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HomeMy Public PortalAbout10009-10011-10015 OLIVE ST_Miscellaneous__ WC;IiKERS'COMPENSATION DECLARATION 76M4I CE 875(15-80) MISCELLANEOUS APPLICATION I hdreby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company— FOR APPLICANT TO FILL IN FOR ADDRESS ❑ Certified copy is hereby furnished. UILDING . D© — i ( LOCALITY 9. ADDRESS Certified copy is filed with the county building inspection — y C � NEAREST department. OC ALITY - _ CROSS T. Date Applicant AREST DISTRICT N GRQUP TYPE PR SSED BY CROSS ST. ``, �j CONS CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v Yi/1 COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY } NO. (CIRCLE) STATE MAJOR SEGO D LOCAL a (This section need not be completed if the work involved NO. OF BLDGS. USE ZONE SPECIAL CONDITIONS O P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) USE OF V SIZE OF LOT EXISTING BLDG, Ir I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner NER R — O so as to become subject to the Workers' Compensation Laws. _ OCCUPANCY GROUPAIL U Aw DDREsS� ' ! Dv J 'p10�pP CL Date Applicant to NOTICE TO APPLICANT: If, after making this Certificate of i er4 111t)ft) dU T — '� 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 E] 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 BELOWI 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 PARKING. effect. SPACES REO'D D PROVIDED O License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ 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 ATURE F OE iness and Professions Code). USE OF BUILDING PrV FINAL APPROVAL ,.7 ENT CI Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE ;2137,5A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- # o D o 0 8 8 ness and Professions Code): NO. PARKING SPACES PROVIDED ❑ 1, as owner of the property, will do the work and the D o G G o o D structure is not intended or offered for sale (Section 0 1.17-85 7044, Business and Professions Code). JI'PPOSRD USE OF BUILDING CONSTRUCTION LENDING AGENCY 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 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, TOTAL FEE and hereby authorize representatives of this County to enter 4na e above-m ntioned r erty for inspectpn purposes. gEE REVERSE FOR EXPLANATORY LANGUAGE ture of Permittee v/Date I � WORKERS'COMPENSATION DECLARATION 76M444 CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self COUN'T'Y OF LOS ANGELES BUILDING AND SAFE'T'Y DIVISION insure, or a certificate of Workers'Compensation Insurance,or �SS�o 23 Z3 a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS Certified copy is hereby furnished. i BUILDING /9®� ° ALOCALITY DDRESS V ' Certified copy is filed with the county building inspection NEAREST department. Fr_ CROSS ST. Date Applicant E DISTRICT NO.• ROUP TYPE PROC SED BY CROSS ST. LDVIK AVE:: ,�• "� CONST. CERTI.FICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE A ` DESCRIPTION LOT NO. 01 MAP ' HIGHWAY STATE MAJOR SECOND LOCAL 1-- NO. OF BLDGS. NO. (CIRCLE) CL (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.) �,,���Y uSE of U I certifythat in the SIZE OF LOT�x,l� EXISTING BLDG. performance of the work for which this '.^ ` permit is issued, I shall not employ any person'in any manner I OWNER Wl�l O so as to become subject to the Workers'Compensation Laws. 1 MAIL r OCCUPANCY GROUP U l W '� ADDRESS W� Date Applicant co NOTICE TO APPLICANT: If, after making this Certificate of CITY `® NOL OCCUPANT LOAD Z 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❑ GEOLOGY INSPECTION No Spec. Knowl. ❑ deemed revoked. Panic D2VIC2S E:1LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter I SAFETY PERMIT I ILIST 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 PARKING. effect. .SPACES REQ'D r� PROVIDED (cense.Number Lic.Class LIMITED TIME USE ontractor Date FROM; DATE TO• DATE 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-I, E ISTING BLDG. STORIES I SIGNATURE iness'and Professions Code). ESENT USE OF BUILDING ;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 `O 4 a 3 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No.PARKING 1 } SPACES PROVIDED t{'0 D 0 - 88 EJ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section c D 0'0 a D a 7044,Business and Professions Code). PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I 0315-83 I hereby affirm ,that there is a construction lending agency ' for the performance of the work for Qiich this permit is I issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCG. Lender's Address PERMIT FEE I certify that I have read this application and-state that the ISSUANCE FEE above information is correct.I agree to comply with all County ordinances and State laws relating to building construction, i TOTAL FEE ar!p hereby authorize representatives of this County to enter ; oAtAabov enion d property for inspection pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE 3. 