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Home My Public Portal About4518 TEMPLE CITY BLVD_Miscellaneous__ -AfORAI RS COMPENSATION ULC!ARATION 76M444 (11eb) CE M ISCELLANEROUS APPLICATION {1 LI I hereby affirm that I haveWoo a Workers' pe of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure or a certificate of Woikeri Compensation Insurance,or a certifted copy thereof(Sec 3800,Lab C) Policy No (ompany FOR APPLICANT TO FILL IN BmLmwG •oow[u d Certified copy Is hereby furnished BD451 8 N.TEMPLE CITY BLVD XX •omoLw[INGu Louury 0 departmentCertifpy is filed with the county budding Inspections LOCALITv TEMPLE CITY cwo.:it Date Applicant N[•w KST GI+rRI r N Gwo . TVPK 'Roe Do Er CROs Sr LOWER AZUSA O�/ CONST (I R III R A7 L OF EXEMPTION PROM WORKERS' LEGAL (OMPI NSATION INSURANCE oK+cw vL'OM Lor No [LOCKNA A no or nom NOP (CIRCLE) STAT[ MAJOR SECOND LOCAL (this section need not be completed d the work involved rw•er NOB on Lor u+E aoNE v[uu<ommTIon+ by the permit Is for one hundred dollars ($100) or less.) usE or �� SIZE Or LOT [}I+TING [LOO 1 certtfy that In the performance of the work for which this P1.111111 1% issued, I shill not employ any person in any manrlekX OR— of building ` sal is In haeme solgest to the Workers' Compensation 1 Sw; Mwu OCCUPANCY GROUP Date Applicant A10" OCCUPANCY CIT BL D TEMPLE CITY TEL 818-442-0452 I OTICIxempt IO APPyou should ANT If, after making this the Wore rs Corsa NO OCCUPANT LOAD 1 semen ti you should femme object , the Workers — (ompenclllon proviswro of the labor Code,you must forth- APPLICATION FOR EXIT HARDWARE loth comply with Stith provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ NO Spec Knowl deemLil resoked 1 R 1 NSI I)(ON 1 RA( TORS DECLARATION OCCUPANCY INSPKCTIOR ❑ Panic Devices I IlLrtlry affirm that I am licensed under proviswnsof Chapter SAFETY PERMIT ❑ )LIST ITEMS BELOW) 9 (commenLing with Section 7000)of Division 3 of the Flow No or EXITS net; and Professions(ode and my license Is in full force all eflLLt Name of business PARKING ELECA INTERNATIONAL INC SPACES "E°° = ProvlO[O I uulx Number __ _ _ I Ic Class IMPORT OFFICE OR ELECTRONICS LIMITED TIME USE (ontnUnr Dale OATS _ ow T. ❑ I am exempt from the lnctnvng requirements as I am a "GN' T. heensed architect or a registered professsonal engineer SIZE or no or INSPECTOR S acting in my professional capacity (Section 7051, But K}I+TIN° BLDG STORIES SIONATuw loess and Professions(ode) FINAL APPROVAL Y� ` I nc or Reg No _ -- Date Pw ESENr USE o► BmLDmo O IIOMI OWNFR BUII DER DECI ARATION no Or ExuTIN:EUILOINGS 0 LOT AMD u+ C I barb) iffunn that I Im exempt from the Contractor's 5'7� 'I (cense I aw for the fulloGmg reason (Seust ron 7031 5, Bu nits sand Professions Code) No PARKING 1, as owner of the properly wdl do the work and the SPACES PROVIDED structure Is not intended or offered for sale (Section 7044 Business and Professions Code) (ONSIRU( 1ION I ENDING AGENCY PROPOSED USE or BUILDING I hLreb) affirm that there is a Lonstructwn lending agency o our the performance of the won for which this permit n issued(Sec 3097,C iv C) _ I ender s Name I ender;Address PROPOSED MAX Gee 3 g 1 teddy Ilut I blue fend this apphtanPERMIT FEE un end stale ilial the T nnl al,ave Information IS Lorrett I igice to Comply with a0 County ISSUANCE FE[ ordinances and State laes relating to budding construction, , and hereby authorize representatives of thin County to enter TOTAL FEE 25.001 upon the above mentioned property for in;PCLnon purposes SEE REVERSE FOR EXPLANATORY LANGUAGE XX XX i WORKERS COMPENSATION DECLARATION CE 875 MISCELLANEOUS APPLICATION CE 4 111 e41 I.her o"U",bo affum that 1 have a s'Com en of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION inwre or a Lerttfip[e of Workers'Compensation Insurance or a certified cops thereat (Sec 3800 Lao C) Policy No Company FOR APPLICANT TO FILL IN SUILolnc jdJ /J ADOResa L 7 jr Certified w is hereby furnished vu'LOINc P3 Y C lP. LOCA LIrr wDDw Cas 1 Cepartted cap} u tiled with'he Lounn budding inspection LOCALITY Tentemple City CROSS sr Date Applicant NEAREST olarR lc o owgyP TYPQ cesaeo ev CROSS 3T D CONfV CERTIFICATE OF EXEMPTION FROM 110RKERS LCCAL J!