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Home My Public Portal About9549 LAS TUNAS DR_Miscellaneous__ P a OR KERS'COMPENSATION DECLARATION 76M444 ' _''0. CE 875 (2-80) MISCELLANEOUS APPLICATION I`herebytaYfirm 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. CompanyFOR APPLICANT TO FILL IN BUILDING' ADDRESS ❑ Certified copy is hereby furnished. BUILDING_ C 7 )A1 5 `I-4' LOCALITY ADDRESS J V�V " Certified copy is filed with the county building inspection "�f C, pw NEAREST department. _ LOCALITY G '� 7 o CROSS ST. Date Applicant NEAREST �(1 /� DISTRICT NO. G UP TYPE PR E ED BY CROSS ST. �L�f /pJ�l/ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL '� COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MPP HIGHWAY >_HO. (CIRCLE) STATE MAJOR SEC O LOCAL d NO. OF BLDGS. (This section need not be'completed if the work Involved TRACT NOW ON LOT , USE ZONE SPECIAL CONDITIONS O by the permit is for, one hundred dollars ($100) or less.) USE OF (/�•I7 SIZE OF LOT�S I EXISTING BLDG.OYU 1 ,�� - cc I certify that in the performance of the work for which-this �/\V// O permit is issued, I shall not employ any person in any manner OWNER IN 01%1A MAY,E WE-S i— so as to become subject to,the Workers' Compensation Laws. `/7� `�[r9 // /�� 1 I� OCCUPANCY GROUP I /{ '1 V .. MAIL / �( ( `4 S �V/V'/� 1J�. I—f� W ADDRESS � N Date Applicant �A n NOTICE TO APPLICANT: If, after making this Certificate of CITY / ///r C/ NOL _; 3 OCCUPANT LOAD z 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 0 • - No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION occuraNcv INSPEcnoN Panic D@VICeS ❑' I hereby affirm that I am licensed under provisions of Chapter . SAFETY PERMIT E] (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 effect. ICJ PARKING SPACES REO'D O PROVIDED License Number Lic.Class, LIMITED TIME USE Contractor Date DATE DATE FRJM 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 IR my professional capacity (Section 705I, BUS- EXISTING BLDG. STORIES UR iness and Professions Code). PRESENT USE OF BUILDING / m�/r� FINAL APPROVAL A&1�44 Lic.or Reg.No. Date ��TIL� HOME OWNER-BUILDER DECLARATION• NO. OF EXISTING BUILDIN 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 ❑ I, 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). PROPOSED USE OF BUILDING I o° c 8 Q Y CONSTRUCTION LENDING AGENCY U I hereby affirm that there is a construction lending agency o D O 8 Q 5 05 for the performanceof the work for which this permit -is issued(Sec. 3097,Civ.C:). 1 1. 1 3—8 5 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)hhreby authorizerepresentatives of this County to enter TOTAL Fehe e-mentioned�tfection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE &— 3� Signature of Perm' tee Date WORKERS'COMPENSATION DECLARATION 7snaaa0 -84)CE 875(11 SC E LLN ® APPLICATION I heiaby 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 certifk d copy.Aiereof(Sec. 3800,Lab.C.). Policy No. Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. u1LDING E 5 TV NI 1 G p r , LOCALITY ADDRESS l l �l G'�J ElCertified copy is filed with the county building inspection LOCALITY NEAREST department. CROSS ST. Date Applicant ARE ST �`ln DISTRICT NO. GROUP TYPE CE SSED BY ROSS ST. �, 1 1e C 9 v I �.�0 G -� CONST. 1/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Q I/ COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. (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 SIZE OF L T EXISTING BLDG. I certify that in the performance of the work for which this C:) permit is issued, I shall not employ any person in any manner Ow C un ��2h i,l y so as to become subject to the Workers' Compensation Laws. MAIL / pp A �� s OCCUPANCY GROUP �_� o DDRESS `.(�YV IIA T's I— Date Applicant w f TEL. g�� 1 c nG �� OCCUPANT LOAD � NOTICE TO APPLICANT: If, after making this Certificate of Irv�V ��Y tlL 1 No. Lo `fes 73 cn Exemption, you should become subject to the Workers' z 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 deemed revoked. ❑ ❑ No Spec. Knowl. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices El 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 REQ'D E� PROVIDED License Number Lie. Class SPACES y- m ('� )aI h G LIMITED TIME USE Contractor Date J ot ` ' rou 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). FINAL APPROVAL �{�—g1 PRESENT USE OF BUILDING N Q(J�I 6 +/ Lie.or Reg.No. Date I z e 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- :I;�;w; ness and Professions Code): NO. PARKING SPACES PROVIDED ..yC 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). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency W 2d� for the performance of the work for which this permit is ++ V issued(Sec. 3097,Civ.C.). W�d�h.� oU1VI rw1`f"A , 61 Lender's Name ' ((i 1 PROPOSED MAX. OCC. I 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 1 ordinances and State laws relat ng to building construction, U/1 and hereby authorize represents 'ves of this County to enter TOTAL FEE upon the above-men ' ed propert for i spec ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si e o Permittee Date WORKERS'COMPENSATION DECLARATION CE44 (2-80) MISCELLANEOUS APPLICATION !' 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 LN BUILDING ADDRESS - ❑ Certified copy is hereby furnished. C,0`&UILDING f; LOCALITY ADDRESS �"J D Certified copy is filed with the•county building inspection NEAREST department. - LoO LOCALITY- f CRO"SS ST. Date - Applicant. EAREST l DISTRICT NO. I GROUP TYPE PR C SED.BY +. CROSS ST. '`. _ coNle s . CERTIFICATE OF EXEMPTION FROM WORKERS" LEGAL ry ((/ DESCRIPTION LOT NO. BLOCK COMPENSATION INSURANCE' .0. HIGHWAY } - - rvo. _(CIRCLE) STATE MAJOR SEC ND LOCAL d (This section need not be completed if the .work involved NO. of BLDGs. p TRACT' NOW ON LOT USE.ZONE' 'SPECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less.) USE OF //�A U SIZE OF LOT EXISTING BLDG. I certify that in the'performance of the work for which thisj� '^ 0 permit is issued, I shall not employ any person in any manner rvER APR A fJ MM Ir A(00 { P v, F_ so as to become subject to the Workers' Compensation Laws. AIL /+ OCCUPANCY GROUP W ADDRESS ` L'/_. /^ �. ..�y •- '. a Date Applicant TEL. " z NOTICE TO APPLICANT: If, after.,making this Certificate of CITY P"'42( e LOAD� 'No. 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 0 No Spec.Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION occuPArvcr IrvsPECTrory Panic Devices ❑. I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness usi- ❑ ness.and Professions Code, and my'license is in full force and effect. PARKING SPACES REO'O O PROVID ED License'Number. Lic.Class LIMITED TIME USE' Contractor Date - - DATE DATE 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 S NATURE ss and Professions Code) E ine : FINAL APPROVAL - SENT USE.OF BUILDING a� Lic.or Reg.No. .Date EXISHOME OWNER-BUILDER DECLARATION No. of AND UNG BUILDINGS ON LOT AND USE . 4.2 2 8 A I hereby affirm that: I am exempt from the Contractor's #"o,o 0 088 License Law for,the following reason (Section 7031.5, Busi- 0 0 0 0 o- . Hess and Professions Code NO. PARKING 'o 0 z ) SPACES PROVIDED - EJ I; as owner of the property, will do the work and the 03113-8.6 . structure is not intended or offered for sale (Section 7044, Business and Professions Code). jo ROPOSED USE OF BUILDING 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.). 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 relatin o building construction, TOTAL FEE and hereby.authorize repr ntat' e�'of this County to enter ul�n the ave-me to pro rt for inspection pu{p es SEE REVERSE FOR EXPLANATORY.LANGUAGE Sign re of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION 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 s IRM 2 Certified copy is hereby furnished. BUILDING 9549 LAS TUNAS D LOCALITY ADDRESS ❑ Certified copy is filed with the county building inspection LOCALITY NEAREST department. TEMPLE CITY CA 91780 CROs ST. (� r Date Applicant NEAREST DISTRICT N Gy�bUP [CYPE � PROCESSED BY CROSS ST.PRIMROSE Lr CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ` , COMPENSATION INSURANCE DESCRIPTION LOT .0244',245 BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECO D LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT 6561 NOW ON LOT USE ZONESPEC IAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usE OF SIZE OF LOT 3600 EXISTING BLDG. 5100 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 OWNER CHUNG—CHENG WU so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP o ADDRESS . 321 N GERONA AVE. Date Applicant LO NOTICE TO APPLICANT: If, after making this Certificate of CITY SAN GABRIEL CA NOS 818 2850829 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 USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. El deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION EJ Panic Devices I hereby affirm that I am licensedunder provisions ofChapter 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' REMOVE GAS TANK.