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Home My Public Portal About5724 CLOVERLY AVE_Miscellaneous__ WO,?,IC RS'COMPENSATIONDECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION • a CE 875 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 copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished BUILDING Cl,ov�lZt �� ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY department --reL-G G I�y CROSS sT Date Applicant CNEAREST ROSS ST L� AS D DIST C Gq�i CONST IPRq�713BY CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL NO V K COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SE ND LOCAL NO (CIRCLE) (This section need not be completed if the work involved TRACT NOWOF BLDGS ON LOT USE ZO E 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 OF LOT EXISTING BLDG permit is issued, I shall not employ any person in any manner OWNER E 1.l �E VEA.�S so as to become subject to the Workers' Compensation Laws MAIL _ OCCUPANCY GROUP . �j o AD DR HSS ��a, 1(, L� L, V`6 _ �J _ U Date Applicant LLi TE NOTICE TO APPLICANT If, after making this Certificate of CITY—rem L,6� LI r_ NOL OCCUPANT LOAD N 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 EJ ❑ 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 Busi SAFETY PERMIT E] (LIST ITEMS BELOW) NO OF EXITS ness and Professions Code,and my license is in full force and RE LE Olaf T effect PARKING REQ D PROVIDED ��}} License Number Lie Class eAA (Eb 'r0 Q0SPACES 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 SI NATURE mess and Professions Code) _ PRESENT USE OF BUILDING FINAL APPROVAL Lie 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 ❑ 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) IJ51 l� � � .!Lt CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING -- I hereby affirm that there is a construction lending agency 1 1(EiR_, for the performance of the work for which this permit is I issued(Sec 3097,Civ C) F I-'I AL " '— Lender's Name {_ -I 1.50 HEV 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 �_C ordinances and State laws relating to building construction, 1��il?j(_� {`ry j� j, elft/C_ and hereby authorize representatives of this County to enter TOTAL, FEE upon the above-mentioned property for inspection purposes P111-4'.U-t SEE REVERSE FOR EXPLANATORY LANGUAGE QvgAmg i- a4 89 Signature of Permittee Date _ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT • DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 9912060002 BUILDING ANO SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGALCONST NEW BUILDING ADDRESS TR 6561 LT 699 SQ FT STORIES TYPE OCCUP GROUP 5724 CLOVERLY AV STRUCTURE 395 1 VN R3 TEMP CA 917802551 ASSESSOR INFORMATION NEAREST CROSS STREET 8587-011-022 EXIST BLDG USE THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY EXIST OCC GRP R3 USE ZONE R-1 ENA ISSUED ON PROCESSED BY EXPIRES 0 B DGS NOW ON LOTVAL A FION 12/14/99 UT 06/11/00 2 0 OWNER TEL NO FINAL D E FINAL BY CqD E CHEUNG,CHIU P (626) 286-3098- LISTTE /� 5724 CLOVERLY AV ` TEMP 917802551 D I T NOFWORK INSPECTION OF 395 SQ FT AT REAR OF GARAGE (STORAG ) OCCUP LOAD EXIST APPLICANT L NO OCCUP LOAD NEW SAME AS OWNER - PARKING SPACES REQUIRED. SPECIAL CONDITIONS PARKING SPACES'PROVIDED EXIT HARDWARE EL�`� co � CONTRACTOR TEL NO /�/z � LIMITED TIME USE SAME AS OWNER LIC NO ,NBR///OF EXIT ; FROM TO I �� FEES PAID p/rF��SCRIPTION QUANTITY UOM AMOUNT APPROVALS DATE INSPECTOR SIGNATURE ARCHITECT OR _ NEER T NO �ITRAILER OA PERMIT ISSUANCE 27 75 LIC NO 01 R/M-OCC-/USE INSPECT 1111111 145 95 SAFETY PERMIT TOTAL FEES 173 70 TERT—STRUCT APPROVED MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP �U pD L �� n n�]�n(�/� S:) TEMP STRUCT REMOVED 150H265 \w//v FL��uS �Li�\� 0 OF FAMILIES DWELLING UNITS APT/—c—ON—D--A7 CLASS NO � O 0 '1� � I SCHOOL THIN HAZARDOUS @ O 0 *, AIR QUALITY 1000 FEET MATERIALS A 0 ® ®� NO NO NO REQUIRED TOTAL SETBACK FROM EXIST 46� I0 SET BACK YARD HWY PROP LINE WIDTH FRONT PL- ServiCifIthl�� SIDE PL- REPORT ID DPR267 ROUTE TO BS0508 COUNTY OF LOS A:GELES TEPIPLE CITY # 0508 MISCELLA^i5:ul PERMIT DEPARTMENT OF PUBLIC, ;WORKS 9701 LAS TUNAS MP 0508 C:40S++290001 BUILDING AND SAFETY / L.A.14" DEVELOPMENT "EPPLE CITY CA 9178" PHONE: (626) 285-0,0:.' L;;T: LEGAL ID: - --- NO. OF CONST NEW �� BUILDING ADDRESS: TR: 6561. LT: 699 SQ. FT STORIES 'TYPE OCCUP GROUP! _ - 5724 CLOVERLY AV STRUCTURE: 395 1 VP- R3 ! -r EMP CA 917802551 ASSESSOR INFORIMATION NUMBER: -- i NEAREST CROSS STREET: j 8587-•011-022 EXIST PLDG USE: _ -i`iOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE EXIST OCC GRP: R3 USE ZONE: P.-1 TENANT: IS SUED ON: PROCESSED BY: EXPIRES ON: I BLDGS. NOW ON LOT: _ VALUATION: 09/'9!'i%4 JK 03/28/05 —_ 2 0 _ OWNER: TEL. NO: _ F:S'!L ?ATE FI L =Y:� CODE- FLING, IVY (626) 285-8689- LIST ITEMS:— —� 5724 CLOVEP.LY AV I 1/ Y ---- TEMP ✓17,','7551 CES.RIPTION OF WORK -Pi INSPECTICIN OF 395 SQ. FT. A REAR OF GARAGE (STORAGE) OCCUP LOAD EXIST: APPLICAN-i" TEL. NO: OCCUP L^AD P!-W: SAME AS OWNER I PARKING SPACES REQUIRED: 1a,Ftu!AL CONDITIONS: PARKING SPACES PROVIDED: I I i E X 1 T ir?AR;::iri:E: - CONTks;t:TGN: TEL. 40: LIM!T:'' SAME ;S OUNER - N"^ aF EXITS: FROM TO LIC. NO _ _! �t:'_S PA 10, i APPROVALS INSPECTOR SIGF2.T AMOUNT ARCHI'TEC? OR ENGI E PC ?EL. PlO: I ER Ute: - --A_v- OA PEPHIT iSk-ujkNCE 27.75 i'� _ -i- 5 LIC. NO: ^/14 GCC/US= INSPECT �. ".•,-'(� �- - ----------- -----------_,--_- 150!;_'•5 -- ---�. � RUC,. APPROVE 1YAP SEWER, MSP CDOO,: PAGE: Fine ZCirE: CMP. EMOVED III NO. OF FAMILIES:DWELLING UNITS:AP /COND:STAT CLASS: _ I ! SCHOOL WITHIN HAZARDOUS I -- AIR QUALITY: 1000 FEET MATERIALS Pio NO NO +� REQUIRED TOTAL SETBAF!: FROM EXIST ! SET BACK YARD: HWY: PROP LINE: WIDTH: �I FRONT PL- SIDE LSIDE PL- -I REPORT ID: DPR267 ROUTE TO: SS0508