7- �J Sit re of Per ttee s7 /Date( WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, ora certificate of Workers' rs'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDINGRESS ❑ .ADD Certified copy is hereby furnished. 1.0 BUIL , 1,ry�y` /�f ❑ ADDRESS 1SJl,'1 `/lr LOCALITY Certified copy IS filed with the county building inspection � A r ��� NEAREST department. i LOCALITY LUtb� cRoss sT. 001, Date Applicant W NEAREST fA� DISTRICT NO. G P TYPE PRO SSED BY CROSS ST. /`� 1/v CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK 'PMA g HIGHWAY V (CIRCLE) STATE MAJOR SECOND LOCAL n.n. NO. OF LOGS. (This section need not be completed if the work involved TRACT NOW ON LOT ONE ECTAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) usE ofI certif that in the SIZE OF LOT EXISTING BLDG. W y performance of the work for which this 0 permit is issued, I shall not employ any person in any manner I OOWNERjj�2F � I. so as to become subject to the Workers'Compensation Laws. AIL Cr LES.( ` OCCUPANCY GROUPUJ �� U 40 Date Applicant AD DRE/,�SyyS So � y A21 t/)_t YYi"- Avid Vvid TEL. /� P VU� NOTICE TO APPLICANT: If, after making this Certificate of CITY No. / OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION NO Spec. Knowl. ❑ deemed revoked. Panic Devices ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Ithereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT Q (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. D E= PROVIDED O SPACES REQ' License Number Lic.Class ' LIMITED TIME USE Contractor Date DATE DATE ❑ FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF INSPECTOR'S acting in my professional capacity (Section 70$I, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). e/i� f FINAL n? RESENT USE OF BUILDING '!J Lic.or Reg.No. Date ` a NO.OF EXISTING BUILDINGS HOME OWNER-BUILDER DECLARATION ON LOT AND USE I hereby affirm that- I am exempt from the Contractor's 343,4A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO.PARKING 1 ' SPACES PROVIDED ❑ I, as owner of the property, will do the work and the G o 0 0 0 0 0 structure is not intended or offered for sale (Section ' \ 7044, Business and Professions Code). orosED usE OF BUILDING 1706—.83 CONSTRUCTION LENDING AGENCY ,,��/;; --7 I hereby affirm that there is a construction lending agency /'�Cf�-?— � Ll W6 for the performance of the work for which this permit is / issued( Sec.3097,Civ.C.). hJ�j l�i�t'eloot 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 and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Pe mittee Date WORKERS'COMPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES — BUILDING AND SAFETY DIVISION insureure,, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.Q. Policy Nod Company FOR APPLICANT TO FI LL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING r lT�Jg&fY'1' LOCALITY ADDRESS /i00/ OLII/` O ,L Certified copy is filed with the county building inspection NEAREST LOCALITY department. c4 T caoss sr. Date Applicant NEAREST ) J��� DISTRICT NO. GROUP TYPE CESSEO BY CROSS ST. ���.�fy J4 `�� O CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL (J COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF SLOGS. (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 I certify that in the performance of the work for which this SIZE OF LOT EXISTING BLDG. :at permit is issued,I shall not employ any person in any manner OWNER 0J6FRT C7 LES/3 Y y so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP o_ MAILDate Applicant 7_ ADDRESS 63 -5 . PARK Rd�� AVIf Lail =1 c� NOTICE TO APPLICANT: If, after makingthis Certificate of clrY ITvo'' OCCUPANT LOAD o_ l►a6aRo oil C8'/* 33 - �i� 0- 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❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION 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 J'} �Q /�A effect. ' w G/\ /�K PARKING REQ'D PROVIDED SPACES JJ License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE FROM: 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 7031, Bus- EXISTING BLDG. STORIES PRESENT USE OF BUILDING l SI ATURE iness and Professions Code). CAA) FINAL APPROVAL ,I I Lic.or Reg.No. Date �"- Ci F E HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (1 ON LOT AND USE I f I hereby affirm that I am exempt from the Contractor's �D _lei+)__.I_I_I License Law for the following reason (Section 7031.5, Busi- ` mess and Professions Code): NO. PARKING �J'7' •t �f+ 1' �': 1 0 I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section rj 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agendy Zoweie Y for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE vU 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 abo e-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Permittee Date WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION 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.) I Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. BUILDING LOCALITY ADDRESS Certified Certified copy is filed with the county building inspection NEAREST department. LOCALITY �. d• CROSS ST. d Date Applicant AREST DISTRICT GROUP TYPE PROCE EI BY 11 CROSS ST. x• ���• CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE I DESCRIPTION LOT NO. NO. F BLDGS. HO. (CIRCLE) STATE MAJOR SECOND LOCAL I1 BLOCK MAP S HIGHWAY >_(This section need not be completed if the work involved TRACT NOWOON LOT USE ZONE 71AL CONDITIONS V by the permit is for one hundred dollars ($100) or less.)j USE OF ��JJ SIZE OF LOT EXISTING BLDG. J/ fr I certify that in the performance of the work for which this ' Q permit is issued, I shall not employ any person in any manner , ' owN U so as to become subject to the Workers' Compensation Laws. ADRESS IL OCCUPANCY GROUP W ADORog d Date Applicant 2 NOTICE TO APPLICANT: If, after making this Certificate of 1.7. Z/ 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 TRAILERUSE GEOLOGY. GEOOGINSPECTION❑ C] No Spec. Knowl. deemed revoked. ❑ OCCUPANCY INSPECTION Panic Devices LICENSED CONTRACTORS DECLARATION I i I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS 9 (commencing with Section 7000)of Division 3 of the.Busi-i I n.9ss and Professions Code, and my license is in full force and PARKING. effect. REQ'D PROVIDED SPACES L;Icense Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE r_1 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-' E TING BLD 6. STORIES SIGNATURE InesS and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL G? _� �7(� • Q� Lic.or Reg.No. Date O / �J 7 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 7031.5, Busi- 2 P 2 0 A ness and Professions Code): No.PARKING SPACES PROVIDED {� 0 O o O V 8 p A El I, as owner of the property, will do the work and the ' structure is not intended or offered for sale (Section o D o 0 0 D u) 7044, Business and Professions Code). I ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency d 6r for the performance, of the work for which this permit is ' issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCG. 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 and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter ; W abov en tion operty for inspec 'on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Permittee Date WORKERS'COMPENSATION DECLARATION !76M444CE 875 (280) 5m6SC E L = N E O U S APPLICATION PPLICFTION I hereby affirm that I have certificate of consent to self COUNTY OF ]LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or I a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. IBUILDING LOCALITY ❑ ADDRESS Certified copy is filed with the county building inspection 11 Olive, Temple Citys NEAREST department. OCALITY Temple Cit CROSS ST. Date Applicant BAREST DISTRICT NO. GROUP ITYP E JPRIIESSEO BY ROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK NAP r4 0j Z�?Q? (CIRCLE) STATE MAJOR SECOND LOCAL a (This SOCtIOn need not be completed if the work involved NO. OF BLO GS. USE ZONE SPECIAL CONDITIONS O P TRACT NOW ON LOT by the permit is for one hundred dollars ($100) or less.) U USE OF �' ,r I certify that in the performance of the work for which this YE OF LOT EXISTING BLDG. ix permit is issued, I shall not employ any person in any manner owNE16T Rbt Gerald Glesb O so as to become subject to the Workers'Compensation Laws. AIL YY OCCUPANCY GROUP W A KESS 5- l Went Duarte Rd. A cac7.ia CL W Date Applicant TEL. W z NOTICE TO APPLICANT: If, after making this Certificate of clrY No. 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 GEOLOGY INSPECTION S ❑ deemed revoked. 