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HomeMy Public PortalAbout9449 LAS TUNAS DR_Building__ WORKERS' COMPENSATION DECLARATION insure,ora6fcertificate of Wbrke srlificCompensat on Insurancef APPLICATION FOR B,U L L D I N G PERMIT . ora cartified.copy`thereof (Sec. 3800, Lab. C.) COUNTY.OF LOS.ANGELES BUILDING-AND SAFETY Policy No. -1085132.Company: State . Fund BUILDING El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 9449 LaS Turias Dr Certified copy is filed with the county building inspec- BUILDING 044'9 LaS Tu-na S.. Dr .. tion department. ADDRESS Temple City 11-13-9�pplicant . SignS ' Express CITY''Tern lA city ' ZIP 91.780 LOCALITY XXXJKNX�t Date NO.,OF BLDGS.. CERTIFICATE OF'EXEMPTION FROM-WORKERS'' SIZE OF LOT NOW ON LOT NEAREST clzoss ST. Roseiziead Blvd . : COMPENSATION INSURANCEASSESSOR. (This section need not be completed if the permit is for one TRACT" BLOCK LOT NO: MAP BOOK PAGE PARCEL hundred.dollars ($100).or less:) TEL. OWNER Thorg- Thai . NO.285--7002 USE ZONE.. MAP I certify that in the performance of the work for which this NO. SPECIAL >_ oil permit is issued, I shall not employ any.personjn any manner_ ADDRESS 9449* •Las T Chas ,Dr CONDITIONS - d so as to become subject to the,.Workers'Compensation Laws: CITY '.'Temple Cit ZIP 91780 Date Applicant "' ARCHITECT OR TEL. Q' PP DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE, TO APPLICANT: If, after•-makin this of ENGINEER NO. 9 CONST. ZONE Exern tion; you should become.subject to the Workers' _Compensation provisions.of the Labor Code, you must-forth=, ADDRESS with. comply,with such provisions .or this, permit•shall be TEL. STATISTICAL CLASSIFI AT N APT. CONDO. N deemed revoked. ; CONTRACTOR Signs, EX rens . NO.44 3-3 3 3 3 ��(/'J/ Z. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. Gi!/`bWELL 6NIi I herebyaffirm that I'am licensed under rovisionsbf Cha ter9 ADDRESS 2446 Merced Ave . LIC. 097 P P LIC. SEWER MAP - (commencing with Section 7000)of Division-3 of the Business CITY South. E1 Monte CLASS C'-45 and,Professions-Code,.and my license is in full force,and effect. BK. PG VALIDATION SQ. FT._ NO. OF NO. OF CHECK License Number 552'097 iLic. Class '.0-45. SIZE STORIES FAMILIES ONE - © VALUATION/ _ Contractor Signs Expr:e site 11-13-91 DESCRIPTION OF WORK NEW $ Wall -.Sign Channel Tetter ADD ❑ Poo. ❑I am exempt under Sec. ❑ ALTER -` Ihtern'all illuminated REPAIR ❑ B.&P.C.'for this reason y S -' - Date: USE'OF' EXISTING BLDG. DEMO' ❑ A ,f'_.. I Signature APPLICANT TEL. -a OWNER-BUILDER DECLARATION (PRINT),",,Terry TO N0.443-3333 FINALx_- DATE . I hereby affirm that I am exempt from the Contractor's License ADDRESS -244'6 Merced Ave. �. S..ElMoht T f L3 Law for`the following reason (Section 7031.5, Business and IN L Professions Code): PRESENT By A . t ' BUILDING ' '' '-"" ' ❑ I, as owner of the'property, or;my employees.with ADDRESS • wages as their sole compensation;will do the work and - =•; . _ ••the structure is not intended or offered for sale(Section LOCALITY 7044;.Business and Professions Code.) MOVING TEL. - , ty.{ r+'s�� :•-'1 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct-the.project.(Sec- ADDRESS tion 7044, Business and.Professions Code:) =is i r t_i•_i i 1! y i. REQUIRED TOTAL-SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP..LINE WIDTH i-• I hereby affirm that there is a construction lending agency for FRONT 'tf . the performance of the work for which this permit is issued P. (Sec. 3097,'Civ:C.).. SIDE - Lender's Name, P.L. m LDMA Ref. # P C.fee$ / Permit Fee. 3 Lender's Address 0 1 certify that I have red his application and state That the Issuance Fee LDMA P/C# above information is torr c.I agree to comply with all County " Investigation Fee 8. ordinances an4tae elating to building construction, Total Fee LDMA Perm. # a and hereby ae tives of this Countyto enterupon the abofor inspection purposes. _ a % SEE REVERSE FOR EXPL NATORYLANGUAGE Signature of'Applicant or Agent Date WORKER$'..COMPENSATION DECLARATION ins ere by or afcertif carte of Worke s' Compensat on eInsuran elf APPLICATION FOR ,B U I L D I NG "PERMIT or.a certified copy"thereof(Sec. 3800, Lab.C. COUNTY,OF LOS ANGELES BUILDING AND SAFETY Policy No. Company - ❑. Certified copy is hereby furnished. <' t FOR,APPLICANT TO FILL'IN is ADDRESS . l U.