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Home My Public Portal About9945 LOWER AZUSA RD_Miscellaneous__ WORKERS'COMPENSATION DECLARATION cE ei54(1 1-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent n 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) PohcfNo Company FOR APPLICANT TO FILL IN BUILDING ADORE88 Certified copy is hereby furnished ADRess 9945 LOWER AZUSA LOCALITY D Certified copy is filed with the county building mspectio LOCALITY TEMPLE CITY NE AREer department CR OBs ST Date Applicant CROSS 8T BALDWIN AVE DISTRICT NO GROUP CONST ITYPS PROCB88ED BY CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY NO OF NO (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT NOW ON LOT s USE ZONE SP6 CIAL CONDITIONS by the permit is for one hundred dollars ($100) or less) USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG permit is issued,I shall not employ any person in any manner OWNER y L ALTON LAI so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP AMAIL DDRESS 9538 NARDINE ST Date Applicant NOTICE TO APPLICANT If,after making this Certificate of CITY TEMPLE CITY NOL 309-5378 OCCUPANT LOAD y Exemption, you should become subject to the Workers' ? Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be ❑ ❑ No Spec Knowl deemed revoked TRAILER U86 GEOLOGY IN SP6CTION LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Busy NO OF EXITS ness and Professions Code,and my license is in full force and {A', effect •`R 1 PARKING REq'D PROVIDED SPACES License Number Lic Class PACIFIC COMPUTER EQUIPMENT INC LIMITED TIME USE Contractor Date DATE DATE DI am exempt from the licensing requirements as I am a PROM TO licensed architect or a registered professional engineer SIZE OF No or INSPECTOR'S acting in my professional capacity (Section 7051, Bus EXISTING BLDG STORIES SIGNATU 6 mess and Professions Code) FINAL APPROVAL PR 686 NT U86 OF BUILDING Lic or Reg No Date HOME OWNER-BUILDER DECLARATION No O"A071WBUILDITIDS NI EE - ON LOT AND USE I hereby affirm that I am exempt from the Contractor's lS� '�,SRXRI{�ffiI��„�$ License Law for the following reason (Section 70315, Busr ness and Professions Code) NO PARKING 0000-MO1 11/20/89 M I, as owner of theroe SPACES PROVIDED p p rty, will do the work and the �, ¢ 1 1111•• I structure is not intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY ROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency COMPUTER PRODUCTS 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 ow have read this app tion d state that the PERMIT FEE (� on is correct I agre to cc ly with all County ISSUANCE FEE Sta laws rely udding construction, „ or re sen Ives o this County to enter TOTAL FEE V me ned pr rt pection purposes � SEE REVERSE FOR EXPLANATORY LANGUAGE e of Permi Date WORKERS'COMPENSATION DECLARATION 1tIM444 P ,2iso 0-006 MISCELLANEOUS APPLICATION i w z I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION f awimm or a certificate of Wdrkers'Compensation Insurance,or t I a certified copy thereof(Set: 3800, Lab.C� Pbhcy No. Company FOR APPUCANT TO FILL IN BUILDING t" ILDING ADDRESS ADDRESS ® I Certified copy is hereby furnished L.o w 2Y Zus0. LOCJtLITY 1 I I Certified enco py is filed with the county building insptcti rrY �� ZIP NEAREST depCROSS Sr Date ` Applicant SIZE OF LOT NO OF BLOGS NOW ON LOT DISTRICT No GRouP TYPE PROCESSED BY CEF=CATE OF EXEMPTION FROM WORKERS CYST ( I COMPENSATION INSURANCE TRACT BOCK LOT N° MAP wGHWAY No (ORCI D STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS I by the permit is for one hundred dollars ($100) or less.) t I certify that in the performance of the work for which s r ry e ! I permit is Issued. I shall not employ any person In any mann r A(� � TEL 3S7'98aS I so as to become subject to the Workers Compensation [a DRESS i„/- t�' '✓d, OCCUPANCY GROUP i 1/w t7 ( Date Applicant ciry K ✓(� z1� NOTICE TO APPLICANT If after making this Certificate 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 Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) t i 9(commencing with Section 7000)of Division 3 of the Busines oBusiness NO OP Exrrs and Professions Code and my license is in full force and effecNG REo'D L_� PROVIDED �� License Number Lia Class � 1)f -w i1:1 s-PAKCES t I Contractor Date LIMITED TIME USE ' amI ❑ I attl exempt from the licensing requirements SS I 8a FROM DATE To DATE licensed architect or a registered professional engineer ( i acting in my professional capacity(Section 7051.Business 0?