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HomeMy Public PortalAbout4327 TEMPLE CITY BLVD_Miscellaneous__ %k0BkLRS OMPLNSATION DI(LARAI ION 76M444 MISCELLANEOUS APPLICA'T'ION {1 L1 1 hereby affirm that I have a certificate or consent to ser CE 875 (11 84)COUNTY 09"hOg ANGELESi� - BUILDING AND SAFETY DIVISION Insure or a certificate of Workers (ompensahon Insurance or I certified Lop} thereof(SeL 3800,Lab C) POIIL) No(h'tG1Ar_3 (ompan)sso(dem Favlc IWSO.A, Ce FOR APPLICANT TO FILL IN Bu 1L°Ixc/ —7 wDDR¢s T © Certified cop) is hereby furnished XX EUDILRDEINa C TQLOCALTY o L E] Certified copv is filed with the county budding inspection LOCALITY n[AREST department JgX CROSS ST Dote Apphclnl (�� L L� xu[esr 1/p 11e p I V 1 olsrwlcr O u• Trr¢ ceRe[o BY ewosa ST p O G �` -� Coxa* Cl RIII K AIF Of EXEMPIIO I ROM WORKERS L.[Gu (OMPI NSA FION INSURANCE DKSCNIPTION Lor No j [LOCK _ ISR^" SrwrE Mwrow SECOND Lout xo or BLDGE RS 1<L<LX (This section need no( be completed if the work involved TRACT NOW ON LOT USE son[ SPECIAL CONDITIONS by the permit IS for one hundred dollars ($100) or less) USEor I Lertlfy that in a1S[ OF LOT EF I¢TING BLDG the performance ur the work far which this ` n permit is waled, I shall not employ any person in any mannelKg owneR of building S /;z �---•� r. w to br,onie whict I to thL Workers (ompen%Ihon 11ae MAIL OCCUPANCY GROUP C7, G �` woow¢aa �L�p Uale�l-1�- Ir APPhL rut Iv1 NOIK I 10 APPLI(ANT If Lfter making this CerlJralc of CITY �/¢ TEL rj79 (vas OCCUPANT LOAD N I xrmption )uu %hound become subject to the WorkersPLICATION FOR EXIT HARDWARE (ompencahov provisions of the Labor Code you must forth- .j uuh Lonrph udh %u0i pto%ision% or this permit shall be TRAILER USE 0 GEOLOGY INSPECT10H 0 No Spee Knowl deemed rc%ohed 1 ICI NSE Il(ON I RACI ORS DECLARATION OCCUPANCY INSPKCTIOn Nr Panic Devices 1 herrbl ltfinn th it I am licensed under proviuonsof Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) 9 (conlmenLing with Section 7000) of Division 3 of the Busy NO OF EXITS nes% and Professions(ode and m) license is m full force ail Name of business PARKING CffCLI SPACE$ w[QO F PROVIOEO I ittnSe Number I Ic (lass m: 1YL VS Y� l LIMITED TIME USE (onto Ltar ---- Date _OAT. _ D T. 0 I IDI exempt from the hlensing requirements as 1 am a I censed Irchiteat or 1 registered profesaunal engineer SIZE Or no OF InSP[erow acting in my professional Lapacity (Section 7051, Bus- EXISTING FLOG 32 3 IS STowl[S I li0]I]n—I]I]�1� SIAxALURM, mess and Professions(ode) FINAL APPROVAL ) 1 Ic or Reg No _ Date PRESENT USE or BUILDING _ IIOMI OWNI R BUILIIFR D1 CLARArION No or [XISTIna Buu.DINas 1 O V On LOT AND LIS[ I hereby affirm that I im exempt from the Contractors I cense law for the follow mg Priam (SeLtion 7031 5 Bust-near and Professions Code) NO PARKING /. 1, as owner of the property nIll do the work and the SPACES PROVIOUD structure is not intended or offered for sale (Section 7044 Business and Professions(ode) (ONS 1 RUCI ION LENDING AGENCY PROPOSED USE or BUILDING I hrrcb) affirm that there is a construction lending agency map C{pyeY for lite performanLe of the cork for which this permit 1s I issued(Sec 3097 Cry C) I ender s Nvnc PweroSED Miss•Dee I endo s AddrlsS— PERMIT FEE 25 -55 I cettdv that I hoc rLld OU% IpphL lion and state that the ibnse Inform ItIllo I%Lortco I IgI7CC to Lo111pI) R illi all(ounty ISSUANCE FEE ordinances Ind State laps relating to building construction A and hereby authorac representatives of this County to enter TOTAL FEE 25. 00 upon the Ibuve mentioned propert) for msptetion purpose% XX f�y�- XX I7--Ir—1r SFE REVERSE fOR EXPLANATORY LANGUAGE I —__ tl n�ln•UFnI I',inti 1, hili