��ys ❑ Certified co is filed with'the count buildinginspe t, (BUILDING. ".�{ '', t ' tion department: Y . . P ��` ADDRESS ��/� c4: / cT CITY' iyr Lam' ` G<7 ZIP LOCALITY Date Applicant ' / , i- NO: OF"BLDGS. NEAREST CERTIFICATE-OF EXEMPTION FROM WORKERS" SIZE OF LOT NOW ON LOT CROSS ST. x'-' COMPENSATION INSURANCE , • ti, ASSESSOR (This section need_noT fie completed if the permit is for.one TRACT ?'"` j BLOCK LOT NO. MAP BOOK PAGE• PARCEL hundred dollars"($100)pr less:). ♦ TEL. /` 6 1 USE ZONE MAP OWNER iL vAS NO. b J NO. I certify that•.in the performance of the work for which this M NS CONDITIO permit is issued,'1 shall nat,employ any person in any manner ADDRESS L�f l(J/1J SPECIAL a so as to become'subject to the Wo?kers`- ompensation Laws. v'� Q / CITY Gr7` ZIP U Date ` 2 / Applicant ARCHITECT OR TEL. ; DISTRICT GROUP TYPE FIRE' OCESSED BY Q .NOTICE TO.APP ICANT; If,.after making'this Certificate of ENGINEER - NO. CON ZO E 0 Exemption, .you should-become, subject to the Workers' ;; U Compensation provisions of the-Labor Code, you must forth ADDRESS -/t a� 3 N with comply.with such. provisions.or. this,permit shall be TEL. _ STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked CONTRACTOR �T'[JnJ S/yN dL/�! No.� — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 96 3 /�eiJ'!7 S� NO. S v63 Z (commencing with Section 7000)of Division 3:of the Business CITY � - /Y(? LIC SEWER MAP ' and,Professions Code,and my.license is in full force and effect. Z L CLASS C-11�r BK FG. VALIDATION Z SQ..FT. NO: OF NO. OF CHECK License Number Lic.:Class SIZE. STORIES FAMILIES ONE VALUATION Contractor��� S/�7/V �Lti �;e.. z DESCRIPTION OF WORK. - NEW $ ElLZ I am exempt under Sec. r W4S[(rl� ADD ❑. ALTER ❑ , , B.&P.C. for this reason ; REPAIR El Date:.. USE OF . DEMO ❑ EXISTING BLDG. TEL Signature APPLICANT . _ �" FINAL OWNER-BUILDER DECIMATION (PRINT)., L/�t/ ,�j� NO. 7 6 DATE . I hereby affirm that I am exempt from the Contractor's License p Law for the following reason (Section.7031.5, Business and ADDRESS /C �L O FINAL Professions Code): PRESENT ByC. F-1 r1,'as owner of theP Y property, or my em to ees with BUILDING ' ACCT" ADDRESS � �y >_ wages as their sole compensation,will do the work and 3607 YV°_0 the structure isnot intended or offered cti for sale(Seon LOCALITY , ITEMS. 7044, Business•and Professions;Code.) ^• MOVING• TEL. CONTRACTOR NO. ❑ I, as owner.of the property, am exclusively-contracting TOTAL 40-50 with licensed contractors•to.construct,thero ect (Sec- Tion 7044, Business and.Professions Code,.) .I ADDRESS}• CHECK 4150 REQUIRED,, ' TOTAL SETBACK FROM EXIST. `'0} CONSTRUCTION LENDING AGENCY. SETBACK YARD' .HWY PROP. LINE WIDTH rHti�-GC °tJ I herebyaffirm that,there,isa,construction lending agency for FRONT the performance of the'work for which this_permit is issued P.L. ' (Sec. 3097, Civ.,C.). _ SIDE: q ' P.L. 0000-0001' 12/qiii'/u Lender's Name, LD i {31fit -� _ /� MA Ref:,#.... - .. 7525.- 1 1 1. 