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Home My Public Portal About9616 LOWER AZUSA RD_Miscellaneous__ c WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION -' Ik- ereby affirm that I have a certificate of consent to CE 876 � CE 876(2 80)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 BUILDING P FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is hereby furnished BUILDING ADDRESS LOCALITY / G� �.w*• i ❑ Certified copy is filed with the county building Inspection /w NEwite ST department LOCALITY CR088 ST Date Applicant EARESTDISTRI T NO OUP TYPE PR 886 Y CROSS ST - �C' �L +J CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL 1 (�G� COMPENSATION INSURANCE I DESCRIPTION LOT NO BLOCK MA► HIGHrAV >_ COMPENSATION 1". .1 STATE MAJOR SlaOND LOCAL d NO OPBI (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS V by the permit is for one hundred.doliirs ($100) or less) USE OF SIZE OF LOT ' EXISTING BLDG ' �� 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 wNER F— so as to become subject to the Workers' Compensation Laws rAIL Ad a OCCUPANCY GROUPDRESS � - NDate ApplicantNOTICE TO APPLICANT If, after making this Certificate of Y . 0 NOL 19 y 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 deemed revoked ❑ No Spec Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT q (LIST ITEMS BELOW) NO OF EXITS a 9 (commencing with Section 7000)of Division 3 of the Busl ness and Professions Code, and shy license is In full force and PARKING effect SPACES REQ'D O PROVIDED O License Number LIc Class LIMITED TIME' USE Contractor Date ~ DATE _ OATR ❑ 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 SI NATURE mess and Professions Code) J SENT USE OF BUILDING FINAL APPROVAL LIc or Reg No Date � 1 46 HOME OWNER BUILDER DECLARATION OR EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's r License Law for the following reason (Section 7031 5, Busi- ness and Professions Code) No PARKING 4.3�1 9 A SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the structure Is not Intended or offered for sale (Section # • • • • 88 7044, Business and Professions Code) OSED USE OF BUILDING CONSTRUCTION LENDING AGENCY ` I hereby affirm that there is a construction lending agency r 0,4,03'-86 for the performance of the work for which this permit is V _y1 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 ordinance and State laws relating to building construction, TOTAL FEE and her autho ize representatives of this Count to enter upon ffabo ve Zonedyloperty r inspects purposes SEE REVERSE FOR EXPLANATORY LANGUAGE M1 ig�ure�e� Date , � f WOERS'COMPENSATION DECLARATION CE 875(11 84) MISCELLANEOUS APPLICATION IrI h bym that I have a certificate of consent to self COUNTY OF LOS ANGELES T BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No Company UILDING _ ( FOR APPLICANT TO FILL IN ADDRESS- qh L Certified copy 13 hereby furnished v pDDR688 LOCALITY ElCertified copy is filed with the county building inspeetioq., LOCALITY — t NEAREST department CROs sr Date Applicant NEAREST D18TR1 T NO 6 O P TYPE PR 8 ED BY CR088 ST (`C C r `1 .V]r 3 CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION Lor NO BLOCK MAP 161HIGHWAY 1 NO (CIRCLC) STATE MAJOR 8 OND LOCAL NO OF BLDGS (This section need not be completed If the work involved TRACT NOW ON LOT use ZONE SPE IAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE OF I certify that m the performance of the work for which this SIZE OR LOT EXISTING BLDG i permit is issued,I shall not employ any person in any manner-( ( o owNLtR so as to become subject to the Workers' Compensation Laws �� N S � F.9�� m MAIL A �/� OCCUPANCY GROUP,� ' Date Applicant v ADDRESS /�' Low-cc' Az�.�.g.