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HomeMy Public PortalAbout5333 FRATUS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I hereby, affirmcertificate of Workers'Compensation Insurance,or that I have a certificate of consent to self insute, or a certCOUNTY_ OF LOS ANGELES � BUILDING AND SAFETY DIVISION a certified copy thereof(Sec 3800,LabpC) i1 .i ' I_ ,', L �,,' -f'\ '' Policy No Company , FOR APPLICA,NT,TO,FI LL IN r ���� BUILDING }rte ,`•`.f A "�.� ..� , .,, . • \ ADDRESS 333 / S- Certified copy is hereby furnished nAe ooeess 3 3 ` jMt i v �, LOCALITY L / ❑ Certified copy is filed with the county building inspection\ LOCALITY.- J'' 7,\ � ( , ,;\Nlk, �i 1•a NEAREST department ,1 ` ' CROSS ST Date Applicant ` NEAREST\ DI TR C''$���,[r11 OU TYPE P ESSE Y CROSS ST t (K� / J CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL i u 14 COMPENSATION INSURANCE DESCRIPTION LOT No I �l BLOCK){ MAP HIGHWAY NO OF BLDGS rvD (CIRCLE) STATE MAJOR S CO D LOCAL, ' (This section need not be completed if the work involved TR{ACT r NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) ��� / -,' USE OF- SIZE OF LOT - EXISTING BLDG ( d I certify that in the performance of the work for which this - _ 4 permit is issued, I shall not employ any person in any manner OWNER -1 V �` �' y so as to become subject to the Workers' Compensation Laws MAIL i OCCUPANCY GROUP o ' `_5' - Date Applicant ADDRESS" U NOTICE TO APPLICANT If, after making this Certificate of CITY TN OL Z?,5 OCCUPANT LOAD °/- Exemption, you should become subject to the Workers' I Z Compensation provisions of the Labor Code, you-must forth- I - APPLICATION FOR EXIT HARDWARE with comply with such provisions oI this permit shall be TR'AILER USE GEOLOGY INSPECTION ❑ deemed revoked ❑ j + ❑ No Spec Knowl• LICENSED CONTRACTORS DECLARATION I OCCUPANCY INSPECTION © _ _� Panic Devices El I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of,the Busi- - - I NO OF EXITS ness and Professions Code,and my license is in full force and + effect C. .- F ISI PARKING REO`D PROVIDED l�( Number A-lq IVSPACES License Lic Class 1LIMITED TIME USE Contractor Date • DATE DATE FROM TO ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SI E OF NO OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG 13 STORIES SIGNATURE mess and Professions Code) + FINAL APPROVAL Lic or Reg No Date PRESENT USE OF BUILDING IV 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- e, ness and Professions Code) NO PARKING ❑ _,.�_{17 �.Il_i I, as owner of the property, will do the work and the SPACES PROVIDED 3 _7 structure is not intended or offered for sale (Section i I 1 L_ 7044,Business and Professions Code) MS CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING f l�i�� 93 ® 00 0-1 I)iereby affirm that there is a construction lending agency' ASH —.+� for the performance of the work for which this permit is t .011issued(Sec 3097,Civ C) CHANGE Lender's Name PROPOSED MAX OCC Lender's Address . D� ���±.rl; PERMIT FEE I certify that I have re th kation and state that the q 9tI� above information is rre gree to comply with all County ISSUANCE FEE O lr 4 1 AM11 I._I,- ordinances and to relating to building construction, O and hereby a oriz resentatives of this County to enter TOTAL FEE o upon the a e-m one erty for inspection purposes 4O SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1204230001 ' BUILDING AND SAFETY / LAND DEVELOPMENT _ TEMPLE CITY CA 91780 ^ PHONE (626) 285-0488 EXT - LEGAL ID NO OF CONST NEW BUILDING ADDRESS ITR 11492 LT •8 BL 001 SQ FT STORIES TYPE OCCUP GROUP 5333 FRATUS DR T I ISTRUCTURE 1 V-B U I TEMP CA 917803119 ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET OLIVE - I8590-001-010 - (EXIST BLDG USE THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl I _IEXIST OCC GRP USE ZONE I I TENANT - _ I (ISSUED ON PROCESSED BY I IBLDGS NOW ON LOT VALUATION 104/23/12 SR I I 1,500- 10WNER - TEL NO I IFINAL DATE - FINAL BY _ CODE I IZHANG, LEI _ _ (626) 560-0.288- ILIST ITEMS I / v 15333 FRATUS DR ITEMP 917803119 - - I - IDESCR PTION OF WORK I I I IRE-CONVERT A 2-CAR DETACHED GARAGE BACK TO ITS INTENDED USE I I 10CCUP LOAD EXIST 1AND USE AS'A 2-CAR GARAGE ALL SUB-DIVIDING PARTITIONS WALLS( (APPLICANT - TEL NO IOCCUP LOAD NEW - - 1ELECTRICAL WORK, PLUMBING WORK, LAMINATED HARDWOOD FLORING *1 ISAME AS OWNER - • - I I I I - IPARKING SPACES'REQUIRED _ ISPECIAL CONDITIONS 1 IPARKING SPACES PROVIDED I IEXIT HARDWARE ICONTRACTOR TEL NO I I LIMITED TIME USE 1 ISAME AS OWNER - - INBR OF EXITS I FROM TO - 1 I LIC NO I I - - I I FEES PAID _ I I I (APPROVALS DATE INSPECTOR SIGNATURE 1 I IFEE DESCRIPTION QUANTITY UOM AMOUNT I (ARCHITECT OR ENGINEER TEL NO I TRAILER USE I I I - I0A PERMIT ISSUANCE 27 80 I I I - LIC NO 101 R/M,OCC/USE INSPECT 146 00 ISAFETY PERMIT I I I TOTAL FEES 173 80 I 1-11 I I - _ ITEMP STRUCT APPROVED IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I w ITEMP STRUCT'REMOVED I I 1141H265 _ I INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I - NO I SCHOOL WITHIN HAZARDOUS (AIR QUALITY 1000 FEET MATERIALS NO NO NO I I I ! I I I r I I I I I * ADDITIONAL DATA ON FILE - I IREPORT ID DPR267 ROUTE TO _ BS0508 _ I i I I I I