8:2222 P.C..Fee$ Permit Fee . V Lender's Address a I certify that,I have-read this application and'state that the' Issuance Fee V LDMA P/C#' above information is correct.'l agree to comply'with,dll County Investigation Fee 8 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # ' a and hereby authorize representatives of.this County to enter . upon the abo a mentione property for inspection:purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigi Lure of Appliclint or Agent Ddte " APPLICATION FOR. BUILDING PERMIT i1 COUNTY OF LOS ANGELES BUILDING AND SAFETY ORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILEADDRE11 [ I hereby affirm that 1 have a certificate,of consent to self insure, L�7 _rL)fldl 5 r or a certificate of Workers'Compensation Insurance,or.a certified ° copy thereof(Sec.3800,Lab.C.). CITY ZIP LOCALITY c; Policy NO. Company SIZE OF 112-90- NO.OF BLDGS.NOW ON LOT Cii 000❑qqq Certified copy is hereby furnished. NEAREST CROSS ST. Certified copy is filed with the count buildin�spection TRACT BLOCK LOT NO. Y 9 USE ZONE MAP NO. Sppa men. ASSESSOR MAP BOOK PAGE PARCEL Date o Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL.NO. YES NO COMPENSATION INSURANCE Q dOf ^ o "fit WITHIN 1000 Fr.OF SCHOOL? ADDRESS t (This section need not be completed if the permit is for One hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE PROLE E 1 44 dollars($100)or less.) CITY ZIP �;I rte. I certify that in the performance of the work for which this permit 1 nt Is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.�DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject t0 the Workers' CONTRACTQP TEL.NO. Ir �^ SI C p��� � y�` SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,'you must forthwith l �O FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC...NNOO.&ry PL 2ntrb "e— LICENSED CONTRACTORS DECLARATION CITY LIC..CLASS SPL IDE CD I hereby affirm that I am*licensed under provisions of Chapter 9 5 ' C�� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORES I NO.OF FAMILIES CD Professions Code, nd my livens is in full force and effect NEW BK PG v DESCRIPTION OF WORK ADD ❑ VALUATION�� W License Number =:Lic.Class ! � S� $ ✓ y Contractor date ( 8 �� ` ALTER ❑ _� ❑ 1 am exempt under Sec. REPAIR C3 $ . B.AP.C.for this reason DEMOL ❑ LDMA P/C# USE OF EXISTING BLDG. - Date: URM. ❑ -ti- Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# r \ El I, as owner of the property; or my employees with wages as Z V d O ? their sole compensation,will do the work and the structure is ADDRESS F FINAL DATE not intended or offered for sale (Section 7044, Business and �� Professions Code.) G WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL... ... ❑ I, as owner of theproperty, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN JQ 1 Y 9 THE AMOUNTS SIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL a licensed contractors to construct the project.(Section 7044, ves❑ No IrG�\ AlCi i o 4 Business and Professions Code.) _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING- '�L�(f i _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST, A.�, ,� FOR GUIDELINES. -�r l�1i' ! 1TErt S I hereby affirm that there is a construction lending agency for YES❑ No the performance of the work for which this permit is issued(Sec. e,l+y_ �3 .r ® 95. I HAVE READ THE HAZAUS ATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITTING CHECKLIS. ND TAND MY REQUIREMENTS UNDER THE LOS ANGELES _ �. COUNTY CODE,TITLE C APT .7(ISEC NS 220 UGH 2.20.140 CONCERNING (_HEC1�•� •,,_ a1}` �1Q �DB�{RQ •i'; Lender's Name HAZARDOUS MATERIAL EPORT 14G ANCf kQR O INB fA N" A PERMIT FROM THE SCAQMD. - Lender's AddressLIU aNNEr;oRAeENT _•t st11)71. o 1 certify that I have read this application and state that the above FEE P.C. O PERMIT FEE information is correct. I agree to comply with all county / �' i` ordinances and State laws relating to building construction,and }i_I�is I!I_ii I �: hereby authorize representatives of this County to enter upon ISSUANCE FEE the above- tioned property for inspection purposes. :"; ""i 1' ��_� w --' m 0 g y INVESTIGATION FEE TOTAL FEE s�/ SWma APPIu Agi LLGG•wwww.