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Home My Public Portal About9142 LA ROSA DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (11-84) MISCELLANEOUS APPLICATION I hereby"affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or 'fl a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. AIUILDING 9 � Q LOCALITY 1 ADDRESS (+C� Certified copy is filed with the county building inspection LOCALITY PL C! �S� NEAREST department. ' ` I a CROS s ST. Date Applicant EAREST , DISTRICT�{'�9y/ GR P TYPE y" ESSED BY CROSS ST. �j /4 / 7 �U�( CONST. CERTIFICATE OF EXEMPTION FROM WORKERS'' LEGAL (((JJJ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NOOF BLDGS. (This section need not be completed if the work involved I TRACT NO.W ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) us of SIZE OF LOT EXISTING BLDG. 1 -I certify that in the performance of the work for which this o permit is issued, I shall not employ any person in any manner OWNER / d�41y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY-GROUP' o DRESS O, s/�j ' U Date Applicant ��++ Q w NOTICE TO APPLICANT: If, after making this Certificate of CITY a`��j0h a %� L. (%�(f��d--�//� OCCUPANT LOAD CL. Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE. ' with comply with such provisions oI this permit Shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Know]. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION CK Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and �I effect. PARKING REQ'D D PROVIDED I SPACES J License Number Lie. Class LIMITED TIME USE Contractor, Date DATE DATE R M: . I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR S acting in my professional capacity (Section 7051, Bus- E (STING BLDG. STORIES 5 GNATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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 foi the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 27 5 S L A 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). �� •..s*e o • •to z CONSTRUCTION LENDING AGENCY PROPOSED usE of BUILDING �o 72 9'`$7 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is — issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address na I certify that I have read this application and state that the PERMIT FEE above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL, FEE upon the above me 'oned pe y or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE f Signa ttee Date WORKERS'COMPENSATION DECLARATION 8 CE 875 (11-84) MISCELLANEOUS APPLICATION CE 75 I beryby^,;gffirm that I have a certificate of coirsent:to self t COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or +Y ��. } �,S3. ��.4)a)�a a certified o y thereof(Sec. 3800, a .C.). 4 ` 1 BUILDING Policy No Company \ LVItG� t FOR APPLICANT TO,FI LL IN / ADDRESS /�j[,�¢� 0 .hh r (® Certil�ed'c �liereby'furnished. BUILDING LOCALITY ADDRESS Certified dopy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant I NEAREST (( (( /`' T/� DISTRICT NO. 605PUP TYPE P OCESSED BY CROSS ST. �,^••ti�L�1lL 1 I j - 2 CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LE 6 A L !� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY • _ NO.' (CIRCLE) STATE: MAJOR SECOND LOCAL NO: OF_BLDGS. (This section need 'not be 'completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that in the performance of the work for which this slzE OF LOT EXISTING BLDG. 0 permit is issued, I shall not employ any person in any manner OWNER JV J so as to become subject to the Workers' Compensation Laws. MAIL n/ --- -,, --- OCCUPANCY GROUP a o ' AD. ES f L .L - � C.5 Date Applicant' uJ NOTICE TO APPLICANT: If; after making this Certificate 'of. CITYerl NOI. , ;Z(( OCCUPANT LOAD Exemption,- you should.become subject to� the Workers' - APPLICATION FOR EXIT HARDWARE. Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LISTXr EMs BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REQ'DPROVIDED SPACES LL�� License,Number iic. Class LIMITED TIME USS—� Contractor -Date DATE DATE FROM: TO: I am exempt from the licensing_requirements as I am a , L°• licensed architect or a registered professional engineer slzE OF NO. OF i y INS ' CTOR'$• i�;y S E acting m my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES NATURo iness and Professions Code): - PRESENT USE OF BU+LD+NG F(NAI. APPROVAL n Lic.or Reg.No. Date >•J� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE S I� I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness usiness and Professions Code): I 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, s-O and hereby authorize representatives of this County to enter TCTAL• FEE a� upon he Opve men i ed p perty for inspection irpos s. � SEE REVERSE FOR EXPLANATORY LANGUAGE _: • Signature of Permittee Date WOJIKERS''COMPENSATION DEGLAR'ATION 76M444' -MISCELLANEOUS APPLICATION CE 875(2-80) I here+y of that t have a certificate of consent to self, COUNTY OF'LOSANGELES BUILDING•AND SAFETY DIVISION', insure, or a certificate of Workers'Compensation Insurance:or a certified copy thereof(Sec. 3800,'-Lab. C.)„ ' Policy No. Company' FOR'APPLICANT TO FILL IN wooRess /. Certified copy.Is hereby furnished. Bu1LDING' I ADDRESS - I 2, � OA - LOCALITY;: .Certified copy is filedthe county.building Inspection �1/ ` � " NEAREST department. LOCALITY-/ l(�/) !� J�y- CROS•S•ST. Date -Applicant NEAREST. /�!/j��} ) ./�/gy� - 'DISTRICT NO. GROUP TYPE' RO, ESSE DI BY - •• CROSS ST. !//��,//N/F�1 d !/�� ., CONST - CERTIFICATE OF EXEMPTION FROM WORKERS! -• LEGAL INSURANCE . 1?ESCRIPTION LOT NO. BLOCK MAP H16H WAV _ NO. � - (CIRCLE) STATE MAJOR SECOND LOCAL N6 OF BLDGS: - O F (This section need,not.be completed if the Work involyed '• 'TRACT` NOW_ON LOT USE,'ZONE SPECIAL CONDITIONS. by the permit is for•one hundred dollais, ($100) .or less.), V''_ .. _ USE OF• SIZE OF LOT - EXISTING BLDG. I certify that in the 'p"erformance-of•ttie'work for which this /��/�,� ]� } /� ) 0 perrrlii is issued, I shalt not employ-any person in any manner' OWNER v/I/muAirr:PiW oS Lz w " (U" so,as,,to'b-ecome sublect'to''the-Workers.' Compensation'L-aws.' ' MAIL C P �.•, .'OCCUPANCY'GROUP,-, //��J W • ADDRESS /..Of it • OJ�- .'rte./��_ •trt,. - '"•'_?— G' Date' ' r'Applicant: fA -NOTICE-TO APPLICANT-'If, making this-Cerflffcate of CITY LG NOI."', OCCUPANT LOADI 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 USE GEOLOGY, INSPECTION a - � No Spec. Knowl.,-❑ S, deemed revoked. ' OCCUPANCY INSPECTI LICENSED-CONTRACT,ORS'DECLARATION ON •.Panic Device's. 0 - I hereby affirm that I am licensed under provisions of;Chapter SA'F'ETY PERMIT Q -(LIST ITEMS BELOW)- NO. O'F EX ITS. 9'(commencing with-Section'7000) of Division 3 of•the;Busl-,•,; ness and Professions Code,=and my license is•m full force and ewRKrne.• effect. SPACES REQ'D PROVIDED .� License,Number Lie.Class - :-LIMITED TIME USE Contractor Date DA;rE DArE ❑ r , m FROM: TO:• I am exempt'from the licensing re4wieents as-I am a' licensed architect or aregistered professional'engineer •,• SIZE'OF OOO S NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- -EXISTING BLDG. v' ST OR IE S.s` " GNAT•URE iness and Professions Code). - ' -1 " FINAL APPROVAL r ' PR ESE NT'USE OF BUILDING d/--�,.ijT- - - Lie.or`Reg.No. Date t �1 I-II•1/ r' HOME OWNER-BUILDER DECLARATION No:,oF EXIS i1NG BUILDINGS ON'LOT'AND USE - I• hereby 'affirm that, I yam exempt" from the Contractor's a - License Law-for the`following.reason-(Section'•7031.5,-Busi- ness and Professions Code): SPACE RKING y' G• ' SPACES PROVIDED y' $-J�,2 9 A I, as'owner of the property, will-do the work and the, a t-•- structure Is not intended or offered..for sale (Section # :o s' 0".88 " 