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Home My Public Portal About9516 GIDLEY ST_Miscellaneous__ RS'COMPENSATIONDECLARATION 78M444 MISCELLANEOUS,APPLICATION� {� CE 876 (11$4) LI +b-here affirtificate of con -sent that I have a cercent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION iusure ora certificate of Workers'Compensation Insurance,or a cart�fiad copy thereof(Sec.3800,Lab.C.). ILDING Policy No. Company FOR APPLICANT TO FILL IN B...... - ADRE// ff�� FICortifled copy is hereby furnished. .v ■UILDINaLOCALITY ADDRESS91T,16 is Ilusey Certifled Copy is filed with the County building inspection.. LOCALITY e A ■T department. CRv// {T Date Applicant NEAREST DISTRICT No. OMP", TYP[• C ■ED+BY V awe// ■r. aoNST CERTIF'IGATE OF EXEMPTION FROM WORKERS' L[aAL 'I— COMPENSATION INSURANCE "SCRIPT ION LOT NO. ■LOCK MA. H"WWAY'' HO. / �� (—cLi) STATE MAJOR SECOND L 1. NO. OF ■LDC/. `•a+a+ section IIOEd not b0 COmplOted iI th0 WOTk i1QvOfVEd TRACT f• NOW ON LOT U/S: ZON[ /rt alALCONDITIONS by the pa>mtt L for one hundred doUsn (;100) or less) usE or SIZE Or LOT ERI/TINA BLDG. ^2 I Miff' that in the performance of the work for which this o permit Is issued, I shall not employ any person in any manner -► OWNER Je so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP °G v MAIL ADDRESS Date Applicant L. r NOTICE TO APPLICANT: If, after making this Certificate of arrY NO.�- � `L OCCUPANT LOAD Exemption, you should become subject to the Worker' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: ^' with comply with such provisions or this permit shall be TRAILER u/E ❑ aEOLooY INSPECTION ❑ No Spec. Knowl. deemed revoked. �y OCCUPANCY INSPECTION 7Yr Panic Devices LICENSED CONTRAC'T'ORS DECLARATION I hereby sffTrm that I am licensed u ❑Vnder provisions of Chapter ■AFETy PERMIT• (LUT rr[M/ B[Lo.) 9 (commencing with Section 7000) of D}fvvWon 3 of the Basi- NO. OF EXITS nets and Proferrions Code,and my license is In full force and PARKNG REG'D IPROVIDED SPACES Contractor Number Lia Class LIMITED TIME U S E Contractor Da LD DAT/ DAT= 0 1 am exempt from the licensing requirements as I am a �wDMI TD. licensed architect or a registered profbsrional engineer SIZE or No. or INSPECTOR'S acting In my professional capacity (Section 7051, Bus EXISTING UTINa BLDG. /TORIs■ c sIa PURE Inca and Profusion Code). 01 J PRE/ENT UDE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION No. or EXISTING BUILDING/ ON LOT AND U/E I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Buai- —7 Z(pS nese and'Professions Code): NO. PARKING F1I, as owner of the property, will do the work and the /PACE/ PROVIDED #I a 4 8 g structure Is not intended or offered for sale (Section • o o • o • • 7044,Business aPrafetaions Code). , � V PROPOSED u/E of Bu1LDlNa 0617-87 CONSTRUCTION LENDING AGENCY I hereby afllTm that there is a constructlon lending agency for the performance of the work for which this permit is Issued(Sea 3097,Civ.Q. Lender's Name PROPOSED Mwx. oac. �\ Lender's Ad.dresa PERMIT F[[ I certtPy that I have read this application and state that,the above information Is correct I agree to comply with aU County ISSUANCE ran crdinarims and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL RE[ 8 a upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE \a Signature of Permittee Date —qVFF.ERS'COMPENSATION DECLARATION 764" CE (11-84) M I SC E L LA N E O U S APPLICATION � Y-helrcb; rffir. that I have a Certificate of consent to Cel£ fL certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION fgslrre or a cert{fled copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BDILDING :U -"ImJ Certified copy is hereby furnished. ■UILDING LO CALIT-Y ADDRESS FCertified copy Is Mad with the county building fnapection 0CDCALrTY NXARXST department. CRO/■ ST. Date Applicant NtAR[■T DISTRICT NO. 6ROU ITY rt p //tD MY cno■■ ST. r� ao HS CERTTFIGATE OF EXEMPTION FROM WORKERS' LX U COMPENSATION INSURANCE DXSCRIPT ION LOT NO. ■LOCK YAP` / HMU AT Noy ��V IcIR CLi) STATS: MAJOR /X CO ND LOCAL No. OI X F ■LDGS. (fidlvNOW CON Section heed not be C�lsppleted if the Fork tnvoed TRACT NOON LOT USI n ■PXCIAL NN CODITIO ■ by the peLmft is for one handred doU2rs (;100) oI leeL) US[ OF ■ X OF LOT XXI/TING BLDG. I certify that In the performance of the work for which this CD permit is Issued, I shall not employ any person in any mumer o>.NXR sJ1 io as to become subject to the Workers' Compensation LawnOCCUPANCY GROUP oe YAIL Date Applicant DRX/■ TEL— NOTICE TO APPLICANT: If, after maIr this Certtl1cate of CITY No. /3 y Exemption, you should become :abject 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 U■X ❑ GXo GY IN■PXCTION ❑ No Spec. Know]. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY IN/rXCTION Panic Devices I hereby affim that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of D on 3 of the a� ■AFXTY PXRY ❑ (LIST IT<Y/ BULOW) NO. OF EXITS ness and Professions Code,and my license Is in fall force and effeGL PARKING 1rACX■ R■q'D rROVIDXD License Number Lia Class LIMITED TIME U S E Contractor Date DAT/ D A T> TDI F1I am exempt from the licensing requirements as I am a P�OY1 licensed architect or a registered profbssional engineer /aX OF NO. OF IN'r■CTOR'■ acting In my profesdonal capacity (Section 7051,Bus- [ STING BLDG. STORM (3 roan and Professions Code). / RXSXNT USX OF 1 TIDING FINAL APPROVAL Lia or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGS ON LOT AND US[ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Buri- Bess gnd Profeasiops Code): NO. PARKING I, as owner of the property, will do the work and the ■PACs■ PROVIDXD structure is not intended or offered for sale (Section 7044,Business and Professions Code). 71 .CONSTRUCTION LENDING AGENCY PROPOSED U■X OF BUILDING I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is ivaed(Sea 3097,Civ.C). Lender's Name rR0 ■XD Y . OCC. Lender's Address O0 rYRMIT F[Q I certify that I have read this application and state that the above information Is correct I agree to comply with t1l County 16SUANCE FE[ ordinances and State laws relating to bull" construction, d hereby authorize representatives of this County to enter TOTAL. F¢[ ou o Itio roperty for inspection purposes ZZ fy+� SEE REVERSE FOR EXPLANATORY LANGUAGE of P ee Date WORKERS'COMPENSATION DECLARATION 70M444 CE MISCELLANEOUS APPLICATION J I hereby affirm that I have a certificate Of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, ora rtfflcate of Workers'Compensation Insurance,or a Cartit'le$ f(Sec.380-�i Lab.C.) Policy Nq. mpany l rem6)n Inaemriii FOR APPLICANT TO FILL IN ■uILDIMo ❑ wDDRKfs Certified copy is hereby furnished. urLDING 1 6 U'idle ►St ADDRi/f LOCALITY Certified copy is flied with the county building inspection NKARKsr department. .. LOCALITYTemple, City CROP/ ■T. pate Applicant NKARKST rp DI/TRIcT No. GROUP rK Roc ■KD^ 21+- CROSS ■T. Tem le Cit .Blvd - CON/T� CERTIFICATE OF EXEMPTION FROM WORKERS' LKGAL COMPENSATION INSURANCE.. DK■c RIFT I ON LOT NO. BLOCK HIGHWAY no. p�D,,� (clnc�K) STATE MAJOR SECOND LOCAL ((�r�,�� `�, NO. Or ■LOO■. (Tld$ section need not b0 COrnl leted if the work hivolred TRACT NOW ON LOT USK ZONK sr KCIAL CONDITIONS ^Y by the permit )a for one illi dollin {$100) or ler,) USK Or ((�� V ■IZK br LOT KXI/TING BLDG. 1"' tr 1 certify that in the performance of the work for which this �} � perdtft li issued, I shall not employ any pernon�in any manner orNK V O lee 0 to as to become subjact'to the Workers' Compensatloh Laws. AIL OCCUPANCY GROUP w ADDRE■ oresAve0- Date- Applicant Z NOTICE TO APPLICANT: Lf, after making this Certificate of v clTv Arcadia^ No� 3-6966 OCCUPANT LOAD Exemption, you should. become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensatign provisions of the Labor Code, you must forth- with comply with such provWons.or this permit shall by TRAILKR USE GEOLOGY INSPKCTION deemed revoked. ❑ No Spec. Knowl. L.