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Home My Public Portal About5617 ROSEMEAD BLVD_Miscellaneous__ I WORKERS (,UMFhNJ.vtuN utLLAX< IL0ty 2o-OO63OP , 2ie0 Ly�L�VGLLHIYGVUJ Hr["LI<.Hl IVIV ~ I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insurc,or a certificate of Workers Compensation Insurance, or I a certified copy thereof (See. 3800 Lab. C) - -r - Pohcy N0. Company FOR APPLICANT TO FILL IN BUILDING \ BUI NG ADDRESS ADDRESS yr ❑ Certified copy Is hereby furtushed LJ LOCALITY ` ❑ Certified copy Is filed mth the county budding inspectiO CITYZIP department e- C` NEAREST CR09B 6T DBIC Applicant 312E OF LOr r NO OF 8[.OGCa NOW ON LOT DISTRICT NOGROUP TYLE PROCESSED BY CONST CERTIFICATE OF EXEMPTION FROM WORKERS TRACT BLOCK Lor No COMPENSATION INSURANCE �+• wAY M ICMCL[I STATE MAJOR SECOND LOCAL (This Section need not be completed If the work Involved ASSESSOR MAP BOOK PAGE PARCEL by the permit is for one hundred dollars ($100) Or IDSA) U9620NE SPECIAL CONDITIONS I certify that In the performance of the work for which th s tryaper er LNo L'v permit is Issued. I shall not employ any person in any manna I d so as to become subject to the Workers Compensation LawsADOR ® OCCUPANCY GROUP N Z Date Applicant TTY— ZIP NOTICE TO APPLICANT If after making this Certificate O -O OCCUPANT LOAD of Exemption you should become subject to the Workers APPLICATION FOR Compensation provisions of the Labor Code you must forthwith EXT HARDWARE comply with such provisions or this permit shall be deemed TRAILER USED GEcI mSPEcMN❑ No Spec Knowl ❑ ' revoked ElCCUPANCY INSPECTION LJ Panic Devices LICENSED CONTRACTORS DECLARATION O 1 hereby affirm that I am licensed under provisions of Chap SAFETY PERMIT❑ (LIST ITEMS BELOW, NO OP EXfT9 I 9(commencing wnh Section 7000)of Division 3 of the Busm s Maine o us eae r/'� �l�l and Professions Code and my license Is in full force and e(fe ec, �Y I PARKING REO O PROVIDED i License Number Lm Class SPACES L�I Contractor Date LIMITED TIME USE ❑ I am exempt from the licensing requirements as I am a mom DATE TO DATE licensed architect or a registered professional engineer acting ,n my professional capacity (Secuon 7051 Business IXIE OF BLDG No Or INSPECTOR 9 and Professions Code) STOWE* SIGNATURE PRESENT USE OF BUILDING Lic or Reg. No Date EFINAL APPROVAL HOME OWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that 1 am exempt from the Contractor s License Law for the following reason (Section 70315 Business and Professions Code) NO PARKING ❑ 1 as owner of the property will do the work and t SPACES PROVIDED structure is not intended or offered for sale(Section 7 ROPOSED USE OF BUILDING Business and Professions Code) i CONSTRUCTION LENDING AGENCY I 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) PROPOSED MAX OCG Lender's NameARLICANT(pA(q TEL NO Lender s AddressREf _STS A 1 certify that I have read this application and state that the above information Is correct 1 agree to comply mth all County PERMIT FEE I ordinances and State laws relating to building construction and hereby authorize representatives of this County to enter upon ISSUANCE FEE I t the above-mentioned property for Inspection purposes. TOTAL FEC 1012, �i SEE REVERSE FOR EXPLANATORY LANGUAGE �e� Signature of Permrtme I Dna N'ORKLRS COMPENSATION DhCLARATION CE 875(11 e4) MISCELLANEOUS APPLICATION CE 875 I hereby affirm that I have a certificate of moment to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ` msureR or a certificate of Workeri Compen�tgn Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No (ompany _ FOR APPLICANT TO FILL IN Certified copy is hereby furnished BmLDmG RX wbbw[Ss ) Loc•urr Certified copy is filed with the county budding inspection. + n[ww ESTOOF department Rx LocwLOCALITYT�y� a7 CROSS R (late Applicant NEAREST -IV DISTRICT NO GROUP