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Home My Public Portal About8843-43 1/4-43 1/2 LAS TUNAS DR_Miscellaneous__ \CORKERS COMPENSATION DEC L_%RATIONI 16Jd444 ,E6r5i11841 MISCELLANEOUS APPLICATION r, I hereby affirm that I have a certificate of consent to self insure. or a certificate or \CorkersConioensanon Insurance.or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof'Sec. 3800. Lab_C.I. _ -- Policy No. _C,mman}' FOR APPLICANT TO FILL IN BUILDING vowESS ❑ i Certified copy is hereby furnished, BUILDING AUIL ENG LITY I I Certified copy is tiled,pith the rnunri bat ildirm inspection LOCALITY Temple City NEAw-d— department. P y CROs ST. Date Applicant 'NEAREST � ^ISTRI GP P TYPE P OC ESSEU OY ICRO55 ST. Q,m eGL CONST./� ! CERTIFICATE OF EXEMPTION FROM 'CORKERS LEGAL C 0\I PL NS:\I10N INS( R.\.\t 1_ OESCP IPT'ON LOT I.. DLOCK 1 MPP IcGw CI_- STATE NAIOR SECOND LOCAL NNi OF BLOCS. (This section need not be Completed if the work involved TRTC' NO\V ON LOT ViE ?ONE i ECIAL CONOITICNS by the permit is for one hundred dollars IS1001 or less.l 1 OF I SIZE OF LOT USE TING wLJU. 1 certifv that in the oeriormance of :'te "'A. for which -hisF,Or _ Permit is issue([. I sh:.11 no; Cmpinv An, ne:von !n an,' manner "o•.vNER Sun so as 10 becmne subject :o the \lorkefs' _,ntrensation r.:nr c. AIL Bgy3 LoS v�LAh �y occLPaNc Roue vvREss I Date— Applicant 1 - NOTICE To APPLIC\NT: If. :titer :nakinc itis L_ea tiicam n IT" ` _E ` / OCCUP.IN- LOAD gi r. Qct I R C-I k Nc. >b Z�6 �' O Eeemotio I. you should become moire :e -he \\I11ke- Lompensation Oro.inions of ;he Labor '�ade. ,'ou rust ordl- OP-1 'CA-1CnI -�O g;ii-4oP, 1 ,cith comply ,Wi:rd.ith :ucli ormisinns . this '-emit ;hail be deemed :e,o _ — - - - AIL_R vsE !1 GEOw Gr :rv.PE�rlcrv ' No SOec. K:aco . /I I — LIC ENSED i'ONT R ACTORS DECLARATION OCCUPANCY INSPECTIONXX Panic Devices I hereby affirm :hat Icam licensed under nrc,mons of Chanter SAFETY PERMIT (LIST ITEMS BELOW) 9 'commencing „still Section 70001 of Division 3 of the Busi- NO. OF EYITs ness and P-otecsions Code. and in, license is in nul (nrce and effect. P,PKINO s'CCE$ REOC C PRCVIOEO License \un)bcr_-- - -ic. LIMITED TIME USE Contractor Date—__ OATE oA-e 7.zTo I am exempt from the iicensine reauhe:nents as I at O 1 licensed architect or a registered rrniessionaf engineer ;aE OF No. o= INSPECTORS z coin`] In :rte prof_,,ional .tud-tv -i,:io:1 -n:l. Boo- ESISTI.Ia OLD G. ;copies SIGNATURE mess and Prof essic ns l oriel. RESENT USE of BUIUIrvG F'NAL APPROVAL Lia or Re^_ i I HO\1E O\CNI'R-BCILDER DECLAR.WON NO. of EXISTING BUILDINGS ON LOT ANO u5E I hereby ,firm that 1 ani eNempt .from the Contractors License La„. for the following reason 'Section _0 1._. Bust- ' ness and Professions Code): NO. RAw KIN. PACES PRCVIOEO El I, as owner of the property. will do :he work and the strnc:ure is not intended or offered for :ale 'Section 1 7044.Business and Protessinns Cold-el, p CONSTRUCTION LENDING ADEN(-\ A PROPOSED USE OF BUILDING I hereby, afCinn that [here is a constmction lending :wency @�ICe I e.