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Home My Public Portal About9168 LAS TUNAS DR_Miscellaneous__ 76M4" I { I WORKI RS' COMPENSATION DECLARATION 200063DPW12/90 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 ceriIfieate of Workers'Compensation Insurance,or - t a certified cope thereof (Sed. 3800, Lab C.)• Policy'No Company FOR APPLICANT TO FILL IN BUILDING BUILDING❑ ADDRESS �/ A A ADDRESS Certified (opy is hereby furnished % d Q/J�F"'O'/ U/I LOCALITY ❑ Certified copy is filed with the county building Inspection CITY, ., ZIP NEAREST department. / eAAV ' / �� cRosssT Date _ Applicant SIZE OF LOT I NO OF BLDGS NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY Q CERTIFIC1ITE OF EXEMPTION FROM WORKERS' CONST C TRACT BLOCK LOT NO I COMPENSATION INSURANCE MAP HIGHWAY 1. No (CIRCLE) STATE MAJOR SECOND LOCAL (This section ITed not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS Ck i by the permit is for one hundred dollars ($100) or less.) C I certify that III the performance of the work for which this syo#�Lt�y er TEL NO permit is issueo I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws ADDRESS OCCUPANCY GROUP Cr ( Date Applicant CIT`�y- ZIP^/.7 F NOTICE TO APPLICANT If, after making this Certificate r �'� OCCUPANT LOAD of Exemption, you should become subject to the Workers' AP4LICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE 1 comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) a F 9(commencing Nith Section 7000)of Division 3 of the Business NO OF EXITS and Professions Code,.and my license is in full force and effect X ame ot Bustness / i ry G 6E � PARKING• REO'D PROVIDED License Numbei Lic Class %/ /�. _�� SPACES i I i Contractor Date f-�d V LIMITED TIME USE ❑ 1 am exem)t from the licensing requirements as I am a DATE DATE FROM TO licensed aichitect or a registered professional engineer t IN sIzE acting in my professional capacity(Section 7051,Business EXISTING BLDG STORIES S IG 'S OF and Professions Code) Lic. or Reg No_ Date PRESENT USE OF BUILDING FINAL APPROVAL -3.•3(-C% HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS I ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 70315, Business and { Professions Cocit) ' 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 7044-1 PROPOSED USE OF BUILDING JlG tz,vl,CE.� NDfi9 Business an J Professions Code) CONSTRUCTION LENDING AGENCY Cl 'F/ N C q IP4AN1;-1 NC I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ( I (Sec 3097, Civ.C). PROPOSED MAX OCG Lender's Name _ AP LICANT(PRINT) TEL NO D A_ 4. s Lender's Address ADDRESSn,' ��¢- ( I certify that I have read this application and state that the 1005 IJGt�/I4Q -Jd above information is correct I agree to comply with all County PERMIT FEE ordin ces and State laws relating to building construction,and here uthonze representatives of this County to enter upon ISSUANCE FEE ( I the o e-mentis ned operty for inspection purposes TOTAL FEE •�_ ' 'O % SEE REVERSE FOR EXPLANATORY LANGUAGE , Slgnatu e of Oerinitt Date 6M444 I WORKERS' COMPENSATION DECLARATION 20o063DPW.2/90 MISCELLANEOUS APPLICA"T"ION 1 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 (Set. 3800, Lab.C), Policy'No Company FOR APPLICANT TO FILL IN ABUILDING DDRESS • BUILDING ADDRESS y Certified copy is hereby,furnished g d k ka'sa Q 5 LOCALITY Certified copy is filed with the county building Inspection CITY ZIP department. m G NEAREST CROSS ST Date ' Applicant SIZE OF L T NO OF BLDGS NOW ON LOT DISTRICT NO. GROUP TYPEPROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO CONST. O COMPENSATION INSURANCE MAP HIGHWAY u NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) 9 I certify that In the performance of the work for which this sw��rfy er TEL NO. 13 permit is issued I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws ADDR�s D V Z has • OCCUPANCY GROUP a Date Applicant CITY ZIP NOTICE TO APPLICANT If, after making this Certificate ern �.+ g178� OCCUPANT LOAD of Exemption, you should become subject to the Workers' AP LIGATION FOR Compensation provisions of the Labor Code you must forthwith EXIT HARDWARE comply with such provisions OC this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION D No Spec Know[ ❑ revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[Qk Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITE] (LIST ITEMS BELOW) 9(commencing with Section 7000)of Division 3 of the Business Mame O tis tress NO OF EXITS and Professions Code,and my license is in full force and effect PARKING• REO'D E= PROVIDED License Number Lic. Class rtf ir7 SPACES �J Contractor Date LIMITED TIME USE I ❑ I am exempt from the licensing requirements as I am a FROM DATE TO DATE licensed architect or a registered professional engineer acting in my professional capacity (Section 7051,Business SZEEXISTOING BLDG STORIES INSPECTOR'S SIGNATURE.R 'S and Professions Code) PRESENT USE OF BUILDING q Lic or Reg No Date FINAL APPROVAL / 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 70315, Business and Professions Code) PARKINGNO SPACES PROVIDED ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale(Section 7044-1 PROPOSED USE OF BUILDING Business and Professions Code). , 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). PROPOSED MAX OCC Lender's Name APPLIC T(PRINT) TEL NO —U O Lender's Address ADDRESS T I certify that I have read this application and state that the Url6l5 �(3. em G•t above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE S .I the above-m tioned property for inspection