The URL can be used to link to this page

Home My Public Portal About9602 LOWER AZUSA RD_Miscellaneous__ 1 WORKERS COMPENSATION DECLARATION 7sM"4 s W- I CE 875(11 84) M ISCELLANEOUS APPLICATION I"tiereby 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 111111..!�1 a certified copy thereof(Sec 3800 Lab C) P"","�J Policy No Company FOR APPLICANT TO FILL IN BUILDING y�oa ADDRESS Certified copv is hereby furnished BUILDING bot � � LOCALITY ADDRESS I ( Certified copy is filed with the county building inspection LOCALITYNBAR EST department Tom` �e C: , cross ST Date Applicant NEAREST /� ¢ Q n DISTRI NO UP ]TYPE J / CBSSBD BY CROSS ST ern le e \ BI4 ` CONS`7//,/ CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSLRANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO (CIRCLE) / (This section need not be completed if the work Involved TRACT NOW OF Lor g USE ZONE SPBCIAL CONDITIONS by the permit is for one hundred dollars (S 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 emplov any person in any manner OWNERE;E] — so as to become subject to the Workers Compensation Laws OCCUPANCY GROUP _ MAIL ESS 4rlo N Tem le C-Ty BI4� ) At,OR Date Aptilicant NOTICE TO APPLICANT If after making this Certificate of CITY Telfe C;T- TEL ��6��142^� �� OCCUPANT LOAD — Exemption you should become subject to the Workers APPLICATION FOR EXIT HARDWARE Compensation provisions of the Labor Code you must forth I with comply with such provisions or this permit shall be TRAILER USE I� GEOLOGY INSPECTION [I No Spec Knowl deemed re%oked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I herebv 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 torce and — etfect g RCBgG REO D PROVIDED „ II��JJ License Number Lic Class LIMITED TIME USE " Contractor Date DATE DATE IFROM To am exempt from he licensing requirements as I am a ,NsreeroR s g i licensed architec or a registered vrotessional engineer SIZE OF No OF SIGNATURE ? acting in m% processional capach% SeLtion "Oa 1 Bus EXISTING BLDG STORIES mess and Proiessions Code) FINAL APPROVAL J LIC or Reg NO Date PRESENT USE OF BUILDING jr-I z ) / HOME OWNER BLILDER DECLARATION NO OP EXISTING BUILDINGS Q .' ON LOT AND USE I herebv affirm that I am exempt from the Contractor s /f NO FEE I License Law for the olio«ing reason I SeLtton 70:1 � Busi ness and Professions Code) NO PARKING gla..�� SPACES PROVIDED no-,fSf�lo 7� I as owner of the prooert� will do the �vorl. and the no-Cool structure is not intended or offered for sale iSection ¢ 40 1 PM 4.2¢ ! 7044 Business and P otessions Code) COASTRL CTION LENDING -kGENCI PROPOSED USE OF BUILDING 1 liereb% atflrm that there is a construction lending agency for the performance of the pork for which this permit is issued(Sec 3097 Civ C) Lender s Name PROPOSED MAX OCC Lender s address PERMIT FEE I I certif% that I ha%e read this application and state that the J above iruormation is correct I agree to comply with all County ISSUANCE FEE ordinances and State la%%s relating to building construction ° and hereby authorize representatives of this County to enter TOTAL FEE ZS O0 upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Sienature of Permit ee Date WORKERS COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION L hereby a cert that 1 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 BUILDOR688 ING /jlvOa'L o� AD77 Certified copy is hereby furnished BUILDING 9Go 2 Lo GvC/Z XX A .R)E8S LOCALITY Certified copy is filed with the county building inspection LOCALITYNEAREST department XX , � eRO.. ST Date Applicant NEAREST /1� DISTRICT NO G OUP TYPE CE SED BY CROSS ST yY' � CONST CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL a COMPENSATION INSURANCE I DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL T1, No ICIRCLe) (This section need not be completed if the Work involved TRACT NOW ON LOT 8 U86 ZONE BPBCIAL CONDITIONS I certify that in thrformance of the work for which this by the permit is for one hundred dollars ($100) or less.) USE OF SIZE OF LOT EXISTING BLDG 4 e permit is issued I shallpenot employ any person in any manneiy DWNER of buildin uN- i4 (✓U�✓ to o� so as to become subject to the Workers Compensation Laws MAIL �,r �` n Q/ OCCUPANCY GROUP o Date Applicant D��A, ADDRESS 4S/O/� J {„� /J`'V� �I � FE V NOTICE TO APPLICANT If after making this Certificate of CITY TEL WlgJ 2—d yS 2 OCCUPANT LOAD °- Exemption you should become subject to the WorkersAPPLICATION FOR EXIT HARDWARE } t __z 7 ' Compensation provisions of the Labor Code you must forth r-,C- with ,cwith comply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec Knowl 12 deemed revoked 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 an effect Name of .business PARKING i 7��1 � SPACES REO D PROVIDED License Number Lic Class LIMITED TIME USE Contractor Date AT. Al.