� OCCU`PAJ4C ACTIO-H Panic Devices R LICENSED CONTACTORS DECLARATION I hereby affirm that I am llcenaed under provisions of Chapter SAFETY PERMIT 9 (commencing with Section 7000) of Dfvisfon-3 of the Bust— nese and Professlors Code, and my license Is in full force and effect. PARKI"- �� I 282098 6,SC—�' SrAC�f RKq'D � rROVID KD LlCense Number Llc.Claes C-2 GontractorLethsDiyw late 11-/11.' 1.. LIMITED TIME USE. OAT{ DAT■ - IRON. TOI I ■m exempt from the licensing req ulremanti:u d amq i licensed architect or a reglsterad proferlonal.engineer ■IZK Or No. or INfrKCTOR'■ acting in my professforfal capacity (Section 7D5I, Bels- KXISTING BLDG. ■TORIK/ SIGKATURK iness and Professions Cod.e). FINAL APPROVAL OVAL USK Or BUILD�NO Office & Yard AP Lic.or Reg.r4o. Date HOME OWNER-BUILDER DECLARATION- IIo. or NXISTINo BUILDIN4■ l '4 ON LOT AND USK /•\ I hereby affirm that, I 'am exempt from the 'Contractor's License Law for the following reason (Section 7031.5, Busi-'- neas and Professions Code): NO. PARKING :93905A ■PACK/ rROVIDKD A I, as owner of the property, will do the work and the structure b not Intended or'offered for side (Sectlon •l0 — 88 7044, Business and Profesalom Code). o l0 0 o e 4,0OrOSKp USK Or, SUILOaraG Office CONSTRUCTION LENDING AGENCY 6-82 I hereby affirm that there is a construction lending agency for the performance of the work for wthich this permit is Issued (Sec. 3097,Cly.C.). Londer's Name PRoro■KD MA-X. OCC. Lender's Address rltRMYT reE I certify that I have read this application and state that the above information Is correct.I agree to comply with all County ISSUANCE ISE ordinances and State.laws relating to building construction, TOTAL FEE 25.00 Pay to City of Temple City and hereby authorize representatives of this C6unty to enter UP4 the ■boyo- entloneQ property for Lrupection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S �-?.'- Signature of P ee Data t �wORIERs'COMPENSATIONDECLARATION 76M4" CE 876 (11-84) MISCELLANEOUS APPLICATION r* I h affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION der a certificato of Workers'Compensation Insurance,or a ontl$bd&py thereof(Sec. 3800,Lab.C.). _ Policy No. Company FOR APPLICANT TO FILL IN ■UILDINS • wDDRE/■ Certtfled copy is hereby furnished. BUILDING 5 I to T LOCALITY ADDRUSS ❑ Certtfled copy is filed with the County building inspection LOCALITY NEAREST departmFF''��--``��",�ent CROSS ST. Date ApplicantNiARt/T &M �� \ DISTRICT NO. OROur ITYrG r OCKzszD my CROSS ■T. V CONST, CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT HwHfAY ho. (alwaLi) STATE MAJOR SECOND LOCAL NO. ON BLDGS. (lisp section need not be cam bted 0 WOLY ed TRACT NOW ON LOT USS ZONE ■PE CIAL CONDITION/ by the permit L for one hundred dollars (;100) or lam) us or, NMAIL EXISTING OLDS. I certify that in the performance of the work for which this permit L issued I,shall not employ any person in any manual- k oso as to became an ect to the workers' Cotion Laws� mpen� OCCUPANCY GROUPDate Applicant NOTICE TO APPLICANT: If, after making this Certfflcate of OCCUPANT LOADExemption, you should become subject to theworicert' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be El GEOLOGY Spec. Knowl. deemed revoked. TRAILER USE GEOLOGY INSPECTION LICENSED CONTRACTORS DECLARATION OCQUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the ausi ■WEEP- PER ❑ (LIST rtEM■ �ELOB) NO. OF EXITS mss and Professions Code,and my license is in ftiIl force and PARKING SPACES RKQ'D PROVIDED Licen10 Number Lia Class LIMITED TIME USE Contractor Date EuuLJ DAT/ OAT/ ❑ I am exempt from the licensing requirements as I am a rwo..J To. licensed architect oI a registered professional engineer SIZE OrrNO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bina_ EXISTING BLDG. STORIES SIGNATURE inm and Professions Code). PRE/ENT U/S OF BUILDING LF = LK, p RINAL APPROVAL r•/�a Lic,or Reg.No. Date �r U O I 0 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS NO FEE ON LOT AND USS _ I hereby affirm that I am exempt From the Contractor's License Law for the following reason (Section 70315, Bud- 0DOD-OW1 8/23/89 ness and