The URL can be used to link to this page

Home My Public Portal About9592 LOWER AZUSA RD_Miscellaneous__ ..-I"' i WORKERS COMPENSATION DECLARATION M ISCELLANEOUS APPLICATION CE 875(11 84)875 � CE I hereby a certificate ert that I have a certificate of consent nc 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) Polic No Com an BUILDING Y P Y FOR APPLICANT TO FILL IN ADDRESS J FiCertified copy is hereby furnished BUILDING ,c )e LOCALITY 1:1 Certified copy 1S filed with the county building inspection ADDRESS J LOCALITY NEAREST department CROSS ST Date Applicant NEAREST DISTRICT NO GROU TYPECROSS ST SSED BY � CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL ' 0� 10-24 CONST % COMPENSATION INSURANCE I DB SCRIPT ION LOT NO BLOCK MAP ` ' HIGHWAY NO OF BLDGS (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONECIAL 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 i SIZE OF LOT EXISTING BLDG o permit is issued I shall not employ any person m any manner OWNER /,p puc� so as to become subject to the Workers Compensation Laws : MAIL s- 8 OCCUPANCY GROUP o Date Applicant I AD DR E88 ; NOTICE TO APPLICANT If after making this Certificate of CITY (90 TEIV 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 oI 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 PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busy NO OF EXITS ness and Professions Code and my license is m full force and effect PARKING REQ D D PROVIDED D SPACES 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 SIGNATURE mess and Professions Code) �� B � FINAL APPROVAL PRESENT USE OR BUILDING Lic or Reg No Date I F HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractors iJ�tG 6 License Law for the following reason (Section 70315 Busi I6 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) 25335A CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ! - # • • o • • I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ? • • s o • o e z issued(Sec 3097 Civ C) i Lender s Name v1 o a29-86 PROPOSED MAX OCC - Lender s Address J p PERMIT FEE 1 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 ab mentioned property for inspection purposes ---7 SEE REVERSE FOR EXPLANATORY LANGUAGE ' ignature of Permittee Date - WORKERS COMPENSATION DECLARATION CE 8764(1 1 84) M I SC E L LA N EO U S APPLICATION I herebyXfum that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION 'fl asure—or a certificate of Workers Compensation Insurance or certified copy thereof(Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN BADDRESUILDINGS r ��_ Certified copy is hereby furnished BUILDING �9 Z LOCALITY ADDRESS Certified copy 15 filed with the county building inspection LOCALITYZ� C �J NEAREST department CROs.sT Date Applicant NEAREST /J DISTRICT NO G�O�1P TYPE PRO H36D CROSS ST ✓ � R(! L COIN./T/ CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP ) .TATE MAJOR SEC D LOCAL NO (CIRCLE)NO OF SLOGS (CI (Tills 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 for which this SIZE OP LOT EXISTING BLDG at permit is issued,I shall not employ any person in any mannerOWNER OF &b61 s ba fff"( Cd ® S' so as to become subject to the Workers Compensation Laws l/y] Y // OCCUPANCY GROUP D_ MAIL ADDRESS 15gV WW�j� Zj{/ IV(,/ O Date ApplicantADDRESS w NOTICE TO APPLICANT If after making this Certificate of CITY ` NO OCCUPANT LOAD z Exemption you should become subject to the Workers App KATION 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 SAFETY PERM (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 REO D DPACES PROVIDED D SARKIN License Number Lie Class LIMITED TIME USE Contractor Date DATE DATE FROM TO ❑ I am exempt from the licensing requirements as I am a INSPECTOR 8 licensed architect or a registered professional engineer SIZE OP NO OP S MATURE acting in my professional capacity (Section 7051 Bus EXISTING BLDG .TORIES mess and Professions Code) y` R PRESENT U86 OBUILDING FINAL APPROVAL Lie or Reg No Date �7/ HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractors # • • • • 8 8 License Law for the following reason (Section 70315 Busi '• • • • • • •2 ness and Professions Code) i NO PARKING ElI as owner of the property will do the work and the SPACES PROVIDED ' Q25-88 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 T "E .SC/mOL for the performance of the work for wluch 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 above information is correct I agree to comply with all County ISSUANCE FEE , ordinances and State laws relating to building construction \'v d hereby authorize representatives of this County to enter TOTAL.FEE Ov- on;thaboveert mentioned p y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORMERS COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION CE 876 I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ms►xre, 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 Certified copy is hereby furnishedBUIDRESS LDING �� LOCALITY X AD Certified copy is filed with the county building inspection LOCALITY NEAREST department eeoss ST Date Applicant NEAREST �I'� D TRIC I ITYPE--r- PR ESS BY CROSS ST t` CONST CERTIFIIiATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR ST. OCAL NO OF NO 'CIRCUM) (This section need not be completed if the work involved TRACT NOW ONLOTS USE ZONB SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT �. �.` `EXISTING BLDG I certify that m the performance of the work for which this S u Al (�'1G1V � permit is issued I shall not employ any person many manner OWNER y so as to become subject to the Workers Compensation Laws MAIL Date Applicant OCCUPANCY GROUP � OZ ADDRESS \Tr O bu g U NOTICE TO APPLICANT If after making this Certificate of CITY �g NO OCCUPANT LOAD uJ o_ H 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 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 9 (commencing with Section 7000) of Division 3 of the Busy, NO SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS nese and Professions Code and my license is in full force ands' b F Ul ess O&AU PARKING RBq D O PROVIDED D V� Awes ( 4esi SPACES License Number Lic Class /J 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 professional engineer SIZE of No of INSPECTOR S acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES SIGNATURE mess and Professions Code) FINAL APPROVAL Lic or Reg No Date PRESENT USE OF BUILDING �""�JhCIA rV � HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDIN S r ON LOT AND USE I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Busi ness and Professions Code) NO PARKING 0000-0001 I as owner of the property will do the work and the SPACES PROVIDED 9467 1 AM 8:1i 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 (, O for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name f PROPOSED MAX OCC I Lender s Address PERMIT FEE I certify t1lat I have read this appheatio nd state that the above mformat n is correct gree to ply with all County ISSUANCE FEE I ordman a Sta ]a s r ting to udding construction and re y or e r re ntatives f this County to enter TOTAL FEE ° up t a e in Ione ro ert f r inspection p s ... SEE REVERSE FOR EXPLANATORY LANGUAGE -7 nature of Permittee Date WORKERS COMPENSATION DECLARATION Zoo x,,,2/90 MISCELLANEOUS APPLICATION i I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION • �rnsur4 or a certificate of Workers Compensation Insurance,or a certified copy thereof(Set 3800 Lab.C.) - llllll Pbhcy No. Company FOR APPLICANT TO FILL IN BUILDING i ® t BUILDING ADDRESS - ADDRESS Certified copy is hereby furnished. — /; I Certified copy is filed with the county building inspection CITYLOCALITY zIP department -Z J N��T CROSS ST Date ` Applicant SIZE OP LOT Mb OF SLOGS OW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CEKTIFICATE OF EXEMPTION FROM WORKERS CQNST a. I COMPENSATION INSURANCE TRACT BLOCK LOT NO MAP HIGHWAY V i No taRCLUI 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.) I I certify that in the performance of the work for which this � y er TEL NO permit is issued. I Shall not employ any person in any manner ' so as to become subject to the Workers Compensation Laws. ADDRESS OCCUPANCY GROUP Z Date Applicant CITY ZIP NOTICE TO APPLICANT If after making this Certificate OCCUPANT LOAD of Exemption you should become subject to the Workers APPLICATION FOR Compensation provisions of the Iabor 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) i 9(commencing with Section 7000)of Division 3 of the Business �@ 0 1><S eSs NO OF EXITS and Professions Code,dnd my license Is in full force and effect OI7 Cl PARKING REQ D O PROVIDED � License Number Lic Class SPACES i Contractor Date LIMITED TIME-USE , I I Sm exempt from the licensing requirements a5 I am a DATE DATE licensed architect or a registered professional engineer FROM TO acting in my professional capacity(Section 7051 Business SIZE OF NO OF INSPECTOR S and Professions Code) EXISTING BLDG STORIEA GNATURE. Lic or Reg.No - Date PRESENT USE OF BUILDING FINAL APPROVAL (3 OiLmk HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE 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 El I as owner of the property will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044 PROPOSED USE OF BUILDING Business and Professions Code) i CONSTRUCTION LENDING AGENCY Irild ma- 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 C) PROPOSED MAX OCC. I Lender s Name APPLICANT IFF"T) TEL NO 1- HA -8 Lender s Address ADDRESS I I certify that I have read this application and state that the 311 CALLS R1=NN0 , CAN ?IWAI,. C 1 above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction and i t jhereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. T J TOTAL FEE 1 X G —�-v„� �6 0'%EE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perinittee Date WORKERS COMPENSATION DECLARATION PE 875(11 84) M I SC E LLA N EO U S APPLICATION %E 875 i hereby affirm that 1 have certrmpof consent tself 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 BUILDING `r- cY P FOR APPLICANT TO FILL IN ADDRess v/ Certified copy is hereby furnished BUILDING 59z ZaWEQ XX. ADDR. LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department CROSS ST Date Applicant NEAREST T n SC C T �) DISTRI T NO G OUP TYPE CESSED BY CROSS ST [ Q�L C l S V i T (! ZC P CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL Q O� COMPENSATION INSURANCE DESCRIPTION LOT NO Zd� BLOCK MAP HIGHWAY No (CIRCLE) STATIC MAJOR SECOND LOCAL NO OF BLOCS (This section need not be completed If the work involved TRACT 2 4 NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) use OF I certify that in the performance of the work for which this slzE of Lor EXISTING BLDG permit is issued, I shall not employ any person in any mannekX OWNER of building ff-N J C!0 so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP tea+ o ADDRESS r" Date Applicant LLLI NOTICE TO APPLICANT If after making this Certificate of CITY BOL 2, k OCCUPANT LOAD Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth _ _ APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Busr SAFETY PERMIT [3 (LIST ITEMS BELOW) No OF EXITS ness and Professions Code and my license is in full force an effect Name of business PARKING 1r�il SPACES REq D PROVIDED LTJ License Number 6*$ ; ;3 Lic Class S t e Al LIMITED TIMEt Contractor Date ,T DATE OATH �' am exempt from the licensing requirements as I am a FROM: TD: hcensed architect or a registered professional engineer size OF No oP ( 11�� IN$PEc�q�a acting in my professional capacity (Section 7051 Bus EXISTING BLDG STORIES SjGNATIik1R mess and Professions Code) FINAL APPROVAL LIC or Reg No Date PRESENT USE OF BUILDING 6,s HOME OWNER BUILDER DECLARATION No OF EXISTING BUILDINGS no o I hereby affirm that I am exempt from the Contractors ON LOT AND USE (/ n License Law for the following reason (Section 70315 Busi ness and Professions Code) NO PARKING ,�A 1 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 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 1 certify that I have read this application and state that the PERMIT FEE 25.00 above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to budding construction and hereby authorize representatives of this County to enter TOTAL FEE 25.00 upon the above mentioned r perty for inspection purposes.XX XX_V q 1SEE REVERSE FOR EXPLANATORY LANGUAGE � Signature of Permittee Date t—