7044,'Business and Professions Code). ` - PROPOSER,USE-OF'.BUILD ING En CONSTRUCTION LENDING AGENCY / j� 't I hereby'affirm that there Is a construction lending agency (�(/ 4lc A (OIC/ CiJ `. r - M i for•the perfo'imance of the work for'•w,hich this•Permit is S'1'8 8 6' issued'(Sec.'3097,Civ.C.). Lender's Name• . .. - PROPOSED MAX. OCC. - - ,• i "-Lendei's Address PERMIT FEE- '.I certify that'I have read .this application and state"that'the 'ISSUANCE FEE •r • ' above Information is corre agree to-comply with,all County {1 ordinances and States relating 'to building construction, a 4. and-,hereb author" e ives of-this'County to enter TOTAL FEE, ' uponthe ned property for"msp�' �p rpo�eS. ,,SEE REVERSE.FOR EXPLANATORY LANGUAGE " Signatur r tee Date WORKERS'COMPENSATION DECLARATION 76M444 CE 875 (2-80) IVI'ISCELLANEOU'S APPLICATION I hereby affirm that I have a certificate of consent to self. COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, Lab.C.) Policy No. - Company FOR APPLICANT TO FILL IN BUILDING ❑ - ADDRESS l 1 /[Q Certified copy is hereby furnished. BUILDING / X J_A SA LOCALITY /p J ❑ - - - ADDRESS I✓iS .L 4/'T s / �O Certified copy is filed with the county building inspection LOCALITY NEAREST department. , .r C4j•j8a CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE _ PROC SSED BY `CROSS ST. - CONST.V1 CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE oEsc RIPTION Lor No. BLOCK MAP /^� HIGHWAY } _ r+o. ��`/ / (CIRCLE) STATE MAJOR SECOND,'LOCAL a NO. OF'BLDGS.' (This section need not be completed if the'work*involved TRACT' NOW ON LOT / USE ZONE SPECIAL CONDITIONS O by the-permit is foi one hundred dollars ($100) or less.) . USE OF M _ • SIZE OF LOT EXISTING BLDG. 1� I 1 CC 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 0WNER - U so-as to become subj to the Workers'•�J(ompensationn Laws. MAIL a OCCUPANCY GROUP LL CY/�/Q/lY6 �f/{�/IV ifS�C �a�w�Cl�' ADDRESS - .d Date �Z-�`' B�Applicant", (ZAI,—ef - /h/Csiew. Cn TEL. Z'' NOTICE TO APPLICANT: -If, after making this.Certificate of CITY j&yjPLC--G/� No. a��j-� •/Z OCCUPANT LOAD Exemption, you -should become subject -to, the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Latior,Code, you must forth- with comply'with such ,provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ' ,deemed revoked., ❑ ❑ No Spec. Knowl.'0 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division,3 of the.Busi- ness and Professions Code, and my license is in-full force and p ' effect. PARKING•- - - SPACES REq'D O PROVIDED D License Number Lic.Class LIMITED 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 SIZE OF, NO.•OF. / INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. ' STORIES SIGNATURE iness and Professions Code). FINAL'APPROVAL ., .PRESENT USE OF BUILDING � J, Lic.or Reg.No. 'Date l 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- 2-4, 01.3A ness and Professions Code): NO. PARKING SPACES PROVIDED 1, as-owner of'the property, will do the work and the `' #-o'o'o-o 4'0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). o 0 o io o e o PROPOSED'USE OF BUILDING •gyp , , • , CONSTRUCTION-LENDING AGENCY 0 2,11 Q—8 I hereby affirm that there is a construction lending agency for the' performance.of the work ,for which this 'permit is issued (Sec.3097,Civ.C.). Lender's Name _ - 'PROPOSED MAX. OCC. Lender'sAddress PERMIT Fee I certify that I have read this application and state that the above information is correct.I agree to oomply with all County ISSUANCE FEE 'ordinances and State laws relating to building construction, ' and hereby authorize representatives of this County to enter TOTAL FEE po the above-mentioned 'property for inspecti -p rposes. SEE REVERSE-FOR EXPLANATORY LANGUAGE- /h .'