>H to M o 71r .rL�TJs° ! for the performance of the work for ,shich this permit is � r;J�=r^ issued )Sec. 3097.Civ.C.). Lender s Name - CID i PROPOSED MAX. OCC. '1' r, Lenders address _ "11,11 I I PERMIT FEE ZSADQ i 1 certify that I have read this application and state that the - above information is correct. I agree to comply with all C ouniv ISSUANCE FEE ordinances and State laws relating to building construction00 and hereby authorize representatives of this County to enter TOTAL FEE 25.00y' I upon the above-mentioned property for inspection purposes. STE REVERSE FOR EXPLANATORY LAVGU:\GG Signature of Permittee Date J y;\Vf)tiFCERS'COMPENSATION DECLARATION CE 875(11-841 MISCELLANEOUS APPLICATION CE 8]5 I hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Wox exs'Compensation Insurance,or a certified copy thereof(Sec. 800,Lab.CJ. Policy No. Compa iy FOR APPLICANT TO FI LL IN BUILDIrvG Coi1� b� f�As ADDRESS QCertified copy is hereby furnished. noow Ess 8843 LOCALITY Certified copy is filed wi h the county building inspection Tv department. LOCA41TEMPLE CITY, CA 91780 CROSS ST. Date Applicant NEAREST DISTRICT NO. I GROUP TYPE PROCESSED BY CROSS ST. �D (/ ^� a>. Y CONSA./ L-2-r-e CERTIFICATE OF EXE. PTION FROM WORKERS' LEGAL o COMPENSATI )NINSURANCE DE SCR I FTION LOT rvo. BLOCK IDwwA NO. OF BLDGS. NO. (CI [Le) STATE MAJOR SECOND LOCAL by t section prm need not be ondred d If the Work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one undred dollars ($100) or less.) usa of SIZE OF LOT EXISTING BLDG. I certify that in the perform nice of the work for which this 999 permit is issued, I shall note to an erson in an manner P P Y 1' P Y OWNER THOMAS FANN y so as to become subject [o t Workers' Compensation Laws. MAIL OCCUPANCY GROUP Date - Applicant wDDREss1� 362 W.Garve Ave . U w NOTICE TO APPLICANT: If, after making this Certificate of CITY Monterey Park�,E`'BI�_z`�ood`El OCCUPANT LOAD 0- Exemption, Exemption, you should be me subject to the Workers' ? Compensation provisions of t e Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such pro isions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. KnUWI. LICENSED CONTRA TORS DECLARATION OCCUPANCY INSPECTIOI� Panic Devices I hereby affirm that I am lie sed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 000) of Division 3 of the Busi- NO. of EXITS ness and Professions Code, d my license is in full force and n b effect. tL PARKING REO'D PROVIDED SPACES License Number Lie. Class T LIMITED TIME USE Contractor Date DATE DATE I am exempt from th licensing requirements as I am a licensed architect or registered professional engineer SIZE OF NO. OF IN.PECYOR'S acting in my professi nal capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions de). FINAL APPROVAL Pq ESENT VSE OF BUILDING General Office Lic.or Reg.No. Date { f Fv HOME OWNER- ILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I �m exempt from the Contractor's ?!_, License Law for the folldwing reason (Section 7031.5, Busi- ness and Professions Cod. , NO. PARKING S, e'� 'i i.j? I, as owner of the roperty, will do the work and the SPACES PROVIDED structure is not in ended or offered for sale (Section 7044,Business and 'rofessions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING General Of f ice 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 PROPOSED MAX. Dec. 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 al khorize representatives of this County to enter TOTAL FEE upon the bov -1 entioned Ljproperty for inspection purposes. - 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P mince D to WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION �- CE 8]5( 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 G 7 � ❑ -� ADDRESS �J . Certified copy is hereby furnished. Y' BUaaING $� LOCALITY _ /\ ADORE SE Certified copy is filed with the county building inspection LocwuTv NfiwREST department. G, sZ cRo.. ST.' Date Applicant N ERRE ST • DISTRICTlN� UP CONST ........ BY CROSS $T., .J/��{{�TJ�— CERTIFICATE OF EXEMPTION FROM WORKERS' LE GwL COMPENSATION INSURANCE OE SCI LOT NO. BLOCK A Ir'RN'J`Y STATE MAJOR SECOND LOCAL • NO. OF BLDGS. NO. (.,.CLE) (This section need not be completed If the work involved TRACT NOW ON LOT USE ZONE $PE CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) uSa OP I certify that in the performance of the work for which this SIZE oP LOT exlsnrvG BLDG. —3 a 0 permit is issued, I shall not employ any person in any manner 7( OWNER so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP , o Date ADORE Applicant w NOTICE TO APPLICANT: If, after making this Certificate of If CITY . _ OCCUPANT LOAD z Exemption, you should become subject to 'the Workers' APPLIC ION 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 El 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 ?( Zfeffect. ^ U ✓ I PARKING Rfi0'O PROVIDED I��1__JI SPACES II License Number Lie. Class ' oN iZ��N1 oN a% P AY--/cG 1� LIMITED TIME USE Contractor Date *E AT. ' I am exempt from the licensing requirements as I am a o7J 6TTSNEE"[� FROM: licensed architect or a registered professional engineer EXISTING OF No. DP wsPE CTOR'S acting in my professional capacity (Section 7051, Bus- ExIsrING BLOC. ST OR IES SIGNATURE iness and Professions Code). FINAL APPROVAL Lie.or Reg.No. Date PRESENT USE OF BUILDING MI HOME OWNER-BUILDER DECLARATION NO. of EXI;'T eUILVJrvcs (%/e .� "' /L`a B I hereby affirm that I am exempt from the Contractor's ON LOT AND USE r L License Law for the following reason (Section 7031.5, Busi- ' r .},'/ ness and Professions Code): NO.-PARKING // I' 7Z p SPACES PROVIDED l�, -1 ♦:i'jx+Y" 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY r' PROPOSED USE OP 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. DCC. 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 FEE upon the above-mentioned property for inspection purposes. 8 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee ate WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION CE 8]5 n 1 hereby affirm that I have a of consent to self COUNTY OF LOS ANGELES .BUILDING AND SAFETY DIVISION ',IL1II insure, or a certificate of Workers's'Compensation sation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). �._•� PolicyNo.—Company puILDIN.. P FOR APPLICANT TO FI LL IN ADDRESS Certified copy is hereby furnished. BUILDING a Twinac ® LOCALITY wDDR Ess aCertified copy is filed with the county building inspection LOCALITY/ NEAREST department. T e G G q �. p O .Ross ST. Date Applicant NEARESTCROSS 8T. O `L ' OISTRICJn NO/j G UP TYPE P E99ED BY v J CONBT. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPnOry LOT NO. BwcK . iDRWA n0e NO. OF BLDG 5' ICIRCLB) STATE MAJOR SECOND LOCAL (This SECf1On need not 6e completed d U36 ZONE SPECI the work involved TRACT HOW ON LOT AL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usa 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 in any manner OWNER 14C1 4 v so as become styqypJct to the Workers' ompenmtion Laws. Mwu. - OCCUPANCY GROUP o _�1t,,,,..e. `1 3 ` ADDRESS TNlhO� Dr a Dates--�—Applicant L,J g e LC G TEL' fly S- � OCCUPANT LOAD NOTICE TO APPLICANT: If, after ma in this Cert'teat. of clTr rvo. VI v ren Exemption, you should become subject to the Workers' - z APPLICATI N FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ ceol.o cY INSPECTION ❑ No Spec. KnOWI. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIONPanic 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 0r— , effect. Q 0 USI S PARKING REOD PROVIDED SPA License Number Lie. Class Q CES LIMITED TIME USE Contractor Date DATE DATE 1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOWS acting h1 my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). ' GD A Essrvr usE of eU u.D lrvct FINAL APPROVAL Q, Lie.or Reg.No. Date u— e S'ttsr�c HOME OWNER-BUILDER DECLARATION OF n c BUILDINGS ON AND /11 - ON LOT AND USE 1 hereby affirm that 1 am exempt from the Contractor's _I1 Q IJI�QQ—IJQ1�1 '1^i'; ,License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING '^ Y [1403 1, as owner of the property, will do the work and the SPACES PROVIDED ((/ 1 1'111%J. structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY oros90 USE OF BUILDING 1 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. Dec. Lender's Address �1 I certify that 1 have read this application and state that the PERMIT FEE p<�f 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 T*4; ed property for purposes. SCE REVERSE FOR EXPLANATORY LANGUAGE ermermittee Date WORKERS'COMPENSATIONDECLARATION CE 875 (2-801 MISCELLANEOUS APPLICATION _ CE 875 I Thereby affirm [hat.[ have a certificate ofconsent 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. CompanyI FOR APPLICANT TO FILL IN BUILDNG X- BILD ❑ Certified copy is hereby furnished. UILDING ,/ / < -r- ��))a/ }T Locnu'rY T ❑ ADDRESS `� �, d 721/V'IJ P Certified copy is filed with the county building inspection rveA REST department. OCALITY Tl ST.' Da1C Applicant AREST DISTRICT�N)P. _ G OVP TYPE / PRO ED BY CROSS ST. �T V IO CONS'./ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL VVV -COMPENSATION INSURANCE DESCRIPTION LOT rvo. ecocro MAP wIC..AY - } N (G Iw CLE) STATE MAJOR $ECO O.LOC pL d (This-section need not be completed if the work involved NO. O BLDGE. USE ZONErPECIAL CONDITIDNS O p TRACT NOW ON,LDT - U by the permit is for one handfed dollars ($100) or less.) - /r /J USE TI / 'jr ' SIZE OF LOT EXISTING BLDG. Il/,J . 1 certify that in the performance of the work for which this -0 permit is issued, I shall not employ any person in any manner w.ER L I/�S 7i ',S _ V so as to become subject to the Workers' Compensation Laws. IL OCCUPANCY,G ROUP W • AD DRE 55 �id I�OX Jh 1 -� ... V)Dace Applicant - _ NOTICE TO APPLICANT: If. after making this Certificate of CITr /J7sd� �/r No S 'Q ' 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 Of 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 1 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 _ PARKING effect. SPACES REO'D D . PROVIDED D License Number Lie.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 5¢E OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. sTORI ES SIGNATURE mass and Professions Code).- - FINAL APPROVAL ESENT USE OF BUILDING Lic,or Reg.No. Date �GiVv D�i�%CGS —R4256A HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS -ON LOT AND USE # . . ... 88 I hereby affirm that I am exempt from the Contractor's - License Law for the following reason (Section 7031.5, Busi- •� �.� • ^ z nee,and Professions Code): NO. PARKING SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the - - structure is not intended or offered for sale (Section �II 9_1' 8 6 7044, Business and Professions Code). OPOSEO USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction ]ending agency (/ for the performance of the work for which this permit is issued(Sec. 3097.Civ.C.). {s Lender's Name PROPOSED MAX. OCC. �(JJ Lib Lender's Address PERMIT FEE 'I certifv 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, TOTAL FEE - - and hereby authorize representatives-of'this County to enter upq e.above-men[ioyed ro r for inspe i01 SEE REVERSE FOR EXPLANATORY LANGUAGE I /Signature of Permittee. Date ' WORKERS (on,ILNSAHDNDL(1_-,Iz \r MISCELLANEOUS APPLICATION h..,L. hercb9 allmn that I Irlcreeltllicale III c II, nl ,II .ell COLIN LY 01 I-OS ANGELES BUILDING AND SAFETY DIVISION i Insure, or ,t certil Icate WoLI.N ( nnpcn,uliuo In.ounce_m ;I certilred cop) Inereui (Dec. .500. La,. �J Policy NO. (omimm, FOR APRLIGANITO FILL III BUaowG BUILDING ADDRESS ADDRESS ❑ Certified cop)' is herclP ImmNlicd. 