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Home My Public Portal About9422 LAS TUNAS DR_Miscellaneous__ i i WORKERS'COMPENSATION DECLARATION 76M444 (11-84) CE 875 MISCELLANEOUS APPLICATION l 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 -1 a certified copy thereof(Sec. 3800,Lab.C.). i L- - Policy No. Company FOR APPLICANT TO FILL IN ADILD ING DRESS �� aa a Certified copy is hereby furnished. BUILDING DDRESS t� VT's} �L\ LOCALITY I Certified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant I:`IEAREST DISTRICT NO. GROJJJ��P TVP CESSED BY i CROSS ST. CONST I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIG..Av NG. (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 (5100) or less.) USE OF y I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. permit is issued. I shall not empiov any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP ( ADDRESS �-- ccuo a.0 � Date Applicant TEL. NOTICE TO APPLICANT: If, after making this Certificate of cITY NO. OCCUPANT LOAD -- Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE: 1 with comply with such p70V1$30115 Or this deemed revoked. permit shall be TRAILER USE F-1 GEOLOGY INSPECTION No Spec. Knowl. `= OCCUPANCY INSPECTION$$ Panic Devices LICENSED CONTRACTORS DECLARATION ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT j l (LISTITEMS BELOW 1 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'O PROVIDED SPACES L License Number Lie. Class LIMITED TIME USE wContractor Date DATE GATE Z FRDM: TO: N I am exempt from the licensing requirements as I am a f licensed architect or a registered professional engineer INSPECTORS P SIZE OF NO. OF Z acting in my professional eapaCltV (SeetlOn IOJ 1, BUJ EXISTING BLDG. STORIES SIG TURE J bless and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL U 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 rJ� j License Law for the following reason (Section 7031.5, Busi- ness 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 i 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY p A' i 6 PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency i ) for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. I Lender's Name PROPOSED MAX. OCC. I--i Lender's Address ( I I certify that I have read this application and state that the PERMIT FEE 2500 pLpq above information is correct. I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, I rY� and hereby authorize representatives of this County to enter TOTAL FEE 25.00 } (d 1 upo th bove-mentioned property for inspec ion pur oses. I.. �1 f— SEE REVERSE FOR EXPLANATORY LANGUAGE p n>« Signature of Permittee Date ,s.� I rvORKERS'CONIPENSATION DECLARATION cE 875(11-841 MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I Have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,ure. or a certificate of Workers' rs'Compensation Insuranc°,or I I a certified copy thereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS 7 Certified copy is hereby furnished. X BUILDING y/—' 22 L)S S �tp ADDRESS t LOCALITY i ❑ Certified copy is filed with the county building inspection X LOCALITY 1�} n �I f1 ` NEAREST department. { \ I I C \1 ) CROSS ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE CESSED•BY CROSS ST. O 6 `j CONST. /X i CERTIFICATE OF EXEMPTION FROG[WORKERS' LEGAL l// COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLOGS. NO. (CIRCLE) (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 (5100) 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 anv person in anv manner X OWNER S S n so as to become subiect to the \Yorkers' Compensation Laws. g OCCUPANCY GROUP — i ADDRESS '-lo Date Applicant _ 2 NOTICE TO APPLICANT: If, after making this Certificate of X CITYI� uo� 1�26 )1) �—�, > OCCUPANT LOAD Exemption, you should become subject to the \Yorkers APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- ! with comD[v with hien provisions or alis permit shall be TRAILER 'JSE I I GEOLOGY INSPECTION % No Spec. Knowl. — deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION (g 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 Susi- NO. OF EXITS ness and Professions Code. and m_v license is in full force and effect. PARKING REO'D O PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE TO: I am exempt from rhe licensing require:nea[s as 1 a �3 7 FROM: m a G l licensed architect or a registered professional angineer ,,zE dF No. OF INSPECTOR'S, ? acting in my professional capacity LSecr,on -051. BLIS EXISTCNG �LnG• ��_ STORIES SIG/ ruRE% iness and Professions Code). FINAL APPROVAL j PRESENT USE OF BUILDING Lic.or Ree. No. Date 1-1/w HOME OWNER-BUILDER DECLARATION ND o. OF EXISTING BUILDINGS ON LOT AND IJ f � r I hereby atiirni that i am exempt from the Contractor's t License Law for the follov:ing reason I Section 7031.5. Busi- ness and Professions Code): V NO. PARKING SPACES PROVIDED [, as owner of ,lie property. will do the work and the structure is not intended or offered for sale (Section 7044.Business and Professions Code). CONSTRUCTION LENDING AGENCY X PROPOSED USE OF BUILDING I herebv affirm that there is a construction lending asencv S(� i for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). I 15 Lender's Name ��yy 'RO� O MAX. OCC, a Lender's Address 25.UU PERMIT FEE I^''' I certify that I have read this application and state that the y above information is correct. I agree to comply with all County ISSUANCE FEET ordinances and State laws relating to building construction. and herebv authorize representatives of this County to enter TOTAL FEE 25.00 ! upon the above-me4itioned property for inspection purposes. I SEE REVERSE FOR E\PLANAVRY LANGUAGE X '7(� z'L�v1ilI L--g Si°naL' tr'of n".:?l itiee Date Ile WORKERS' COMPENSATION DECLARATION I z 00630P4V'2;90 1. MISCELLANEOUS APPLICATION I hereby affirm that I have.a certificate of consent to self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION- sinsure,or a certificate of.Workers'Compensation Insurance, or a certified copy thereof (Sec.3800, Lab.C.) t , Policy'No. Company FOR APPLICANT TO FILL IN BUILDING - BUILDING ADDRESS - _ ApOREss - ❑- Certified copy-is hereby:furnished. O by, LOCALITY ❑ Certified copy is filed with the county building inspection CITY ZIP n- +� n /� C, ( NEAREST ' ' department. -l.