HomeMy Public PortalAbout9510 OLIVE ST_Miscellaneous__ IVORKERS'yCOMPENSATION;DECLARATION '76M444
r ci . i-\I' ;CL 875,(11-84) MISCELLANEOUS APPLICATION
I hereby a£fAm"'that�i'have..a'••certificate of consent to sel£ BOUNTY OF I.O5 ANGELES BUILDING AND SAFETY DIVISION
inwre, or a certificate of.,Workers'Compensation Insurance,or `
a-&rtified copy thereof(Spc:3800,Lab.Q. !
Policy No. Company FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is hereby furnished. BUILDING
ADDR ESS �f�0 C• OL�V�� LOCALITY1M 4
DC
ertified copy is filed with the county building inspection LOCALITY NEAREST
department. ies+a�<< Ci cRoss sT. YR
Da'te' Applicant NEAREST CROSS ST. DISTRICT O GR i CONST.1 J PRO SED BY
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL v
COMPENSATION INSURANCE DESCRIPTION LOT No. BLOCK MAP �. HIGHWAY STATE MAJOR'SE D LOCAL
NO. (CIRCLE)
NO. OF BLDGS.
(This section need not be completed if the work involved TRACT NOW ON LOT USA ZONE SPE IAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) usE of /I
SIZE OF LOT EXISTING BLDG.
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 11L
ro as to,become subject to the Workers' Compensation Laws. OCCUPANCY GROUP
MAIL ✓p YZ7--r�/1�9�?cewaco~.s
ADDRESS
Date. �� Applicant a LLI
NOTICE TO APPLICANT: If,after making this Certificate, of CITY A.- AL --40 V--) No 7G y —;W/e 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 GEO GY INSPECTION ❑
deemed revoked. ❑ ❑ No Spec. Knowl.
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 an Professions Code,and my license is in full force and j Acc��e %17A -oft Ua�vO•l PARKING
REq D D PROVIDED
SPA ME
J
License Number Lia Class I .L° ^+ A�""o'"',t '` �ec'4.a&,o e I
LIMITED TIME USE
Contractor Date pL ,a/v.o�G
DATE DATE
I am exempt from the licensing requirements as I am a I PROM: I TO:
licensed architect or a registered professional engineer [SIZE OF NO.OF INSPECTOR'S
acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. , STORIES SIGNATURE
iness and Professions Code). FINAL AP AL
IPR ESENT USE OF BUILDING '
Lic.or Reg.No. Date
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS (�Q I�1.q
` 1 A
I hereby affirm that I am exempt from the Contractor's ON LOT AND USE �9 S 7, A C�•r/
License Law for the following reason (Section 7031.5, Busi-
ness
usiness and Professions Code): NO. PARKING \ t{ o.o $a 5(7
UKI, as owner of'the property, will do the work and the SPACES PROVIDED ,
structure is not intended or offered for sale (Section o o o 8 d 5 0 C
7044,Business and Professions Code). r
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING P b/ 0 1 5=588
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 • f
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 LJ�
ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter Torai.FEE
upon the'above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE.
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508. MISCELLANEOUS PERMIT
4' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS -MP 0508 9908020003=
BUILDING AND SAFETY / LAND-DEVELOPMENT -TEMPLE CITY :CA 91780
PHONE: (626).285-0488 EXT:
LEGALID: NO. OFCO S E D G-A S
TR: 17190 LT: 80 BL: .001 SQ. FT STORIES TYPE 'OCCUP'GROUP X9510 OLIVE ST__�
STRUCTURE: 441 1 VN R3 \—TEMP•,CA 91-78Q3131
ASSESSOR INFORMATION NUMBER: NEAREST CROSS` STREET: TEMPLE CITY BLVD.
8590-005-001 EXIST BLDG US RESID THOMAS•PAGE: 59¢ . GRID:-J4 LOCALITY: TEMPLE CITY
EXIST OCC GRP: R3 USE ZONE: R-1 ' . •
TENANT: ISSUED ED 0 : -; I OCESSED BY:. -EXPIRES
D S. NO T: w0 08/02/99 UT . , 01/29/00
0
OWNER: TE 0: FINAL -DATE FINAL B :•
ONG;SILENUS (626) 614-8911- IST ITEMS-.— ��p
9510 OLIVE ST T
TEMP 917803131 DESCRI P_- _0 --WOR
TO-•PERMIT NEW 2 CAR GARAGE (PERMITS RID #989.0A AND
OCCUP LOAD EXIST: C#989`4)
APPLICANT: - TEL. 0: OCCUP LOAD NEW:
SAME AS OWNER -
PARKING SPACES REQUI ED* SPECIAL CONDITIONS:
PARKING SPACE�sPR�II-DED:
EXIT HARDN-�R1�EL'ES �®
CONTRACTOR: TEL. NO: //Av �/� LIMITED TIME USE
SAME AS OWNER - NSA ,'�. FROM TO
LIC. NO ,
DES)
FEES1PR'
/qb A PROVALS _ DATE INSPECTOR SIGNATURE-7
TEE/ TT QUA TY: UOM: AMOUNT:
ARCHITECT OR ENGINEER: . NO: - / J 1 R ER SE
jr0 PERMIUA CE 27:75
LIC. NO 0 /J�I� E NS 45.95 —SA—FE—TTPERMI
L -T L FEES 1111;11 73.70
P. STREET. KP ROVED
1MAP NO:
47H269 SEWER MAP BOOK: PAGE: FI ZONE: P„,�! n D ��� n��O�0/J � TEMP. STR CT. REMOVED
0. OFFAMILIES: DWELLING S: AP /COND: ST CLAS
:�—%U \J n U\\,\
NO
O ❑ , ��1,_
SCHOOL-WITHINHAZARDO S
AIR QUALITY: 0 LITY: 10000ElFEET MATERIALS
NO \ ❑ ®�
REQUIRED 0 SETBACK FRO EXIST XSET �w�Otomy
FRONT
CK YARD: HWY: PROP LINE: WIDTH: ,/C aS�woCe T�at�I
SIDE PL-
REPORT ID: DPR267 ROUTE TO: BS0508