�+-r-y W / SEE REVERSE FOR EXPLANATORY LANGUAGE W(aRKF�-COMPENSATION DECLARATION tom" hereby a 'irm_th `�I have a certificate of consent ,r self APPLICATION , FOR BUILDING .PERMIT insure, or certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800;Lab. C.) Folic No 7 S ��e v'.1 O COUNTY OF LOS ANGELES BUILDING AND:SAFETY Y b��3 ? Company ❑ Certified copy is hereby furnished.-' FOR APPLICANT TO FILL IN- BUILDING ADDRESS L4 Cl C.rtified.copy is filed with the,county building inspec- BUILDING RESS 6 l,jJZ' �. lll��GJJ tion department. � n ADD ^T Date\l- ' �j rt} Applicant w�*^YC' CITY-�_VEM Vq- ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS'.. ' NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT : CROSS ST. (This section need not be completed if.-the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP.BOOK PAGE PARCEL TEL. USE ZONE MAP OWNER (Zr Q'. eeenj% ache 2.r NO. NO. I certify that in the.performonce of the work for which this permit is issued, I shall not employ any person in any,marner SPECIAL so as to become7?,subject to the Workers'Compensation Laws. ADDRESS 3 J \'t VAVN 03C Vt., CONDITIONS _ CITY \ M�2C� ZIP. Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If,-after making this Certificate of ENGINEER NO. DISTRICT :GROUP TYPE FIRE PROCESSED BY Exemption, you should Izecome subject to the Workers' CONST. lNE Compensation provisions of the Labor Code, you must forth- ADDRESS ✓, �� `v/ with comply with such provisions or this permit shall be TEL., WATISTICAL CLASS IC TION ' APT. CONDO., deemed revoked.' o C N0.751 "`75,5:Z3 CONTRACTOR ��1� ' LICENSED CONTRACTORS DECLARATION LIC. _ CLASS NO. ELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9.- ADDRESS ���' tE Q(t t S NO.fJa J (commencing with Section 7000).of Division 3 of the Business andLIC SEWER MAP Professions Code, and my license is in full force and effect. CITYt vJ ,� >S CLASS y f BK PG: VALIDATION Q, SQ. FT. NO. OF NO. OF CHECK License Number Lic.Class ` SIZE STORIES FAMILIES ONE c VALUATION ❑ Contractor ,,liV��\�� J►Ct,�bate ! DESCRIPTION OF WORK NEW ' : ADD r''"1 a I am exempt under Sec. C �+ e- CS� HL L, •a ` 0 iJQI ALTER .❑ Lt-'fv7 7otS� \A 1 :J'-ft. . B.BP.C. for this reason \'1 �• � REPAIR ITEMS. •USE OF ❑ f _ �,• 1_-1�11�. .- (/)1 . Date: EXISTING BLDG. DEMOL ❑ [ A g� Signature APPLICANT TEL.' FINAL/,, ai TOTAL �AL 4 a �-y��-y4. PRINT) �'� - (Q '✓. I}7nLt OWNER-BUILDER DECLARATION N�' DATE �� C.HEC��: I hereby affirm that.I am exempt from the Contractor's License •C}^i Law for the-following reason (Section 7031.5, Business and ADDRESS FIN ��: CHANGE . Professions Code): PRESENT B r� ❑ BUILDING I, as owner of the property; or my employees with ADDRESS ' wages as their sole compensation,will do the work and 413000-(j03.)1 ii, 4489. the structure is not intended or offered for sale(Section LOCALITY ii ;k qq :nom_ 7044, Business and Professions Code). MOVING TEL. {'r7� 1 "ff`lil• t!} F7I, as owner of the property„am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec-* ADDRESS tion 7044,'Business and Professions Code). FROM CONSTRUCTION LENDING AGENCY, REQUIRED YARD ' HWY TOTAL SETBACK SET BACK PROP. LINE WIDTH .1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued- P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name CDMAL_R m P.Cr Fee$ Permit Fee c/ Lender's Address '3 1 certify'that I have read this application and state that the o Y PP - • Issuance Fee CDMA above information is correct. I agree to•comply with all County Investigation Feeordinances and State taws relating•to building construction, Total Fee �(and.hereby authorize representatives of this County to enter f V .CDMA m upo the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agell