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HomeMy Public PortalAbout9586 LOWER AZUSA RD_Miscellaneous__ WORKERS COMPENSATION DECLARATION CE 875(2 80) MISCELLANEOUS APPLICATION 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 TO FILL IN BUILDING ADDRESS Certified copy Is hereby furnished BUILDINGsp Ot+►tl� /� L� LOCALITY ADDRESS O t/ Certified copy is filed with the county building inspection NEAREST department LOCALITYYe ni 16 C''L CROSS ST t� Date Applicant NEAREST DISTRICT NO GROUP TYPE PROCE ED BY CROSS ST C.e / v CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY No D (CIRCLE) STATE MAJOR SECOND LOCAL DIF(This section need not be Completed if the work involved TRACT NOW ON LOT SLOGS /O USE ZONE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less) SIZE OF LOT usEXISTING BLDG IU, 4r—.2—OF V s E 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 so as to become subject to the Workers Compensation Laws MAIL 0 Ld1L OCCUPANCY GROUP U AD DRES �� W Date Applicant SD 5���o aaj or .TE NQTICE TO APPLICANT If after making this Certificate of clTr O.S A / * N0 LQ 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 C] GEOLOGY INSPECTION ONo Spec Knowl deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCYINSPECTION Pa nic Devices I hereby affirm that 1 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 Busl 1 O ness and Professions Code and my license is in full force and C f Q enC , h r e ,L•TI effect �+ PARKING REQ D PROVIDED LL License Number Lic Class T 0 V 's SPACES cy LIMITED TIME USE Contractor Date O DATE DATE aFROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SITE OF / �+v �� S of / INSPECTOR S acting in my professional capacity (Section 7051 Bus EXISTING BLDG J , STORIES (/ SIGNATURE ✓ iness and Professions Code) PRESENT USE OF BUILDING FINAL FINAL APPROVAL �( ` Lic or Reg No Date ,•` / No HOME OWNER BUILDER DECLARATION LOT AND UEXISTING BUILDINGS p n 0_/ AL 4 SE ON LO (J 0 T I hereby affirm that I am exempt from the Contractors leen— License Law for the following reason (Section 7031 5 Busi ness and Professions Code) SP PARKING SPACES PROVIDED 3-1 I as owner of the property will do the work and the @ 14 G3 A structure is not intended or offered for sale (Section 7044 Business and Professions Code) # • • • - 88 PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY � LL 1 • •'•t• • • • 2 1 hereby affirm that there is a construction lending agency est T l e for the performance of the work for which this permit is a O 1 -81 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 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 upon Ihp above mentionef property for inspection 00purpos s SEE REVERSE FOR EXPLANATORY LANGUAGE 911miture of Permittee F Date WORKERS COMPENSATION DECLARATION CE 87576M444 4(2 80) MISCELLANEOUS APPLICATION 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 TO FILL IN BUILDING -10 ADDRESS ❑ Certified copy Is hereby furnished IJ ILD ING LOCALITY ADDRESS ❑ Certified copy Is filed with the county building Inspection Q o NEAREST department OCA Y CI:Oss sTLit DW Date Applicant AREST DISTRICT NO GR P TYPE V PROCE Y ROSS STe-A /I CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL V COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP (CIRCLE) STATE MAJOR SECOND L A d NO OF BLDGS NO (CIRCLE) (This section need not be completed If the work involved TRACT NOW ON LOT USE ZONE PECIAL CONDITIONS V by the pernut is for one hundred dollars ($100) or less) USE OF C�z SIZE OF LOT EXIXI STING BLDG WJA I certify that in the performance of the work for which this 0 permit is issued I shall not employ any person in any mannerNER 5, U so as to become subject to the Workers Compensation Laws EMD OCCUPANCY GROUPE CL Date Applicant to NOTICE TO APPLICANT If after making this Certificate of NE " 2376-369Z 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 deemed revoked ❑ No Spec KnOWI ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO OF EXITS ❑ 9 (commencing with Section 7000)of Division 3 of the Bust ness and Professions Code and my license is in full force and