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 INSPECTOR 8 acting in my professional capacity (Section 7051 Bus- EXISTING BLDG 90V S CR STORIES SIGTURF mess and Professions Code) NFINAL APPROVAL Lrc or Reg No Date PRESENT U86 OF BUILDING HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS /� �l_► ON LOT AND USE / I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Bust- ness and Professions Code) NO PARKING F1I as owner of the property will do the work and the SPACES PROVIDED n structure is not intended or offered for sale (Section L 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 C) Lender s Name PROPOSED MAX OCC Lender s Address I certify that I have read this application and state that the PERMIT 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 UU upon the_Above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE XX � 1* XX XX '/2 zlys Signature of Permittee Date i \VflR1.ERS COtiIPCVSATIONDECLaK.aTION CE 875 11 841 MiISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of consent to self Workers OF L4S a1�;ELES BUILDING aND SAFETY DIVISION insure or a Lertiticate tit orkers Compensation insuranle or �L,I a certified copy thereof(Sec 3800 Lab C 1 HG Poltc% No Company ORESS FOR APPLICANT TO FILL IN ADORMS SS Q�O ADDR Certified Lopv (c ADDRESS liereb% turnlshea BUILDIda LOWS dS ?'a---P—&, LOCALITY NG /+ �+ �t 1 I Certified Lop% is tiled with the Lount% buddmc inspection LOCALITY Temple Cit Cz ` CROSS ST department P Y Date AppliLant NEAREST DISTR T/.�NO Ga CONST CESS ED BY CROSS ST V �/ CERTiFIC kTE Of E\EMPTiON FROM \ORURS LEGAL o i it COMPENSATION INSLR\\CL OESCRIPT ON LOT NO BLOCK i HCP HIGHW Av STATE MAJOR SECOND LOCAL 1 NO OF SLOGS (CIRCLE) (This section need not be completed if the %%ork involved -RAC- NOW ON LOT USE TONE SPECIAL CONDITIONS by the permit is for one hundred dollar-. (5 1001 or less) use or i i SIZE OF LOT EXISTING BLDG 1 certify that in thL pLrtormance of he i% irk or %loch his _ permit is issued I shall not emplo% an-, ne son n an% manner OWNER 7- L I� so as to become sub)eLt to the\%orkers Cumoensation Lai%s XL OCCUPANC( GROUP MAIL i Date applicant ADDRESS `d 9 x NOTICE TO \PPLIC INT It v a niakmc 'its CLrtlilafe it CITY rZa& SLY No (Q,( Q ( C)CCUP4N" LOAC Exemption Lou hould become sumect L t17L Rnrkers APOLICA-ICNa:�F -KIT 4ARC'VAPE - t_ompensation oro%isions of he Labor I-ode \ou must forth a 1 pith comps% Alth `ULII pIo%IS ons Lr hi-. ^ermit shad be -RAILER USE GEOLOGY iN-PECTION _ NO SoeC tO VI deemed e%okea LICENSED CONTRACTORS DECLAKATIO\ OCCUPANCY INSPEC-IONfflt Panic Dewres i herebv affirm hat I -in licensed under provisions of Chanter SAFETY PERMIT (LIST ITEMS SELOW) a t 9 (LommenLine with Section -000) of Division ) n the Bucy NO OF EXITS ness and P otecsionc Code and m% licence is in till force and t� etfeit PARKING REO O PROVIDED I a SPACES L1LLnse \unibLr L c Clam o LIMITED TIME USE LL H Contractor Date DATE DATE TO Z 1 am exempt trom the IiLensine requirements is i am a Fg7M m I ' licensed SrchltLCt or a registered professional enemeer -IZE OF VO OF INSPECTOR SNATURE Z altins n m pr011.,monal ava..it S ion moi) 1 BUS E`CISTING BLDG -ORIEL m iness and I otessicns Cadei O PRESENT USE OF BUILDING FINAL APPROVAL \.�L, r%. I ��i f ,7 U Lu or Res \a Di L J (� t.!- rjo 7 7 X ( HOME O\\NFR BUILDER DECLAR\TIO\ NO OF EXISTING BUILDINGS y1 G 3941 1 N 3� 1 hereby af`irin that 1 am exempt from the ContraLtor s ON LOT AND USE 4 License La%% for the follov ing reason (Set-tion -0_1 :� Bust ness and P otesslons Code) NO PARKING �1 1 as -inner of the propert% %%ill du tht. %%ork and the SPACES PROVIDED strut ore is not intended or offered for sale (SeLtion i 7044 Business and Professions Code) PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGF\Cl hLrcbv affirm that there is a Lonstructiun IendmE aeemv for thL performance of thL \%ork for %%hiLli this ptrmit is issued I Set. 3097 Civ C 1 s ( t Lender s Name PROPOSED MAX OCC Lender c Address I 1 certifl that 1 have read this application and state that fife PERMIT FEE 25.00 i above information is Lorrect I agree to comply with all Countv ISSUANCE FEE ordmartLes and State laws relating to budding constru%.tion and hereby authorize representatives of this County to enter TOTAL FEE 25.00 I upon the above mentioned property for incpeLtlon purposes e I SEC REVERSE FOR EXPLANATORY L ANGU AGC ` Signature of Permittee Date i WORKERS COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION ' CE 875 I hereby affirm that 1 have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a cerpficate of Workers Compensation Insurance e or a certified copy thereof(Sec 3800 Lab C) 1 .1, 4 — 'fl Policy No —Company Certified /On FOR APPLICANT TO FILL IN p DRESS Certified copy is hereby furIliSlied BUILDING ADDRESS 2 Lower Azusa Road LOCA LIT Certified copy is filed with the county building inspection LOCALITY NEAREST department Temple City, CA 91780 CROSS Sr Date Applicant NEAREST DIST IND 6 OUP TYPE P ESSED BY - =ROSS ST le it Blvd .