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Home My Public Portal About9655 OLIVE ST_Miscellaneous__ WORKERS"COMPENSATION DECLARATION CE 875 M I SCE L L A N EO U S APPLICATION � ,� _ CE 875(1 1-84) �' I kerebo a cer icaf°o have a certificate of consent tc self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insures or a certificafb of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN BAUILDING L DDRESS Certified copy is hereby furnished. wncwEss 1 E�A -e LOCALITY Certified copy is filed with the county building inspection LOCALITY C` NEAREST department. 5 V CROSS ST. Date Applicant NEAREST DISTRICTNO. G OUP TYPE CESSED BY CROSS ST. 'O �� CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I LOT NO. BLOCK MAP HIGHWAY NO. (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLD6S. (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. t / o permit is issued,I shall not employ any person in any manner OWNERi G y`j L so as to become subject to the Workers' Compensation Laws. MAIL _ OCCUPANCY GROUP o � `� F— Date ADDRESS F Applicant w NOTICE TO APPLICANT: If, after making this Certificate of CITY e Q fl NOL TE .ArS-J7—�, OCCUPANT LOAD en Exemption, you should become subject to the Workers' AppLIC TION 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 ❑ deemed revoked. ❑ ❑ No Spec. Knowl. 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 effect. PARKING RSQ'D PROVIDED - /� / SPACES J License Number Lic. Class LIMITED TIME USE Contractor Date DATE MATE I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO.OP FROM: TO: INSPECTOR'S SI acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE URE FINAL APPROVAL „n PRESENT USE OF BUILDING1-7-1P.; c,�J Lic.or Reg.No. Date { HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS 3011 ON LOT AND USE �''s I hereby affirm that I am exempt from the Contractor's ACCLOT License Law for the following reason (Section 7031.5, Busi- 3303 238=35 ness and Professions Code): NO. PARKING FENS I, as owner of the property, will do the work and the SPACES PROVIDED 1, j I structure is not intended or offered for sale (Section238 _-- 7044,Business and Professions Code). Tl)Tt � ,� CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING [:HECK 238.35 I hereby affirm that there is a construction lending agency CH4NGE =i ail for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). _ Lender's Name �} / '�'�_ PROPOSED MAX. OCC. 4-}000"00 ` 'fir` �IF � Lender's AddressUUU 1 yt tt 8° I certify that I have read this application and state that the PERMIT FEE 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 3 auponabove ntioned property for insp tion purposes. EEREVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WQRKk1K-S'COMPENSATION DECLARATION CE 76M444 (11-84) 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 thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL ADDRESS... R O IN BOf`s 'J Certified copy is hereby furnished. LOCALITY ADDREss ECertified copy is filed with the county building inspection LOCALITY //yy NEAREST department. •Of r &aUd.0(- ��+ ( cR OS s ST. Date Applicant NEAREST ` II+y^ DIS I No. CCRo t!�j TYPE PROCESSED BY CROSS ST. r 1 lA � !4�CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL JJJ COMPENSATION INSURANCE DESCRIPTION LOT NO. 5 BLOCK MAP HIGHWAY STATE MAJOR COND LOCAL ' NO. (CIRCLE) 5` a4p NO. OF SLOGS. (This section need not be completed if the work involved TRAC � Ae/V NOW ON LOT 7.071 SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT 6 ?M 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 OWNER0J SP so as to become subject to the Workers' Compensation Laws. OCCUPANCY GROUP Ds Date Applicant ADDRESS 655 01Ive,ST. NOTICE TO APPLICANT: If, after making this Certificate of CIT YT ITvo 7 79fj OCCUPANT LOAD y Gb 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 oI this permit shall be tIR GEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. KnoWl. LICENSED CONTRACTORS DECLARATION P cY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of ChapterAFETY 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 Cyt �/di/AJ pp RKINc effect. SPACES REq'D PROVIDED License Number Lie. Class XG LIMITED TIME USE Contractor Date Z � Jam DATE DATE �D � PROMI TO: I am exempt from the licensing requirements as I am a (�/f' !,J% /�fl�'licensed architect or a registered professional engineer NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- G. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL _ Lie.or Reg.No. Date PRESENT USE OF BUILDING 8 HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS o 0 0 0 ;.0 ON LOT AND USE I hereby affirm that I am exempt from the Contractor's 1 0 0 8 O 5 Q License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PARKING o o ❑ I, as owner of the property, will do the work and the SPACES PROVIDED 1 L 1 4 —E7 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 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. OCG. Lender's Address PERMIT FEE -70,00 1 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, an hereby thorize representatives of is County to enter TOTAL FEE hyt 17-0 up n the o tinned property fo i spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee IV 6ate" l COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0212130001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGALOF CONST NEW BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 9655 OLIVE ST STRUCTURE: 1 VN U1 TEMP CA 917803250 ASSESSOR INFORMATION NUB : NEAREST CROSS STREET: TEMPLE CITY 8588-024-021 EXIST BLDG USE: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY EXIST OCC GRP: USE ZONE: TENANT: ISSUEDPROCESSED BY: EXPIRES 0 : BL GS. NOW ON LOT: UA 12/13/02 JK 06/11/03 0 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: BERSANE SAM R JR (626) 287-6786- LIST ITEMS: -- 9655 EMS:9655 OLIVE ST TEMP 917803250 DESC o 0 TO REPAIR ROOF AND WALL ON HOBBY ROOM OCCUP LOAD EXIST: A PL CAN L. O: OCCUP LOAD NEW: SAME AS OWNER - PARKING SPACES REQUIRED: SPECIAL CONDITIONS: PARKING SPACES PROVIDED: EXIT HARDWARE: CONTRACTOR: TEL. NO: LIMITED TIME SE SAME AS OWNER - NBR OF EXITS: FROM TO LIC. NO FEES-PAID APPROVALS DATE INSPECTOR SIGNATURE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCHITECT OR GI T 0: TRAILER US - OA PERMIT ISSUANCE 27.75 LIC. NO: 01 R/M OCC/USE INSPECT 145.95 SAFETY PERMIT TOTAL FEES 173.70 MP. STRUCT. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP. STRUCT. REMOVED 0. OF FAMILIES: DWELLING TS: AP /CO D: C ASS: NO SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED 0 SETBACK EXIST SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508 a COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0212130001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE PHONE: (626) 285-0488 EXT: -LEGAL0. OF CONST NEW BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 9655 OLIVE ST STRUCTURE: 1 VN U1 TEMP CA 917803250 ASSESSOR INFORMATIONR: NEAREST CROSS STREET: TEMPLE CITY 8588-024-021 EXIST BLDG USE: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY EXIST OCC GRP: USE ZONE: TENANT: 0 ROCSSDB PR 0 : BLDGS. NOW ON LOT: VALUATION:-- 12/13/02 JK 06/11/03 0 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: E SAM R JR (626) 287-6786- LISTITEMS: 9655 O 9655 OLIVE ST J TEMP 917803250 D-ESORIPTION OF WORK TO REPAIR ROOF AND WALL ON HOBBY ROOM OCCUP LOAD EXIST: PP L. 0: OCCUP LOAD NEW: 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 ES APPROVALS DATE INSPECTOR SIGNATURE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCHITECT OR ENGINEER: L. 0: TRAILER S - OA PERMIT ISSUANCE 27.75 LIC. NO: 01 R/M OCC/USE INSPECT 145.95 SAFETY PERMI TOTAL FEES 173.70 TEMP. STRUCT. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIR ZONE: CMP: TEMP. STRUCT. REMOVED 0. OF FAM S: D G TS: CO D: STAT CLASS: NO SCHOOL WITHINHAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED 0 L T FROM S SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: SS0508