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Home My Public Portal About9588 LOWER AZUSA RD_Miscellaneous__ WORKERS COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION CE 875 I hereby a cert that I have certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure 1 or a certlf�}'cate of Workers rs Compensation Insurance e or a certified copy thereof(Sec 3800 Lab C) Q Policy No Company FOR APPLICANT TO FILL IN ADDRESS 0 Certified copy is hereby furnishedADDRILDENSSIG 9588 Lower Azusa Rd Temple City LOCALITY Certified copy is filed with the county building inspection CALITY NEAREST department Temple City, CA CROSS ST Date Applicant NEAREST ffF" OUP TYPE PR ESSED BY CROSS ST Fiesta/Tejo le Cit Blvd CONST CERTIFIQATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK HIGHWAY ( ) STATE MAJOR SECOND LOCAL � NO OP BLDGS CIRCLE(This section need not be completed if the work involved TRACT NOW ON LOT CIAL CONDITIONS [by the permit is for one hundred dollars ($100) or less) use of ooycertify that in the performance of the work for which thisSIZE of LOT Hx1SrING BLDG CD permit is issued,I shall not employ any person in any manner OWNE � usa R n Chej3 y so as to become subject to the Workers Compensation Laws MAIL _ OCCUPANCY GROUP �'pZ Date A licant ADDRESS`p DFi BOX'66 F- PP LU NOTICE TO APPLICANT If after making this Certificate of CITY] •v:kf&haambxa, CA'f`QI TEL 1 % p , you should become sub ; i 3J OCCUPANT LOAD el- Exemption, Exem tion subject to the Workers APPLICATION FOR EXIT HARDWARE z Compensation provisions bf the Labor Code you must forth with comply with such provisions or this permit shall be ❑ ❑ No Spec Knowl deemed revoked TRAILER USE GEOLOGY INSPBCTION 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 Busy NO OF EXITS ness and Professions Code and my license is in full force and effect PARKING REQ D O PROVIDED D SPACES License Number Lic Class Sun International Inc LIMITED TIME USE Contractor Date Coin-Op Laundry Service DATE DATE I am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR S acting in my professional capacity (Section 7051 Bus EXISTING BLDG 2,400 Sq FT STORIES 1 SIGNATURE mess and Professions Code) FINAL APPROVAL ///^ LIC or Reg No Date PRESENT USE OF BUILDING V�O. rI Coin-Op Laundry Service Business V HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS 2 NCI FEE /A I hereby affirm that I am exempt from the Contractors ON LOT AND USE 1 liVl License Law for the following reason (Section 70315 Busi ness and Professions Code) NO PARKING '7' 0000-00C.1, ,./27,9? I as owner of the property will do the work and the SPACES PROVIDED 2 459 2 9M oCi_ 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 Coin-Op Laundry Service Business for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCG Lender s Address I certify that I have read this application and state that the PERMIT FEE above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction and hereby apthorize representatives of this County to enter TOTAL FEE o d upont entioned property for mspec n urposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate ..WORKERS COMPENSATIOr[DECLARATION 76nn444 MISCELLANEOUS A P P L I C AT l O N CE 875(11 84) I h>rg or a ceril that I have a certificate of consent to c self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION msurg or a certificate of Workers Compensation Insurance or a certifiedc y t reof ec,,((,,3800 Lab Policy NO�� ff� O f LA --c- 4 BUILDING FOR APPLICANT TO FILL IN ADDRESS ryd Certified copy is hereby furnished ffA sm LOCALIT Certified copy is filed with the county ul mspe Y NEAREST If department CROSS ST Date /Applicant NEAREST �� 11 / DISTRI T NO GROUP TYPE P 6836D BY CROSS ST �1[ V `�� CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION I 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 US6 ZONE SPECIAL CONDITIONS I by the permit is for one hundred dollars ($100) or less) UXISE OF I certify that m SIZE OF LOT ESTING BLDG the performance of the work for which this � permit is issued I shall not employ any person in any manner OWNER so as to apcome subject to the Workers Co jlon s MAIL �( OCCUPANCY GROUP EZ:1 ADDRESS �6 '+ rq. `' V Date ` -tipphcant ; ��77 t NOTICE TO APPLICANT If after makmg.SJ;Certificate of ITYMaw j/'� NO 2��'2 Q OCCUPANT LOAD N 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 ❑ ❑ No Spec Knowl deemed revoked TRAILER U86 GEOLOGY INSPECTION 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 m full force and • effect PARKING REO D PROVIDED SPACES License Number Lic Class 0.