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Home My Public Portal About9158 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N I h>re' o,baffirm that I have a certificate of consent tself CE 875(11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a'bertificate of Workers'Compensation Insurance, e,or , a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING PD /r A DRESS /�(/ e. LOCALITY DCertified copy is filed with the county building inspection OCALITYNEAREST department. Q Q A /`�/ d CROSS sr. Date Applicant EAREST '/ DISTRICT NO, GROUP TYPE ROC SED HY CROSS ST. off C'7/. ' Vp CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 5-e COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP ,4/HIGHWAY NO�f�Z1v._/ (CIRCLE) STATE MAJOR SECOND LOC NO. OF BLD 65. AL (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 �-�� ?• I certify that in the performance of the work for which this SIZE OF LOT. EXISTING BLDG. o permit is issued, I shall not employ any person in any manner OWNER � y so as to become subject to the Workers' Compensation Laws. AIL �� OCCUPANCY GROUP V �j{ o ADDRESSO f-f•/1. I Date Applicant w �jr TEL �r�-�� OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. V p N 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 USEElGEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (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 andI� effect. PARKIN Py -C SPA CESG REQ'D PROVIDED I License Number Lie. Class LIMITED TIME USE J Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXIs ING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL �q PRESENT USE OF BUILDING t��Y — Z S// Lie.or Reg.No. Date (� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS /1 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- ness and Professions Code): NO. PARKING ElI, 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). 4 (� PROPOSED USE OF BUILDING D �' I z CONSTRUCTION LENDING AGENCY — 0 81 8 8 8 I hereby affirm that there is a construction lending agency p C f//Z e for the,performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Or +f f Lender's Name PROPOSED MAX. OCC. n 'O Lender's Address / �y u I certify that I have read this application and state that the PERMIT FEE 00 above informat' ree to comply with all County ISSUANCE FEE - ordinances an State laws re ti to building construction, and hereby auth a representatives this County to enter TOTAL FEE 0 Ipo the ab en r erty for nspection purp es. EE REVERSE FOR EXPLANATORY LANGUAGEPe ; Si na Date CORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION ^ CE 875 I herffi by arm 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. CompanyFOR APPLICANT TO FILL IN BUILDING ADDRESS Od ❑ Certified copy is hereby furnished. BUILDING ADDRESS i LOCALITY `'- ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST / department. YA IVQ¢ CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE PR ESSED BY CROSS ST. - CONSTr-� CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. tj BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need-not be completed if,the work involved TRACT p NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) 59 USE OF SIZE OF LOT sQEt I EXISTING BLDG. Y' 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 so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP J ADDRESS .�� ues.s /�"/►- �' Date Applicant TEL' D> OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY pie m�, N. _ >� 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 INSPECTIO 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 effect. � � PARKING REQ'D PROVIDED I I SPACES LJ License Number Lic. Class �-� LIMITED TIME USE Contractor Date' DATE DATE ❑ I am exempt from the licensing requirements as I am a PROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. :270 } STORIES SIGNATURE iness and Professions Code). Llc.or Reg.NO. Date PRESENT USE OF BUILDING FINAL APPROVAL HONE 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- ness and Professions Code): NO.PARKING -_ SPACES PROVIDED _ I, as owner of the property, will do the work and the �I 'i . a ini 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 o�CJ�J 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 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 upo the above-mentioned property for ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature cf Permittee Date .: WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P P L I C A T I O N I hereby affirm that T, have a certificate of consent tself CE 875 (11-84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN ^ ABU I DDRESS Certified copy is hereby furnished. BUILDING ADDRESS �� LOCALITY ®� ❑ Certified copy is filed with the county building inspectionLC1 LOCALITY 'NEAREST department. (� ,/'�Wig CROSS ST. Date Applicant NEAREST DISTRICT NOG UP TYPE ESSED BY CROSS ST.LEGAL _a CONS CERTIFICATE OF EXEMPTION FROM WORKERS' d' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (clR CLe) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT s NOW ON LOT / USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT o 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 s') so as to become subject to the Workers' Compensation Laws. oc tMML OCCUPANCY GROUP RESStxa VDate Applicant* wNOTICE TO APPLICANT: If, after making this Certificate of ` No� �p OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code, you must forth- A APPLIC ION FOR EXIT HARDWARE: _ with comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] 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 effect. PARKING REQ'O D PROVIDED D SPACES License Number Lic. Class iSOC! LIMITED TIME USE Contractor Date DATE DATE I am exempt fromthe licensing requirements as I am a FROM: 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). I 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 for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ` SPACES PROVIDED i I, 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 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 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. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee —� ~ DW WORKERS'COMPENSATION DECLARATION CE 875 (11-84) MISCELLANEOUS APPLICATION CE 875 C � I hereby affirm that i have 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 ADDRESS Certified copy is hereby furnished. BUILDING /� S U ADDRESS ✓ LOCALITY Certified copy is filed with the county building inspection LOCALITYNEAREST department. Z CROSS ST. Date Applicant NEAREST DISTRICT NO I GROUP TYPE /// P CESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. CONST. , yi r/ /f LEGAL (JO �/7) COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY INO. (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 _ SIZE OF LOT EXISTING BLDG. �V I certify that in the performance of the work for which this f�� permit is issued,I shall not employ any person in any manner OWNER OP 6-- r 'n , o so as to become subject to the Workers' Compensation Laws. MAIL 9 A/ 11> OCCUPANCY GROUP ///J{/A� ADDR. W/ �j ^�" U Date Applicant E3 O TEL.�Q OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY No. b^7 1 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 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 r /n effect. G PARKING REQ'D PROVIDED J License Number Lic. Class Q SPACES LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a FROM: To: INSPECTOR'S licensed architect or a registered professional engineer SIZE OF 14b. OF acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGGNn RE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING Lie.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS _ } :-s,r Z ' ON LOT AND USE c1CI-1-4-•0001 ISI! i i ,7 I hereby affirm that I am exempt from the Contractor's i i _ License Law for the following reason (Section 7031.5, Busi- i._,. fl ' "2`I 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 PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency ..GZ for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE 06 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. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ✓ WORKERS'COMPENSATION DECLARATION CE 875(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, or a certificate of Workers'Compensation Insurance,or ' a certified copy thereof(See. 3800, Lab.C.) - Policy No. CompanyFOR APPLICANT TO FILL IN, BUILDING ADDRESS CI ❑ Certified copy is hereby furnished. ADDR..DINS T LOCALITY a. ESS / Certified copy is filed with the county building inspection NEAREST department. OCALIrY -- CROS -S ST. Date Applicant AREST DISTRICT N��'O/// GROU TYPE ]PROM BY CROSS ST. �"" N "i., Z'JCONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �(jo COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP -HIGHWAY STATE MAJOR SECON LOCAL d NO. OF SLOGS. No.. � (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars (5100) or less.) USE OF ^7 X 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 an manner ER „� ' o as to become subject to the Workers' Compensation Laws. ac OCCUPANCY GROUP W M a DRESS •LL/ ••'.