Date - WORKERS' COMPENSATION DECLARATION :. insure,'orherebaafirm certif carte of Worke s' Comcertificate pensation consent Insuran e, APPLICATION F O.R. B'U I L D I N G P E RM I T or a certified copy thereof (Sec. 3800,,Lob. C.) COUNTY OF LOS'ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified,copy.is hereby furnished.. FOR APPLICANT. TO FILL IN ADDRESS Z( '3 ❑ Certified copy.is filed'with the county building inspec- BUILDING L tion department. ADDRESS Date Applicant CITY' - ZIP —6 7� LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION-INSURANCE ASSESSOR 1 (This section need not be completed if the permit is for one TRACT ' BLOCK LOT NO. MAP BOOK - PAGE PARCEL hundred dollars ($100) orrless.) TEL. ' OWNER ��L� NO. USE.ZONE MAP NO. ,.I certify that-in,-the-performance.of'the work"for which this r � u`� l" SPECIAL' permit is issued, I shall not employ,ny-person in any manner ADDRESS As "w ' — • a CONDITIONS O so as to become subject to The Workers' ComPensation'Laws. _ U CITY ZIP Dated Applicant ARCHITECT OR­ TEL. M ENGINEER - NO. DISTRICT GROUP .TYPE FIRE SSED BY NOTICE TO APPLICANT: If, after making this Certificate of CONST. ZON _ Exemption, you should become' subject 'to the.:Workers' `�._ � k U Compensation provisions of the Labor Code, you must forth ADDRESS- Vim' a with comply with such provisions or This permit shall be _. .TEL.Qy� STATISTICAL CLASSIFICATION APT. CONDO.' to deemed revoked. ' CONTRACTOR Y�<2JL�`W NO.OV4 1 O v O Z LICENSED,CONTRACTORS DECLARATION. " LIC. CLASS NO. �" y DWELL. UNITS I hereby affirm that I am licensed,under proyisions of:Chapter 9. ADDRESS l2 Z NO._ 1�" LIC. SEWER MAP (commencing-with Section 7000)of Diyision:3 of the Business t���'Lv and Professions Code,ond.my license is in full force and effect:, CITY, CLASS i BK PG VALIDATION t SQ. FT—' NO. OFNO. OF CHECK License NumberLic. Class ICS SIZE /7e1 STORIES FAMILIES ONE ..e VALUATION ,.Contractor ✓ - Date - 0 DESCRIPTION OF WORK' NEW ❑ /' �/1 ADD ❑ a /pZ t/ v v ❑1 am exempt under Sec. ►' �. .. ALTER ❑ B.&P.0 for•this reason " $' . ` - ' REPAIR❑ _ Date:: USE OF ... EXISTING BLDG. DEM 0L Signature APPLICANT ^'_ TEL.M �q� FINAL 7 OWNER-BUILDER DECLARATION' (PRINT):. �"9�'^ NO DATE I hereby affirm that f am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN j Professions Code):• - PRESENT BUILDING ❑ I, as owner.of the property; or'my'employees with ADDRESS wages as their sole compensation,will do-the work and { the structure is not intended or offered for sale(Section❑ LOCALITY MOVING TEL.7044; Business and Professions Code.) ' I, as owner.of the property; am.exclusively contracting CONTRACTOR NO. t. with licensed contractors to.construct the project (Sec- gDDRESS `ui ' �« as +� - tion 7044,'Business and Professions Code..) . REQUIRED TOTAL SETBACK FROM EXIST. y CONSTRUCTION LENDING AGENCY YARD HWY - SETBACK PROP. LINE WIDTH. I hereby affirm.that there is a construction lending agency for FRONT n91�. the pe'rformance.of the work for'-which this permit is issued P:L." ;� (Sec. 3097, Civ. C.). rinvestiqotio� Lender's Name, 3' /. J• /3 LDMA Ref. # . Permit Fee ! € P+(+ Lender's Address a I certify that I have read this application and state that the Issuance Fee LDMA P/C# �G: 5� , , _ above information is correct..I agree to comply,with all County ee t_ 8 ordinances and State laws relating to building construction, Total Fee / �� LDMA Perm.# a and hereby authorize-representatives of this County-to'enter upon'the above-mentioned property for inspection purposes. �—r�••t> Q� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of'Applicant or'Agent Date WORKERS' COMPENSATION DECLARATION APPLICATION.: FOR:,BUILDI.N.G:, PERMIT I 'hereby affirm that.I have a certificate of consent to self - insure, or a certificate of-Workers' Compensation Insurance, or d certified copy thereof (Sec.'3800;Lab C. -� COUNTY'OF.