TYPE cuuo eY CROSSST C— r i C."ST�Tr (FRl If I(ATF OF EXEMPTION FROM WORKERS LK..L � (OAIPFN9A ZION INSURANCL DESCwIPTION I LOT No [LOCH M+. wN.w we (CI.CL.) STAYS Mwiow •EconD LOCAL (This section need not be completed if the work involved I TRACT MOB OF DoT S USK ZONE S.EeuL CONDITIONS by the permit is for one hundred dollars ($100) or leas) USE or San or LOT EXISTING BLDG I certify that in the performance of the work for which this permit is isuied I shall not employ any person in any manneXX ONN.. of building HS ,e�av su as to become aihject to the Workers (ompenvtion Laws Mwn OCCUPANCY GROUP �pZ 01- bite___ Applicant mob bw[S• d w NO(ICI TO APPLI(ANT If after making Ihw Certificate of CIT Sao rTKL _ 3 OCCUPANT LOAD 1 xemption, you should become subject to the Worker = Compensation provisions of the Labor Code, you must forth- 3 APPLICATION FOR EXIT HARDWARE %Lith Lomply Gish sucli pro%tuons or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec Knowl deemed revoked I ICI NSF D(ON 1 RAC IORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices I perch} affirm that I am licensed under provisions of Chapter Swr ETY PERMIT ❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000)of Division 3 of the Bust- No or EXITS nese and Professions Code and my license is in full force an ellect Name of business PARKING SPACES R[p b E:= Pw ovm[o 1 icenw Number 1 ie (Iris E LIMITED TIME USE (onlrit(Or DateEl •nOw TO I am exempt from Clic licensing requirements as 1 am a licensed architect or a registered professional engineer SIZE or No or INSPECTOR S acting in my professional capacity (Section 7051 Bus- EXISTING BLDG SrowlES SIG TURF loess and Professions Code) FINAL APPROVAL 1 Ic or Reg No Date PRESENT US[ Or BUILDING Q� Jr .4 HOAfl OWNER BUILDER DECLARATION No or [EUrim*BUILDING[ on LOT AND USE (_ I Hereby that I am exempt from the Contractors I0 I nse enI awfor for the follo¢mg reason (Section 7031 S Bust- nes and Professions(ode) NO PARKING EJ1, ag owner of the property ndl do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044 Busmess and Professions Code) (ONSI RUCI ION LLNDING AGENCY PROPOSED USE Or BUILDING 1 hereb) affirm that there 1% a construction lending agency for the performance of the cork for which this permit Is tssoed(Sec 3097 Civ C j iJ I ender s Nene PROPOSED NAR-Occ Q i I ender s Address—_ j �m 'r, certify that I h,oc read this application and state that the PERMIT FEE 25.00 LI. ibove information is cortcct I igrco to LOMPl) with all County ISSUANCE r[[ 1-11 ordmutces and State laws reliting to building constructwn, and hereby autborve representatives of this County to enter TOTAL rEE 25 .00 upon the Ilwve InC111101led Property for in`ection purposes J <XX - SEE REVERSE FOR EXPLANATORY LANGUAGE r� , cwL oar' xx �1 lR '� c ,n,I n., � 11ite WORKERS'COMPENSATIONDECLARATION 76M444 MISCELLANEOUS APPLICATION CE 878 111 841 J� I hereby nffmm that 1 have a oof consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION ylu'I claire, or a certificate ofWorkers Compensation Iwmnce,or a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN .BUILDING�!i/� Certified Copy is hereby furnished BUILD Ina DS Lo cAurI — ADDnEee Certified copy is filed with the county buddmg mspection LOCALITY NEAR eaT department CROSS ST Date Applicant NEAREST (^1 015TRJCT No a u• rvPIS • ¢SPED BY CROaa ST N J�- D f CONST iT/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL C7 �j COMPENSATION INSURANCE DESCRIPTION LOT No BLOCKP ,...ION . NONOI.I.CLE) STATE MAJOR SECOND LOCAL (Thu section need not be completed If the Work involved TRACT NOWDF SEDGE ON LOT USE ZONE EPQCIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) use OF ISTIXG BLDG I certSy that m SIZE OF LOT the performance of the work for which this / Xo permit u issued, I shall not employ any person in my manner