8643 E .LAS TUNAS_ DRIVE, LOCALITY I ❑ C'ertilied copy is fikd with the count, huilding im.pectiao nn TEMPLE CITY ZIP CA91 786 NEAREST - .. department. CROSS ST. Dale Applicant t SIZE OF LOT NO.OF BLDG$.NOW ON LOT DISTRICT NO. GROUP TYPE PROCE SSED BY �jQ CONST. (LKllll('AI'E UI_ I-.X EhI PI'I(1N I'ROA1 U-OR I:P.I:S n?ACT -- BLOCK LOT No.------ - I (ONIPE NSAHON INSURAN(1. �rr,..Y C. a. ,clgae, STATE MAJOR SECOND LOCAL (This section need not be pnnpleled II IIIc NOrI. imol%ed ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS IT) the permil is lin' one hundred dollars 01001 or Icss.) 7 T U 1 ccrlily that in Iltc perin un :ulec "I' thd e ark 111 ,I'hiat [Ili' TEL NO. permit IS issued. I shad not nllplol any Penna ul ;my :n:Iiacr so as ro become Subject a, the 1l'UrAcrs' C'om pen.alion L:ncs. ADDRESS - OCCUPANCY GROUP ® I„ Cute _ Ap poi cant ary zIa NOTICE TO APPLICANT. h. alta m:lkin_ this (ntiliede OCCUPANT LOAD o! Exemption, you Should become ;uhiect to the Worker APPLICATION FOR Compensation provisions or the Labor Code)Lot nnlst ILrthvith EXIT HARDWARE: comply with Such prm'isions or LF1 Rel'nlll .,hall be deemed TRaLERUSED GEOLOGYINSPEc ION D No Spec Knowl_ ❑ ..I revoked — -I OCCUPANCY,NSPECrIONN Panic Devices ❑ I ICENSLD (ONE RAC'IONS UF('I_AR V1ION I hereby' allirn that 1 :mt licensed under provision of !'haplcr SAFETYPERMITD ,LIST ITEMS BELOW, ❑ i 9(commencing with Scction 7000)IT Divi soon i Ill'tie Eusinem, - NO.OFEXITS and Professions Code and In)' licuuse is in Tull Ioicc and ellen. PARKINA � SPACESG' REQ-0 PROVIDED 4 Liccnx Number Lie. LIMITED TIME USE �� — -- I � Contractor Date I ❑ I am eeempt from rhe licensing reyuirenrcn(s ;D I and it FROM DATE TO: DATE lieenud ULhiteci or it regimcrcd prolcsslau.11 eneim<r — acting in nt)' prllcs.i lld capaul) (S ctiuu 7051 iiu,ims, 911""1' TN.. �- INSPECTOR'S and I IY I...ons (1 Lie) Ex sIING DILC.. 1 I Rus SIGNATURE Lie. or Reg. No. _ U',Ila PRESENT USE OF BUILDING office FINAL APPROVAL LJ QI HMIE OWNER-BUILDER ELL 1, \RAI ION r Ir rX ISI N.:BUILuwcs m Lor nrvo use I hereby ullinn that I mn cscnt pl Imin the Cant tactor. Liccns Law for the following reason (Section 71111.5. lhjNm:s and _ Pmles,ions Coder No_PARrciNa L :a aa'uer nl die pnlpcn). II iII J„ the II„rk JnJ IbSPACE,LRovroeOc —�--__ ._ structure i, not intended Ur u11cied G,I site(Sccllon /11-11. PROro SBD USE OF BUILDING Business and Processions Codc). — General trading business for CONSTRUCTION LENDING AGIiN( ) I herchy :Ill m that these I, it clmsNuction Icndua I_- c ILr importation and exportation . the perlurnmucc ul (h work lir vouch this pun'lnI I Imued --- I (Sec 3097, ()v. ('.). PROPOSED MAX.OCC. Lender's Name _ _ _ _ _ APPLICANT Il'ti'I'I*) Ey No _ Icnder's Addrrss X HSIU TA0 ,WP..NG �o26 ) --99-9 _ 77 AnnREss � I I certil)' that I have read (his app0uuiin ;mJ state :[,ill the 5107 N.ROSEMEtjD PLVD 414 S-,AN G1 S IEL CA91776 above information ¢correct. I agreeAocompi) with all('....r PERMIT FEE ordin;mces and State laws relating fit building Cnn'IT"Coun.:md hereby autliorive repfeslimatiYcs ul' this (nnnly m el,tcr upon ISSUANCE FEE the above-ntentioncil