purposes. Q TOTAL FEE A _ r 3/03 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pcnn..Ftee Date WORKERS' COMPENSAIIUN UE(LARAIIUN 20-0063DPW12/90 M15CFLLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION 4-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 BUILDING ADDRESS ADDRESS ❑ Certified copy is hereby furnished X 9170 Las Tunas Dr. LOCALITY ❑ Certified copy Is filed with the county building Inspection CITY - ZIP department em l e Cit CA 91780 NEAREST , CROSS ST Date Applicant SIZE OF LOT NO.OF BLOGS.NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY n CONST CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT NO. I COMPENSATION INSURANCE MAP HIGHWAYIL NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL i Ck by the permit is for one hundred dollars (S 100) or,less.) USE ZONE SPECIAL CONDITIONS I certify that in the performance of the work for which this T`tplisirfy ei TEL NO. L permit is issued. I shall not employ an} person In any manner l SO a5 LO become SllbJCC[ IO the Workers' Compensation LBWS ADDRESS tr a 731 S. Garfield Ave, Unit A OCCUPANCY GROUP Date Applicant CITY � Alhambra zIP CA 91801 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❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION[ 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 Business 8IDe O i1S ess NO OF EXITS and Professions Code.and my license is in full force and effect 21 PARKING• REO'DD PROVIDED O License Number Lie Class Max International Financial k3rQU SPACES t I Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am aFROM• DATE DATE licensed architect or a registered professional engineer ro acting in my professional capacity(Section 7051,Business SIZE OF c NO OF ^ INSPECTORS and Professions Code) EXISTING BLDG a�C 7, STORIES Ol SIGNATURE. Lrc, or Reg No " Date PRESENT USE OF BUILDING FINAL APPROVAL S� 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 70315, Business and { Professions Code) NO PARKING El 1. as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044_1 PROPOSED USE OF BUILDING Business and Professions Code) t Office 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.) SED MAX OCC. Lender's Name APPLICANT(PRI EL NO. nnis Iwasaka 26 9430033 Lender's Address ADDRESS l I certify that I have read this application and state that the bra, CA 91 801 above information is correct. I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authorize repre entatives of this County to enter upon ISSUANCE FEE the above-mentione roperty r inspection purposes. TOTAL FEE % SEE REVERSE FOR EXPLANATORY LANGUAGE" Sig t re of nn ttee Date WORKERS' COMPENSATION DECLARATION 20-0063DPW12/90 MI�C:t LLAN EL)US APPLIUATIUN 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 t I a certified copy thereof (Sec. 3800, Lab C) ` Policy'No. Company FOR APPLICANT TO FILL IN BUILDING BUILDING ADDRESS ADDRESS ❑ Certified copy-is hereby furnished, g 9168-70 Las Tunas Dr. LOCALITY ❑ Certified copy is filed with the county building inspection CITY - ZIP t department. Temple City CA 91780AREST Date Applicant SIZE OF LOT NO.OF BLDGS.NOW ON LOT DISTRICT NO GROUP TYPE PROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' coNsr TRACT BLOCK LOT NO. i I COMPENSATION INSURANCE MAP - HIGHWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE iPARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I I certify that ,n the performance of the work for which this rA��ri�y er TEL No. permit is issued. I shall not employ any person in any manner ADDRESS so as to become subject to the Workers' Compensation Laws- OCCUPANCY GROUP 9168-70 Las Tunas Dr. ! � Date Applicant eirY ZIP NOTICE TO APPLICANT If• after making this Certificate Temple City CA 91 780 OCCUPANT LOAD of Exemption, you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code.you must forthwith EXIT HARDWARE comply with such provisions or this permit shalt be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec Knowl ❑ revoked OCCUPANCY INSPECTION C$ Panic Devices ❑ LICENSED CONTRACTORS DECLARATION 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 Business Sane o Business NO OF EXITS 3 and Professions Code,and my license is in full force and effect PARKING• REO'D D PROVIDED D License Number Lie Class Max Realty & Assoc. Inc. SPACES t i I Contractor Date LIMITED TIME USE ElI am exempt from the licensing requirements as I am a DATE DATE FROM TO licensed architect or a registered professional engineer f acting in my professional capacity (Section 7051,Business SIZE OF No of INSPECTOR'S and Professions Code) EXISTING BLDG 2400 f STORIES 2 SIGNATURE, Lie or Reg No - Date PRESENT USE OF BUILDING FINAL APPROVAL HOME OWNER-BUILDER DECLARATION No OF EXISTING BUILDINGS I ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 70315, Business and ( Professions Code). NO.PARKING EJ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044,li PROPOSED USE OF BUILDING Business and Professions Code) 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 1 I (Sec. 3097, Civ C.) PROPOSED MAX OCG l Lender's Name APPLICANT(PRINT) SunnyLau 26 09430033 Lender's Address ADDRESS ( I certify that I have read this application and state that the CA 91 801 above information is correct agree to com 1 with all Count r g p y y PERMIT FEE ordinances and State laws r ting to building construction,and hereby authorize represe tives of thi unty to enter upon ISSUANCE FEE L the above-mentioned r y for i pe on purposes - ' I TOTAL FEE - % SEE REVERSE FOR EXPLANATORY LANGUAGE' il Sign re o Pe rttee Date L