��BLDG NO of INSPECTOR'� and Professions Code) STORIEA, PRESENT USE OF BUILDING /W.. FINAL APPROVAL Lic or Reg.No. - Date O 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 License Law for the following reason (Section 70315. Business and ( Professions Code) PARKING ❑ L as owner of the property, will do the work and the CES PROVIDED structure is not intended or offered for sale(Section 7044 POSED USE OF BUILDING Business and Professions Code) i 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 (Sea 3097,Civ C) PROPOSED MAX OCC jLender's Name CANT(A T) L TEL o Lender's Address DORESS I�r� N S7'90S ( ' I certify that I have read this application and state that the I �' lI� 6/✓� � Yd✓�1 �A. 9�bI above information is correct I agree to comply with all County Pg MIT, IT FEE I ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE , the above-mentioned pro rt for inspection purposes - I TOTAL FEE 0 <�-2ri—fl31--SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permlte Date WORKERS:COMPENSATION DECLARATION • C CE 876 CE 875(11 84) MISCELLANEOUS APPLICATION {� t LI 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 Bu1LDING AQDRB88 77 Certified copy is hereby furnishedXX BUILDING S A p e• LOCALITY .V Certified copy 18 filed with the county building DR 688 ,T ding Inspection JLOCALITY NQ AR68T department J. CROSS ST Date Applicant NEAREST DISTRICT NO O OUP ITYPS CESSED BY CROSS ST (/ CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL O COMPENSATION INSURANCE DESCRIPTION LOT NO BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO Or BLDGB NO ICIRCLE) (Th�I,is section need not be completed If the work involved TRACT NOW ON LOT USE=ONE 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 SIZE OF LOT EXISTING BLDG permit is Issued,I shall not employ any person in arty manner ow—N of building —TUII� LFr I= v so as to become subject to the Workers'Compensation Laws. MAIL OCCUPANCY GROUP5= o Date Applicant ADDRESS 1113M. M T'KC .4 v& L�LI PP ,.�Q NOTICE TO APPLICANT If,after making this Certificate of CITY W Ld V/JJ (J+91J/1ioL ip 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 oI this permit shall be MAILER 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❑ (LIST ITEMS BELOW) a 9 (commencing with Section 7000)of Division 3 of the Busi- ness and Professions Code,and my license Is in full force an*x Name of business PARKING effect SPACES RQQ'D E:= PROVIDED License.Number Lic Class L CULT Z` C LIMITED TIME USE Contractor Date C ATR CATS 0 1 am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineerINSPKCTOR'S SIZE of, No of 1 acting m my professional Capacity (Section 7051, Bus- EXISTING BLDG STORIES / 810Tuns mess and Professions Code) �7 PRESENT Y86 OF BUILDING co . 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 Contractor's b v License Law for the following reason (Section 70315, Busy ness and Professions Code) NO PARKING I, as owner of the property, will do the work and the d►ACBS PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USQ OF BUILDING I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is o : Issued(Sec 3097,Civ C) 4'o '= e_e Lender's Name I..- PROPOSED MAX OCC Lender's Address I certify that I have read this application and state that the PERMIT FEE 25.00 r-+ above Information Is correct I agree to comply with all County ISSUANCE FEE M ordinances and State laws relating to building construction, 1 25 00 and hereby authorize representatives of this County to enter TOTAL FEE upon the above-mptipr property for Inspection purposes. I RX ]CX 9 SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ire of Permittee Date -" '