HomeMy Public PortalAbout4327TEMPLE CITY BLVD_Miscellaneous (2) k,'G R K f:RSP EN, S A'.-i'l ON -.Lll,t i 11,1'
C E 2 S
APPLICATION
I hereby affirm that I have a ccrldficate -f :on.Q;-st '_.-i
L
suze. or 3 cer, icate of Workers'Ci "C" S i31.1LD1NG :* N'.. 4;.�!��Tv DfVTSION
In ifi mp"n.11on fi,-�Su_II,.,C. OF LOS
�-certifled copy thereof I See. 3800 Lab.C.i.
Pnlicv No.-_--Company FORAP��;_:C,A .:T ILD ING
7
C%nrtifled copy is filed with the count:building ir--Y,ection
;___j 1 106& CATI K�55
Certified copy is hereby furnished. I
Xx _LIICAL:TY I/
LOC ALI
-r Y NEAREST
JIf
department. ST.
Dav_r__.—Applicant ITYPE
OISTRICT 7=,ED ey
ctytc =qN, kz0
CERTIFICATE OF EXEMPTION FRONI IVORKE11s, —- -0/ 1 a, rti
e
GIA L "A.- HIGHWAY
COMPENSATION INSURANCE H ��T,.N LOT .4, ::1"
11. (CIRCLE) STATE MAJ40R .... 1.�L.CAL
(This section need not be completed if the work z rvolved TRAM Z c T S E ZC.-4r=ISP.ECIAL. CONDITIONS
ny the permit is for one hundred dollars (SIOO) 1-c less..
I certify that in the performance of the '.cork for W- ch thir SIZE OF LOT 1 7 z:4 C, a
permit is issued. I shall not employ any person in anY nnnno,&- OWNER Of
Xx _e
so as to become subject to the Workers' Comper-ati(. Lasr OCCUPANCY GROUP
„AIL
A DDRESS
Date—Applicant
07
NOTICE TO APPLIC,1\'T: If, after making this cat, of OCCUPANT LOAD
Exemption, you should become subject to the
Compensation provisions of the Labor Code, you rru--.; �vh- J ','PR1_;CATt0N FOR W EXIT HARQWARE:
with comph with such pray iti4ons or this permit Ilail e
7I�A: R U S E !N-Sr!:ZT!C�
deemed revo,"ked. No Spec. Knowl. L_J
LICENSED CONTRACTORS X.'�L.a R"TIO OCCUPANCY 1 3 P E CT 10% Panic Devices
I hereby afflim that I am lieensed f7
9 (commencing vv-iti, Section 7001) of Dklsion or' c;e 140, OF aXITS
' ' !
:cess and Professions Code. and lwv liceme is in
ef,ec-1. IName of business -'ARKIN-
7 a C C 3 REQ'D
&0
Nil n�-cr Class
L I M I i E0 T MPI E USE
Co ntractor Da re
Tf DATE
am c%.-rnnt iron. --he v.:c:nsiniz reauirenner,7% A. TO:
ucen,ea archireci or a or lorlai SIZE: OF I.ISPECTOR'Z
acting in n\- prc-fes,;on_--I c,-,uacivv iSe;on EXISTING SLOG. .IG iiA!URE
;,.'-IAL APPROVAL
Lic.i?r Re--z.No. Da-.e
OF EXIBT,N��t B-JILDiNG:i
HOME 0W.NER-BUILDER Di i:'_IRAm ONo.N LOT AND USE C
I hereby affirm that I am exenint `,,,oin the
I.Jcensel-a-,v for the following _-e�ison Se:-tinn I
n;ss and Professions Code i: '40. PARKING
1, as owner of the pront�rzz. i,- -I,,- ri�_.i SPACES -ROVIOFiO
not -'e,
arm ture is or of,e-'d .-.)r �jie
7044.Business and Proftassicms Code I.
CONSTRUCTION I.LND[\G PROPOSED USE OF BUILDING
I ilereby affirm that there ;s a jn !,emlin- a_-7e-
for the perfornianc, of the work
issued(See. 3097,Civ.C.I.
Lender's Name PROPOSrD MAX. OCC.
Lender's Address-------------
I PERMIT FEE 25. 0
1 certify that I have read this application and state 4,1111t the
above information is correct.I agree to compiv with:;Il
County iSSUANCE FEE
ordinances and State laws relating to building cons ruction. -
and hereby authorize representatives of this County To enter I TOTAL FEE 25 . 0�O
up:�theabove-mentioned property for inspectioripploys. I
XX &V SEE REVERSE FOR EXPLANATORY LANGUAGE
ZI
Signature of Permittee Dat: