HomeMy Public PortalAbout5027-5029 SULTANA AVE_Miscellaneous__ ' It -
WORKERS'COMPENSATIONDECLARATION CE 875(1 l 94) M ISCELLANEOUS APPLICATION
CE 876
i hereby a firriacert that I have a s'Compensation
of consent to Ulf
insure, or a certificate of Workers'Compensi[ion Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
a certified copy thereof(Sec 3800,Lab C)
Policy No Company FOR APPLICANT TO FILL IN euICDINo G ('y
HO DR¢t0 5Q �� 2-1 iJ I�ti
Certified copy ts hereby furnished BUILDING 5- D d v
AO D...e LOCALITY
Certified Copy Is filed with the county budding inspection LOCALITY N.AR.ST
department T'6wA ,E C.O.. .r
Dale Applicant N.A..[T I � 1 DISTRICT no QQQ��t111our TVP¢ ..ED Rr
CRO.. .T Y��v l •O5 () CONST
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL J ll ,h
COMPENSATION INSURANCE I LOT No BLOCK mDNw AY
nor tont L.1 STATE MAro s¢c OCAL
(This section need not be completed IP the work involved TRACT NO or BLDG.
ow ON LOT us¢ zoNEsP¢CtAL CONDITIONS
by the permit is for one hundred dollars ($100) or less) u.e or
mz¢or LOT ¢xI.TINO BLOC
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person many manner ONN.R - R v
so as to become subject to the Workers' Compensation Laws MAIL OCCUPANCY GROUP
0
Date Applicant ACOR¢SP
NOTICE TO APPLICANT If, after making this Certificate of eITY - T L - OCCUPANT LOAD y
Exemption, you should become subject to the Workers' z
Compensation provisions of the Labor Code, you must forth- APPLICATION FOR EXIT HARDWARE
with comply with such provisions or this permit shall be TRAILER u..
deemed revoked ❑ GEOLOGY INSPECTION ❑ No Spec Knowl
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION ❑ Panic Devices
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST rrSms .ELOw)
9 (commencing with Section 7000) of Division 3 of the Busr NO OF EXITS
nese and Professions Code, and my license u in full force and - - I
effect s SO S ► n./ PARKING
11 •PAC.• RED D D PROVIO EO D
License Number Lic Class b' -t
LIMITED TIME USE
Contractor Date Sd
Al.OAl.O
1 am exempt from the licensing requirements as I am a &J'.),-7-7 S (B 6 _ r.oN
T.
licensed architect or a registered professional engineer SliT;d¢��$yT{rR� I/r)'/r NO OF INSPECTOR a
acting in my professional capanty (Section 7051, Bus- ER"V'I- BIJEb .TORIES SI NATURE
mess and Professions Code) P, FINAL APPROVAL
Lic or Reg No Date r s U Q�� 7
HOME OWNER BUILDER DECLARATION o or E .TING BUIL INDS
ON LOT AND us.
I hereby affum that I am exempt from the Contractor's
License Law for the following reason (Section 7031 5, Busi- 1 dole 2 ei 3 sed eW _
ness and Professions Code) .O PARKING
I, as owner of the property, will do the work and the SPACES PROVID.O
structure is not intended or offered for sale (Section —11%
` O cep7044,Business and Professions Code) =1l
CONSTRUCTION LENDING AGENCY P.oro... use tF euILOING - ACCT.:
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is -1-D33 i`4•�r
issued(See 3097,Cw C> 1 ITEM=
Lender's Name
Lender's Address
PROPOSED MAX Dec TOTAL 234 45-
1 certify that I have read this application and state that the PERMIT FEE 20 CHECK 23,t.*c
above information is correct I agree to comply with all County ISSUANCE FEE ¢0 CHANGE •�I�
or noes and State laws relating to budding Construction,
,pild hereby authorize representatives of this County to enter TOTAL FEE 3 4 45
upon the above-mentioned roperty for mspectiorypurp us I
r SEE REVERSE FOR EXPLANATORY LANGUAGE CI�CId_�1 O/
Signature of1sermiW9 Qdte 1589 1 AM11:20
COUNTY OF LAS ANGELES TEMPLE CITY N 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS MP 0508 1404160002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91900
PHONE (626) 285-0488 EXT
ILEGAL ID NO OF CONST NEN BUILDING ADDRESS
ON FILE SQ FT STORIES TYPE GCCUP GROUP 5029 SULTANA AV
I STRUCTURE 1 V-B U TEMP CA 919803046
(ASSESSOR INFORMATION NUMBER I ) NEAREST CROSS STREET PENTLAND
IS388-021-009 EXIST BLDG USE THOMAS PAGE 596 GRID HS LOCALITY TEMPLE CITY, Cl
EXIST OCC GRP USE ZONE I I
TEMP ISSUED ON PROCESSED BY
BLDGS NOW ON LOT VALUATION 04/16/14 SR
1,000 1
OWNER TEL NO FINAL OATTTFFF6FI[AL BY /j�,�//L CODE
LAM MICHAEL (909) 993-'1080- (LIST ITEMS /v/j/p/,y 4�% L�i'/(/�(I�
5029 SULTANA AV D LG//
TEMP 917803046 IDESCRIPTION OF WORK
(REMOVE UNPERMITTED ENCLOSED OF EXISTING COVERED PATIO AND
OCCUP LOAD EXIST JCONVMT BACK TO ORIGINAL CONDITION AS (OPEN PATIO COVER)
APPLICANT TEL NO loccup LOAD NEW
SAME AS OWNER
(PARKING SPACES REQUIRED ISPECIAL CONDITIONS
IPARKING SPACES PROVIDED
I
I I
( IEXIT HARDWARE
CONTRACTOR
TEL NO LIMITED TIME USE
(SAME AS OWNER - INBR OF EXITS I ) FROM TO
LIC NO I I
FEES PAID
IAPPROVALS DATE INSPECTOR SIGNATURE
IFEE DESCRIPTION QUANTITY 00M AMOUNT
(ARCHITECT OR ENGINEER TEL NO I I TRAILER USE
- OA PERMIT ISSUANCE 29 80 1 11
LIC NO 101 R/M OCC/USE INSPECT 146 00 SAFETY PERMIT 1
( TOTAL FEES 193 90
ITEM? STRUCT APPROVED
MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP TEM- STRUCT REMOVED
I I I
1T/
NG OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I 111
SCHOOL WITHIN HAZARDOUS
LAIR QUALITY 1000 FEET MATERIALS
I NO NO NO �d
i
I
IMPORT ID DPR269 ROUTE TO BS0508
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