-LOS ANGELES. BUILDING AND SAFETY- Policy No ompany a l.�`. . BUILDING ❑ Certified copy is hereby furnished. • FOR.APPLiCANT TO.FILL IN' ADDRESS I' Rd BUILDING Certified copy is filed with the;countybuildirig inspec f "�� �- tion department..: . ADDRESS DateAppl scant' CITY' ZIP LOCALITY NO:OF LDGS:, 'CERTIFICATE F EXEMPTION FROM•WORKERS SIZE'OF LOT NOW ON'LOT ' NEAREST... CROSS ST, COMPENSATION INSURANCE- ASSESSOR (This section need novb> e completed if"the permit is for one TRACT "BLOCK. LOT NO.. MAP BOOK % PAGE. PARCEL hundred.dollars ($100)-or,less:) TEL. „ r OWNER. NO. USE"ZONE MAP I certify that in the-performance of the.work for which this ' permit is issued, I shall.,not employ any,person in any manner ADDRESS d S ECIAL so as to become subject�ee orkers'Co on Laws: •- O CITY ZIP CONDITIONS:Date ApARCHITECT OR TEL. I G TYPE FIRE SENOTICE TOAPPLICA 'If,..after makin this-Certificate of ENGINEER> DISTR CT ROUP PR CESD BY9 CONST ZONE �Exemption;• yo ould bcomsubject:'.to. the. Workers' L�O� . Compensation proJjsions of The Labor.Code you must forth- ADDRESS �/! with comply with such provisions or this.permiT shall be TEL. ,� (� _ STATISTICAL CLASSIFICATION PT. CONDO. N deemed revoked:' CONTRACTOR NO.1� _ Z LICENSED CONTRACTORS DECLARATION. ` LIC: CLASS NO. DWELL.UNITS = I hereby offirm that I am licensed under provisions.of Chapter 9 ADDRESS ¢y 114,31 Ul NO: `� (commencing with Section 7000)of Division 3.of the Business LIC. SEWER MAP and Professions C0 -and my license is in full force and effect. CITY, 941-It-- / CLASS BK PG. VALIDATION SQ. FT. O. OF NO- OF CHECK License Number �' Lic:'Class_ SIZE STORIES FAMILIES ONE -VALUATION Contractor - �71)afie DESCRIPTION OF'WORK NEW t. ADD �'G W t A s 7'pp ,rfv I am exempt under Sec. r ALTER •❑ BAP.C.for this reason I 3' D . REPAIR USE OF ; .. .. . - EXISTING BLDG. '. > DEMO' Signature.: . fINAI APPLICANT TEL. OWN ILDER DECLARATION (PRIM T) NO. I• I hereby affirm t I am exemptfrom the Contractors License /" ) 1 DATE Law for the following:reason,(Section=7031•.5,;Business and ADDRESS LIE `` S� �� FIN Professions Code): PRESENT.' B BUILDING ❑ ''I, as owner of the property, or my. employees with ADDRESS wages 6s;their.sole compensation,will do the work and the structure is not intended or,offered for sale(Section LOCALITY 7044,,Business'and Profess ions.Code.-) - - -.� MOVING ;', TEL. ❑ - I, as owner of the property,.am exclusively contracting CONTRACTOR NO. +f;,•_; = k ,. . with licensed-,contractors to`constructthe-project (Sec- _ : t ADDRESS tion 7044, Business and Professions Code.): REQUIRED''. TOTAL SETBACK FROM.' - EXIST: CONSTRUCTION LENDING AGENCY.' „ SET BACK YARD" HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT _I_tE` t ,'L;%. the performance of the work for.which.this permit is issued P:L- (Sec 3097, Civ. C. , - SIDE'- NJ Lender's Name a.�• m t E ; i c LDMA Ref. N P C.'Fee$ Permlt Fee ' Lender's Address r a o I certify.that-'I. ve read this ap76 plication and state that the ' Issuance Fee +' '- I� LDMA P%C - 1 above information is correct. I agree to comply with all County Investigation Fee t i 8 ordinances and State laws relating To building.construction, Total Fee DMA Perm.#"' `* HECK. v a and hereby authorize representatives of.this County to enter w P P P Y P R P3S s t d tai, y IY13'• M u on the a�b�e-iinentionecl ro pert ns ection. Ur ores. �;(� SEE REVERSE FOTF"".-EXPLANATORY l]�NGUAGE P .' Sign ure of pplicant or,Agent Date' �r•. aj s:j �+ - - - - - WORKERS'COMPENSATION DECLARATION I hereby affirm that I hove a certificate of consent to self insure, or a certificate of Workers' Compensation,.lnsurance, . APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolPolicy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS Certified copy is filed with the county building,inspec- BUILDING' n tion department. ADDRESS ! % / Date Applicant CITY ZIP /79 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS',- O.