� 3 Si ature of Permittee Date WORKERS'COMPENSATION DECLARATION 768444 CE 875(11-84) MISCELLANEOUS APPLICATION I su o rebaffirm 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(j�ec. 3800,Lab.C.). Policy NoI1l �inpany ��L�FdUir9 CEN,rn�N FOR APPLICANT TO FI LL IN BUILDING a �,�//� ADDRESS Certified copy is hereby furnishyx ADDRESS 9142 E. LA ROSA DR. , LOCALITY V. Certified copy is filed with the cou bu d• g inspectionNEAREST department. LILY TEMPLE CITY, CA. 91780 . CROSS ST. Date Applicant NEAREST ENCINITA DISTRICT NnO. G UP TYPE }}yy}}•• P CESSED BY CROSS ST. ' OtJ e� CONSTr CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o STATE MAJOR SECOND LOCAL COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NO. (CIRCLE) • NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) $E SIZE OF LOT • kISOF TING BLDG. I certify that in the performance'of the work for which this o permit is issued, I shall not employ any person in any manner OWNER OTTING ENT. so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP o Date ADDRESS Applicant P. 0. BO 2 0 6 6 , C~.7 21 65n Q0-1) R4 7rpn NOTICE TO APPLICANT If, after making this Certificate of CITY AVON COLORADO oL• OCCUPANT LOAD a Exemption, you should become subject to the Workers' APPLICATIQN FOR EXIT HARDWARE: Compensation provisions of the Labor Code,'you must forth ❑ with comply with such provisions or this permit shall be TRAILER USE ' GEOLOGY INSPECTION deemed revoked. ❑ El No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ® Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) t, 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING REq DD PROVIDED SPACES License Number Lie. Class REUTER GARMENT CORP. I— LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF 6 , 000, sq. ft. NO. OF 1 FROM: TO: I SSIGNATUR'E acting in my professional capacity (Section 7051, Bus-' EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING SEWING FACTORY, FINAL APPROVAL. II_l�-43 7 Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS 8 90 � ON LOT AND USE FEE I hereby affirm that I am exempt from the Contractors \\ License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING SPACES PROVIDED 18 9� I, as owner of the property, will do the work and the i structure is not intended or offered for sale (Section �'!i +=•-'�` 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING SEWING. FACTORY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is' issued(Sec. 3097,Civ.Q. Lender's Name yp PROPOSED MAX. OCC. XX40 Lender's Address PERMIT FEE pO I certify that I have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the t' pe for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee / Date WORKERS'COMPENSATION DECLARATION 76M444 , 'CE875 (2-80) MISCELLANEOUS 'APPL-ICATION I hereby affirm that.T have certificate of consent`to self COUNTY OF LOS ANGELES :BUILDING AND SAFETY DIVISION ,insure, or'a certificate�of Workers" rs'Compensation Insu'rartce,or � � ,a certified copythereof(Sec:3800,Lab. C.) Pol1C NO. Com aR - BUILDING,' / Y' P Y ' - FOR APPLICANT TO FILL ADDRESS _;!Ii ❑ Certified'copy is hereby furnished'., u1LDrnG" LOCALITY .•: , ADDRESS Certified copy is-filed with the county"building inspection: NEa•REs,T, LOCALITY ' department. CROSS ST. ` ,Date Applicant AREST DISTRICT N ROUP TYPE P ESSED By, ' - CROSS ST: Cl - a CONST. .. > ;. -CE 'OF EXEMPTION FROM WORKERS' LEGAL y ' DESCRIPTION LOT NO. BLOCK.' _ M- H—HWAY COMPENSATION_ INSURANCE NOP (ci CLE) STATE MAJOR SECOND LOCAL, > - . - NO. OF,BLDGS. CLO (This section, need not be cornpleted.if the work' involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by''"the permit is,for,one-hundred dollars`($100) or less.). V � -- ° •-, 9 .- _-_ .USE OF " ' SIZE OF LOT - EXISTING BLDG. �'- -,I'certify`that,in the performance'of the-work for which this O permit_Is'"•issued,',I'shall'not employ any:person�_m.any manner OWNER.'