•- Q -PS to 0. Date Applicant Z . g TEL J�G�7 ��2 OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of r � No.. �i 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 El 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 PARKING effect. . - SPACES REq'D O PROVIDED D License Number Lic.Class LIMITED TIME USE Contractor Date ' DATE DATE _ FROM: - TO: 13 I am.exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE of NO. of INSPEcroR's acting In my professional capacity (Section' 7051, Bus- EXISTING BLDG. STORIES GNATURE iness and Professions Code). uSE OF BUILDING / FINAL APPROVAL Lic.or Reg.No. Date ` o HOME OWNER-BUILDER DECLARATIONO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's 7 License Law for the -following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING SPACES PROVIDED -i'•''• • • YY 1 • • • • i Z I, 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). �. PR ED USE OF BUILDING 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 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, U O and hereby authorize representatives of this County to enter TOTAL FEE �\�• upon•the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE l ` Signature of Permittee U Da e WORKERS'COMPENSATION DECLARATION CE 875 (11-84) M I SC E L LA N E O U S APPLICATION CE 875 I hereby affirm 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(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING . ADDRESS ❑ Certified copy is hereby furnished. LOCALITY BUILDING �+ DRESS ,=�.. ,• ' El Certified copy is filed with the county building inspection CALITY NEAREST department. w CROSS ST. _✓ Date ApplicantAREST DISTRICT NO. GROUP TYPE PROCESSED BY ROSS ST. 7 CONST.- CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 4t `" 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 � SIZE OF LOT EXISTING BLDG. ✓ V I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner io6WNER L'i_ so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP LL ADDRESS .^ r �••' Date I` Applicant a L. NOTICE TO APPLICANT: If, after making this Certificate of ITY TNO. OCCUPANT LOAD o Exemption, you should become subject to the Workers' ° FOR EXIT TIOHARDWARE: APPLICATION Compensation provisions of the Labor Code,you must forth- A ❑ F 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 1 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 REO D PROVIDED License Number Lie. Class SPACES LIMITED TIME USE Contractor Date - DATE DATE El I am exempt from the licensing requirements as I am a TD. licensed architect or a registered professional engineer SIZE OF NO. OF RDN. INSPE CTOR•S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL a PP R o v a i -•--•�- Lie.or Reg.No. Date 40 PRESENT USE OF BUILDING 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- ness and Professions Code): No. PARKING El1, 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 6 iI I hereby affirm that there is a construction lending agency s for the performance of the work for which this permit is i issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. f 4 Lender's Address 1 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 F E E ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mention)d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 6ee COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0802150001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: I NO. OF CONST NEW 1 BUILDING ADDRESS: I ITR: 5905 LT: 67 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI 9158 LAS TUNAS DR I I (STRUCTURE: 1 V-B B I TEMP CA 917801905 I (ASSESSOR INFORMATION NUMBER: II NEAREST CROSS STREET: ENCINITA I 15387-017-036 IEXIST BLDG USE: I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I 1EXIST OCC GRP: USE ZONE: I I (TENANT: I (ISSUED ON: PROCESSED BY: EXPIRES ON: I ISUNSHINE DOOR & WINDOW IBLDGS. NOW ON LOT: VALUATION: 102/15/08 SR 08/13/08 1 1 1 0 1 1 (OWNER: TEL. NO: I IFINAL DATE FIN BY: CODE: I (WANG, DANIEL - ILIST ITEMS: 1I 19154 LAS TUNAS DR I 1 I ITEMP 917801905 IDESCRIPTION OF WORK I I I IREMOVAL SHOWER ROOM & RESTORATION (ALL PLUMBING & I IOCCUP LOAD EXIST: (ELECTRICAL) (APPLICANT: TEL. NO: IOCCUP LOAD NEW: I I ISTEVE CHEN (626) 