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Home My Public Portal About5810 LOMA AVE_Miscellaneous__ SRYCERS:COMPENSATION DECLARA CE 875(11-84) ��Y�M �SC E L LA N EO U S A P P lL��C A T I®N ^ CE 875 1 hEaf£irm that I have a certificate of co-ISM-617COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insud•e, or a certificate of Workers'Compensation In�. :.e,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING �/ ADDRESS Certified copy is hereby furnished. BUILDING yy �� g �Y��D DDRESS ib �"�'-W •��' LOCALITYAe (it Certified copy is filed with the county building inspection LOCALITY � pZ� �p gyp`, NEAREST department. 7 CROSS ST. Date Applicant EARESTNP CROSS ST. �•�'iJ �/�`�� LEGAL DISTRILT N . GfU TYPE P OCESSED BY ONS CERTIFICATE OF EXEMPTION FROM WORKERS' ` COMPENSATION INSURANCE DESCRIPTION Lor NO. BLOCK MAP HIGHWAY NOOF BLDGS. NO. (CIRCLE) STATE MAJOR SECOND LOCAL . (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 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 //�/� "�' jy1• so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP O Date Applicant DDRESS 2,7,y4p � � Ce /� �� E. LO NOTICE TO APPLICANT: If, after makingthis Certificate of cITY 0 CA TEL. � �y77�c>5� Gr, ayS„W*s- OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: _ Compensation provisions of the Labor Code, you must forth- wrth comply with such provisions oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ E] No Spec. 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 EXITS ness and Professions Code, and my license is in full force and effect. PARKING SPACES REO'D D PROVIDED License Number Lic. Class LIMITED TIME USE II�� Contractor Date DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SJAE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus ISTING BLDG. STORIES s� S1 NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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 0 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section lY 7044,Business and Professions Code). V # Q PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY o 0 0 0 0 0 00 I hereby affirm that there is a construction lending agency Rb'TAJ L DFF«' Co t,F6VkC—A(C ZW 0 8. 1 6'=8 8 for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. .'1d1or*scN® Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE 0f, above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, 13 and hereby authorize representatives of this County to enter TOTAL FEE d u on thabove-mentioned pro for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) W SC E L LA ®U A P P U C° T O®s `3 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 'fl a certified copy thereof(Sec. 3800,Lab.C.) 59 Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING L LOCALITY ADDRESS Certified copy is filed with the county building inspection T u NEAREST LOCALITY f `� �LC A 1+ 1 CROSS ST. department. t. Date Applicant RAREST ,' `_ DISTRICT NO. GR UP PE PROCESSED BY CROSS ST. :-_4 T CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP IGHWAV rv0. 211 (c IRCLE) STATE MAJOR SECOND LOCAL d. (This section need not be completed if the work involved NO. OF BLDGS. p TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS Q 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 , Q permit is issued, I shall not employ any person in any manner WNER Ld07> 17jV p_ so as to become subject to the Workers' Compensation Laws. AILIMp //�� LE r-�y OCCUPANCY GROUP _ U ADDRESSV �{.L rlI Date Applicant Q j g TEL. &94—48/� OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of CITY � o. (J 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. El revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ 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 REO'D O PROVIDED License Number Lie.Class LIMITED TIME USE I't ractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a. licensed architect or a registered professional engineer slzE of NO. OF INSPECTOR'S acting In my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE mess and Professions Code). RESENT USE OF BUILDING VA �/7� FINAL APPROVAL 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 %2 71.6 A License Law for the following reason (Section 7031.5, Busi- ness and PI'OfeSSIORS Code): NO. PARKINGSPACES PROVIDED 4 0 0 0 0 3 ` I, as owner of the property, will do the work and the structureis not intended or offered for sale (Section 0 0 0 o D 0 D z 7044, Business and Professions Code). - PROPOSED USE OF BUILDING 2—p'\ 5 1 /1 L�JJ /C� 0,x: 1 0-83 CONSTRUCTION LENDING AGENCY A ` ®� S ��- I hereby affirm that there is a construction lending agency S f TO for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. ? 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, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned rope y f r insp ct n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I n WQRKERS'COMPENSATION DECLARATION 76M444 n� ��n p�®�� ®p p CE 875(11-84) M u�l ��I I sure, o 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 aScertified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BU ILD I"G 5810 Loma LOCALITY ADDRESS a Certified copy is filed with the county building inspection LOCALITY Temple City NEAREST department. V I CROSS ST. �GCQ� Date Applicant AEAREST DISTRICT{ GR8P TYPE 1PROC E S D BY CROSS ST. Las Tunas /) ONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` (� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SECOND CAL 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. }. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ' OWNER King D• TOMC3 so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP o MAIL ADDRESS 2746 Sycamore Ave Date Applicant i3 LU NOTICE TO APPLICANT: If, after making this Certificate of Vc,w Montrose Ca. NO'(818) 24.8 6345 OCCUPANT LOAD a--- Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION 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 Panic Devices 0 I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM 9 (commencing with Section 7000) of Division 3 of the Busi ❑ (LIST ITEMS BELOW NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKINSPACES G READ PROVIDED LLE= 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 SIZE OFry0, CF INSPECTORS acting in my professional capacity (Section 7051, Bus- E STING BLDG. STORIES SIG ATURE iness and Professions Code). PRESENT USE OF BUILDING Empty FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS # 0 D o D 88 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 O O O O O O O U) ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 1206-87 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDINGOffice I hereby affirm that there is a construction lending agency 3� 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 PERMIT FEE I certify that.1 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 rely i g to building construction, D d hereby authorizer re n ives of this County o enter TOTAL FEE pon the above- d r erty for inspection p poses SEE REVERSE FOR EXPLANATORY LANGUAGE a Signature of Permittee Da . ' 'JRKERS'COMPENSATION DECLARATION CE 875 (2-80) W SC E L LA N E U A P P UCAT�O d � CE 875 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 ❑ Certified copy is hereby furnished. BUILDING .5p/�, t .y��j ;L !Yr/�f� %C G!T LOCALITY ADDRESS V !2FA L ❑ Certified copy is filed with the county building inspection NEARES ^ department. LOCALITY �')� /// CROSS ST. Date Applicant EAREST � ,{".��( /1 DISTRICT. G OUP TYP 1PROC ED BV CROSS ST. '••'f l / H�`•/S ^ CO S CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAPIGNWAY STATE MAJOR SECON OCAL NO. OF BLDGS. �D' (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE Z N SP CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) O USE OF SIZE OF LOT EXISTING BLDG. .r I certify that in the performance of the work for which thisrq� `— permit is issued, I shall not employ any person in any manner OWNER +- l C I l Q so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP y ADDRESS 2-746 S CHMv1.,E. rL rL Date Applicant ID�t? jp to TEL. / OCCUPANT LOAD NOTICE TO APPLICANT: If, after making this Certificate of Iry a fJ R�S t No.C�l. ) �'(' T l 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 0 No Spec. Knowl. ❑ deemed revoked. OCCUPANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT [� (LIST ITEMS BELOW) No. of exlrs ❑ 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: ❑ 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- EXIS ING BLDG. STORIES IGNATURE a (ness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. of EXISTING BUILDINGS ON LOT AND USE 21 19.9A I hereby affirm that• I am exempt from the Contractor's # o o•o o 8 8 License Law for the following reason (Section 7031.5, Busi- 0 0 0 0 0 0 0 a ness 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 7044, Business and Professions Code). 12 1 O $4 ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY �� ' / d S — S C I2 V ILL 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, and hereby authorize representatives of this County to enter TOTAL FEE upon e above-mentioned property for inspect, n pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sig4iature of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) ` CE 875 M I SC E L LA N EO U S APPLICATION I hereby a c6rt 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 thepeof(Sec. 3800,La C. fl Policy No.J141 /` ompany S7 �C�� BUILDING j� FOR APPLICANT TO FILL IN ADDRESS O Certified copy is hereby furnished. BUILDING LE ADDRESS LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST.- de aItm nt. G CROSS T. Date Applicant NEAREST c DISTRI NNNffp��//J TYPE P CES BY CROSS ST. T(f�jq„� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY rvo. (CIRCLE) STATE MAJOR 5 CO 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. a- 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 OWNERU -so as to become subject to the Workers' Compensation Laws. MAIL V L OCCUPANCY GROUP cc O Date Applicant ADDRESS S OCCUPANT LOAD o_ L3 -STEL. NOTICE TO APPLICANT: If, after making this Certificate of clrY � No. �-2 g b35/,S 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 ppovisions or this permit shall be TRAILER USE GEOLOGY INSPECTION E] No Spec. Know]. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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. CS PARKING SPACES REQ D D PROVIDED D License Number Lia Class S. Al- ST c'S�'Sa LIMITED TIME USE Contractor Date DATE DATE 0 I am exempt from the licensing requirements as I am a FROM: To. licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL - Lie.or Reg.No. Date ✓ GGII// HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS FES„ 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 l 1,100-0001 4/20 13 I, as owner of the property, will do the work and the SPACES PROVIDED -1 ; i A 7.1;1 structure is not intended or offered for sale (Section O`3. 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.Q. Lender's Name i 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, and hereby authorize representatives of this County to enter TOTAL. FEE Ov n the above-me tioned property for inspection pup oses. _/ SEE REVERSE FOR EXPLANATORY LANGUAGE 1;e1 7-7 Signature of Permittee Date