- - U so,as to:become 'subject to'the Workers'•Compensation,Laws. AIL /^/ OCCUPANCY GROUP �• W ADDRESS _ .- vV`+ LL Date- '' Applicant :.cnn TEL. NOTICE'TO APPLICANT: If,'after making this Certificatof CITY V, .No. �'�� ?j OCCUPANT LOAD - -,-Exemption,,'you,_should• become: subject to.the Workers'- APPLICATION FOR EXITHARDWARE: ,Compensation provisions of the Labor Code,,you•must forth-_ - =" with comply,_ with,such p 6visionS Or";thlS permit Shall 'ue TRAILER USE GEOLOGY INSPECTION� NO Spec. Know,l:' ❑ deemed,revoked;,' -i LICENSED CONTRACTORS DECLARATION occuPdricv INSPECTION Panic Devices ❑ '/• .00 I'hereby"affii'in that I am licensed under,provisions of Chapter s'w Fe TY PERMIT•. (LIST ITEMS BELOW) '.Sn(commencing with Section 7000)of Division 3 of the BUsi- NO.OF EXITS ' "ness and Professions Code, and my.'license is In full force and PARKING ,�ffeCt. •,' - - - - - SPACES REO'D D PROVIDED „ L:':cense Number• Lic.Class J 1 . LIMITED TIME USE ': ' Corifractor Date- - DATE DATE �. TO: �. I am'exempt from the licensing requirements as I am a• licensed architect or a registered.professional engineer SIZE OF •• _ NO. OF - INS TORS. acting in my professional capacity (Section 7051,;BU$- EXISTING BLDG, STORIES SIGNATURE iness acid Professions Code). FINAL APPROVAL' / PRE S EN TU S E'O F'BUILDI NG lO-•./� � '.Lic.or.Reg.No. Date 00 HOME OWNER-BUILDER DECLARATION NO. OF EXISTiNG'BUILDINGs ; ON LO,T'AND USE. } I hereby.-affirm, that, I airi exempt .from the Contractor's , License`Law-for the following reason .(Section.,70 31,.5, Busi- ' •• NO. PARKING - - -r ness'and.Piofessions,Code): ; 'SPACES PROVIDED' I, as owner of"the.property, will do the,work and the �.Jr.7.2�.a structure,,is n'ot intended or offered'for_ sale'(Section �" r 7044, Business and Professions Code). ' e s o 8`8 't ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY " ' Q p 3—8'3 I-hereby affirm that there is a construction lending"agency 'for the,'performarice of the work-for N Jhich this' permit is issued(Sec. 3097,Civ.C.)'. ''Lender's Name' PROPOSED MAx. occ.. J: Lender's Address ' PERMIT F.EE i:. I certify that'I'have read 'this application and'state that the _ above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and. State.laws relating to building construction, „ And hereby authorize repres t tives:of this County.to enter• ToTAL FEE, -Upon I -me on r perty ` ins c io pur oses: - SEE REVERSE FOR EXPLANATORY LANGUAGE ✓ fj3 - Signature of Perm' tee ate WORKERS'COMPENSATION DECLARATION CE 8754 (2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate,of consent to Self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, ora certificate of Workers'Compensation Insurance,or a certified copy ihereof.(Sec. 3800,Lab.C.)- Policy No. Company FOR APPLICANT TO FILL'IN BUILDING ADDRESS ❑ Certified copy Is hereby furnished. BUILDING ` ADDRESS 9142 La Rosa. DriveLOCALITY ' a Certified copy is filed with the county building inspection City, C/1/�A NEAREST department. LOCALITY Temple Ci L , CROSS ST. Date Applicant NEARESTDISTRICT N GR UP TYPE PR SSED-BY CROSS ST. Encinita CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGALL - DESCRIPTION- LOT NO. BLOCK .MAP - HIGHWAY' COMPENSATION INSURANCE' NO. (CIRCLE) '' 'STATE �Oa SECOND LOCAL a NO. OF BLDGS. USE ZONE SPECIAL CONDITIONS a-- (This section'need not be completed if the work involved _ TRACT., Now oN LOT' - VO by the permit is for one hundred dollar's ($100) or less.): '' -USE OF _ - SIZE-OF LOT' 'EXISTING BLDG. 'I certify that in the performance of the work for which this '0 permit is issued,'I shall not employ any person in ariy'manrier JOWNEk WERNER KUC E ~ so as to become subject to-the Workers' Compensation Laws. OCCUPANCY GROUP U ADDRESS 348 NO'. ARROYO DRIVE •� - a Date Applicant' NOTICE'TO APPLICANT: If„after making this'Certificate of W CITY .SAN” GABRIEL " NO. 576=7991 OCCUPANT LOAD Exemption, you should become subject to .the Workers' APPLICATION FOR °' - EXIT HARDWARE. Compensation provisloris of the Labor'Code, you roust.forth- with comply with such provisions or this permit•shall be TRAILER USE GEOLOGY INSPECTION 0 No Spec. Knowl. 