�t-R� ` . _ h , t-- NOTICE TO APPLICANT If,after making this Certificate' ofN'-1 clrYNO £$I�''�/Y3-9i2 OCCUPANT LOAD H Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE z Compensation provisions of the Labor Code,you must forth ❑ with comply with such provisions oI this permit shall be TRAILER USE 0 GEOLOGY INSPECTION❑ No Spec Knowl deemed revoked P LICENSED CONTRACTORS DECLARATION OCCUPANCY INBPE CTION Panic Devices - E I hereby affirm that I am licensed under provisions of Chapter dAPETY PERMIT (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Bust- NO OF EXITS ness and Professions Code,and my license is in full force and effectPPACES ARKING RBq'D O PROVIDED S License Number Lic Class LIMITED TIME USE I Contractor Date DATE OATR 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 STORIES SI ATURB mess and Professions Code) Date v PRESENT U86 OP Lic or Reg No ;Bu1LDING FINAL APPROVAL 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 70315, Busi- ;16936A ness and Professions Code) NO PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 7 # • • • • 88 structure is not intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING C ' 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 .�O I certify that I have read this application and state that thg 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 authorize representatives of this County to enter TOTAL.FEE a Q d /� �f \�(� upon the above-mentioned property for inspection purposes V SEE REVERSE FOR EXPLANATORY LANGUAGE , Signature of Permittee Date WORKERS'COMPENSATION DECLARATION - 76Mt CE 875(2 80) MISCELLANEOUS APPLICATION I hereby affirm that Ihave certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate offWorkers' rs'Compensation Insurance, e,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 / GY ORES / LOCALITY Certified copy is filed with the county building inspection - NEAREST department LOCALITY CROSSST Date Applicant NEARESTti • DISTRICT R TYPE PR CESSED BY CROSS ST � , Cif /l/ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL c COMPENSATION INSURANCE DESCRIPTION LOT No BLOCK MAPIGNWAY NO (CIRCLE) STATE MAJOR SECOND LOCAL d NO OFBI (This section need not be completed if the work involved TRACT ' NOW ON LOT USE ZONE FECIAL CONDITIONS O by the permit is for one hundred dollars ($100) or less) USE OF U , t ' I certify that in the performance of the work for which this SIZE OFLOT EXISTING BLDG Cr permit is issued, I shall not employ any person in any manner WNER _ ` O so as to become subject to the Workers'Compensation Laws MAIL C OCCUPANCY GROUP ;�] W DDRES Date Applicant I Cn NOTICE TO APPLICANT If, after making this Certificate of ITV ' j"t NOL S�� OCCUPANT LOAD Exemption, you should become subject to the Workers' FAPPLICATION 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 iNSPEcr1oN No $ ec KnOWI ❑ deemed revoked � Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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- . effect PARKING RBQ'D I PROVIDED SPACES PARKIN Lice Number tic Class ` LIMITED TIME USE Co , 3ctor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM TO licensed architect or a registered professional engineer SIZE OFNO OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- x!STING BLDG STORIES SIGNATURE iness and Professions Code) FINAL APPROVAL /�� RBSBNT USE OF BUILDING Lic or Reg No Date HOME OWNER BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE �. zq Yf O 4 3 5 ^ I hereby affirm that I am exempt from the Contractor's HJ License Law for the following reason (Section 7031 5, Busi- #I• • • • 8W ness and Professions Code) NO PARKING SPACES PROVIDED - � b } ' 9 I, as owner of the property, will do the work and the s e • • • • • structure Is not intended or offered for sale (Section i I t 7044,Business and Professions Code) I 0 3 4^8 3 kNROPOSED USE OF BUILDING 'Se' CONSTRUCTION LENDING AGENCY I T ► eG I I hereby affirm that there is a construction lending agency VIr I'a for the performance of the work for wJiich 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 an State laws r ting to building construction,' TOTAL FEE a hereby or.:L repr tatives of this County to enter U n t e e me ti property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE t atur7 --tee I n' Date WORKERS'COMPENSATION DECLARATION a ..IF c* CE MISCELLANEOUS APPLICATION CE 87 876(71-84) - I hereby a cert that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,e,or SAFETY' DIVISION certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING - ADORESS Q Certified copy is hereby furnishedDDRESS BUILDING -^ n ALOCALITY Certified copy is filed with the county building inspection OCALITY - NEARE9T department CROSS ST Date Applicant BAREST DIST IC O U TYPE PROCB D BY CROSS ST - CONBTJ / CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL- (((///000 �/ COMPENSATION INSURANCE I DESCRIPTION i.OT NO BLOCK MAP (CI C U) STATE MAJOR SEC LOCAL NO OR 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 ($100) or less.) - USIICIOF I SIZE OR LOT I certify that in the performance of the work for wluch this EXISTING NG BLDG permit is issued,I shall not employ any person in any manner OWNER y so as to become subject to the Workers''Compensation Laws MAIL OCCUPANCY GROUP o < . ADDRESS 9608 Loiter A,zu$a' Road 8 Date Applicant ra LU OCCUPANT LOAD O_ NOTICE TO APPLICANT If, after making this Certificate of clTrTe111 le Cit N 28 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 $11th provisions or this permit shall be TRAILER USE GEOLOGY INSPECTIONNo Spec Knowl ❑ deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Busy SAFETY PERMIT (LIST ITEMS BELOW) NO OF EXITS ness and Professions Code,and my license is in full force and effect PARKING REq`D PROVIDED SPACES License Number Lic Class Contractor TIME USE Contractor Date OATH OATS F1I am exempt from the licensing requirements as I am a PROM TO licensed architect or a registered professional engineer SIZE OF NO OR INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES IGNATUR9 mess g dProfessionsCode) 4anitorial FINAL APPROVAL n�J� Lic or Re No Date PRESENT USE OR BUILDIN "6s HOME OWNER-BUILDER DECLARATION No OF EXISTING BUILDINGS Y L ON LOT AND USE 'I hereby affirm that I am exempt from the Contractor's _ License Law for the following reason (Section 70315, 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 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING COMPUter I hereby affirm that there is a construction lending agency rrogramming Service for the performance of the work for which this permit is issued(Sec 3097,Cry C) UI\" Lender's Name PROPOSED MAX OCC f Under's Address ,O 0 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 Ffifi a u on the above- nti pro inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date j WORKERS'COMPENSATION DECLARATION x,;,12,90 MISELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION f rxngurS or a certificate of Wdr7 n'Compensation Inswimce,or - - ( a certified copy thereof(Set 3800, Lab.C} . Pbhcy No. Coa>pany FOR APPLICANT TO FILL IN BUILDING \ ® ILD1 DV? ADDRESS Cwbfred copy is hereby fumished. D b Lower Azusa Rd. L&AUTY 1 Certified copy is filed with the county building inspection ZIP ' I department Tem le Cit Ca 91780 SSST Date Applicant SIZE OF LOT NO OF SLOGS NOW ON LOT DISTRICT NOGRouP TYPE PROCESSKD BY 4 CONST CERTIFICATE OF EXEMPTION FROM WORKERS' ( COMPENSATION INSURANCE TRACT BLOCK LOT NO MAP 7a904WAY S (Thts section need not be completed if the worst involved ASSESSOR MAP BOOK PAGE PARCEL ' �' STATE MAJOR SECOND LOCAL ' I by the permit is Por one hundred dollars ($100) or less) USE ZONE [!��MONB t I I certify that in the performance of the work for which thi r cy er TEL No I I permit is issued. I shall not employ any person in any manner hen —Yi LO — so as to become subject to the Workers Compensation LawREss Laws. OCCUPANCY GROUP t 6237N. Muscatel Ave ( Date Applicant CITY ZIP NOTICE TO APPLICANT If, after making this Certificate Sari Gabriel Ca 91775 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❑ No Spec Knowl ❑ revoked ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION( Panic Devices I hereby affirm that I am licensed under provisions of Chapte game SAFETY PERMIT❑ (LIST ITEMS BELOW) ' I 9(commencing with Section 7000)of Division 3 of the Busine o 118 Ss NO OF EXITS �JL_11 and Professions Code and my license is in full force and effec I PARKING �Q'D �� PROVIDED License Number Lic Class LL ( , I Contractor Date UMITEO TIME USE I ❑ I am exempt from the licensing requirements as I am a rROM DATE To DATE licensed architect or a registered professional engineer