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Home My Public Portal About5010 MCCLINTOCK AVE_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(17-84) MISCELLANEOUS APPLICATION I hereby '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,e,or a certified copy thefeof(Sec.3800,Lab.C.). Policy No. - Company FOR APPLICANT TO FI LL IN BUILDING /� ADDRESS vC' '` Certified copy is hereby furnished. BUILDING // e f /�� ADDRESS yD(,O `CGr(/VI✓b/ LOCALITY FICertified copy is filed with the county building inspection LOCALITY�— NEAREST department. 917CJ9 CROSS ST. Date Applicant NEAREST DISTRICT No. GROUP TYPE PR €SSED BY CROSS ST. I .O �I CONST:'T CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL S COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE JO SE LOCAL NO. OF SLOGS. NO. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I USE OF I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. O permit is issued, I shall not employ any person in any manner OWNER so as to become subject to the Workers' Compensation Laws. MAIL Vice OCCUPANCY GROUP o Date Applicant ADDRESS l� a e_L,fA77-0—C I/ ~viI NOTICE TO APPLICANT: If, after making this Certificate of CITY le "'t (�?may 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 USE ❑ GEOLO Y 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 Busi NO. OF EXITS ness and Professions Code,and my license is in full force and ;USG.\ 2e. effect. ?�V l�� • PARKING c SPACES REQ'D PROVIDED ! License Number Lic. Class N �1 vL � -�' 5�p I�JQ 200 A 1-a XIV453(o LIMITED TIME USE Contractor Date . ^ DATE DATE L I am exempt from the licensing requirements as I am a N(� Z l� L-,J. "Y��FF'� L 2- FROM: TO: licensed architect or a registered professional engineer .s,zE-aFNe-as INSPECTOR'S acting in my professional capacity (Section 7051, Bus- •EiH94Ift6-B 6q G. s`TORfEs SIGNATURE iness and Professions Code). NG FINAL APPROVAL Lic.or Reg.No. Date lUw.L-7-1* • -} - 53-1 U C0p24— t HOME OWNER-BUILDER DECLARATION NO. OF EXISTiNd BUILDINGS ' ON LOT AND USE I hereby affirm that I am exempt from the Contractor's ��eC�rl'CC�I �e�-+F 5,�� (D�� O f License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING r I, as owner of the property, will do the work and the SPACES PROVIDED 30 structure is not intended or offered for sale (Section A4jr1'°a 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 3307 227.7- 1 hereby affirm that there is a construction lending agency 1 ITEMS for the performance of the work for which this permit is TOTAL - a® .c issued(Sec. 3097,Civ.C.). I� Lender's Name PROPOSED MAX. OCC. CHECK 227.75 Lender's Address ° CHANGE 10 I certify that I have read this application and state that the PERMIT FEE 2O� .(��j above informatio is correct.I agree to comply with all County ISSUANCE FEE ordinances Ranate laws relating to building construction, 0-QG-0001 4/29/93 and herebyXZ iz epresentatives of this County to enter TOTAL FEEel upon th Toned ro -inspection purposes. t��3C 1 AM 8:52 ^t_� 2�/ SEE REVERSE FOR EXPLANATORY LANGUAGE �°�� Signature of Pe a Date /� I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 I MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0601060003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 ERT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 13384 IT: 2 SQ. FT STORIES TYPE OCCUP GROUP 5010 MCCLINTOCK AV STRUCTURE: 1 VN C TEMP CA 917803554 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8574-005-002 EXIST BLDG USE: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY, C iEXIST OCC GRP: USE ZONE: TENANT: ISSUED ON: PROCESSED BY: EXPIRES ON: BLDGS. NOW ON LOT: VALUATION: 01/06/06 JK 07/05/06 0 i OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: MUNOZ GUSTAVO;ELISA (626) 442-0806- LIST ITEMS: /Q /- 5010 MCCLINTOCK AV J i W TEMP 917803554 DESCRIPTION OF WORK TO FINALIZED BUILDING PERMITS ISSUED ON 03/10/93, 09/14/89 OCCUP LOAD EXIST: 08/29/89, 09/11/89 FOR EXPANSION OF (E) GARAGE, STORAGE APPLICANT: TEL. NO: OCCUP LOAD NEW: FIREPLACE, KITCHEN ADDITION AND LIVING ROOM SAME AS OWNER - PARKING SPACES REQUIRED: SPECIAL CONDITIONS: PARKING SPACES PROVIDED: EXIT HARDWARE: CONTRACTOR: TEL. NO: LIMITED TIME USE SAME AS OWNER - NBR OF EXITS: FROM TO LIC. NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ARCHITECT OR ENGINEER: TEL. NO: TRAILER USE - OA PERMIT ISSUANCE 27.75 1 LIC. NO: 01 R/M OCC/USE INSPECT 145.95 SAFETY PERMIT TOTAL FEES 173.70 TEMP. STRUCT. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP. STRUCT. REMOVED NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED TOTAL SETBACK FROM EXIST SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508