0 destmed revoked. LICENSED CONTRACTORS DECLARATION - OCCUPANCY INSPECTION Panic Devices 0- I jhereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT i (LIST ITEMS BELOW) NO. OF EXITS '9,,,(commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is In full force and PARKING effect. SPACES 1 REO'D O PROVIDED O License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE O - ' FROM: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPE CTOR's acting in,my professional capacity—(Section 7051, BUS- EX.STING'BLDG. _ STORIES - SIGNATURE iness and Professions Code). FINAL APPROVALi RESENT USE•OF BUDDING, SALES AND REPAIR - Z4 OF Q � LIG.or Reg.No. Date OF CONSTRUCTION & INDUSTRIAL SU HOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGS ON LOT AND USE t I hereby affirm that I am •exempt from the Contractor's #le • e•- 8-8 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING - - - 'Y e e 'ele• o'O t ,� I, as owner of the property,.will do the work and the SPACES PROVIDED structure is not intended or offered for'sale (Section rS.1 9—BZ 7044, Business and Professions Code). ROPOSED USE OF BUILDING - - CONSTRUCTION LENDING AGENCY I•hereby Affirm that there is a construction lendmg,agency ALES AND• -REPAIR -OF CONSTRUCTION - for- the performance of the �vork.for which this permit-IS & INDUSTRIAL SUPPLIES Issued(Sec. 3097,,Civ.C.). Lender's Name PROPOSED MAX. OCC. " Lender's Address PERMIT FEE I certify that I have read this application and siate that the 6 above information is correct. I agree to comply with all County Issu ArreE FEE 'I ; ordinances and State laws relating to building construction, TOTAL FEE , and hereby authorize representatives of this County to enter (Pavy •to ,City of Temple City) ��"�"�ff the above-me tloned p'operty for inspection purposes. SEE-REVERSE FOR EXPLANATORY LAN UAGE �1Cp o MAY 10 , 1983 Signature of Permittee — Date f WORKERS'COMPENSATION DECLARATION �E 875412 80 :.M I SC:E.LLA NEO US A•PPL ICAT 10 N. ., I hereby 'affirm. that I have a certificate of'consent to self COUNTY OF,LOS ANGELES •, = BUILDING AND SAFETY DIVISION insure, or a certificate of Woikers'Compensafion Insurance,or a certified copy thereof(Sec. 3800,Lab. C.) Policy No. CompanyFOR APPLICANT TO FILL IN BUILDING d/ - ADDRESS, ❑ Certified,copy is hereby furnished, , BUILDING E" LOCALITY'S , ADDRESS aCertifibd copy is filed.with the county building inspection NEAREST- . department. L CALITYCROSS ST. - de Date - .Applicant' NEAREST' - - •' '-DISTRICT N UP TYP PRO SED BY -, _ SS STE'nci n i to 1 - - CONST.' , CERTIFICATE'OF EXEMPTION FROM•WORKERS' LEGAL Q - -. DESCRIPTION LOT NO. BLOCK-. +" � °a i:COMPENSATION INSURANCE , NOP G ' (��c`�EL - STATE MAJOR SECOND LOCAL /This section need not be completed if the work involved No. OF ei D6s. O l P I- TRACT - NOW ON LOT USE ZONE�SPEgIAL.CONDITIONSby the, permit is for- one"hundred dollars ($100) or'less.) � USE OF.,SIZE•OF LOT- EXISTING BLDG.certify`that"in the performance of the'work for which this O. permit Is issued, I shall not employ ariy person in any manner, - NER` . ° so as-'to become subject to-the Workers' Compensation Laws.- MAIL f OCCUPANCY GROUP �' W DRESS. t. .as r Date •'Appficant `•` NOTICE TO APPLICANT: If,'after,'making-thfs Certificate of ' Temp l,e' C i ty, Ca • Nb� �81$�286=•3342 OCCUPANT LOAD Exemption, 'you should "become- subject to ;the.