propert ' Ill, inspection purp<ao. TOTAL Fre yOb Sl 1: RI[\'L'RS[ POR fiX PLANATORT LANGUAGE a � Signamreul Permlrcc Ia:tc I "'°R ER' °°'IPE 5 T'°" °E`LARAT'°" E44 875 (1 L841 CE MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of content to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of W"orkers'Compensation Insurance,or LI a certified copy thereof(Sec. 3800,Lab. C.). _ Policy No. Compana' FOR APPLICANT TO FILL IN oulLOlrvG O-G�(i1 ��J ❑ ADDRESS Certified copy is hereby furnished. BUILDING 9Y(+, LQS UYIUS r-� LOCALITY !/ ADDRESS J Certified copy is filed kith the county building inspection LO cw urr NEAREST department. Temple City cRoss s_, Date Applicant NEAREST DISTR IC' N��11. GRO{yp TYPE // P ESSEO BY CROSS ST. D� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' �. LEGAL COMPENSATION INSURANCE t DESCRIPTION LOT NO. STATE MAJOR SECOND LOCAL NO. OF ISLOG5. NO� AL c (This section need not be completed If the work involved !TRACT NOW O\ LOT VSE ZONE SPECIRCONDITIONS by the permit is for one hundred dollars ($100) or less.) 1 usE of ISIZE OF LOT EY.ISTING BLDG. I certify that in the performance of the work for which this11 _ Permit is issued. 1 shall no: cmpley any person in any manner YY� D1 ER SLI IJ - I�(� yJ so as to become subject to The Workers' Compensation Laws. `�(' OCCI.!PANCY GROUP d MAIL p Os Date Applicant t - TEL. -- N'OTICE 70 APPLICANT: I`. after mai:ing this Certificate of gl CI:Y T>I7 �2 rvD.- �j1�' ��'uf"'I S OCCUPANT LOADD Exemption. you should become subject to the Workers IAP, 1_;C°TION FOR EXIT F:ARDW A,R E: Compensarion provisions of the Labor Code. you must fo-th- I with comply with such Proeistmu or :his permit shall be rR A1LER USE '. GEOLOGY msPEcnoN No Spec Knev✓!. deemed revoked. LICENSED CONTRACTORS DECLARATION I o__ueANc, INSPECTIOt:as Panic Devices D hereby affirm that 1 am licensed under provisions of Clutter __ L - O i I SAFETY. -ER.;T (LIST ITEMS BELD%%j No. Or Ex1T1 - (colrmencing with Section 7000) of Division 3 o:tite BUsr ness and Profession-s Coda and nt}- license is in full force and I caec . I PA RY.irvG REO'O PRo1•m Ec License Number L]<. Class _ LIMITED TIME USE Cortra ctor !-late —T. ogre :mi c%enipi ti, , ne ncensill rel u m - t - _ licensed ar li ce' a _istL ( h or ss t t t e E DE N of IN 1.2 .UR's 1 �.S:IN'G BLGC. STORKS- SIG TVRE Aar t inn - Prur s�nna su f ,>-....L, f 1. Rt .- bless and P o essio. s Code). / 9 ^ �I . ._sF TOSE OF Evr_DInG FI OVAL r'4 �`0/:I t HOME O }' WNER '.TILDE R DECL !.F-�,110\ - No. DF �rIAnNG Bu r_DINc / n f'D .DN ANL Use ✓' I hereb,' affirm that i mn etiemp: from rite Can'.:actot's i License Lay. for Tile fobmt in, reason (Sectiarl 70515: Bus, ness and Professions Code T: NO. -ARNINe . '_c PACES PROVIDE` L1. as ov ncr of the proper,:. ,till do the vork and the I structure is no; hnendee or offend for stle (Sectio,, 704 Busm_ss and Profession ,-od ) Pq OOOSED VSE OF BUILOIN�. CONSTRUCTION LENDINGAGENcS _1 1 hercb}' affirm that th r i. a Lon u trop lenom- yen Com- r + for the Performance of the n'oxl_ ,o. volcit ,nis permit IS j issued (Sec. 3097.Gc. C.). Lender's Name � �( Lender's Address III PERMIT FEE 25.00 r 1 cert;i} that I have read this application and state that the }`1 above information is CArrecT. I agree.m.comply with all Coum} FISSUANCE FEE ordinances and State la,,s relating to buildinc construction. and hereby' authorize representatives o_ this Counn to enter ( TOTAL FEE 25.00 upon III abov -m5c—�foned opert>ic:inspection purposes. ^^ ERSE FOR -%D--%NATOR) LANGU AG! I_, Sign; e of Perminee Date