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Home My Public Portal About4914 PERSIMMON AVE_Miscellaneous__ \ aORKiRS'C01iPENSATIONDECLARATION CE 875(11-84) 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.Q. Policy No. Company FOR APPLICANT TO FILL IN lL E.S R E S S !!J� / LJ�Js i I m_&LQkL A V ve. Certified co is hereby furnished. ILDINC . PY Y ORE5sr- 44714 &r.5 l/71 1mov! Ave. CA LITY /J ❑ Certified copy is filed with the county building inspection OCALITYT �/' N AR EST G department. I R SS ST. Date Applicant ARGST w DISTT G i� CONS;/ITYPE PROCESSE BY 055 ST. a vQ CERTIFICATE OF EXEMPTION FROM WORKERS' \ LEGAL ` COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY No. (CIRCLE) STATE MAJOR SEC(-f LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZO E SPE CIA Le,. by the permit is for one hundred dollars ($100) or less.) .4 USE OF eLE I certify that in the performance of the work for which this zE of LOT ��$ EXISTING BLDG.�G'$ �- o permit is issued, I shall not employ any person in any manner NER j'1� rli s' so as to become subject to the Workers' Compensation Laws. IL �, OCCUPANCY GROUP iJ o Date Applicant DRE55 r Q�YS�Kt/nd+L �J � W NOTICE TO APPLICANT: If, after making this Certificate of Pj G'% N0. 3S —D41or OCCUPANT LOAD N Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- APPLIQATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be ❑TRAILER USE GE LOGY INSPECTION ❑ No Spec. Knowl. deemed IBVOked. 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 and Professions Code,and my license is in full force and //�� • n/� effect. O (q O All f// PARKING REq'D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date DATC DATE I am exempt from the licensing requirements as I am a FROM: TOC licensed architect or a registered professional engineer SIZE OF NO. OF I ECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). Lic.or Reg.No. Date ESENT USE OF BUILDING FINAL APPROVAL !A-9:m�a Z Z dkl HOME OWNER-BUILDER DECLARATION O. OF EXISTING BUILDINGS Q (� NLOT AND USE �939. $p I hereby affirm that I am exempt from the Contractor's rUS f✓ � License Law for the following reason (Section 7031.5, Busi- # 0 0 0 0 3 0 ness and Professions Code): ACES PROVIDED. PARKING I, as owner of the property, will do the work and the .1 0 o80,50 structure is not intended or offered for sale (Section 7044,Business and Professions Code). o o o $0,5 Q v CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency SQ 0� 5 -88 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 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, and hereby authorize representatives of this County to enter TOTAL FEE upon the above menti ned property for inspection purposes. PE REVERSE FOR EXPLANATORY LANGUAGE i Si turef ermitte Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0307080001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL TU-. NO. OF CONST NEW BUILD ADDRESS: TR: 4902 LT: 7 BL: E SQ. FT STORIES TYPE OCCUP GROUP 4914 PERSIMMON AV STRUCTURE: 1309 1 VN R3 TEMP CA 917804114 AS85=R_TNFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8574-024-011S G . THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY EXIST OCC GRP: USE ZONE: ISSUEDOC .. SLOGS. NOIVON LOT: VALUATION: 07/08/03 JK 01/04/04 0 OW L. 0: FINAL DTEI A By CODE: CHANG;PYNG YU (626) 917-6839- LIST 1044 INDIAN SUMMER 7 -9-0-3 WEST COVINA 91790 05SCRIPTION OF_90Rr_ FINALIZE 1988PERMITS(ADD 36D,FAMILY,DINING;CONVERT GARAGE TO OCCUP LOAD EXIST: BD86A;NEW 2CAR GARAGE;INT.REMODEL)TTL: 6BR/4.5BA 2037SF APPLICANT: TEL. . OCCUP LOAD NEW: SAME AS OWNER - PARKING SPACES REQUIRED: SPECIA COND IO S: PARKING SPACES PROVIDED: EXIT HARDWARE: CONTRACTOR: TEL. NO: LIMITED TI USE SAME AS OWNER - NBR OF EXITS: FROM TO LIC. NO FEES-PAID ' FEE DESCRIPTION: QUANTITY: LION:: AMOUNT: APPROVALS DATE INSPECTOR SIGNATURE ARCHITECT OR ENGINEER: RA - OA PERMIT ISSUANCE 27.75 LIC. NO: 01 R/M OCC/USE INSPECT.. 145.95 SAFETY PERMIT TOTAL FEES 173.70 TEMP. MAP NO: SEWER MAP BOOK:---PA-GT. FIRE ZONE: CMP: TEMP. STRUCT. REMOVED 0. OF FAMILIES: DWELLING APT/CO : STAT CLXFS-.- NO SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED TOTAL SETBACK SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: OS0508