Professions Code): No. P"PCING I, as owner of the property, will do the work and the /PLACE/ PROVIDED 5266 1 `4:37 structure is 'not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPossD ueE of ■u1LDING M �N �}L I hereby affirm that there is a construction lending agency PaIE—CAST STOAJO AN)o L T for the performance of the work for which this permit is issued(Sea 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. _ Lender's Address PERMIT FEE DO I omtify that I have read this application and state that the above information is correct I agree to comply with all County 189UANCE FEE ordinances and State laws relating to building construction, 0 and hereby authorize representatives of this County to enter TOTAL FEE the abovo- entioned property for inspection urposea SEE REVERSE FOR EXPLANATORY LANGUAGE �' SlKature of Pq&lttw Dati WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hVeby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFE'T'Y DIVISION inrilhre, or ■ certificate of Workers'Compensatlon Insurance,or a cerNfled copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANTTO FILL IN ADDREa■ ❑ Certified Copy is hereby furnished. UILDING LOCALITY ADDRESa ❑ Certified copy is filed with the county building Inspection NEARE/T _ department. LOCALITY CRO■■ aT Date Applicant EAREaT DISTRICT 6 P TY E PR SED ■Y CROS■ ■T. �'^ ,�` CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v t COMPENSATION INSURANCE DESCRIPTION LOT NO. ■LOCK „A► HI�HwAY Ro. (CIRCLE) STATE MAJOR •KCON OCAL ((��7�h{,i�s� NO. OF 11111-13021. 8 \+"'� rection need not be completed if the work imotved TRACT NOW ON LOT U/E ZONE /P sSGIAL CONDITIONS � l}J{ by the permit is for One hundred dollars ($100) or led&) u■I TI Cr SIZE OF LOT EXISTING MILDG. I certify that In the performance of the work for which this Q permit Is issued, I shall not employ any person in any manner NERUr so as to become subject to the_Workers'.Compensation Laws. AIL OCCUPANCY GROUP LL ADDRESS d Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate of CITY NoL OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall,s TRAILER USE GEOLOGY INSPECTION NO Spec. Knowl. El revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INiFECTN Panic DEVICESro I hereby affirm that I em licensed under provisions of Chapter SAFETY PERMIT L t 9 (commencing with Section 7000) of Division.3 of the BUzi- (LIST rrEM• BELOW) No. of Ezrr■ ness and Professions Code, and my license is In full force and PARKING. effect. REq'D O PROVIDED ■PACEa License Number_ Lic.Class LIMITED TIME USE Contractor Data DAT■ DATK ❑ I am exempt from the licensing requirements as I am a r Ror I ro I licensed architect or ■ registered professional engineer SIZE OF No. of IN■ ECTOR's acting In my professional capacity (Section 7051, Bus- ExI■rlNa ■Loa. ■roR1F ■ NwruRE )neat and Professions Code). FINAL APPROVAL 0 ESENT USE OF BUILDING Llc.or Rei.No. Date NO. OF EXI/TI ■UILDI S HOME OWNER-BUILDER DECLARATION ON LOT AND USE Lt ;F 0 8 9.5 A I hereby affirm that, I am exempt from the•Contractor's License Law for the following reason (Section 7031.5, Buri no. PARKING ( �l # • •,b * 88 nes and Professions Code): SPACES PROVIDED • • o 'D o • o ❑ 1, as owner of the property, will do the work and the IQ 16-84 structure Is not intended or offered for sale (Section 7044, Business and Professions Code). oPOSED uSE of ■ullDInG ¢ CONSTRUCTION LENDING AGENCY I hereby affirm that there is ■ construction lending agency for the performance of the work for vzblch this permit is issued (Sec. 3097,Civ.C.). Name Lender's - - PROPOSED MAX. OCC. Lender's Address PERMIT FSE I certify that 1 have read this application and state that tbb ' above information is correct.I agree to comply with all County ISSUANCE FEE ordlnan and Stain laws relating to building construction, TOTAL FEE ! V LA and h y authorise representatives of this County to enter upon ve-me tl ed p party for Lnspec Ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r atura of Perml 01 Date