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Home My Public Portal About9202 LAS TUNAS DR_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875 MISCELLANEOUS APPLICATION {� CE 875 (11-84) LI 1 hereby a cert tit I have a cert>frcate 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 ADDRESS �✓ � ` , r� ��'Cr� FlCertified copy is hereby furnished BUILD INGDRESS G LOCALITY � ,`�' Certified copy is filed with the county building inspectionLOCALITY NEAREST department CROSS ST Date Applicant NEAREST DISTRICT NO GROUP TYPE CESSED BY CROSS ST. 1610 � CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL I OG COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP ��jj�� HIGHWAY N0 Z�� (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 ZE OF LOT �\ EXISTING BLDG. C (/ I certify that in the performance of the work for which this CNV CD permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP I= MAIL p DDRESS ~ Date Applicant 2 LUI-I NOTICE TO APPLICANT- If, after making this Certificate of CITY 1 �APPL Tr,o� � Q OCCUPANT LOAD Exemption, you should become subject , the Workers' 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 INSPECTIONNo Spec ❑ deemed revoked . Knowl. 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 Busi- No of Exlrs ness and Professions Code, and my license is in full force and effect. PARKINGSPACES REQ'D O PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer sa OF No. OF INSPECTORS acting m my professional capacity (Section 7051, Bus- E STING BLDG. STORIES SI NATURE mess and Professions Code) —^� FpAt_aLINAL APPROVAL RESENT USE OF BUILDING Lic.or Reg.No. Date HOMEOWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS� u� 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 0 I, as owner of the property, will do the work and the SPACES PROVIDED 0 structure is not intended or offered for sale (Section q 7044,Business and Professions Code). p CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ;291 2 7.6 A I hereby affirm that there is a construction lending agency S # ° • • • 88 for the performance of the work for which this permit is issued(Sec 3097,Civ.C.). 1207,-88' Lender's Name PROPOSED MAX. OCC Lender's Address d 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 herelly auth��ritatives of this County to enter TOTAL FEE o re a ve perty for mspectron rpose SEE REVERSE FOR EXPLANATORY LANGUAGE r/ Signature o ermittee Dat 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(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ) ADDRESS L-1''6 ' ❑ Certified copy is hereby furnished BUILDING _ LOCALITY ❑ ADDRESS 9 L J 2 C L • Certified copy is filed with the county building Inspection NEAREST department OCALITY CROSS ST Date Applicant NEAREST DISTRICT NO. GR^ P TYPE IIR.;f-SSED BY CROSS ST �� iV �/ 8 S CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL {{�iJ L COMPENSATION INSURANCE. DESCRIPTION LOT NO BLOCK NOP IGHWAY O�C � (Ci H E) STATE MAJOR SECOND LOCAL d NO OF BLDGS (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 ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG G� )- I certify that in the performance of the work for which this 0 permit is issued, I shall not employ any person in any manner WNERU- I— so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP 0 UJI ADDRESS ` - CL Date Applicant T Z NOTICE TO APPLICANT If, after making this Certificate of Iry No 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 be TRAILER USEGEOLOGY INSPECTION ❑ E3 No Spec. Knowl. deemed revoked a' LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑' /^, I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO OF EXITS I "� 9 (commencing with Section 7000) of Division 3 of the Busi- LLL}e�� _JJl ness and Professions Code, and my license is in full force and - PARKING. effect. SPACES REO'D PROVIDED License Number Lic 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 SIZE OF No OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code) LjmqESENT USE OF BUILDING "- V FINAL APPROVAL Lic.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 3 b 4.7 A ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure Isnot intended or offered for sale (Section # •'• • • 8 8 7044, Business and Professions Code) P POSED USE OF BUILDING I •,O 1B O O • • CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 010 1 4-82 for the performance of the work for wjiich 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, Q B // TOTAL FEE and hereby authorize representativ s of tills County to enter upon the ove-m coned` ropy y for i pection purposes. SEE REVERSE FOR EXPLANATORY ANGUAGE —Signa_ re of ermitte Date I WORK.ERS' (.,UMYi✓NJF111U1V L/C.I,LHKH11VlV 20-0063DPW'.2/90 IVI i.�L+G,LL.f�l�l G V U.