-N LIMITED TIME USE Contractor Date DATE DATE D I am exempt from the licensing requirements as I am a FROM To licensed architect or a registered professional engineer SIZE OF No OF INS P TOR S acting m my professional capacity (Section 7051 Bus EXISTING BLDG STORIES SI URE mess and Professions Code) FINAL APPROVAL PR 63E NT USE OF BUILDING �h— U � �,� Lic or Reg No Date HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS p 1493 FEE ON LOT AND U86 I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Busi COOO-0001 12/ 1/94 ness and Professions Code) spaces PROVIDED KlCisII! 9:5 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) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency y 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 repr ntatives of this County to enter TOTAL FEE upon the abovem i ned ert inspection pu O!SeA SEE REVERSE FOR EXPLANATORY LANGUAGE nature of P rmittee Date •� WORKERS COMPENSATION DECLARATION CE 875(2 80) MISCELLANEOUS APPLICATION {� CE 875 L J 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 6U[LOS NGADDRESS ❑ Certified copy is hereby furnished BUILDING LOCALITY ADDR6S3 Certified copy is filed with the county building Inspection NEAREST department OCALITY CROSS S7 , Date Applicant NEAREST DISTRICT N 6R P TYPE, PRO ED BY d CROSS ST ` COI�$T CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL VVV COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP (CIRCLE) STATE MAJOR SEC O D LOCAL d NO OF BLDGS NO (CIRCLE) O (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less) USE OF SIZE OF LOT EXISTING BLDG I certify that In the performance of the work for which this 0 21- permit is Issued I shall not employ any person In any manner OWNER so as to become subject to the Workers Compensation Laws AIL OCCUPANCY GROUP' W ADDR688 /I3 -3 0I 1� "'" + ' y Date Applicant NOTICE TO APPLICANT If after making this Certificate of CITY S NO 13— 6~ Q OCCUPANT LOAD ? Exemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you must forth with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION NO Spec KnOWI ❑ deemed revoked Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION z I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO OF EXITS 9 (commencing with Section 7000)of Division 3 of the Busi ness and Professions Code and my license is in full force and PARKING effect SPACES REO D PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date DATE DATE ❑ FROM TO I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO OF IN PECTOR S acting In my professional capacity (Section 7051 BUS EX STING BLDG STORIES IGNATUR mess and Professions Code) RESENT USE OF BUILDINGFINAL APPROVAL Lae or Reg No Date �� ` HOME OWNER BUILDER DECLARATION NO O EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5 Busi A 4 1 7 8 A ness and Professions Code) NO PARKING SPACES PROVIDED I as owner of the property will do the work and the # • • • 088 structure Is not intended or offered for sale (Section • • • • • • • 7044 Business and Professions Code) 04y�'�/ ` PROPOSED USE OF BUILDING J /� !" (- 030$ 86 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) ` Av Lender s Name PROPOSED MAX OCCCP ' 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 lbws relating to building construction TOTAL FEE ano hereby authorize representatives of this County to enter u on the above mentioned proper for in ection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE g ure of Pe ttee Date