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HomeMy Public PortalAbout9094 LAS TUNAS DR_Miscellaneous__ TEMPLE CITY 78M444-�DFr37511.59 MISCELLANEOUS APPLICATION DIVISION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS '?0911 E• 4,9-S /11/VAS CASSATT D GRIFFIN,SUPT OF BUILDING LOCALITY 1-;epz 15 ;r ly, F R.APPLICANT TO FILL IN cRoss sr. �oC� Yr �A'0 f OWNER /9 c G " ADDRESS MAIL DISTRICT NOr/I GROUP I TYPE T. CITY NOI. / ©� MAP STATE TEL. NUMBER i HWY YE NO CONTRACTOR NO. USE ZONE SPECIAL 0/'� CONDITIONS ADDRESSLEGAL DESCRIPTION I LOT NO. 4-4/)Q / "BLOCK BUILDING I I I EXIST. HWY STREET NAME WIDTH NO OF C� SETBACK YARD TRACT J � •'16IV2 �//I NOW ON LOTS _FPROINT SIZE OF LOT I EX STUSE O NG BLDG. SIDE P. L. APPLICATION FOR INSPECTION RECORD OCCUPANCY �/ INSPECTION ,(� SAFETY PERMIT TRAILER USE I LIMITED TIME USE DATE DATE I _I•-•--•��� FROM' TO: USE OF STRUCTURES OR DEVICES I - 114 INSPECTION FO OCCUPANCY AS --• -- --- ••• APPROVALS - I HEREBY ACKNOWLEDGE TH APPLICATION AND STATE THAT THjE ABOVE IS RRECT AND AGREE TO COMPLY WITH ALL COUNTY OR NANCES OCCUPANCY APPROVAL AND STATE LAWS GULATING BU I DING C NSTRUC- GROUP OCC.LOAD TION SIGNATURE OF TRAILER USE PE-RMITTEE / C SAFETY PERMIT ADDRES �� TEMPORARY ef x9.42L STRUCTURE APPROVED TEMPORARY �\ FEE� STRUCTURE REMOVED � � C/ v FINAL APPROVAL JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION--, CL D M.C B SP TAR CK f MO CASH) Lri��4 j_ 5 a' CIC � � �1 v 76M444.DBS7t12-34 MISCELLANEOUS APPLICATION DIVISION OF BUILDING AND SAFETY OCCUPANCY-SAFETY-TRAILERS Department of County Engineer County of Los Angeles U/� WM. J. FOX, COUNTY ENGINEER BUILDING ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING IF�OJRyAAPPPLI ANT TO INf� LOCALITYNEARE OWNER K..C�Y •-" (! — cIJ CROSS ST 'ACADDRESS !. U� J DISTRICT NO. GROUP TYPE CONST. CITY TEL. TE MAP STATE .�� �I< HWY TEL. NUMBER YES 10 CONTRACTOR NO. USE ZONE SPECIAL CONDITIONS ADDRESS C -3 3 LEGAL DESCRIPTION I LOT NO - BLOCK BUILDINGEXIST. YARD HWY STREET NAME D � 0�-~ 9f. OF BLDGS.SETBACK WIDTH TRACM_ W ON LOT FRONT �t� / (J USE OF P. L. SIZE_OF LOT EXISTING BLDG SIDE P L APPLICATION FOR INSPECTYON RECORD OCCUPANCY INSPECTION SAFETY PERMIT TRAILER USE -LIMITED TIME USE _ 7 DATE DATE V 4, , • I , FROM, 'TO: V USE OF STRUCTURES OR DEVICES .`?. ..I I .........._..... 4ef 4&,A . . ............................... __. .. ............ 1 .._.. . .... F&Z-Ak zlw kA5 ROVALS �/� INSPECTION FOR I DATE I INSPECT S GNATURE OCCUPANCY AS OCCUPANCY APPRO 1 HEREBY ACKNOWLEDGE, THAT I HAVE READ THIS GROUP occ D APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES TRAILER USE AND -STATE LAWS REGULATING BUILDING CONSTRU - S\ TION. SAFETY PERMIT SIGNATURE OF 'TEMPORARY PERMITTEE ,STRUCTURE APPROVED ADDRESS a TEMPORARY STRU CTURE REMOVED FINAL APPROVAL WILLIAM J. FOX, COUNTY ENGINEER TIbN } 4 6 5 2 Nov 2? 5.0 0 c BY BY DEPUTY - DEPUTY MISCELLANEOUS �. WORKERS'COMPENSATION DECLARATION CE 875(2-80) I�� I SC E L LP's N E®U S A P P L I C A-T I®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 Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Leb%C.) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished BUILDING LOCALITY ❑ - ADDRESS Certified copy Is filed with the county building inspection v NEAREST department LOCALITY = CROSS sr Date Applicant EAREST DISTRICT NO - TYPE RO ESSER BY CROSS ST , CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO eLocK MAP / HIGHWAY No (CIRCLE) STATE MAJOR SECOND LOCAL } NO. OF BLDGS d (This section need not be completed if the work involved TRACT NOW ON LOT USE Z NE SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) ` USE OF SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this 4,/JO permit is issued, I shall not employ any person in any manner wrvER / so as to become subject to the Workers'Compensation Laws AIL ��ry i� OCCUPANCY GROUP ^7 V ADDRESS �- /'! Date Applicantto CL TEL. NOTICE TO'APPLICANT If, after making this Cerfificate of ITY NO. `� b OCCUPANT LOAD Z_ Exemption, you should become subject to the Workm 26& PLICATION 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. a❑ deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic DeVICBS 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- El ness and Professions Code, and my license is in full force,and PARKING. effect. SPACES REQ'D O I PROVIDED O License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FRGM To 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) f FINAL APPROVAL ESENT USE OF BUILDING Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION No OF EXISTING BUILDINGS - ON LOT AND USE ;2 5 0 a 9 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- nessand Professions Code) NO. PARKING SPACES PROVIDED 0 0 0 0 0 0 0 ❑ I, as owner of the property, will do the work and the ' I structure is not intended or offered for sale (Section 0 7 2 1 —8 2 7044, Busmess and Professions Code) OPOSED USE OF BUILDING C CONSTRUCTION LENDING AGENCY 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 25'.00 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, TOTAL FEE $25 .00 (Pay to the City of Temple City) and hereby authorize representatives of this County to enter u on above-niloned roperty for inspe tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatuh of Perm t e Date