ow R i� ® s.l La so as to become subject to the Workers' Compensation Laws MAIL Q OCCUPANCY GROUP a o_ ADDRESS 0 Date Applicant NOTICE TO APPLICANT If, after making this Certificate of CII TEL Sgt 7 OCCUPANT LOAD i Exemption, you should become subject to the Workers z Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec KOOWI deemed revoked P LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMITLIST ITEMS BELOW 9 (Commencing with Section 7000) of Division 3 of the Busy NO) NO OF EXITS ness and Professions Code,and my license is in full force and effect NME r-irw5S r PA RKIryG SPACES REp D D PROVIDED License Number Lic Class ori S LIMITED TIME USE Contractor Date GAT. ..T. I am exempt from the licensing requirements as I am a PROMY. licensed architect or a registered professional engineer SIZE or NO OF INSPECTOR . acting in my professional capacrty (Section 7051, Bus EXISTING BLDG ETO.IEs a1 NATURE Riess and Profesmons Code) FINAL APPROVAL Lic or Reg NoDate PRESENT USE OF BUILDING 607 tI G I I o HOMEOWNER-BUILDER DECLARATION NO OF EXISTING BUILDINGS y __J_ 1 ON LOT ANO USE I hereby affum that 1 am exempt from the Contractor's �-" License Law for the following reason (Section 7031 5, Busr `Jyj nese and Professions Code) NO PARKING 1, as owner of the property, will do the work and the SPACES PROVIDED structure a not intended or offered for sale (Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING 1 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 Lender's Address PROPOSED MAX GCC I certify that 1 have read this application and state that the PERMIT FEE OG above information is Correct I agree to comply with all County159UANCE FEE a _ordinnces and State laws relating to budding Construction' and hereby auth raze representatives of this County to enter I TOTAL FEE ✓V upon the above :;Boned perty for inspection purposes SEE REVERSE rOR EXPLANATORY LANGUAGE 1 IS Date I WORKERS'CQMPENSATIONDECLARATON M ISCELLANEOUS APPLICATION } CE CE I 8 a75 111 84)76 1 hereby that I havi4la certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, o rtrficate of Workers Compensation Insurance,or a cert d y thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN ADDRESS F1 Certified copy n hereby furnished eulLo lnc L wcwurT ADDwsee564 ❑ Certified Copy is fled with the county budding inspectioLoe LOCALITY !�. NEAREST department TLC-- CROSS By Date Applicant N¢wCROSS ewerBT L1"iJ 1 A i CONST S DISTRICT ND awouP rt,Pe PROCESSED eT CERTIFICATE OF EXEMPTION FROM WORKERS LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO CLOCK MOP STATE MAJOR SECOND LOCAL No IF OLDGS (This section need not be completed if the work involved TRACT Non ON LOT UBE ZONE SPECIAL CONDITIONS by the permit rs for one hundred dollars (5100) or less) USE OF SIZE OP LOT EXISTING BLDG CD I certify that in the performance of the work for which this 1 U permit is issued, I shall not employ any person in any manner OWNER SO as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP o ADDRESS W Date Applicant TEL OCCUPANT LOAD a NOTICE TO APPLICANT If, after making this Certificate of CITY NO 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 ❑ GEOLOGY INSPECTION ❑ No Spec Knowl deemed revoked - Panic Devices LICENSED CONTRACTORS DECLARATION occurwwcr lNar¢cnoN 1 hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO ow EXITS 9 (commencing with Section 7000) of Division 3 of the Bust, ness and Professions Code, and my license is in full force and PARKING RHD D PROVIDED effect tit SPACES License Number Lic Class f h LIMITED TIME USE Contractor Date °ATS °Aa .»GN I am exempt from the licensing requirements as 1 am a INSPECTOR 8 licensed architect or a registered professional engineer SIZE owno oP SIONATURK acting m my professional capacity (Section 7051, Bus- EXISTING GtaG Srowue n mess and Professions