WORKERS COMPENSATION DECLARATION 76M444 CE 875 (280) 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 Certified copy is hereby furnished UILDING ADDRESS LOCALITY Certified copy is filed with the county building inspection NEARES department "LOCALITY / /� CA CROSS ST Date Applicant -ST ` ` DISTRICT NO GR P TYPE P GE SED BY- ARF CRST CONS CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL DESCRIPTION LOT No BLOCK HIGHWAY COMPENSATION INSURANCE 'HOMAP (CIRCLE) STATE MAJOR SECOND LOCAL d NO OF SLOGS 0 (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) U USE } 1 � 512E OF LOT EXISTING BLDG � cc I certify that in the performance of the work for which this �w Q permit is issued I shall not employ any person in any manner C oVWNER )— so as to become subject to the Workers Compensation Laws MAIL OCCUPANCY GROUP li�zl W ADDR DRESS ®` t1 Date Applicant ��+ U)NOTICE TO APPLICANT If after making this Certificate of Irr ` 4 NOL JA4 I OCCUPANT LOAD 2 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 deemed revoked , ❑ C] No Spec Knowl r OCCUPANCY INSPECTION PinIC Devices LICENSED CONTRACTORS DECLARATION I herety affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO OF EXITS 9 (cgi{nmencing with Section 7000)of Division 3 of the Busi ness Sind Professions Code and my license is in full force and PARKING effect SPACES REO D E:= PROVIDED D IL License Number Lic Class LIMITED TIME USE Contractor Date 1 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 ESENT USE OF BUILDING 7(II Q Lic or Reg No Date HOME OWNER BUILDER DECLARATION ON LO O EXISTING BUILDINGS OT AND USE I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5 Busi T ness and Professions Code) NO PARKING 8 81 2 A SPACES PROVIDED I as owner of the property will do the work and the #I• • • • 88 structure is not Intended or offered for sale (Section 1 7044 Business and Professions Code) •i• • • • • • OPOSED USE OF BUILDING , i CONSTRUCTION LENDING AGENCY 0 1 05-83 L 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 a 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 T ordinances and State laws relating to building construction TOTAL FEE and hereby authorize representatives of this County to enter upon the above me tioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ti J )WORKERS OMPENSATION DECLARATION 4 CE 875(11 84) MISCELLANEOUS APPLICATION CE 87 I hl<rebo affirm that I have a certificate of consent tself 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 BAUILDING DDRESS Certified copy is hereby furnished BU ILDIN6 LOCALITY ADDRESS Certified copy is filed with the county building inspection LOCALITY NEAR EST department CROSS ST Date Applicant NEAREST DISTRICT NO GROUP TYPE ______[PROCESSED BY CROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP MIONWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL _1N0 OF (This section need not be completed if the work involved TRACT NOW ONBLOT S 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 31ZE of Lor EXISTING BLDG permit is issued, I shall not employ any person in any manner OWNER � so as to become subject to the Workers' Compensation LawsMAIL OCCUPANCY GROUP o Date Applicant ADORES L~vi.l NOTICE TO APPLICANT If after making this Certificate of CIT - NOL OCCUPANT LOAD a N Exemption, you should become subject to the Workers ? Compensation provisions of the Labor Code,you must forth APPLICA ION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USEGEOLOGY INSPECTION deemed revoked ❑ ❑ No Spec Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERM ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busy NO OF EXITS ness and Professions Code and my license is in full force and effect PARKING RBq D O PROVIDED D SPACES 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 OF NO OF INSPECTOR S acting in my professional capacity (Section 7051 Bus- XISTING BLDG STORIES SI NATURE mess and Professions Code) 2 PRESENT USE OF BUILDING 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 Contractors