HomeMy Public PortalAbout9720 OLIVE ST_Miscellaneous__ WPRKF1'tS'COMPENSATIONDECLAI2ATION CE 875(11-84) MISCELLANEOUS APPLICATION
I hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION LJ
a certified copy thereof(Sec.3800,Lab.Q.
Policy No. Company FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is hereby furnished. BUILDING �!_ �'] Ir LOCALITY
ADDRESS V C/
Certified copy is filed with the county building inspection LOCALITYr' NEAREST
department. !� ,ys �' /,�/�,1„/, NOSS ST. L
Date Applicant NEAREST D RICT N 1:!�.PNEST..hPRykSSDD BYCROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL
COMPENSATION INSURANCE DESCRIPTION LOT NO. � BLOCK MAP HIGHWAY
NO. (CIRCLE) STATE MAJOR SLOCAL
NO. OF SLOGS.
(This section need not be completed if the work involved TRACT NOW ON LOT USE ZONESPECIAL CONDITIONS
by the permit is for one hundred dollars (SI00) or less.) us9 of eJF/ +
�` p
SIZE OF LOT � -,C-Ace- EXISTING_BLDG! `� 0�..
I certify that in the performance of the work for which this o
permit is issued, I shall not employ any person in ti manner OWNER =1 Ct d- " T(' C Cif kl C.k f
so as to become subject to the v r re Compe tion L S.� MAIL OCCUPANCY GROUP Ea]
C�
// ADDRESS C) J� Z3
Da5✓�Applica CW-7 LO
NOTICE TO APPLICANT: if of r making this Certificate of CITY �M rl+ No� Q�5. 6 OCCUPANT LOAD
Exemption, you should b ne subject to the Workers' AP LICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code,you must forth-
with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl.
deemed revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION V 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. se 01-,, QR PARKING REQ'D PROVIDED
`f SPACES 11��
License Number Lic. Class ' ^` /�140PL-- ell M k '1?1`J'I
/�,r�
LIMITED TIME USE
Contractor Date ��I C���4`Y\ ao .n _ -s DATE DATE
/y 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 SIGNATURE
iness and Professions Code).
PRESENT USE OF BUILDING FINAL APPROVAL
Lic.or Reg.No. Date zi
,r
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS c 1 4 Q 4 A
ON LOT AND USE
I hereby affirm that I am exempt from the Contractor's # D D o 0 3 0
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): NO. PARKING I D D 8 Q 5 0
I, as owner of the property., will do the work and the SPACES PROVIDED
structure is not intended or offered for sale (Section D D o 8 Q 5 0 L=-,
7044,Business and Professions Code).
PROPOSED USE OF BUILDING I 223-88
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.Q.
Lender's Name
PROPOSED MAX. OCC.
Lender's Address
PERMIT FEE 170 ,011
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 L
ordinances and State laws relating to building construction, J
and hereby authorize representatives of this County to enter TOTAL. FEE G7
upon t above mentioned property f inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
S
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0905040002
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
ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 9720 OLIVE ST I
ISTRUCTURE: 1 V-B U I TEMP CA 917803252 1
[ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18589-003-018 (EXIST BLDG USE: I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
[EXIST OCC GRP: USE ZONE: [ I
ITENANT: I ISSUED ON: PROCESSED BY: EXPIRES ON:
[ BLDGS. NOW ON LOT: VALUATION: 05/04/09105/04/09 SR 10/31/09
I
(OWNER: TEL. N0: I I FINAL DATA FI BY: CODE: [
ITAO, LING (626) 679-8979- ILIST ITEMS: I [
19720 OLIVE STREET I I�1
[TEMPLE CITY CA 91780 [ IDESCRIPTI N OF WORK I
I I ]RECONVERT GARAGE BACK TO INTENDED USE
I JOCCUP LOAD EXIST:
(APPLICANT: TEL. NO: IOCCUP LOAD NEW: I I
ISAME AS OWNER -
I [PARKING SPACES REQUIRED: ISPECIAL CONDITIONS: [
1 PARKING SPACES PROVIDED:
]
EXIT HARDWARE: 1
(CONTRACTOR: TEL. NO: I I LIMITED TIME USE
ISAME AS OWNER - INBR OF EXITS: [ FROM TO 1
[ LIC. NO I1
I I FEES PAID [ ]
I I ]APPROVALS DATE INSPECTOR SIGNATURE
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[
(ARCHITECT OR ENGINEER: TEL. NO: I ITRAILER USE I I I
I - IOA PERMIT ISSUANCE 27.75 1 1 1 I
1 LIC. NO: 101 R/M OCC/USE INSPECT 145.95 ISAFETY PERMIT I I
TOTAL FEES 173.70
I ITEMP. STRUCT. APPROVED
I I I I I ]
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ (TEMP. STRUCT. REMOVED I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
I NO I I I
[ SCHOOL WITHIN HAZARDOUS I I I I
[AIR QUALITY: 1000 FEET MATERIALS 1 1 1 I
[ NO NO NO I I I I I
(REQUIRED TOTAL SETBACK FROM EXIST I I I I I
ISET BACK YARD: HWY: PROP LINE: WIDTH: [ I I I I
IFRONT PL- I [ I
I SIDE PL- I I I 1
I ] I I I I
I I I I I
IREPORT ID: DPR267 ROUTE TO: BS0508 I I 1 1
I I I