effect PARKING SPACES REO D PROVIDED License Number Lic Class LIMITER TIME USE Contractor Date DATE DATE FROM TO F1I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OFNO OF INSPECTOR s acting in my professional capacity (Section 7051 Bus EXISTING BLDG STORIES ,?19NATURE iness and Professions Code) p NT USE OF BUILDING hu,_/J� FINAL APPROVAL Lic or Reg No Date male) -1 HOME OWNER BUILDER DECLARATION ON LO O EXISTING BUILDINGS OT AND USE I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5 Bust {S ness and Professions Code) SP PARKING ;13 9 9 9 A SPACES PROVIDED ❑ I as owner of the property will do the work and the structure is not Intended or offered for sale (Section # • • • • 8 8 7044 Business and Professions Code) r POSED USE OF BUILDING 02 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0207"';'-86 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 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 enter Upon the ab mentioned perty for inspects p rp[es SEE REVERSE FOR EXPLANATORY LANGUAGE I J d Signator Permittee 1 Dae/W /�/ WORKERS COMPENSATION DECLARATION CE 875(2 80) MISCELLANEOUS APPLICATION �hereby affirm that 1 have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION re or a certificate of Workers Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) Policy No CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished B LDiNG PFa C�lQ LOCALITY O D�tES3 Certified copy is filed with the county building inspection L C DING NEAREST department CROSS ST Date Applicant NEAREST �A JQ DISTRICT NO GROUP TYPE PRO ED BY CROSS ST /// L G cy 1 I 2 O �� CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWA; 56ND LOCAL } NO OF (CIRCE STATE MAJOR tl (Tills section need not be completed if the work involved TRACT NOW ONBI L LOT Use ZONE SPECIAL CONDITIONS V by the permit is for one hundred dollars ($100) or less) USE OF I certifythat in the SIZE OF LOT EXISTING BLDG C fr performance of the work for which this Q permit is issued I shall not employ any person in any manner OWNER G' F— so as to become subject to the Workers Compensation Laws � � /' OCCUPANCY GROUP � V Date Applicant MAD R.S. P. D. �X G(p� d /+ Q rn NOTICE TO APPLICANT If after making this Certificate of CITY(/� NOL 2. '� ZS(o -1 OCCUPANT LOAD ? Exemption you should become subject to the Workers L APPLICATION FO-A 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 N ❑ No Spec Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PER (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000)of Division 3 of the Bust 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 El FROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF,1 NO OF IN PE CTOR S acting In my professional capacity (Section 7051 Bus EXis G BLDG STORIES GNATURE mess and Professions Code) RESENT USE OF BUILDING �' o ' FINAL APPROVAL Ltc or Reg No Date HOME OWNER BUILDER DECLARATION ON LOT AND USE I hereby affirm that I am exempt from the Contractors n 7 n n License Law for the following reason (Section 7031 5 Bust Y • iR 7Rf G R B ness and Professions Code) NO PARKINGSPACES ROV106D '� 4—85 I as owner of the property will do the work and the Q 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 performance of the work for which this permit is issued(Sec 3097 Civ C) `fi Lender s Name v PROPOSED MAX OCC Lender s Address PERMIT FEE ��1✓[ I certify that I have read this application and state that the Fd 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 upon✓ aboveen ned pro r f inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ature of Permittee Date 76M44 WORKERS COMPENSATION DECLARATION CE8764(1184) - IVI'ISCELLANEOUS APPLICATION 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) Policy No Company FOR APPLICANT TO FILL IN BUILDING 4 (O ..BUILDING 29 Certified copy is hereby furnished pD DR 6SG LOCALITY de Certified copy is filed with the county building inspection LOCALITY Ng AR BST department CROs. ST Date Applicant NEARRST 1 DISTRICT NO GROUP TYPE CBS ISO BY CRO88 ST �Q CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL O � COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY NO (CIRCLET STATE MAJOR SECOND LOCAL NO OF (This section need not be completed if the work involved TRACT NOW ONBLOT 3 USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less) USE OF SIZE OF LOT EXISTING BLDG ' 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 OWNER 5� so as to become subject to the Workers Compensation Laws MAIL / OCCUPANCY GROUP -� o Date Applicant ADDRESS-j( !:3 NOTICE TO APPLICANT If after making this Certificate of CITY TEL OCCUPANT LOAD H Exemption, you should become subject to the Workersz 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 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITrJ& (LIST ITEMS BELOW) ti 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 1. ,�/i Iv`-�� PARKING REq D PROVIDED License Number Lic Class S I( // SPACES LIMITED TIME USE Contractor Date DATE DATE 0 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 SIG URE mess and Professions Code) / ��_ INAL APPROVAL t! y� Lic or Reg No Date PRESENT USE OF BUILDING A R HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS r y FE ' ON LOT AND USEAIJ �� I hereby affirm that I am exempt from the Contractor s s �� License Law for the following reason (Section 70315 Busi -mol 11/23/92 ness and Professions Code) NO PARKING ' ❑ I as owner of the property will do the work and the SPACES PROVIDED ° 1 PM 3:39 structure is not intended or offered for sale (Section 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINGf.4 lAaf/,e S 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) *--/4 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 herchy authorize representatives of this County to enter TOTAL.FEE on the a ve ment d p erty for mspecti purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur Permittee Date 1tORILLRS (-OtIPL\5aT10\ DE(L1RaT10\ E 875 1 1 861 CMISCELLANEOUS APPLICATION - CE 875 I hereb% affirm that I have a certificate of Lonsent to self insure or a Lertfticateof tinders LomvensatlonlnsurtnLe 1rr COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ' Ia a wtified Lops thereof ISeL 38111) Lan L i -- Popc. No —Comram FOR APPLICANT TO FILL IN ioowess B� E] Certified Lops 1,herein rurnisheo ■uILDINe 1LoewLIT woowsas 1 Certified .tip% is tiled utth the Duan ouildme tnsrLLtton LOCALITY --AR EBT department Temple City CROSS ST Date %vnit.ant NEAREST DtT IST.I O� OR�JP TTPE CEffED ■y CROSS ST b//J cows 1 CERTim_\TE Of E\E\IPTIO\ CROtI %(`Rr ERS 1 LEGAL ' t OMPE\S MON I\SI Z t\t L DESCIrIPT O•I LOT VO BLOCK 11rAP N111"WA. f-ATE AAJOR SECOND LOCAL t INO OF BLOGS 'e (CINCLsI (This section need not he Lomvleted if the %tint m%cilted -.AC- 1.1011 oN Lor Iu SE TONE SPEC AL CONDITIONS by the permit is for one hundred dollar IS1001 or lees i ! USE of 1 i 1 -ertif% that In he ve--nnnan.e `I Iv %+t u- %hick Its alzs of LOT ,LISTIN BL , permit I% `swed I %hall tot •mrim tn% '+C'a`st �an% minnl• O wkvw ' SO as rL1 heLomL ,111nrLt n the 'tort e•c ' ^estcrtnr, t it ot MAIL `VNER OCCUDANC 3ROUP 1 ADDR6ff I Date tpvlicastL _ NOTICC TO tPPLI('t\T It u e•-".,t,im SIL lie + $I e- - �c 1� ; 4CCUPt:N-LOa� E%emvt`c,i uu .nould hetorn ,u mec 1 hLI.L+mrensa Ion -rn isinn% 11 hL 11111`- +ue %Oil 'ntl%t Inroftway-1 C'%' 4 - - i 11tth Lntst+l tn111 .U.11 •ra`t.,nt+ III L Il, +had 1+. -NA s.3N _ZK /D3o 7E0.Or/ YQPQC-CV — lY0 $CCC \+Q'rl deemed-L +Lis — — ❑ Ll r\SGD1L0\1R%CTORS DG(LaRa'IO\ 7CCJPANC- INSPEC-10'0:0 11 Pan C GE"'C55 1 'te-eb% alhrm hit I am Itcersed undo-Pre%1 oma,( tarrL- I 9 itomn enune pith Santo 0001 of Ditmon . 11 ,Ile BUaF fAFE-,' SER MIT (LIST IT6Mf BELO Y1 nes% Ind t'-I'IeWOne C1+ 1% NO OF E,1I-s dL tnd T% ti.e,se m t Ll t1 r.e roa et1e. NA RXESNNG WHO D I �NQ JID ED SPAC = Ll.tn,r \111 thL•_ _ L,. CI l., LIMITED TIME USE (untrlLtc` _ ---- 1ni,.