-OF HEATER WATER PARKING SPACES REgD D PROVIDED D License Number Lic. Class METALSINK USELESS WOGD— SHELVES. 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 T OF INSPECTORS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). � % PRESENT USE OF BUILDING FINAL APPROVAL � 9G/ Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 12 1.8 A ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 0 0 0;0 30 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I 0 - 80.50 F1I, as owner of the property, will do the work and the SPACES PROVIDED o o o80,5070- structure 80, cJ07structure is not intended or offered for sale (Section 7044,Business and Professions Code). .1 ,1,29-88 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.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE - 0� 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, 1 and hereby authorize representatives of this County to enter TOTAL FEE C1 upon the above- en ioned groperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE II l SignatuW of Permittee Date >� WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION • CE 875 Lf� � 1 hereby affirm that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION lU insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.). L-I Policy No. Company I FOR APPLICANT TO FILL IN ADDDRDR IESSSS A NG Certified copy is hereby furnished. X BUILDING � _qJ �� ADDRESS C L�u�a. LOCALITY i Certified copy is filed with the county building inspection LOCALITYTem Temple Cit canes sr. department. Y Date applicant NEAREST �I Irel1 o DISTRIC NO, GROJJP CONE CESSED BY CROSS ST. ®' O-i/J['"Ug,A �j�{ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL G I COMPENSATION INSURANCE DESCRIPTION LOT NO. IBLOCK MAP Hlc ww AY NO. (CIR CIE) 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 (S100) or less.) USE OF t SIZE OF LOT EXISTING BLDG. } I certify that in the performance of the work ,or which this PLaper permit is issued. I shall not employ any person in any manner OWNER �. LL. so as to become subject to the Workers' Compensation Laws. MAIL j r OCCUPANCY GROUP E 1 I Date applicant AD DR SS '-NOTICE TO APPLICANT: If, after making this Certificate of X cITY,)� Q vo� f OCCUPANT LOAD � = Exemption, you should become subject to the Workers APPLICATION FOR =XiTHARDWARE:: i ^� Compensation provisions of the Labor Code, you must forth M with comply With such provisions or this permit shall be TRAILEP. JSE GEOLOGY IN SPECTIO(t No Spec. KnoWl. deemed reyOked. — ; LICENSED CONTRACTORS DECLARATION I OCCUPANCY INSPECTION Funic Devices I n thereby affirm that I am licensed under provisions of Chanter — o i SAFETY PERMIT (LIST 17-N.S BELOW) i I 1 9 rcommencin_ with Section 7000' of Division 3 of the Susi- 1111 NO. DF Ex,Ts ness and Precessions Code. and my license is in full force and etIeCt. I PA i2 K:NGI I 1 y; SPn CES REOI0 i I PROVICED II L'--ense Number Li.. `lass LIMITED TIME USE Contractor Date j �om: Tc: I i am exempt 'nom the licensing reeui ements as 1 am a i licensed architect or a registered professionaln engineer I S;=E OF i;;c. DF I INSP&CTO lC7ing Ln to} prole.J$10na1 :,aD art: ISec ion. -0_`:. Bus- `EXISTING BLDG. I STORIE_ SI -U - iness and Professions Code). IPRESENT USE OF BUILDING 1FINAL APPROVAL Li_.or Reg. No. Date ' I ! HOME OWNER-BUILDER DECLARATION I NC. OF EXISTING BUILDINGS ON LOT AND USE / I hereby affirm that I am exempt from the Contractor's 13 License Law for the :ollo«ing reason (Section 7031.3. Busj ness and Professions Code): I NO. PARKING 1, as owner of the property. Will do the Work and the ;SPACES PROVIDED structure is not intended or offered for sale (Section [ I I 7044.Business and Professions Code). X I PROPOSED USE OF BUILDING CONSTRUCTION LENDING.AGENC. I o I hereby affirm that there is a construction lending agency I44AA q M nkp 1 142 for the performance of the work for which this Permit is issued(.Sec. 3097,Civ.C.). `1 -h,(AU {� ph Lender's dame PROPOSED MAX. OCC. If wv. Lender's Address 1 I certify that 1 have read this application and state that the LPERMIT FEE 25,00 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 25.00 upon the above-ment�one pr erty for inspectio purp I SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of Permittee Da e