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Home My Public Portal About9440 GIDLEY ST_Miscellaneous__ l 1 l WORl+1:RS'(OAIPENSATIONDECiARATION CE 878(11-84) MISCELLANEOUS�APPLICATION J( 1 herdby affirm that I have a certificate of consent to self Insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES-, �3t1I�QING AND SAFETY DIVISION a certified copy t1teTeof(Sec. 3800,Lab.C.). Policy No. ADDRDRKSS Company FOR APPLICANT TO FILL IN ■ [// Certified copy is hereby furnished. ■UILDING LOCALITY XX woowu■ 0 Gidle St. Certified copy is filed with the county buBdh*Inspection LOCALITY N[AR[■T department. XX Temple City ORO// ST. Date —Applicant N[AR[aT DISTRICT NO. UP JTYPK�r ES■ED SlyCRO■S ST. CON CERTII KATE OF EXEMPTION FROM WORKERS' w LE SAL COMPENSATION INSURANCE DESCRIPTION LOT NO. I.L.C. Rb. (cmcLi) ■TAT[ MAJOR SECOND LOCAL NO. OF ■LDQS. (This stction need not be COmp4eted. If the work involved TRACT NOK.ON LOT Us4 ZONE SPK Q IAL CONDITION by the permit Is for one hundred dollars ($100) or leas.) u/E OI< � SIZE OF LOT E][1/TING BLDG. 1 certify that In the performance of the work for any raa ne L permit ♦a Issued, I shall not employ any person in arty manrael�X OS N[R of building :: Fairchild Ind. xi as to become s iNect to the Workers' Compensatlorl laws. OCCUPANCY GROUP MAIL 306 W. Service Rd. A06R[Y■ U Ibte_ — Applicant — w NOTICE TO APPLICANT: If, after mAtirllt this Certificate of c,,Chantilla, VA NoL-703-478-3800 OCCUPANT LOAD Exemption, you should b000me subject to the Workers — Compensation provisions of the Labor Code, you must forth— with comply with such proYisions or this permit shall be TRAILER U/[ GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Ktwwl. LICENSED CONTRACTORS DECLARATION occuPwwar IN/PEOTwN Panic Devlges I hereby affirm that I am licensed under provisions of C3lapter SAFETY PERMIT (LIST ITEM/ ■FLOW 9 (commencing with Section 7000) of Division 3 of the 11* ❑ NO. OF EXIT/ mesa and Profesdom Code,and my license bin hull force ani r�t effect. Name of bus Hess ►A RKInG REp'D �— I PROVID[D Word Century Apparel Industry, Inc. License Number Lie, Class ' LIMITED TIME USE Contractor. ._,_ — Date Reliance Auto Sales, Inc. owrS ow t F RQMt To. ❑ 1 am exempt from the Itemizing requirements as I am a I IN■PEQTOR'/ licensed architect or a registered professional engineer SIZE OFNo.of acting In my professional capacity (Section 7051, Bur I EXI/TING BLD 6. /TORIES /1 wruwE inestand Professions Code). FINAL APPROVAL PR[S.ENT US[ OF ■UILDING 2 l.ic.or Reg.No. Date HOME OWNER-BUILDER DECLARATIONNo. of EI[I/TINB ■u1LDINGs ON'LOT AND U/[ I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5, Bust- nets and Professions Code): NO. PARKING El1, as owner of the property, will do the work and the ■PACES PROVIDED structure Is not Intended .or offered for sate (Section I 7044,Bpslness and Professions Code). CONSI'RUCI70N LENDING AGENCY PROPOSED USE OF ■UILDINB 1 hereby affirm that there Is a construction leading agenry for the performance of the work for which this permit b tuned(Sec. 3097,Civ.CA. Lender's Name i PROPOSED MAX.'OCC. Lender's Address— -- PERMIT FEE -00 ' 1 cmtlfv that I have read this appllation and state that the above Information is omect. I agree to comply with all County' ISSUANCE FEE ordirmnces and State laws relating to buitdirlg Construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 1 upon the above-mentioned property for Inspection purpose& SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX �Ir 11",I lllr.,f I'rnnillrr Dale WORKERS'COMPENSATION DECLARATION +t CE 876 11 1-841 MISCELLANEOUS APPLICATION CE 87 I hereby afflrm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING .AND SAFETY DIVISION insure, or a certificate of Workers'Compenstioz Insurance,or a certified copy thereof(Sec-3800,Lab.C-). IJ Policy No.16027Qtompany V T P APPARFT. FOR APPLICANT TO FILL IN ■ ADU-RDR[//Ks- 944 Gidl ® Cercif d copy is hereby frg&g@pINC. BUILDING 9440 Gidle Street --L-Temple Cit CA X1780 building ADDRESS l El Ce cePY f�Dd �the -�+ LOCALITY NEAREST Temple City, City CA {{9��pf1 =RD/, 1T4em le Cit Blvd Date' DA-11—t CNEAREST -ROSS ST. -T� n •Cid BIIJ VLl DISTRICT NO. GROUP TYPK PROCESSED ■Y I CERTIFICATE OF E ON FRO ORkO RS'. LEGAL COMPENSATION INS CE DESCRIPTION L6T NO. BLOCK YAP ""HRAT STATE MAJOR f[CD ND LOCAL No. (CIRCLa) (This section need not be completed if the work involved TRACT NOY/ON LOT U/[ ZONE SPECIAL CONDITIONS by the permit is for one hundred dollm (SI00) or less.) "' OFty� T�1� I SIZE OF LOT58,602 [X,/TIN►44nijfacturi 9 I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any mann AT OWNER BAR AN 1,1.4 I t' U so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP �3 0 ADDRESS 1 150 East Pico Boulevard L l Date ApplicantL J NOTICE TO APPLICANT: If, after maicin this CDrtiflcate of CITY Los 8 Angeles NOL' ( 2 1 3) 488-0 7 0 OCCUPANT LOAD � Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth I with comply with such provisions or this ,PCrtnit shall be - GEOLOGY INSPECTION O1 deemed revoked TRAILER U/[ J No Spec. Knowl. LICENSED CONTRACTORS DECL.IR.aT]ON OCCUPANCY INS►[CTION Panic Devices I hereby affirm that I am licensed under Provisions of Chapter I 9 (commencing with Section 7000) of Division 3 of the Bu¢ SAFETY PERMIT ] IL,ST rrEvs ■ELox} _ No. OF EXITS ness and Professions Code. and my license is tr, full force and effect. Hine of Business PARKING REO'D PROL'ID[D ■PAC[1 License NumberSOS 79 Lie. Class R V-,"I-.`P APPAREL GROUPP IN['_ LIMITED TIME USE Contractor Till iB AquilaDate 12/22/00 - -T. DATM I am exempt from the licensing -equirements as I am J I licensed architect or a registered professional engineer SIZK of Nc. Or IN/PECTURE ammo in m} profeufonalpacin (Section ',051. Bus EXISTING BLDG. /TORIE: SIGNATURE iness and Professions Code). I /¢ PRE/ENT USE of BUILDING FINAL APPROVAL lL� Lie-OI Reg.No. D1lt I Marlufact-urine; Manu acturin HOME OWNER-BLALDER DECLARAa ION No. OF EXISTING BUILDINGS ON LOT AHD UfE ``Ip I hereby all'im that l am exempt from the Contractor's License Law for the following reason (Section '031.5. Bucy 1 Manufacturing nest and Professions Coded: NO. PARKING 0 I, as owner of the property. will do the work and the '1-ACES PROVIDED structure is not intended or offered for sale (Section 53 onsite I 704Business and Busiand Professions Code). CONSTRUCTION LENSING AGENCY Z PROPOSED us[ of BUILDING I hereby afflml that there is a construction lending agency Ga ment ManufacturiII /Contracts g/ t ) for the performance of the work for which thL, permit is imed(Sec. 3097,Civ.C.). Sereenprintin Lender's Name PROPOSED MAX. OCC. Lenders Address - 'C M { l PERMIT FEE t-5 sW I cer-Eify that I have read this appllcarion and sate that the above Information is correct-I agree to comply with all County ISSUANCE FIs[ ordinances Lad State Taw's relating to building construction. Gad hereby authorize representatives Of t4iS ounty to enter TOTAL FE[ 25. 1. I upon the mKioi pro tion purposes SEE REVERSE F II - 1 ) ARSHT ' DEH. Pre ent AR ZARABIAN , Secretary