- -- = DATt DA-F '-y .D C I am eitempt rom )tr IL.n%inc rLareen+n • u I art I y 1 IlLenced archtlLL n• , -eziiaefeu I+Iewon-d ancln - -IZE OF VO D- INSPECTOR S Z a. In- n T% rTLI .Innd ' I. I till ENIs-147 8.242 S-9w'.r SIGNATUR Ir4E5E4- USE OF ■UILOIVO FINAL ADDROV AL , I Lit. w Ree \1, -- D, -- I 11044.OWY1 R Rl ILDER DKLVI tilt)\ YOOF EXISTING BUILDINGS \\ ON LOT AVD USE 7V/ I hereb% at,-unt that I tin L\empt Ifnm the Cnntrutor5 1 LtL.nse Lau to- the folloninL rci%on ISLLtion -11-1 • Bu I B 1100 �r nese and I'viestsions Code l ' no PARKING I as -aner of the proper,% will do `he icon and the SPACES PROVIDED 1 struc tire is not intended or offered for .de ISLumn I M44 Iiu,111L%%and PrtllLssilms(ndt t I , COt%STRLCTIO\ LENDING AGI wN 1 a PROPOSED USE OF BUILDING �t , 1 hLreb% affirm that there is a Lonstructwn lendma leek% a, I for tIlL PLI'lormanLe of the norh tot 111101 11115 permit t% totaled i SL L 309' Cit t-1 ;Q Lender s\.fine O Lender 5 address PROPOSED MAX OCC I 1 certtf% that 1 have recd this applt©tion and state that the PERMIT FBe 25. above inform ituln is Lorreut I tame to Lnmpl) with all(oulit` ISSUANCE FEE 1 ordm.fnLes and State last% relating to buddirge LonstruLtion and hereby uthortze representati5es of this Count) to enter TOTAL RNE 25.00 1 upon t e-menti tied p %for in%peLtton purpoote► � /0�J SGL Rn 1;°ItS�COR E\PLaNATORI LAVGLt tGC µ I U Signature of ' ittee Date { WORKhRb LUMYCNbAILUN Ur-t-LAKAHUN 20-0063DPW12/90 M1Za4MIL.LAN r.UUP Ae rLALIAI 10111 L hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION t alnsum or a certificate of Workers Compensation Insurance or - b� certified copy thereof(Set;. 3800 Lab.C.) , Pbhcy NaCompany_ Bul INC ADDRESS FOR APPLICANT To FILL IN BUILDING •- �� ��sa � t ADDRESS ��� 4+� I HCertified Certified copy is hereby-furnished s$�p Lp (Z &UA ep copy is filed with the county building Inspection CITY ZIP 1 I NEAREST department. TN � CROSS ST Date Applicant SIZE ONLOT NO OF BLOGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CEKTIFICATE OF EXEMPTION FROM WORKERS v vo CONST CL TRACT BLOCK LOT NO C ( ) COMPENSATION INSURANCE MAP HIGHWAY 9. (TIAs Section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL NO (CIRCLIK) STATE MAJOR SECOND LOCAL by the permit is for one hundred dollars ($100) or less.) USE ZONE SPECIAL CONDITIONS ( I I L certify that in the performance of the work for which this er er TEL NO I permit is issued I Shall not employ any erson in any manner I so as to become subject to the Work Compe sac n Laws ADDRESS OCCUPANCY GROUP Z ( I Dat '0-t -Applicant rY ZIP I Non-Wro APPLICANT [ e Ing this ertificate S' N ��03 OCCUPANT LOAD of Exemption, you should become su --t a Workers APPLICATION FOR ' Compensation provisions of the I*bor Code.you must forthwith EXIT HARDWARE comply with such provisions Or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ ' 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 Business - us ess NO OF EXITS and Professions Code and my license is In full force and effect 2;Name or PARKING REQ D � PROVIDED I License Number Lie J Class SPACES ( i I Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am aDATE DATE ' licensed architect or a registered professional engineer O1N ro acting in my professional capacity(Section 7051 Business SIZE OF NO OF INSPECTOR S (� I and Professions Code) EXISTING BLDG STORIE! SIGNATURE. i Lim or Reg.No, Date PRESENT USE OF BUILDING FINAL APPROVAL —em HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS i ON LOT AND USE ` D i I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Business and ( I Professions Code) NO PARKING I ❑ L as owner of the property will do the work and the SPACES PROVIDED LE.p structure is not intended or offered for sale(Section 7044 2 PROPOSED USE OF BUILDING Business and Professions Code) f i CONSTRUCTION LENDING AGENCY s I I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 1 i (Sec. 3097 Civ C) PROPOSED MAX OCC Lender s Name APPLICANT(FRWr TEL NO �N 6 Lender s Address A DRESS ( iI certify that I have read this application and state that the Ldp r above information is correct. I agree to comply with all County t I ordinances and State laws relating to building construction and PERMIT FEE �_ Aw,� hereby authorize representatives of this County to enter upon ISSUANCE FEE 1 the above-men oned propgfty for i - I TOTAL FEE 4 I % , '� I� OZ SEE REVERSE FOR EXPLANATORY LANGUAGE- r SjjWure oikawdflitee jDate