License Law for the following reason (Section 70315 Busi- 7 Ira 8 A 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 PROPOSED USE OF BUILDING 2 7'6$7 I hereby affirm that there is a construction lending agency b �� for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s Address O0 I certify that I have read this application and state that the PERMIT FEE , above information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction n 0 and hereby authorize representatives of this County to enter TOTAL FEE OI upon thea�mentioned pr rty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Per ittee Date A(7Rhl RS (OAIPLNSATION DI(LARATION 76M444 MISCELLANEOUS APPLICATION i hereby affirm that 1 have a certificate of consent nc self CE 875(11 84)COUNTY OF LOS ANGELES B,yi�dLDING AND SAFETY DIVISION insure or a certificate of Workers Compensation Insurance or certified copy thereof(Set. 3800 Lab C) 002 Policy No _._ (ompany FOR APPLICANT TO FILL IN BUILDIADDRESSN9S8 G Certified copy is hereby furnished XX BUADDRILDENSSI5 g LO tr AZUSA D LOCALITY G Certified copy is filed with the county budding inspectionLOCALITY L NEAREST department ]tX QV(n �QJ I'I CA 709 Icwoss ST D1te __Applicant NEAREST �� /I 1 6 I u _i D19T$ICT O a.RpUP TYPE ESSED BY CROSS ST C V G �j O /( CONST (1 RI 11 K ATI or EXEMP710N 1 ROM WORKERS LEGAL vv OYY ��'JJJ !� (omprNSA PION INSURAN(L DESCRIPTION LOT NO BLOCK MAP NIONwwY STATE MAJ oOR SECOND LOCAL OF SLOGS NO (CIRCLET N (This %ection need not be completed if the work involved TRACT NOMI ON LOT usesoils. SPECIAL CONDITIONS by I certify that in the performance of the work for which this the permit is for one hundred dollars (SI00) or less.) USE or SIZE OF LOT EXISTING BLDG ,l Permit i%isnied I shall not employ any person in any manneRX OWNER of buildin ITU f 110t v" Men z:J -' so I% to nr betoe subsea hOCCUPANCY GROUP to the Workers. (ompensaon Law% MAIL P ADDRESS • 0P 3535 �- Date Applicant _ w NO fl(1 10 APPLI(ANT If after making this Certificate of CITY s SQ d enAJ C TEL -10), 5a-30 a OCCUPANT LOAD y 1%emption )ou should become subject to the Workers APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you must forth with Lomply with suss provisions or this permit shall be TRAILER USE 0 GKOLOGY INSPECTION No Spec Knowl deemed re%oked I R L NSI D(ON I RACI ORS DECLARATION OCCUPANCY INSPECTION p Panic Devices I hereb) affirm that I am licensed under provisions of Chapter SAFETY PERMIT O 'LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Bust NO OF EXIT$ neer and Professions(ode and my licence is in full force anix effect Name of business PARKING SPACES REO D PROVIDED ND I Icimse Number_ Lic (lass LA NLA LIMITED TIME USE (ontriLtor____ ___ Date DATE DATE I -im exempt from the licensing requirements as I am a FROM To licensed architect or a registered professional engineer SIZE OF NO OF INSPECTOR S acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES NATURE iness and Professions Code) 7 PRESENT USB OF BUILDING FINAL APPROVAL '�27�j b 1 is or Reg No _ _._ _ _ Date `e 7 110MI OWNr R BUILDFR DECLARATION NO OF EXISTING BUILDINGS UV O�j• L I hereb) iffum brit I Int exON LOT AND USE empt from the Contractors 0' v icense I aw for the lollow ing rei- n (Section 7031 5 Bust ness inti Professions(odes 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 Business and Professions(ode) (ONS1 RUCTION LENDING AGENCY PROPOSED USE OR BUILDING hereb) affiri» that there i% a construction lending agency �,t for the performance of the work for which this permit is Issued(Sec 3097 (iv ( 1 C', o tit 1 ender s Nine PROPOSED MAX*OCC I ender s Address I cerhly that 1 have read this apphca(iPERMIT FEE on and stale that the 00 lbove inform loon Is Lotted I (Free to conipl) with all(ounty ISSUANCE FEE ordinances and State laws relating to building construction Ind hereby ani ry representatives of this County to enter TOTAL FEE 25.00 3 upon the IN) It d property for inspection purposes SEE REVERSE COR EXPLANATORY LANGUAGE XX XX