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Home My Public Portal About9159 LA ROSA DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 I ?u o rebaffirm 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 L! ADDRESS O�y� Certified copy is hereby furnished. BUSSiILDING ADv LOCALITY /{/7 DRE Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant NEAREST DISTRICT NO. G UP TYPE PR ESSED BY CROSS ST. .O O CONST. C � CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 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 SIZE OF LOT EXISTING BLDG. >0:VF�which this' permit is issued, I shall not employ any person'in any manner O W NE A-v y so as to.become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP � o ADDRESSA - O �• � U Date Applicant- _ - 1„ �F�-�/1 NOTICE TO APPLICANT: If, after making this Certificate of cITY� � No.TEL. �"' WWWV --_ �" OCCUPANT-LOAD Z 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 El deemed revoked. ' ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPdNCY INSPECTION EJPanic 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 effect. , PARKING REQ•D D PROVIDED SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE DATE PROM• TD. 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 SIGN URE inessand Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date _ HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDS D� / )/, y �_� �� ON LOT AND USE i ;s`.'"- _ 0� I hereby affirm that I am exempt from the Contractor's _ r License Law for the following,reason (Section 7031.5, Busi- ness usi ness and Professions Code): NO. PARKING SPACES PROVIDED C,•C.-. V ��C,�t I, as owner of the property, will do the work and the LL- ,6._39 1 'S a 7 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, and hereby authorize representatives of this County to enter TOTAL FEE CO "bove;enti ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur f Per ttee Date 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 'fl insure, or a certificate of Workers'Compensation Insurance,or, a certified copy thereof(Sec. 3800,Lab.C.). 00 4 Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. J BUILDING _ ADDRESS LOCALITY , D Certified copy is filed with the county building inspection LOCALITY NEAREST department. �L� C/� C� G CROSS ST. Date Apphcant `` NEAREST DISTRICT NO. I GRO}JP TYPE PROC SSED BY V CROSS ST. y CONST.. / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v IV/ COMPENSATION INSURANCE DESCR IPTIOry LOT NO. BLOCK MAP GMwAr No. (CIRCLE) STATE MAJOR SECCAD LOCAL (This section need not be completed if the work involved TRACT NOW ON LOT SN6. OF USE IAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF l ,• �• SIZE OF LOT EXISTING BLDG. d I certify that.in the performance of the work for which this permit is issued, I shall not employ any person in any manner <1 OWNER _ s� so as to become subject to the Workers' Compensation Laws. MAIL \� _ OCCUPANCY GROUP ` �� Date Applicant ADDRESS 9Y� �` ) �ni 1 n-/(/G- o C-3 v CITY 'U 1f r ''�%'i� rTio� OCCUPANT LOAD i NOTICE TO APPLICANT: If, after making this Certificate of _ ,,.�, � �/�?,o Dv�� Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or' this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION El No Spec. Knowl. ❑ deemed revoked. • LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of ChaptersnFeTY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi NO. OF EXITS ness and Professions'Code, and my license is in full force and effect. PARKING REq D D PROVIDED D SPACES License Number Lie. Class LIMITED TIME USE Contractor Date DATE 7ATS 2 A FROM: TO: • NIPS AEB'I$R•S I am exempt from the licensing requirements as I am a - - • licensed architect or a registered professional engineer SIZE OF NO. OP 5 GNATURE acting in my professional capacity (Section 7051, Blas- EXISTING BLDG. - STORIES Z 4 � t iness and Professions Code). . . . FINAL APPROVAL �• PRESENT USE OF BUILDING �� Lie.or Reg.No. Date Nr HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT'AND USE _ I hereby affirm that I, aril exempt from the Contractor's License Law for the,following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 0 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 v PROPOSED USE of BUILDING I hereby affirm that there is a construction lending agency �� AJI—r— for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). CE Lender's Name 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 ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEEco upon the above-me tuned property for inspection purposes. s_ ,'y_ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Per itte l Date ' I WORKERS'COMPENSATION DECLARATION CE 8754(11 84) M ISCELLAI4EGUS 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 Certified co is hereby furnished. BUILDING.. (� ((�� L copy y XX ADDRESS 1L5_7 _Ea.C1t. --L ,a --V LOCALITY Certified copy is filed with the county building inspection LOCALITY Temple City cwoss sr. department. 