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT ' NOW ON LOT CROSS ST. (This section need not be completed if the permit.is for one ASSESSOR hundred dollars ($100)or less.,), TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL 19USE ZONE MAP ' I certify that in the performance of the work for which this OWNER' NO. NA permit is issued, I shall not employ any person in any ma ner �1I �� SPECIALi so as to become su e t o the Workers'Com aws. DRESS �3.�5, fi..,71, wSOYL �3 CONDITIONS U, L CITY ZIP 9/8D Date pylic t NOTICE TO APPLI ANT: If, t a ing this Certificate of RCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR ESSED BY GINEER NO. CONST. ZONE Exemption, you hould become subject to the Workers' (J O Compensation provisions,of the Labor Code, you must forth- DDRESS 5 v /� 3 W with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION- - APT. NDO. N deemed revoked. NTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION a LIC. CLASS NO._L—Lff!:::DWELL. UNITS ' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code, and my license'is in full force and effect. CITY CLASSBK + VALIDATION SQ. FT. NO. OF NO.OF CHECK 1 License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION � Contractor Date DESCRIPTION OF WORK NEW ❑ ADD ❑ f � ✓� , �-� ❑ I am exempt under Sec. - ❑ TER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG./cr7 ��77q •D MOL ❑ Signature APPLICANT TEL. FINAL /7 PRINT /} /E S / NO. �� OWNER-BUILDER DECLARATION d DATE m I hereby affirm that I am exempt frothe Contractor's License ADDRESS-9 / S7&," Law for the following reason (Section 7031.5, Business and FINA Professions Code): PRESENTBY BUILDING 1,I, as owner of the property, or- my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property,'am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ; tion 7044, Business and'Professions Code). EDD } c D YARD HWY TOTAL SETBACK FROM 3 r• f i. a 4`• t # 0 0 0 0 0' CONSTRUCTION LENDING AGENCY PROP. LINE WIDTH � ) 9 o Z I hereby off irm that there is a construction lending agency for a 50 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). i.;' o o 0 2 B rj Q s y` t 8 8 Lender's Name 4;` Permit Fee ,• LDMA•Ref. # Lender's AddressI certify that,) have read this application and state that-the Issuance Feet/ LDMA P/C#ig above information iscorrect..l agree to comply with all Countyon Fee o ordinances and State laws relating to building construction, N and hereby authorize representatives of this County to ent(gri/ Total Fee 0 LDMA Perm. ## upon the above-mentio d property for' ction p�uppo�@sir GG� ----� �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date { V � COUNTY OF LOS ANGELES" TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0205140003 PHONE: (626) 285-0488 EXT: LEGAL ID: NUMBER OF SIGNS: 1 BUILDING ADDRESS: TR: 8526 LT: 1 BL: .001 SIGN DESCRIPTION: "PHONE2GO" IN BLUE & BLACK CHANNEL LE 9449 1/4 LAS TUNAS DR TEMP CA 917802100 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-008-018 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON: PHONE2GO EXIST OCC GRP: 05/15/02 JK 11/11/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL °AT FINAL Y• CODE: TEMPLE CITY PROPERTIES - 1,100 � �. 