627-8268- 1 1 1 12275 .HUNTINGTON DR. IPARKING SPACES REQUIRED: (SPECIAL CONDITIONS: 1 ISAN MARINO, CA 91108 IPARKING SPACES PROVIDED: 1 1 I I I I 1 IEXIT HARDWARE: ICONTRACTOR: TEL. NO: I I LIMITED TIME USE ISTEVE CHEN (626) 627-8268- 1NBR OF EXITS: I FROM TO I 12275 HUNTINGTON DRIVE LIC. NO I 1 I 1#541 901937 B I FEES PAID 1 I ISAN MARINO, CA 91108 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:(_ 1 1ARCHITECT OR ENGINEER: TEL. NO: I ITRAILER USE I I I I - IOA PERMIT ISSUANCE 27.75 1 1-1 1 LIC. NO: 101 R/M OCC/USE INSPECT 145.95 ISAFETY PERMIT I I I 1 I TOTAL FEES 173.70 1 I I 1 I ,(,TEMP. STRUCT. APPROVED I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (TEMP. STRUCT. REMOVED 1 . I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I NO I I I I I I I I I I I 1 SCHOOL WITHIN HAZARDOUS 1 I I I I 1AIR QUALITY: 1000 FEET MATERIALS1 I I I 1 NO NO NO IREQUIRED TOTAL SETBACK FROM EXIST I "fir I 1 1 1 SET BACK YARD: HWY: PROP LINE: WIDTH: n C I C (FRONT PL- i or I I I I I I SIDE PL- I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I I I (REPORT ID: DPR267 ROUTE TO: ES0508 1 I I 1 A 9 16—IL.—A-- 14 A— I—F I hereby affirm that I have I certificate of consent [o sell' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers*Compensation II1SLIranCC. or a certified copy thereof (Sec. 3800. Lab. C.) Policy Company., FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified cop), is hereby furnished. L A -rjN,6-S D P, LOCALITY' .El Certified copy is filed with the county building Inspection clyY ZIP department.. '? NEAREST nl--m P t& c4-rr CROSS ST. Date Applicant. SIZE OF LOT I NO.OF BLDGS.NOW ON LOT DISTRICT No. GROUP TYPEPRO CESSED BY CONST. (,LRTiFicATE OF EXEMPTION FROM WOR K 1:1Z ZS' TRACT BLOCK LOT NO. COMPENSATION INSURANCE HIGH— ICIRCLE) STATE MAJOR SECOND LOCAL (This.section need not be complete([ if the work involvpd ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S I00) or less.) -O —Pk'l-6-C Tr NO w— I certify that in the performance of the wwWNER lwork for which this _0/ permit is issued, I shall not employ any person in any manner — W A-AJ dr so as to become Subject to the Worke'rs' Compensation L. ADORESKo /i LOM A A449 OCCUPANCY GROUP Date ZIP —j Applicant CITY 64 1 q / making NOTICE TO APPLICANT: If, after makinthis Certificate OCCUPANT LOAD of Exemption. you should become subject f to the Workers' 'APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code.\01-1 must forthw;th comply With SLICII provisions or this permit shall be deemed TRAILER USE GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ revoked. OCCUPANCY INSPECTIONX Panic Devices ❑ LICENSED CONTRACTORS DECLARATION affirm that I am licensed under provisions I hereby of Chapter SAFETY PERMIT[:' LIST ITEMS BELOW, 9(commencing with Section 7000)of Division ',of the Business NO.OF EXITS and Professions Code.and my license is in full force and effect. FARKING: REWD PROVIDED License Number Lie. Class SPACES E:=- U Cs -rD kij R,"tflV Contractor Date LIMITED TIME USE DATE DATE ❑ I and exempt from the licensing reqLIiIk2I1)CI1tS its I ani a I FtROM: TO: licensed architect or it registered professional engineer acting III Ill)' prof,--ssional capacity (Scciion 70i I. litisincSIZE OF OF INSPECTOR'S s" EXIS TING BLDC.. STORIES SIGNATURE and i3roicssioi)s Codd. LIC. or Reg. No. Date F PRESENT USE:OF BUILDING FINAL APPROVAL I IOM E OWNER-BUILDER DF(TARNI ION NO.OF CXIST ING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt froin the Coniractor, :L.I CC�s L: Law for the following reason.(Section 7031.5. Business and Professions Code): NO.PARKING ElLas owner of the propert). ilk, she \\ojk :111L, Ille SPACES PROVIDED structure is not intended or ollcied lot sale (Section 71144-A PROPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is it construction lendini! ;1.-,Llic\ for r 1issued4 the performance�forance of the work for willI I�hich [his permit f (Sec. 3097, Civ.C.). PROPOSED MAX.OCC Lender's Name APPLICANT(PRINT) I TEL NO Z?7 Ole Lender's Address L)cr EADDRESS I certify that I have read this application and state that the t. &14 L004 AV? 7*=L 7- OT f (�4 �Iqdo-J above information is correct. I agree to C0111PIV with all COLinly !PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this Count)' to enter upon ;ISSUANCE FEE the abov -.mentioned property for inspection purposes. TOTAL FEE —71f ilo SEE REVERSE FOR EXPLANATORY LANGUAGE i0 n tare of Date