Code) FINAL APPROV AL /P O PRESENT USE OR BUILDING o Lm or Reg No Date HOME OWNER-BUILDER DECLARATION No IF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's �Q FEE License Law for the following reason (Section 7031 5, Bust, ness and Professions Code) No PARKING �r� tiPACE8 PROVIDED ,�,r0n_nnf11 ID/20/89 I, as owner of the property, will do the work and the UOW-vu� structure is not intended or offered for sale (Section - Z�;1 7044,Business and Professions Code) vwo»osED USE OF BUILDING 60'29 CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a Construction lending agen for the performance of the work for which this permit is fn \ issued(Sec 3097,Cw C) ` 111UUU\ Lender's Name PROPOSED MAX Dec Lender's Address PERMIT FEE yu, I certify that I have read this ton and state that the above information is correct agreegree toocomply with all County ISSUANCE FEE ordinances and State laws relating to budding construction, and hereby authot¢e representatives of this County to enter TOTAL Tee n the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATIONDECLARATION 7SM444 MISCELLANEOUS APPLICATION L J 1 eaffirm that I have a certificate of consent to Self 875 (2 80)lr COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insursure,, o or a certificate of Workers Compensation Insurance or e certified coyy thereof(Sec 3800 Lab C) Policy No � Company FOR APPLICANT TO FILL IN BuiLOiwG /_�7 ❑ woawsss f0 Certified copy Is hereby furnished ulLo irvo ❑ a00 wHea / Je� a dLoc wLlTTr Certified u copy fled with the county budding inspection NQw RQB department LOCALITY ent ewoea •r Date Applicant s AREST / Disrw ry N aw u• TYPE P o[O BY Cw OSS ST (—Q .(A�ysA I /J� COXaT CERTIFICATE OF EXEMPTION FROM WORKERS' LHGAL COMPENSATION INSURANCE DKSCRiPTION LOT NO BLOCK Iaer.r jc lwc LE) ¢rwr¢ Mwrow accon0 LOCAL el.(TIII$ sectlOn need not be Completed d the work involved TRACT No ON BLDG.oN LOT Oe¢ Ne SPECIAL CONDITIONS OU by the permit a for one hundred dollars ($100) or less) uae ow /� ya 6S SIZE OP LOT cXIBTiNG BLDG 1 can ify that in the performance of the work for which this � permit Is Issued I shall not employ any person in any manner owwe .S so as to become subject to the Workers Compensation Laws IL f� C UPA Y GROU _ r W ADDRESS Rlbe CL Date Applicant H NOTICE TO APPLICANT If after making this Certificate of CITY T Z OCCUPANT LOAD 2 Exemption you should become subject to the Workers Compensation prosisions of the Labor Code you must forth PPLICATION POR EXIT HARDWARE with comply with such provisions or this permit shall be TRAILER USE O GEOLOGY INSPCCYION NO Spec KnOWI ❑ deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION O Panic Devices ❑ I hereby affirm that 1 am licensed under provisions of Chapter SAFETY PHRMIT q (LIST ITEMS BELOW) NO OF Extra 9 (commencing with Section 7000)of Division 3 of the Busi ness and Professl0ns Code and my license is in full force and PA:KIN6 we0 o effect P..DEO avwc Ea License Number Lin Class Me U M / � LIMITED TIME USE Contractor Date owrc owTx F1am 1 licensing exempt from the censg requirements as l em a I censed architect or a registered professional engineer SIZE OF ND ow INSPECTOR a acting in my professional capacity (Section 7051 Bus EXISTING BLDG STORIES Sia TURE loess and Professions Code) FINAL APPROVAL RHSQNT USE OF BUILDING /L ['� Lie or Reg No Dale V f M/z. 8 M�/HF HOME OR'N ER BUILDER DECLARATION NO OF Exunrvc BUILDINGS oN LOT AND USE �I I� I riJVll 317/10/51 1 hereby affirm that I am exempt from the Contractors /O � 7524 V I211, License Law for the following reason (Section 7031 5 Busi ness and Professions Code) NO PARKING wPwco PROVIOHO ❑ I, as owner of the property will do the work and the _ structure is not Intended or offered for sale (Section 7044 Business and Professions Code) PROPOSED USE OF BUILDING CONSTRUCTION