-Workers' Compensation provisions of the'Labor Code;you must'forth- "APPLICATION FOR EXITHARDW4RE'' with comply with' Such provisions or this permit shall be TRAILER USE'0 GEOLOGY INSPECTION•❑ No'S' ec. 16'0W. � ' - deemed revoked.'," '_ , :'Panic bevices' LICENSED CONTRACTORS DECLARATION occupAlvcY INSPEcr1oN ' I herebyaffirm that I am licensed"under provisions of Chapter swFErY PERMIT [� '(LIST ITEMS BELOW] 9 (commencing with,Sectlon'7000)-of-Division 3 of'the Busi- ness and Professions Code, and,my license-is'in full,force and , PARKING •' effect. REO'D C� PROVIDED - , n SPACES , dLicense Number Lic.Class LIMITED TIME'USE Contractor Date:' _ DATE onTe , < - - • - FROM: To, I am exempt"from the licensing requirements as-I am a_ '�. , - - •..INSPECTOR'S..• licensed architect or 'a-.registered professional engineer SITE o'F No.'oF acting in'iny professional capacity (Section'705,1', Bus' EXISTING BLDG. STORIES SIGNATURE s iness.and Professions Code). SENT U'sE OF•BUILDING FINAL ABPROVA'L �� _ Machine Par-ts 0 Lic.or;Reg.No. L Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS a ON LOT AND USE I hereby affirm that I am exempt trom. the Contractor's " License Law•for the following'reason (Section 7031.5,,,Susi- ness:ii d Professions'Code): 4 -NO. PARKING - - - SPACES PROVIDED ,. _ - - _ n• oI as •owner of the'prop ert s° Y; will''do the work and the ' �.3 7,2 9 A structure -is not•'.intended or offered for sale (Section '"r „ 7044, Business and Professions'Coae)., x, • { - O,POSED.USE OF BUILDING #,l�O'�O O 88� Out Door''Furn i tu,re I ; - CONSTRUCTION:LENDING AGENCY 'o o,o I hereby'affirm that'there is a construction lending agency,,, f , I•. I i =,for the:'perforinance of the work for which this`permit is ' 0,'8,2 3�-,8 4 issued (Sec.-3097, Lender's,Name "pRoposeD MAX: occ. = Lender's"Address' 4 PERMIT FEE I certify that I have read."this application 'and_state that the ISSUANCE FEE above information is correct.-I agre to comply with'all County ~= M ordinances nd'State laws relate to bu'ding construction,' and here 'TOTAL FEE' •., - - y"authoriz reprXtatAies of is County to enter'upon eabAe-merits fo nspection.purposes. SEE REVERSE FOR-EXPLANATORY-LANGUAGE - M `,•, .Signature c f Per ittee _ Dater j WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION ' > CE 875 I hereby affirm that 1 have a certificate of consent to self r ii insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGEL_: . BUILDING ANI) SAFETY DIVISION ` I a certified copy thereof(Sec. 3800,Lab.C.). Poli yNo.ul4StR18oIQ�{npany C,�1L-COMP IUSt112ANC� FOR APPLICANT TO FILL IN ADDRESS ��o? Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS LA Ras,4 z �J El Certified copy is filed with the county building inspection LOCALITYNEAREST department. Temple City CROSS ST. Date Applicant NEAREST CISTRICT NO. GR P TYPE�� CESSED BY CROSS ST. C�O P CONS j CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. F BLD GS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF j I SIZE OF LOT EXISTING BLDG. ; *d I certify that in the performance of the work foi which this - permit is issued; I shall not employ any person in any manner OWNER p r1YQ ENERM 156 INC so as to become subject to the Workers' Compensation Laws. MAIL9OCCUPANCY GROUP ADDRESS 10.r1 l C) 2� 66 L' Date Applicant / NOTICE TO APPLICANT: If, after making this Certificate of CITY AVON C 0 �I6� NOL 62b—33 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INS PE CTIONIX Panic Devices ` I hereby affirm that I am licensed under provisions of Chapter `7 9 (commencing with Section 7000) of Division 3 of the Busr SAFETY PERMIT ❑ LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code, and my license is in full force and effect. PARKING SPACES REq'D E::� PROVIDED M1I License Number Lic. Class ale LIMITED TIME USE Contractor Date DATE DATE F HO M: • 1 am exempt from the licensing requirements as I am a TO _- licensed architect or a registered professional engineer SIZE OF NO. OF