acting in my professional capacity(Section 7051,Business 87ZE OF NO OF INSPECTOR'S (` I and Professions Code) EXISTING BLDG STORIEA SIGNATURE. Lic or Reg Na - Date PRESENT USE OF BUILDING FINAL APPROVAL — I HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS I ON LOT AND USE I hereby affirm that I am exempt from the Contractor's Lic Law for the following reason (Section 7031.5. Business ( Professions Code) 'i, NO PARKING i ❑ I, as owner of the property, will do the work and t SPACER PROvIDED structure is not intended or offered for sale(Section 7 POSED USE OF BUILDING Business and Professions Code) XKOQ,T 6R CONSTRUCTION LENDING AGENCY I I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ' ( i ' (Sec.3097•Civ C) PROPOSED MAX OCC. Lender's Name A areas Chang b-582-80 ' Lender's Address ( 1 I certify that I have read this application and state that the rFS Lower Azusa Rd.Tem 1 e Cit-1 above information is correct I agree to comply with all County PERMIT FEE ordinances and State laws relating to building construction,and hereby authona representatives of this County to enter upon ISSUANCE FEE the above-mentioned pro for inspection purposes - I TOTAL FEE o % SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Of rmI a Date � WORKERS'COMPENSATIONDECLARATION 76M444 Cert MISCELLANEOUS APPLICATION . �I hereby a that I have a certificate of consent nc self CE 875(11 84) insure, or a certdcate of Workers'Compensation InsuranceCOUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION,or � ' a certified copy thereof(Sec 3800,Lab C) • Policy No Company FOR APPLICANT TO FILL IN BUILDING ADDRBSS Certified copy is hereby furnished BUILDING XLowor u�►50. d woowasS U 616 LoewLlrr Certified copy M filed with the county building inVe LOCALITY " t NEAREST department LOCALITY —T— C>ir^ �fl G CROSS Sr Date Applicant NBARBST Q J DISTRICT NOA OR P TYPE P SSBD BY CROSS ST TQM' IE. G� y �'Jd ✓OV CONST 7/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO BLOCK NAP HIGHWAY NOF SLOGS No (CIHCti) STATE MAJOR SECOND LOCAL ��IO 9his section need not be completed if the work involved TRACT NOW ON LOT USB'*"IF IAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) SIZE OF LOT USB or TI 1 certify that in the performance of the work for which th EXISTING BLDG permit is issued,I shall not employ any person m any in owNBR of building -Y' [-o w as to become subject to the Workers'Compensation La a MAIL , OCCUPANCY GROUP /� C31 Date Applicant ADDRBSS *S10 "T�^^ IQ G 691 dd /"' W v NOTICE TO APPLICANT If,after making this Certificate of clrY "T�4M � G' TEL �)44L-0 4S L OCCUPANT LOAD 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 USEGEOLOGY INSPECTION deemed revoked O O No Spec Knowl LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices 1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT[3 (LIST ITEMS BELOW' 9 (commencing with Section 7000)of Division 3 of the B NO OF EXITS nese and Professions Code,and my license is in full force effect Name of business PARKING SPACES RBp'D PROVIDED License Number Lic Class A VJ A Leto VI dtD LIMITED TIME USE Contractor Date DATE GATT 1 am exempt from the licensing requirements as I am a PHO" 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 SI NATUR mess and Professions Code) FINAL APPROVAL Lic or Reg No Date PRESENT USE OF BUILDING —0 HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS r ON LOT AND USB 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 70315, Busi- ,�t� 1200 1 PO A,; ness and Professions Code) NO PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is riot intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 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 1 certify that 1 have read this application and state that the PERMIT FEB 25.00 above information is correct I agree to comply with all County ISSUANCE FEB ordinances and State laws relating to building construction, sand hereby authorize representatives of this County to enter I TOTAL FEE 25.00 on thea ve mentioned property for inspection purposes x]C /9 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pernuttee Date