11 No Spec. KnOWI. ❑ 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 Atcommencing with Section 7000)of Division 3 of the Busi- s and Professions Code, and my license is in full force and etilect. PARKING SPACES REQ'D O PROVIDED License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ FROM: TO: 1 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- IEXI ING BLDG. STORIES SIGNATURE mess and Professions Code). PRESENT USE OF BUILDING Retail Sales' FINAL APPROVAL Lic.or Reg.No. Date a CI I HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE '8669A I I hereby affirm that- I am exempt from the Contractor's : o O o o i; License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): 'NO.PARKING SPACES PROVIDED O O'O 0 0 0 0 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section I Q 203-84 7044,Business and Professions Code). ROPOSED USE OF BUILDING 'Retail Sales - CONSTRUCTION LENDING AGENCY 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 PERMIT FEE I certify that I ha/Is application and state that the above information gree to comply with all County ISSUANCE FEE ordina and Stati to building construction, TOTAL FEE /ind h re y authores of this County to enter CJbovmr y for nspe on purposes. SEE REVERSE FOR EXPLANAi7e Y LANGUAGE gnStare of Pefmitiee Date I WORKERS'COMPENSATION DECLARATION CE 875(7 1-84) M I SC E L LA IV EO lJ S 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 thereof(Sec. 3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS�E�I.S �.�Ir�Ci Certified copy is hereby furnished. BUILDING / �� , LOCALITY _ ADDRESS 7JL_ Certified copy is filed with the county building inspection LOCALITY , NEAREST , department. .�') [C CROSS ST. Date Applicant NEAREST �y7�14 1 /l ]� DISTRICT NO. GROUP TYPE P CESSED BY `14,!,-,,L! ^ /I �_a CONST. = 7 CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.LEGAL G,d COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY NO. ICIRCLDI STATE MAJOR SECOND LOCAL (This section need not be completed if the work involved TRACT JNOW ONOF L OT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) SE OF SIZE OF LOT XISTINppG BLDG. 1 �- f. I certify that in the performance of the work for which this Qf �/��JN� L/�C T �T�15$ V o permit is issued, I shall not employ any person in any manner OWNER - 7 cl�p so as to become subject to the Workers' Compensation Laws. MAIL q OCCUPANCY GROUP v� OZ Date Applicant ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of CITY l• No. Z OCCUPANT LOAD w Exemption, you should become subject to the Workers' 1 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. 11 LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic DevicesEl 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 effect. /�T,/ PARKING REq'D PROVIDED ' SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATE DATE r-1I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF FROM: o: INSPECTOR'S acting in my professional capacity (Section 7051, BUS- EXISTING BLDG. STORIES SI6 URE iness and Professions Code). 51 '4161IL�C J JP FINAL APPROVAL PRESENT USE OF BUILDING J Lic.or Reg.No. Date HOME OWNER-BUILDER DECLARATION No. OF EXISTING BUILDINGS G� IIS ON LOT ANI I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ✓�► 0000-0001 SPACES PROVIDED G'}�7` 11/13/9 ! • I, as owner of the property, will do the work and the y 1 PMPM4a:3 �2 structure is not intended or offered for sale (Section 7044,Business and Professions Code). ✓ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING ^ ,11jaj[ 6 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.Q. 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 and State laws relating to building construction, _ and hereby authorize repres ntatives of this County to enter rTTAL FEE a upon the abov -mentione o ty Z nspectig/prpos s. SEEREVERSE FOR EXPLANATORY LANGUAGE Signature of Permitte / Date y WORKERS'COMPENSATION DECLARATION 17SM444 ICE 875(11-84) MISCELLANEOU.-3 APPLICATION I hereby affirm that I Have a certificate of consent to self I insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION u a certified copy thereof(Sec.3800,Lab.Q. ` F�J , Policy No. Company I FOR APPLICANT TO FILL IN BUILDING 01/" ADDRESS Certified copy is hereby furnished. AAcceess 10015 Olive Ave. Temple LOCALITY f ) ' ❑ Certified copy is filed with the county building inspection LOCALITY Temple City, CA 91 780 NAREST department. E CR 055 ST. Date Applicant NEAREST DISTRICT iVQ GZP TYPE ESSED BY 1 CROSS ST. ��(+^!/hOy CONS t CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. 