� '�� _� CONS CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO OF SLOGS NO (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT 12 USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less) OF L T use of SIZE I certify that in the performance of the work for which this EXISTING BLDG �� o permit is issued I shall not employ any person in any manner O so as to become subject to the Workers Compensation Laws —Y Lo ® m MAIL OCCUPANCY GROUP o Date Applicant ADDRESS 9602 Lower Azusa Road TE W NOTICE TO APPLICANT If after making this Certificate of CITYTem le City NOL 818-4438998 OCCUPANT LOAD CL_ 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 oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec Knowl deemed revoked P LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITLIST 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 01*1 effect PARKING SPACES REQ D D PROVIDED D 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- XX STING BLDG SroRles SIGNATURE messandProfessionsCode) 1 ner FINAL APPROVAL It?-244#Llc or Re NO Date PRESENT YS6 OP BUILDING I y� HOME OWNER BUILDER DECLARATION No OR NO FEE EXISUSE TING BUILDINGS Q� `I/",► ' I hereby affirm that I am exempt from the Contractors ON LOT AND License Law for the following reason (Section 70315 Busi 0000-0001 8 f." /9* ness and Professions Code) NO PARKING t�6i j [11e1 i.i I as owner of the property will do the work and the SPACES PROVIDED O 7G 1 rf! ■T 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 for the performance of the work for which this permit is issued(Sec 3097 Civ C) Lender s Name Lender s Address PROPOSED MAX OCC U� 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 ;Amr9i2� tives of this County to enter TOTAL FEE CrVrty for in ection purpo8'Z ZSEE REVERSE FOR EXPLANATORY LANGUAGE e Date WORKERS COMPENSATION DECLARATION 76M444 MISCELLANEOUS A P PL I C AT I O N I hereby affirm that I have a certificate of consent tself CE 875(11 84)COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure ora certificate of Workers Compensation Insurance e or a certified copy thereof(Sec 3800 Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRESS P Certified copy is hereby furnished ILDIN ®� ADDRESS LOCALITY Certified copy is filed with the county building inspection ALITY NEAREST department cROss ST Date Applicant NEAREST DISTRICT NO 6 UP TYPE P 68Sno BY CROSS ST D� r( �I CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL �J WA COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP NIGNwwT NO (CIRC L6) STATE MAJOR SECOND LOCAL NO OF BLD68 (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) SIZE OF LOT EXISTING I certify that in the performance of the work for which this EXISTING BLDG permit is issued I shall not employ any person in any manner OWNER s� so as to become subject to the Workers Compensation Laws OCCUPANCY GROUP ® m MAIL Date Applicant ADORES 8 arV � W NOTICE TO APPLICANT If, after making this Certificate of CITYno OCCUPANT LOAD y Exemption you should become subject to the Workers AP LIGATION FOR EXIT HARDWARE z Compensation provisions of the Labor Code you must forth E]with comply with such provisions or this permit shall be TRAILER USE C] GEOLOGY INSPECTION❑ No Spec Knowl deemed revoked 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 Buw _ _ NO OF EXITS ness and Professions Code and my license is in full force and �i effect PARKING REQ DD PROVIDED License Number Lic Class SPACES 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 I R S acting in my professional capacity (Section 7051 Bus- EXISTING BLDG STORIES 81 RE mess and Professions Code) FINAL APPROVAL Lic or Reg No Date PRESENT U36 OF BUIL INE 79293 1 AM 9-017 HOME OWNER BUILDER DECLARATION No OF EXISTIN BUILDINGS ON LOT AND U86 ✓ 1 /� I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 70315 Busi ness and Professions Code) SP 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 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 C) Lenders Name Lender s Address 019 PROPOSED MAX OCC 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 the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date