533 SANM 904022927 FEES PAID DESCRVPTION OF WORK SET OF CHANNEL LETTERS FOR CELL PHONE STORE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: j APPLICANT: TEL. NO: LAVENDER FUND, SIGNS EXPRESS (626) 443-3333- AA BLDG PERMIT ISSUANCE 27.75 2446 MERCED AVE AX BUILDING REVIEW FEE 54.70 SPEC'AL CONDITIONS: SOUTH EL MONTE D2 PERMIT W/O EN-HC 1100.00 VAL 82.20 TOTAL FEES 164.65 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SIGNS EXPRESS MANUFACTURING COMPANY (626) 443-3333- 2446 MERCED AVE LIC. NO LOCA-"ION AND SETBACKS SOUTH EL MONTE, CA 91733 552097 C45 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC: NO: SUPPORT STRUCTURE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 00 a NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:- NO LASS:NO 20 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 ArrUCAT�ON FORSUILDNG PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING,-/ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS • 3 J ora certificate of.Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company CITY /-n�LC 1T y ZIP�/,�� LOCALITY SIZE OF LOT NO.OF BLDGS.-NOW ON LOT ❑ Certified Copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant - ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER � TEL NO. c COMPENSATION INSURANCE C (2 /lQ le S 'C�d WITHIN 1000 FT OF SCHOOL? YES NO This section need not be completed if the permit is for one hundred ( ADDRESS— 5-t DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) - CITY I certify that in the performance of the work for which this permit �� is issued, I shall not employ any person in any manner so as to ✓ become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS - CLASS NO. ef?4 DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 4I-A56 FRONT Comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION s (UVC s- SIDE CITY _ �1 LIC.CLASS - PL /� I hereby affirm that I am licensed underprovisions of Chapter 9 0nAC ` y GA SEWER MAP (commencing with Section 7000)of Division.3 of the Business and SQ.FT.SIZE NO.OF STORIES I NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW El BK PG License Number Lic.Class DESCRIPTION OF WORK ADD &r VALUATION O Contractor Date `l S t? h" h Qi ALTER 11 $ G U El I.am exempt under Sec. REPAIR 11 $ B.&P.C.for this reason DEMOL ❑ LDMA P/C# U . W Date: USE OF EXISTING BLDG. URM ❑ (L • S r c) Signature APPLICANT(PRINT) /� TEL NO. _ LDMA Perm# i;~ z �I, es�er of the property, or my employees with wages as E A. wee — �2'151.3 Z — their sole compensation, will•d0 the work and the structure is ADD ESS _ O fi ti•i a T not intended or offered for sale (Section 7044, Business and C. aL/dam — FINAL DATE SQ - - -- — Professions Code.) _ r��' I_,_Ii_ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL" � �- ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE P P Y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �! licensed contractors to construct the project (Section 7044, Yes❑ NOV -- a 4' Business and Professions Code.) f l•t Eau WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. � ' I hereby affirm that there is a construction lending agency for ..Yes El No L11/ j 1 - t � � the performance Of the Work for Wf11Ch this permit IS ISSUed(Sed. (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING j I�(tt'�IL '�,`�a.d.$.-'p 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY.CODE, w TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100THROUGH 2.20.140 CONCERNING HAZARDOUS s 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 6 FI_t"•!': a Lender's Address {` y {" p - OWNER OR AGENT CHANGE o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct:I agree to comply P.C.FEE '`�D PERMIT FEE fD� N with all county ordinances and State laws relating to building / n co construction, and.hereby authorize representatives of this County ISSUANCE FEE �/ 0013,13-0013 M to e upon the above-mentioneedd pr pe for inspection purposes. o{��' / `� - j tl E co 4 � /L///3Y i � s INVESTIGATION FEE TOTAL FEE Cl /� /7� _ +t'-• i H�: .;; . /Sgnatw d Applrc nt or Agent Date / • —] SEE REVERSE FOR EXPLANATORY LANGUAGE