9L0 CK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLOGS. NO, (CIRCLE) (This section need not be completed if the work involved II TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars (S100) or less.) USE OF I I 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 mannerOWNER Rose Glesby - so as to become subject to the Workers' Compensation Laws. MAILOCCUPANCY GROUP Date Applicant - ADORESS631 So. Park Rose Ave. EZ1 _ ! ; NOTICE TO APPLICANT: If, after making this Certificate of CITYMonrovia, CA NOL• (81 8) 359-95 2 OCCUPANT LOAD - Exemption, you should become subject to the Workers' i APPLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be I TRAILER USE ❑ 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 9 (commencing with Section 7000) of Division 3 of the Busi- SAFETY PERMIT❑ (LIST ITEMS BELOW NO. OF EXITS ness and Professions Code,and my license is in full force and effect. PARKING REO'D D PROVIDED D yf I SPACES o ) License Number Lic. Class LIMITED TIME USE LL wContractor Date DATE DATE Z i F-1I am exempt from the licensing requirements as I am a F40M: rD: m I licensed architect or a registered professional engineer SIZE OFNO.OR INSPECTOR'S Z acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S ATURE m iness and Professions Code). O f-21 �� PRESENT USE OF BUILDING FINAL APPROVAL S Lic.or Reg.No. Date /=PP- HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's I License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): I NO, PARKING I as owner of the property, will do the work and the I SPACES PROVIDED i_ Cklr/�yaI structure is not intended or offered for sale (Section I � i [� . 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY XI PROPOSED USE OF BUILD1NGRetail store I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Seo.3097,Civ.Q. I Lender's Name PROPOSED MAX. OCC. Lender's Address ' PERMIT FEE 25.00 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, I and hereby authorize representatives of this County to enter TOTAL FEE 25,00 t•jl I upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE � ) Signature of Permittee Date I 1VORKERS'COMPENSATION DECLARATION ;CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of cgnsent to self , insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION Ll a certified copy thereof(Sec.3800,Lab.Q. , Policy No. Company FOR APPLICANT TO FILL IN BUILDING 0 r A' ADDRESS 'Off/I - D S(V Certified copy is hereby furnished. XX woowess Q 0�4�� OLIVE LOCALITYt3A> &P t;3►a(„M70 No1101hV� Certified copy is filed with the county building inspection LOCALITY1,109TW .5t0; NEAREST department. SX L,QsI Of' 13 W Ito of a Laves CROSS ST. Date Applicant NEAREST ',`p' f� DISTRICT NO. GROUP TYPE ,r, CESSED BY CROSS ST. ALDW (� �/ CONST:// CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL ' o 1I/ COMPENSATION INSURANCE DESCRIPTION LOT NO. g BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRC LH) (This section need not be completed if the work involved TRACT NNOW 0. OONL OT S. USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less:) use of SIZE OF LOT EXISTING BLDG. p I certify that in the performance of the work for which this o permit is issued,1 shall not employ any person in any manneRX OWNER of building G2T f'° so as to become subject to the Workers'Compensation Laws. MAIL OCCUPANCY GROUP r- Date ADDRESSL. Applicant NOTICE TO APPLICANT: If,after making this Certificate of clrY 1W0AJrZDVZA N0. ,3.517 Qs"/.1 OCCUPANT LOAD N 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 ❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTIO_-g1::: 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 anix effect. , Name of business PARKING -r SPACES RECD D PROVIDED E:=License Number Lic. Class T R JC\L 01J LIMITED TIME USE Contractor Date DATE GATE F1 I am exempt from the licensing requirements as I am a i FROM: TO: INSPECTOR licensed architect or a registered professional engineer SIZE OF NO.of acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES / SIGNATU iness and Professions Code). � � FINAL APPR VAL qqq PRESENT USE OR BUILDING � Lic.or Reg.No. _Date f HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE /J o I Hereby affirm that 1 um exempt from the Contractor's License Law for the following reason (Section 7031.5, 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 I PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency2 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 J fl 1 certify that 1 rr� PERMIT FEE ead this application and state that the above infor ion is cdrrect.I e to comply with all County I ISSUANCE FEE a' ordinance and State laws ting to building construction, and Here y auth rize re sentatives of this County to enter TOTAL FEE 25.00 upon the ov ention property for inspection purposes. 4 SEE REVERSE FOR EXPLANATORY LANGUAGE rXX XX OI-x/- 97 ature f 1'e mittee Date