HomeMy Public PortalAbout10151 OLIVE ST_Miscellaneous__ (3) WORKERS'COMPENSATION DECLARATION 2 0063DPWIP'90 MISCELLANEOUS APPLICATION
1 hereby affirmthat 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 BUILDING _ ,-^
BUILDIN ADDRES / poDREss _ i .J�
❑ Certified copy is hereby furnished. ��'��� L t o,C' LOCALITY �
❑ Certified copy is filed with the county building inspection CITY / ztP L�/`J,✓ 'yam C'`
department. NEAREST
1r! C CROSS ST.
Date Applicant__ _ _ SIZE OF LOT 'OF BLDGS.N W ON dLOTDISTRICT NO. GR UP TYPE 1 OCESSED BY
�� CONST. G
CERTIFICATE OF EXEMPTION FROM WORKERS' -�
COMPENSATION INSURANCE TRACT BLOCK LOT NO. HIGHWAY
fIMAP
c RCLEI STATE MAJOR SECOND LOCAL
(This SCCtIOn recd not be completed If IIIc work InYOIvCd ASSESSOR MAP BOOK PAGE PARCENE 71ALCONDITIONS
by the permit is for one hundred dollars (,S100) or less.) V
I certify that in the performance of the work for which this WNER TEL NO.
permit is issued. 1 shall not employ an Irv ' �' ai IVN
LA
p p y y person in any manner
so as to become subject to the Workers' Compensation Laws. ADDRESSI OCCUPANCY GROUP
llu
Date _ Applicant _ _ CITY
ZIP
NOTICE TO APPLICANT: If• after making this Certificate `M'p Lf C.+T e, Q\\-1�v
of Exemption. you should become subject to tite Workers' OCCUPANT LOAD
P J 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. ❑
OCCUPANCY INSPECTION El Panic Devices
LICENSED CONTRACTORS DECLARATION
I hereby affirm that 1 aim licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW)
9(commencing with Section 7000)of Division 3 of the Business NO.OF EXITS
and Professions Code,and my license is in full force and effect. �., -� _-C' �« PARKING
License Number -- Lic. Class L SPACES REWD E::= PROVIDED
Contractor —_______ _— Date LIMITED. TIME USE
DATE DATE
❑ I am exempt from the licensing requirements as I am a FROM: TO: '
licensed architect or a registered professional engineer
acting in my professional capacity (Section 7051. Business SIZE OF NO.OF INSPECTOR'S
and Professions Code). EXISTING BLDG. STORIES SIGN URE
Lic. or Reg. No. _ Date PRESENT USE OF BUILDING /+ FINAL APPROVAL
HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS
ON LOT AND USE 30
I hereby affirm that 1 am exempt from the Contractor's License ACCTAJh
Law for the following reason (Section 7031.5. Business and ,(�]
2
Professions Code): NO.PARKING 3393 24 .70
1, as owner of tileSPACES PROVIDED property, will do the work and the 1 ITENS
structure is not intended or offered for sale(Section 7044, PROPOSED USE of BUILDING
Business and Professions Code). TOTAL 242.70
CONSTRUCTION LENDING AGENCY CKECK 242070
1 hereby affirm that there is a construction lending agency for I
the performance of the work for which this permit is issued OHMN'GE oGo
(Sec. 3097,CIV.C.). PROPOSED MAX.OCG
Lenders Name __- __ ___ -_ _ APPLICANT(PRINT) TEL NO.
Lender's Address __ _ ADDRESS 63DO—CM
0I 11/ 7/95
1 certify that I have read this application and state that the 1 31873 1 AN110004
above information is correct. I agree to comply with till County
ordinances and State laws relating to building construction,and PERMIT FEE /�'7
hereby authorize representatives of this County to enter upon ISSUANCE FEE /•30
the above-mentioned property for inspection purposes. /,
TOTAL FEE :�53--o-1A-70
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of -mnte Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1104060001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I
IBK: 33 PG: 86 PC: 4 I SQ. FT STORIES TYPE OCCUP GROUPI 10151 OLIVE ST
ISTRUCTURE: 1 V-B U I TEMP CA 917803345 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BALDWIN I
18586-026-030 (EXIST BLDG USE: I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
(EXIST OCC GRP: USE ZONE: I 1
ITENANT: I ISSUED ON: PROCESSED BY:
1BLDGS. NOW ON LOT: VALUATION: 104/06/11 SR I
TOWNER: TEL. NO: 1 1 ,000 1F BY : CODE: I
ILUI, PAUL (626) 389-8684- ILIST ITEMS: I I
110151 OLIVE ST I IF TE I
ITEMP 917803345 I IDESC I TION OF,WORK
I 1 _ IREMOVE UNPERMITTED STORAGEROOMBEHIND GARAGE AND REMOVE ALL1
I IOCCUP LOAD EXIST: 1PLUMBING I
(APPLICANT: TEL. NO: IOCCUP LOAD NEW: 1
IWEBER ENGINEERING INC. (714) 898-3862- 1 1 I
1P.0. BOX 1585 1PARKING SPACES REQUIRED: 1SPECIAL CONDITIONS:
1CYPRESS CA 90630 1PARKING SPACES PROVIDED:
I 1EXIT HARDWARE:
(CONTRACTOR: TEL. NO: I I LIMITED TIME USE
IC K CONSTRUCTION (626) 807-2378- INBR OF EXITS: 1 FROM TO
12205 ECKHART AVENUE LIC. NO I I
IROSEMEAD, CA 91770 497984 B I FEES PAID
I 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT-1 I I I
(ARCHITECT OR ENGINEER: TEL. NO: I (TRAILER USE
I - LOA PERMIT ISSUANCE 27.80 1 I I I
LIC. NO: 101 R/M OCC/USE INSPECT 146.00 ISAFETY PERMIT I I I
I TOTAL FEES 173.80
I 1TEMP. STRUCT. APPROVED I I
1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 1TEMP. STRUCT. REMOVED I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I
I NO 1 I I I I
SCHOOL WITHIN HAZARDOUS 1 I I I I
(AIR QUALITY: 1000 FEET MATERIALS I I I I I
1 NO NO NO I I I 1 I
1 I I I I I
I I I I I I
I 1 I I 1
I I I 1 I I
I I
I I
1R ROUTE TO: BS0508 EPORT ID: DPR267 I I I
I 1 1 I I