am exempt from the licensing requirements as I am a li ensed architect or a registered rofessional engineer SIZE OF No.0 F INSPECTOR'S c g P !p acting in my professional capacity (Section 7.051, Bus EXISTING BLDG.G. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL Lic.or Reg.No. Date PRESENT USE OF BUILDING HOME OWNER-BUILDER DECLARATION NO. OF RXISTINU BUILD14fis 01, dl ON LOT AND USE `I I hereby affirm that I am exempt from the Contractor's ;�-r; ; 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 X 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 1 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-mention d property for inspectio purposes. 1 SEE REVERSE FOR EXPLANATORY LANGUAGE \� vi% Signature of Permit ee Date c WORKERS'COMPENSATION DECLARATION CE 875 I (2 -80) MISCELLANEOUS APPLICATION I hereliy affirm that I have 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 , Certified copy is hereby furnished. uILDING s.' LOCALITY ADDRESS `! 1415 El Certified copy is filed with the county building inspection NEAREST department. I LocALlry d CR OSS sr. Date Applicant EAREST T-- DISTRICT NO. TYPE PRO ESSED BY I CROSS ST. GROUP CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' I LEGAL COMPENSATION INSURANCE I DESCRIPTION LOT NO. BLOCK MAP HIGHWAY } l NO. (CIRCLE) STATE MAJOR SECOND LOCAL a NO. OF BLOGS. (This Section need not be completed if the work involved I 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 for which this SIZE LOT EXISTING BLCjG. .0,«((((permit is issued, I shall not employ any person in any manner ' 0 0 so as to become subject to the Workers' Compensation Laws. AIL —. ' OCCUPANCY GROUP J/�)J� U 04JUJ ADDRESS CL Date Applicant r/) NOTICE TO APPLICANT: If, after making this Certificate of I CITY r L OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION OR 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. I ❑ No Spec. KnOWI.Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS i (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code, and my license is in full force and 4ffect. I PARKING SPACES REQ'D PROVIDED License Number Lic.Class I LIMITED TIME USE Contractor Date I DATE DATE FROM: TO: F1I am exempt from the licensing requirements as I am a licensed architect or a registered•professional engineer SIZE OF NO. OP INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). I ESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS I ON LOT AND USE 0,4R K I A-Al 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 SPACES PROVIDED • �•/' n� EJ 1, as owner of the property, will do the work and the �& /A/ # 1/6 //fI/V structure is not intended or offered for sale (Sectiony- 7044,Business and Professions Code). I1. I �� f e4 j� `f TRe e OPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCYM�� IC,4, I hereby affirm that there is a construction lending agency ��7 i L/ J�/ „/ for. the performance of the work for which this permit is p I � issued(Sec. 3097,Civ.C.). i (� Lender's Name i • PROPOSED MAX. OCC. I Lender's Address I PERMIT FEE $ 0 D � I certify that I have read this application and state that the ISSUANCE FEE I v VV I '� ° Na above information is correct.I agree to comply with all County I CA o 'D N, ordinances and State laws• relating to building construction, TOTAL FEE �i O ° o 0. cti and hereby, au � thorizpresentatives of this County to enter Q V I � upon hi bo 'elit"oned prop y for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE � Cp ° D QJ O` S46-ature o er 'tEee' Date i' NS