(,L (/c` -1( / CROSS ST. Date Applicant SIZE-OF L T NO.OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY Q CERTIFICATE OF EXEMPTION FROM WORKERS' �60� � � �' CONST. I COMPENSATION INSURANCE TRACT BLOCK LOT NO. MAP HIGHWAY IL- - - - 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 Ck by the permit is for one hundred dollars (S100) or less.) TW erfy er TEL NO. s. I certify that in the performance.of the work for whichthis permit is issued,I shall not employ any person in any manner `� A LL so as to become subject to the Workers' Compensation Laws. ADDRESS a 533`1 OCCUPANCY GROUP ( Date Applicant . :. CITYzIP� ,l NOTICE TO APPLICANT: If. after making this Certificate l 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❑ revoked. No Spec.Knowl. F-1' LICENSED CONTRACTORS DECLARATION - occuPANcv INSPECTION[ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) 'ya t r 9(commencing with Section 7000)of Division 3 of the Business �e O u$lIIe$$ NO.OF EXITS and Professions Code,and my license is in full force and effect. -. PARKING• REWD I I PROVIDED License Number Lic- Class l2 SPACES U 1 F i Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a DATE DATE licensed architect or a registered FROM: TO: : professional engineer t I acting in my professional capacity (Section 7051,Business EXISTING BLDG.SIZE OF STORIES INSIGNATURE. and Professions Code). LIC. or Reg. No. - - Date PRESENT USE OF BUILDING FINAL APPROVAL - Z, 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, 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,X PROPOSED USE OF BUILDING Business and Professions Code). - t i CONSTRUCTION LENDING AGENCY l� h 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 APPLICANT(PRINT) TEL NO. Lender's Address ADDRESS I certify that I have read this application and state that the v 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 / the above-mentioned property for inspection purposes. I TOTAL FEE X �j— �_ ( �C?�I) SEE REVERSE FOR EXPLANATORY LANGUAGE Si ure of Per ittee Date I t WORKERS'COMPENSATION NSATION DECLARATION 76M444 CE 875(11-84) MISCELLANEOUS' APPLICATION hereby'afeirm that I have a certificate of consent nc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION lusure, or a certificate of Workers'Compensation Insurance,or it certified copy thereof(Sec. 3800, Lab.C.): Policy No.—__--Company FOR APPLICANT.TOL,L•'N BUILDING - ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY XXI ADDRESS 9422- LAS TUNAS- - r Certified copy is filed<vlth the county building Inspection- LOCALITYNEAREST' -department. xy. TEMPLE CITY, CA, 91780- 1 CROSS ST, Date — .Applicant —,. - NEAREST DISTRICT NO, GROUP TYPE CESSED BY CROSS ST. OAK - _ (j CONST CF;RTIFICATE OF EXEMPTION FROM WORKERS' LEGAL o COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK r+pP Hla tiw qY -NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (Chis 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 ($100) or less.) USE-OF I certify that in the performance of-the work for which"this SIZE: of LOT 160-0 SO—F EXISTING BLD e. 0� C�7 permit is issued,1 shall not employ any person in any mannelCX OWNER of building so as to become suhject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP, ADDRESS 5337 N FRATUS DR. Date-------- Applicant — u, NOTICF TO APPLICANT: If, after making this Certificate of CITY TEMPLE CITY CA NOL 818-289-145OCCUPANT LOAD C/3 Exemption, you should .become subject to' the Workers' APPLICATION FOR-. EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth with comply with such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION No Spec. Knowl. deemed revoked. ❑ LICINSLD CONTRACTORS DECLARATION OCCUPANCY INSPECTIONU Panic Devices I hereby affirm that I arll licensed tinder provisions of Chapter SAFETY PERMIT LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS ness and Professions Code, and my license is in full force aIX �7 effect. NctII1P of business PARKING REO'D E= PROVIDED I I SPACES J LJ License Number _— Lia Class THE O- STORE LIMITED TIME USE Contractor_-__.- ___-_ Date DATE DATE a{ - FROM: - TO: I ani exempt from the licensing requirements as 1-am a licetised architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S IES STOR actino in my professional capacity (Section 7051, Bus- iness us- EXISTING BLDG. � 1 SIGNATURE PRESENT USE OF - inessandProfessionsCode)• FINAL APPROVAL - BUILDING Lic.or Reg. No. _ Date UNOCCUPIED �� 1 t. r r HOME, OWNER 1 UILDER DECLARATION No. OF EXISTINGBUILDINGS ON LOT AND USE - 1 hereby affirin that I aril exempt.from the Contractor's License Lilw for the following reason-(Section 7031.5, Busi- Iles$ and Professions("ode): NO. PARKING 4 EACH 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 I hereby affirm that there is a construction lending agency` RETAIL CLOTHING OUTLET for The performance of the work for which this-permit is issued(.Sec. 3097,Civ.C.). Lender's Name-- PROPOSED MAX.'OCC. ' L.ender's Address— —_ — PERMIT"FEE - I cerlity that,I liave 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 represents s of'this County.to enter, TOTAL FEE 25 .00 upon the above-menti led r ert or inspection purposes. 'SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX cII:0111' M 171111illee Date i