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Home My Public Portal About9112 OLEMA ST_Miscellaneous__ 76M444-CElf'047$-4-ei . ..MISCELLANEOUS AP LICATIO -� `COUNTY-OF LOS-'ANGELES z� DEPARTMENT OF COM Y ENGINEER AA D D R DDREE NG SS. ZIB BUILDING AND. SAFETY DMSIONLOCALITY JOHN A. LAMBIE. COUNTY ENGINEERCOLEMAN W.JENKINS.SU P'T. OF BUILDINGNEAREST CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO G TYPEPR r CONST. BUILDING 67, ADDRESS 9112 E. Olema St HIGHWAY NO. (C.IRCLE) STATE MAJOR SECOND LOCAL LOCALITY ample City , . US ONE SPECIAL CONDITIONS NF-ARES CROSS.s4ea on den-& Rosemead _ - REQ IRED LEGAL 00 ,L pa es SETBACK YARD H•WY STREET NAME w1D1TH DESCRIPTION LOT NO. a3a7 BLOCK FRONT TRACT 12115 NOW ONLOTS 1. P.L. - - SIDE y USE OF rest ante P.L. SIZE OF LOT a roX� EXISTING BLDG. . OWNER Dale L. Knapp V I AMAIL DDRESS 9112 E. Olema Ste TELCITY Tem le alt NO.. 256-8220 >- CL APPLICATION FOR OCCUPANCY C) INSPECTION X SAFETY PERMIT v LV TRAILER USE CAI USE OF STRUCTURES OR DEVICES Z; conversion of garage and . breezeway into living quarters completed under previous owner LIMITED TIME USE DATE DATE FROM: T0: APPROVALS' DATE INSPECTOR'S .SIGNATURE OCCU P'ANGY APPROVAL I T HEREBY ACKNOWLEDGE THATI HAVE READ THIS GROUP - -OCC. LOAD APPLICATION AND STATE'THAT THE ABOVE IS COR - RECT AND AGREE. TO COMPLY WITH ALL COUNTY TRAILER USE ORDINANCES AND STATE LAW T(N�C',p_S _ WORK AS INDICATED HEREON - SIGNAT RE.OF EE Dale L Kna SAFETY PERMIT TEMPORARY 9112 E. Olema St STRUCTURE APPROVED ADDRESS TEMPORARY' Temple City, Calif -STRUCTURE REMOVED FEES /� FINAL APPROVAL APPLICATION VALIDATIO JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER (NOT A PERMIT) cK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH i O620oral, -AM 302 -2 D 15-.00- 4 WORKERS'COMPENSATION DECLARATION a CE 87 MISCELLANEOUS APPLICATION {� CE 875(11-84) I� I hereby affirm that I have a certificate of consent to self insure, or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.). Poli-#y No. Y- --Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. BUILDING /a�� LOCALITYAf_ ADDRESS % // E] department. copy is filed with the county building inspection LOCALITY .�• ��yy +- Cl/r NEAREST department. / CROSS ST. Date Applicant NEAREST // DI$$$TRICTJJJ��.NO. G OUP TYPE P OC SSED BY CROSS ST. {r I�!/q C,( -� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL G COMPENSATION INSURANC DESCRIP71 ON LOT NO. BLOCK Mar N^ J Nlc HWAY STATE MAJOR SECOND LOCAL NO. "f� (CIRCLE) NO. OF 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.) USE OF SIZE OF LOT EXISTING BLDG. �� a 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 OWNER Xil o so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP Date Applicant ADDRESS gi� 61_,rA 5r '— L�LI NOTICE TO APPLICANT: If,after making this Certificate of CITYTA"�el 1j7-NO' s fo25,0OCCUPANT LOAD Exemption, you should become subject to the Workers' AP KATION 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. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El 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 COG�/iJ3iGJf OF �� TD effect. PARKING REQ'D D PROVIDED SPACES License Number Lic. Class �QUOM LIMITED TIME USE Contractor Date �r1^ v0 DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: licensed architect or a registered professional engineer SIZE OF NO.OF - INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES 31 NATURE iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING (/ 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 ACCToQ License Law for the following reason (Section 7031.5, Busi- 3M7 80.50 ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 1 ITEMS structure is not intended or offered for sale (Section TOTAL 80 o�� 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING CHECK 80.M I hereby affirm that there is a construction lending agency CHANGE Q1] e for the performance of the work for which this permit is issued(Sec.3097,Civ.C.). Lender's Name (�0{�0{�0 W�I�IDr�i [ 12/ PROPOSED MAX. OCC. �JY6IL/�VWJi bl ld/V9 Lender's Address -+ I certify that I have read this application and state that the PERMIT FEE d V +a�3 1 AN vo�� above information is correct.I agree to comply with all County ISSUANCE FEE j ordinances ZState laws relating to building construction, and ere authorize representatives tli ountno enter TOTAL FEE D. V� sioWposes/ ,upon ove-mentioned p�V` ty SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee4 Date