IN ECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 1 NATURE inessand ProfessionsCode). FINAL APPROVAL PRESENT USE OF BUILDING L 6 Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS — is}'14 � ON LOT AND USE I hereby affirm that I am exempt from the Contractor's ,J License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 1�1 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE oP BUILDING tCN 1��(TS I hereby affirm that there is a construction lending agency SLCW�tvq S v for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE 25.00 I certify that 1 have read this application and state that the above information is correct.1 agree to comply with all County ISSUANCE FEE ordinances and,State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE 25.00 t upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date { , WORKERS' COMPENSATION DECLARATION zo oos DPW'.2/90 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION iinsure,or a certificate of Workers'Compensation Insurance, or ll (� a certified copy thereof (Sec. 3800, Lab. C.)• a Policy'No. Company FOR APPLICANT TO FILL IN BUILDING - - B LDING AD RESS m_ ADDRESS H Certified copy is hereby:furnished. g I Z 1 '\ LOCALITY Certified copy is filed with the county building inspection c: zIP department —1 Q t 7 00v CROSS ST . Date Z Applicant SIZE OF LO NO.OF SLOGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY C CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT No. I COMPENSATION INSURANCE MAP HIGHWAY ' NO. (CIRCLE) STATE MAJOR SECOND LOCAL IL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE zoNE SPECIAL CONDITIONS a I by the permit is for one hundred dollars ($100) or less.) s. I I certify that in the performance.of the work for which this - Ll t A A a TEL NO. permit is issued. I shall not employ any person in any manner T I I b G I so as to become subject to the Workers' Compensation Laws. ADDRESS 11 ( Oe, 0 L OCCUPANCY GROUP v Date Applicant CITY ZIP q I (Sti U NOTICE TO APPLICANT: If, after making this Certificate OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code,you must forthwith EXIT HARDWARE: comply with such provisions or this permit shall be deemed TRAILER USE E] GEOLOGY INSPECTION❑ 1- No Spec.Knowl revoked. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[jt Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) ' ❑ t , 9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS 3 and Professions Code,and my license is in Rill force and effect. came ot Busluess PARKING r j License Number Lic. Class �� 1- y� �Z SPACES REQ'D PROVIDED t I I Contractor Date /v ��'-\ n h e� 13 LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a 7 ��1 DATE DATE licensed architect or a registered professional engineer / FROM: To: acting in my professional capacity (Section 7051,Business SIZE OF (/�o®� (� } No.of INSPECTOR'S and Professions COde). EXISTING BLDG. lT/ J ("'" STORIES I SIGNATURE. PRESENT USE OF BUILDING �� c) Lic. or Reg. No - Date FINAL APPROVAL EVA HOME OWNER-BUILDER DECLARATION NO.OF EXI TIN 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, Business and I 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 70441 PROPOSED USE OF BUILDING Business and Professions Code). t � � o•�ti �. S 'I c..� - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for < w ` the performance of the work for which this permit is issued OPOSED MAX.ROCC. ( � (Sec. 3097, Civ. C.). • Lender's Name APPI npi TEL NO. 9Y[+1T Lender's Address ADDRESS ( I I certify that I have read this application and state that the above information is correct. I agree to comply with all County p RMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter' upon ISSUANCE FEE { the above-mentioned property for inspection purposes. ` X TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date