3LX Date Applicant NEARESTDISTRICT NO. GRO��}}11P TYPE PR SEED BY CROSS ST. Encinita Avenue ,� /j� CONST. CERTIFICATE OF EXEMPTION FROM'WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lor 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 r SIZE OF LOT EXISTING BLDG. ///+/ I certify that in the performance of the work for which this Y( °C-3 permit is issued, I shall'nbt employ any person in any mannekX OWNER Of buildirig Otting Enterprises J so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP MAIL P. O. BOX, 722 . ADDRESS LJ Date Applicant 41 NOTICE TO APPLICANT: If, after making this Certificate of CITY Glendora NO. (8 18)338-211.6 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 beTRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. E] Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) E 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 arlX r effect. Name 'Of business PARKING REQ'D PROVIDED I ' . SPACES J LL--.. License Number Lie. Class Darlin ton International LIMITED TIME USE Contractor Date dba G. P. Garment Company OATH GATE FROM: TO: I am exempt from,the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OP INSPECTOR'S acting in my professional capacity (Section 7051, Bus- _EXISTING BLDG. X000 SQ. fte.`- 'I STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date <- S�ortwear and Swimwear Manufacturing HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS n ON LOT AND USE - i,jlt;il -Eli IIS:i A ii.� - 1 hereby affirm that I am exempt from the Contractor's �J �pr, iii License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING P, as owner of the property, will do the work and the SPACES PROVIDED appro. 20 structure is not intended or offe*ed for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE of BUILDING 1,hereby affirm that there is a construction lending agency Clothing Manufacturing 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 I have read this application and state that the above information is correct. 1 agree to comply with all County ISSUANCE FEE r ordinances eandt State laws relatr�ppgg to building construction, and hereby authorize rep resent of this County to enter TOTAL FEE 25-00 upon thelabove-mentioned prople ty for inspection pur os C / SEE REVERSE FOR EXPLANATORY LANGUAGE l6 Signature of Permittee DAte W07KERS'COMPENSATIONDECLARATION 76M444 � M1�CELLANEOU� APPLICATION I herby affirm that I have a certificate of consent to self CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a cert�cate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). Policy No. CompanyFOR APPLICANT TO FILL IN BADUILDING DRESS Certified copy is hereby furnished. XBUILDING9159 E. LA ROSA DR.TEMPLE CITY LOCALITY ADDRESS i Certified copy is filed with the county building inspection X LOCALITY CA 91780 NEAREST � department. CROSS ST. DateApplicant NEAREST DISTRI T NO. GROUP TYPE CESSED BY CROSS ST. ENCINITA STREETN 1 _ ;CERTIFICATE OF E`CEMPTION FROM WORKERS' LEGAL 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 (S I00) or less.) USE OF I certify that in the performance of the work for which ,.his SIZE OF LOT EXISTING BLDG. permit is issued, I shall not employ any person in any manner % OWNER OTTING ENTERPRISES INC. so as to become subject to the Workers' Compensation Laws. g MAIL OCCUPANCY GROUP = AD OR ESSP.O. BOX 722 Date .applicant X _ rEL. OCCUPANT LOAD -- NOTICE TO APPLICANT. If, after making this Certificate of CITY GLENDORA No 818 8-2116 Exemption, you should become subject to the Workers APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code, you must forth ❑ V with comply with such provisions or- this permit ;stall be TRAILER USE I I GEOLOGY INSPECTION ❑ No Spec. Know[. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION- OCCUPANCY INSPECTION (B I Hereby affirm that I am licensed under provisions ofCliapter 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 // effect. PARKING SPACES REQ'D D PROVIDED • _ License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE ElI ain exempt from -.he licensing equireinents :s I ain .1 z i licensed architect or are istered professional _ngmeer 3IZE OF No. OF acting in m}- proiesional cap.icr• Secion ,OS i. Bus- INSPECTOR'S Z ZXIST:NG BLDG STORIES SIGNATURE t iness and Professions Code). FINAL APPROVAL � � - PRESENT USE OF BUILDING — D Lie.or Reg No. Date = i HOME OWNER-BLILDER DECLARATION NO. OF EXISTING BUILDINGS �{� NCO FEE - ON LOT AND USE � 1 I hereby affirm that i am exempt from the Contractor's �'`/ DOM-000 11 W ( License Law for the folio«ing reason (Section 7031.3. BUST- ness and Professions Code): NO. PARKING 1 titl�l/ ElI, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for ;ale (Section 7044.Business and Professions Code). CONSTRUCTION LENDING AGENCY X PROPOSED USE OF BUILDING SWIMWEAR MANUFA URER I herebv affirm that there is a construction lending asencv for tine performance of the work for which this permit is issued (Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's.Address 25.00 I certify that I lime read this application and state that the PERMIT Fee above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laic s relating to building construction. and herebv authorize representatives of this County to enter TOTAL FEE 25.00 h upon tln above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE X Sig .e of!1�7-nittee Date WORK ERS' COMPENSATION DECLARATION 1. -U(7)6'3DPW 12/J0 MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to sell COUNTY OF LOS ANGELES BUILDING AND SAFETY. DIVISION l� I insure, or a certificate of Workers' Compensation Insurance. or l a certified copy thereof (Sec 3800. Lab. C.) of Policy No- CompanyFOR APPLICANT TO FILL IN BUILDII IG 0. ADORE?S iQ�pl X BUILDING ADDRESS ( 1p ❑ -Certified cop; is hereby furnished ?�C . e q t 1� LOCALITY ❑ Certified copy Is filed with the county building inspection CITY P ¢� department e j U v NEAREST CROSS ST Date t� Applicant Slz OF LOT NO OF BLDGS NOW ON LOT DISTRICT NO GRO P TYPE ESSED BY _ ;. CERTIFICATE OF EXEMPTION FROM WORI:ERS'_ 000 a oe®. JQ�' CONST TRACT, BLocK Lor No COMPENSATION INSURANCE NOP HIGHWAY (CIRCLE, STATE MAJOR SECOND LOCAL (This section need not be completed if the work inx Uived ASSESSOR MAP BOOK PAGE PARCEL USE ZONE I SPECIAL CONDITIONS b) the permit is for, one hundred dollars (�,100) of less.) 1 certify that in the performance of the work fur which- this OWNER TEL NO { X property i permit is issued, 1 shill not employ, an+ person in am• manner so as to become subject to the Workers' Compensauon Laws ,DDR, s X �06� OCCUPANCY GROUP X DD i Date Applicant CITY ZIP NOTICE TO APPLICANT If ,ilei making this CeruficateX Xlleoo, OCCUPANT LOAD of Exemption, you >nould become subject to the Workers APPLICATION FOR E XIT HARDWARE Compensation pro+isions of the Labor Code.you must forthwith comply with such pro\isions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ NO Spec Knowl ❑ revoked I LICENSED CONTR ACTORS DECLARATION OCCUPANCY INSPECTION ElParnc'Devices ❑ 1 hereto affirm that I am licensed under provisions of Chaplet SAFETY PERMIT❑ )LIST ITEMS BELOW, 9(commencing with Section 7000)of Division 3 of the Business NO OF EXITS and Professions Code, and m) license is in full force and effect PARKING, REO D PROVIDED License Number ___-__--___ ___ Lic Class _ _ SPACE'S L� Contractor Date ___ _ _-. - ___-____ t LIMITED TIME USE ❑ DATE DATE I am exempt from the licensing requuements as I am'a FROM TO licensed archueci or .I registered piofessional :nuincer 1 — i acting in m} rolessnm.il p`ca icit (Section 7(151 Busmcss 51zE of NO of Ns ecroR s p I�EXISTING BLDG STORIES / iN�URE and Professions Code) - Lic or Reg NO _ Date t PRESENT USE OR BUILDING _ FINAL APPROVAL HOME Okk NLR-BLIILDL-K DEC'LAR Al ION 110 OF EXISTING BUILDINGS ON LOT AND USE ' I hereby affirm that I .un exempt from the Contractor's LiLense ; Law for the follox+inc reason (Section 7031 5. Business and — Professions Code) )SPACES PROVIDED "NO PARKING O ) El Las owner of the property. will do the wotirk and th, •r, YV' structure is not intended or offered for sale (Secon 70.14, PROPOSED USE 01 BUILDING / Busmest and Professions Code) I' CONSTRUCTION LENDING AGENCY ' a 1 hereby affirm that there is a construction lending agency for the performance of the wort, for which this permit is issued (SCC 3097, CivC ) PROPOSED MAX OCC Lenders Name APPLICANT(PRINT) TEL NO Lender's Address ADDRESS 1 certify that I have read this application and state that the above information is correct. I agree to comply with all CountyPERMIT 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 'ERSE OE ATORY LANGUAGE F Signaiure of Permittee Date