� 1-11-Il—L,i[ t�1 1% I-4 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION iinsure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Set 3800, Lab. C), - Policy No Company FOR APPLICANT TO FILL IN BUILDING ' ILDING ADDRESS ADDRESS ❑ Certified copy is hereby furnished g AS LOCALITY ❑ Certified copy is filed with the county building mspectio ITY ZIP ' department. _ be J ,4 r 0 NEAREST I CROSS ST ' Date ' Applicant SIZ OF LOT NO.OF BLDGS NOW ON LOT DISTRICT NO GROUP TROC YPE PESSED BY CONST CERTIFICATE OF EXEMPTION FROM WORKERS' TRACT BLOCK LOT No. O COMPENSATION INSURANCE MAP HIGHWAY O • Ho (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less_) USE ZONE SPECIAL CONDITIONS I certify that in the performance of the work for which tht z,a��Z fy e2 TEL No. - w permit is Issued I shall not employ any person in any mann '3 a w "ADDRESS . so as to become subject to the Workers' Compensation La OCCUPANCY GROUP Cn Date Applicant CITY zipZ 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 USED 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 Busmes NO OF EXITS and Professions Code,and my license is in full force and effec e o uslnes5 PARKING• REQ'D D PROVIDED L�J � License Number Lic Class SPACES LL�� 1 I 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 SIZE OF NO OF INSPECTOR'S and Professions Code) EXISTING BLDG STORIES SIGNATURE. Lic. or Reg No - Date PRESENT USE OF BUILDING 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): NO PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 70446P OPOSED USE OF BUILDING Business and Professions Code). CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency for the performance of the work for which this perrrut is issued I (Sec 3097, Civ. C.) PROPOSED MAX OCC I Lender's Name PLICANT(PRINT) TEL NO. Lender's Address DDRESS I certify that I have read this application and state that the above information is correct I agree to comply with all County PERMIT FEE I 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. I .S ' TOTAL FEE � �Co �tl?� ��Date� SEE REVERSE FOR EXPLANATORY LANGUAGE l enPer iItee COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0309100007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL N CONST L S: TR: 6561 LT: 8 BL: .001 UN: .002 SQ. FT STORIES TYPE OCCUP GROUP 9202 LAS TUNAS DR STRUCTURE: 1 VN U1 TEMP CA 917801907 ASSESSOR-flTFUURTIONNUMBER: NEAREST CROSS STREET: ALESSANDRO 8587-002-014 EXIST BLDG USE: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY EXIST OCC GRP: USE ZONE: TENANT:- ISSUED PROCESSED EXPIRES THE EDIBLES BLDGS. NOW ON LO 09/10/03 JK 03/08/04 0 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: KOLOPOULOS B M;S TRS L . A 750 OAK TREE DR 1 AL's-3 COVI 917233613CR WORK OCCUP LOAD EXIST: INSTALL AWNINGS ON WINDOWS PLIC N TEL. NO: OCCUP LOAD NEW: NICHOLS AWNING - PARKING SPACES REQUIRED: SPECIAL CONDITIONS: PARKING SPACES PROVIDED: EXIT HARDWARE: CONTRACTOR: EL. N0: LIMITED TIME USE ROGER NICHOLS (714) 821-1611- NBR OF EXITS: FROM TO 11041 DALE LIC. NO STANTON, CA 90680 740319D03 FEES PAI APPROVALS DATE INSPECTOR SIGNATURE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCHITECT OR E TRAILER E - OA PERMIT ISSUANCE 27.75 LIC. NO: 01 R/M OCC/USE INSPECT 145.95 SAFETY PERMIT TOTAL FEES 173.70 TEMP. U T. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP. S RUCT. REMOVED OF FAMILIES: DWELL T CLASS: NO SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIREDT S TBACK FROM SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508 WORKERS' COMPENSATION DECLARATION as 20-0063DPW 12/90 �.MISCELLANI- OUS APPLICATION 0-0 I hereby affirm that I have a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISI�? -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 $ yt>> LQS l u n0 �Y LOCALITY ❑ Certified copy Is filedwith the county building Inspection CITY ZIP department. rn � , C, / NEAREST -rP _ Date Applicant SIZE OF LOT NO.OF BLOGS NOW ON LOT DISTRICT NO GROUP TYPEPROCESSED BY CERTIFICATE OF EXEMPTION FROM WORKERS' ✓V CONST. TRACT BLOCK LOT NO. COMPENSATION INSURANCE O MAP HIGHWAY u NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work Involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) or less.) usE ZONE SPECIAL CONDITIONS I certify that in the performance of the work for which this T'iC>�f ray ei TEL NO. V permit is issued, I shall not employ any person In any manner �`%a o u W Q. so as to become subject to the Workers' Compensation Laws ADDRESS in -7<'I> OAIC ��, OCCUPANCY GROUP Date Applicant CITY ZIP NOTICE TO APPLICANT If, after making this Certificate 90� OCCUPANT LOAD of Exemption. you should become subject to the Workers' APPLICATION FOR Compensation provisions of the Labor Code you must forthwith EXIT HARDWARE comply with such provisions or this peimit shall be deemed TRAILER USE[] GEOLOGY INSPECTION❑ No Spec Knowl ❑ revoked OCCUPANCY INSPECTION C$ 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 Name O uslIIeSS NO OF EXITS and Professions Code,Lind my license is In full force and effect PARKING• REO'D O PROVIDED i License Number Ltc Class �•9 SPACES ' Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered professional engineer FROM To acting in my professional capacity (Section 7051, Business SZEEXISTING NO OF BLDG STORIES INSPECTOR'S SIGNATURE.R 'S and Professions Code) LIc or Reg No - Date PRESENT USE OF BUILDING FINAL APPROVAL --Ty—/S -03 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 ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044,X PROPOSED USE OF BUILDING Business and Professions Code) CONSTRUCTION LENDING AGENCY + ' r I hereby affirm that there is a construction lending agency for i the performance of the work for which this permit is issued (Sec 3097, Civ C) PROPOSED MAX OCG ' Lender's Name APPLICANT(PRINT) TEL NO Lender's AddressADDRESS i I certify that I have read this application and state that the 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 I S I the above-mentioned property for inspection purposes TOTAL FEE %�`r �� / Cs�-��- O2 SEE REVERSE FOR EXPLANATORY LANGUAGE 'Sigilature of Pennittee Date