LLNDING AGLNCY F 1 hereby affirm that there Is a construction lending agency / i Y for the performance of the work for which this permit is issued(Sec 3097 Civ C) W Lender s Name PROPOSH Mwx OCC Lender s Address PERMIT FEE 1 certify that 1 hose read this application and state that the above mformation is correct I agree to comply with all County ISSUANCE FEE ordinances and State lases relating to budding construction and hereby authorize representatives of this County to enter TOTAL FEE a r upon ve me on CLproperty for inspects rposes SEE REVERSE 1 OR EXPLANATORY LANGUAGE Signal re of'Pernlittee at WORKERS'COIPENSATIONDECLARATION 76M444 MISCELLANEOUS APPLICATION CE 876(11 84) n I hereby affurin cert that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �l'LfII Insure, or a Copy thereof of Workers'Compensation Insurance,or a certifxd copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDIAD a ❑ Certified copy is hereby furnished DuoR¢e. I N RMEMCAD 13Lyp 1110190 LOCALITY T-, ❑ Certified copy is filed with the county budding InspectionLDCALITv NEAR981 department 'fE,T/IQ(�,GIT cwoS9 aT Date Applicant NEARESTST�Mq DISrR IC o u TrrE •floc sir CR098 9T Rr.()�rf t CONT/ CERTIFICATE OF EXEMPTION FROM WORKELEGAL RS' t/ COMPENSATION INSURANCE DESCRIPTION I Lor No wLDGS NO (CIRCLE) OF eLDa9 'OMR'^• STAT¢ MAJOR SECOn CAL no (Thss section need not be completed ff the work involved rwwcT Now ON LOT u9� :oN¢ 9RecuL cono�nonS by the permit Is for one hundred dollars ($I00) or less.) LIS¢ Or V'l/ SIZE Or LOT ¢x19Tlna •LOO Certify that in the performance of the work for which this o Permit Is issued, I shall not employ any person many manner OWNER r, sa as to become subject to the Workers Compensation Laws AIL OCCUPANCY GROUP o LOG OREU 7 Date Applicant D NOTICE TO APPLICANT If, after making this Certificate of Irr TOL `� OCCUPANT LOAD r„ Exemption, you should become subject to the Workers' qpp LICATIO FOR EXIT HARDWARE Z Compensation provisions of the Labor Code,you must forth with comply with such provisions or this permit shall be TRAILER LIS¢ GEOLOGY INSPECTION ❑ No Spec Knowl deemed revoked LICENSED CONTRACTORS DECLARATION oe eu rwn Cr INSPECT'O Panic D8VIC8a I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Dnision 3 of the Bust •wPErr PERM]T (LIST ITEMS BELOW) NO Or EXITS ness and Professions Code, and my hcertse Is in full force and effect PARKING 9Pwcee REG o � PRovlo¢D License Number Claus;Lic Ci LIMITED TIME USE Contractol Date AT. GAT. ❑ I am exempt from the licensing requirements as I am a 'ROM TO INEP OTOfl f licensed architect or a registered professional engineer SIZE or No or S NATURE acting in my professional capacity (Section 7051, Bu, ¢x nwo BLDG STORIES messandProfessions Code) FINAL APPROVAL ^f 9l Ltc or Reg No Dale R¢S¢NT u9e or Eu1LDINo G L�/ At-roct,uel HOME OWNER-BUILDER DECLARATION NO Or EXISTING BUILDINGS ON LOT AND USE 2 8 8 9.7 A I hereby alTEm that I am exempt from the Contractor's License Law for the following reason (Section 7031 S, Busy # • • . . 88 ness and Professions Code) NO PARKING S s.1 I, as owner of the property, will PROVIDED • R 0 0l do the work and the 2 structure Is not intended or offered for ale (Section 0202-88 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY PROPOSED USH Or BUILDING I hereby affirm that there IS a construction lending agency sy yl CV J for the performance of the work for which this permit 1s issued(Sec 3097,Cry C) Lender's Name PROPOSED MAX OCC Lender's Address n a'V 1 certify that I have read this application and smote that the PERMIT FEE above Information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to budding construction, and ereby authorize represen trves gf this County to enter TOTAL PER t Ove-mention n r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE WAZ S lure of Permittee 11fte