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HomeMy Public PortalAbout5703TEMPLE CITY BLVD_Miscellaneous (2) 11UMIM, LU\IP1.NbALIUN UtULAKAIIUN MISCELLANEOUS APPLICATION CE 875(11 841 C I hereby aAum that l hale Certificateof consent to ser COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION mstire, or a Certificate of Workers Compensation Compensation Insurance,or a certified co j - sec 380SL3p )� / [ulLn lNo Policy No mpanv TT/R+ FOR APPLICANT TO FILL IN �0 �1 wODwcas EaCertdied cap) is hereby furnished [UILDI"c �. 5703 C! U Locw Llrr ADDRcxs gi Certified copy is filed with the county budding inspection 'LOCALITY / l.. NEAR EST department cwoaa aT Date Applicant I CROSS IT �-�. (V� DlarRl Vo owgq"uP 7 cwoaa e- ✓�IV e �L(.N O G /{ COConar CERTIFICATE OF EXEMPTION FROM R'ORKERSLecwL C �d COMPENSATION INSURANCE } ocacRnn oN LOT NO Bloc% .c jcwcLsj STATE MAJOR SECOND LOCAL /-�y rv0 OF BLDaa `. m Section need not be completed 1f the work mSolved I TRACT NON oN LOT USE SOrv[ sPeelwL CONDITIONS by the permit is for one hundred dollars IS 100) or less) I uSe or 1612[ Oi LOT E%16TING BLDG 1 certif) that in the performance of the work for which this c =_ permit is issued 1 shall not emplos an) person in any manner XI Ov NeR Q,NIQ/� /wo-n- Qq m as to become subject to the INo•kers' Compensation Leas MAIL OCCU'ANCY GROUP Date Applicant NOTICE TO APPLICANT If, after making this Certificate of I CITY NOL N./ OCCUPANT LOAD -_ Exemption, )ou should become subject to the Yorkers _ Compensation pros icons of the Labor Code, sou must forth APPLICATION FOR EXIT Hr,RDWARE with comply with sucn provisions or this permit shall be ❑ a¢oLD cr INSPECTION ❑ No Spec Knowl deemed resoled TRwus+ un¢ LICENSED CONTRACTORS DECL ARATIO\ OCCOFANCV INSPKCIIONZ Panic Devices I herebs affirm .ha I am licensed under prosislons of Chapter 9 (commencing urth Section 70001 of Dwlslon 3 of the Burr SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS ness and Professlons Code and ms license is in full force and effec, I .w...IN. RCB PROV10[D 6PACE3 License Number Llc Class LIMITED TIME USE Contractor _ Dan D.T. DA TS 1 am exempt Irom ,he lt_ensulc requucmems as I am I •ADM o licensed arcnl,ce, or a registered professional _enclnecr saE c. Cl NO OF Insvc roR s T7 61 TUR[ ac,mg in ms pro essnnal capactix (Section 70Y1 BU] EX16T`1 f RLD6 ` STORIES mess ana Dre.esslons(ode) I FINAL APP OVAL / Llc or Reg Dato :PRESS I- USE OP BUILDING QC GDUYI / ! \� _ — �}C� OU o' HO`IL \ER BL,LDER DECLARATIO\ I NO De EX ISn NG BUILDINGS �OVV1 7I lVt/ ON LOT AND USE n� V�f Q O N/ L/ G'l�1�[ { Alii /'n I herebs affirm that 1 am e.emp, train the Con ractor s —-- License Law tom he Tollowme reason iSection 7031 Bus ness and Professions Carle l NO PA1 KING I as owner o' the prop.rs will do the noil and th- SPACE• PMOVIDED s,rucmrc t, no, imen&d or otfLred .or sale (SL.1101 7044 Burnes,ana Pro essluns Codes "Pope ED use of BUILD I. CO\STRI CCIO\ LENDING AGLNC \( I 1 herebs affirm ,ha, here Is a constmc,lon ILndinc agencs 11 C_ IY/vL io+ the performance of the cork lot which this permit Ic Ir ssued (Sec 3097 CI C I Ll Lender s Lame — PROPOSED MAX OCC Lender s Address 11 667 1 certd\ that I have read this application and state that the PERM + FEE Ibose information is Lorre C, I agree to comph w Ith a8 Counts I ISSUANCE FEE ardiances and State laws relating to building construction Ind herebs authorize rep-esentatwes of this Counn to enter i -OTA _FEE 5 �� Spon the abose mentioned proven, tar Inspection purposes "CL RC\"EASE FOR C\PLA\\TORI L.tNGhA(,E _ Si¢hature of Permatee Date