/� 1 COMPENSATION IVSLRA\CE 0e 3CRIPTION LOT VO aLO CK • laxr• x0, IuwCLel STATE MAJOR a[CONO LOCAL r RLDca (This section need not be completed If the ssork AOC'Invoked - No NOONON LOT U96 ZONE 9IHCIAL CONDITIONS by the permit is for one hundred dollars (S 100) or less) uaE OI I I SI:Q OF Sar Exlsn tic RLOG I certify that in .he pertormanLe of ,he Soil. or x%hich .lits permit Is issued 1 shall not emplos Sits person n an} manne• aWNeR C �O I� -- so as to became subject ,o the Workers Compensation Laws MAIL ✓ OCCUPANCY GROUP AOOR ES. , p, �'D'^ �, 1 Date APPheant I NOTICE TO APPLICANT If atter makmc his Certificate of X CITY�t�N�L,E T NDL OCCUPANT LOAD E%emption sou should become subjeci to .he llorke-s APPLICATICN DOR EXIT HARDWARE Compensauon provisions at the Labor Code sou must .o^h I s%ith camph with such provu,ons or rhes permit shall be TRAILER usE F7 GEOLOGY INare C-ION — No Spec Knowl O deemed resoked occUPAN CY ins PQ c-lav Panic Devices LICENSED CONTRACTORS DECL AR ATIO\ I hereby affu-m that I am licensed under provisions of Chanter SAFETY PGRMIT 0 (LIST ITEMS BELOW) NO or EXITS 1 9 (Commencing with Section 7000) of Dn mon 3 of .he Bust ness and P•ofesstons Code and my license u in ull torte and (ARK effect Reo o vw ovlO CO $PACQ9ING a I License Number Lie Class LIMITED TIME USE ContraLtor Date G.r. a•T. nT. I am exempt tram the licensing er requuession as I e a I licensed architect or a reeis[ered protesvonal en¢ineer srzC OF no or Ins GUNCTOATU z actinr in ms professional Savants (SeLdon 7051 Bus- EXISTING ELOc sroRlEs SlwrU Q m am and P•otessions Code) o PRESENT USE OF BUILDING FINAL APPROVAL v Lie or Rest No Date C 1OHOME OWNER BUILDER DECLARATION No O eXD USE BUILDINGS on LOT AND aC j I hereby affirm that I am exempt from the Contractors V 1 I License LaW for the following reason [Section 7031 5 Bust- \ ness and Professions Code) no PARKwG 11 I as Darter of the property will do the cork and the SPACES IROvIDEO structure Is net intended or offered for sale (Section 7044 Business and Protessions Code) - - '- CONSTRUCTION LENDING AGENCY g Pnoroaco USE o euuowo 1 hereby affirm that there is a constmctron lending agenev [ 1 for the performance of the work for which this permit u owed(Sec 3097,Civ C) Lender s Name I� PROPOSED MAX OCC Lender's Address 1 ryr I certify that I have read this application and state that the PERMIT FEE 25.611 l.J T above information u correct 1 agree to wmply with all County ISSUANCE Pee ordinances and State laws relating to budding construction and hereby authorize epresentatwes of this County to enter TOTAL FEe 2 I� 1 1 upon the abov en tied property for inspection purposes _ I SEE REVERSE FOR EXPLANATORY LANGUAGE �^>wt ermittee Date WORKERS' COMPENSATION OBeaDPWiarao ON DECLARATION rRMAaa MISCELLANEOUS APPLICATION n I hereby affirm that I have a certificate of consent to-self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION "I(Lllf insure,or a certificate of Workers'Compensation Insurance or >� a certified copy thereof (Sed 3800 Lab C) . Pohcy Na Company FOR APPLICANT TO FILL IN BUILDING BUILD WG ADDR�B A��E H Certrfted copy is hereby furmshed �C� �/ /,ft.✓A'� LOCALITY Certified copy is filed with the county building Inspection em ZIP? ,p NtAR[fT department Tt/N�C C^ C/7 ��0 0 CROSS ST Date Applicant SIZE OF LOT NO OF BLDGS NOW ON LOT OroTRK:T No GtiOUP NP[ PROCEBEm W CL CERTIFICATE OF EXEMPTTON FROM WORKERS coNsr O I COMPENSATION INSURANCE TRACT BLOCK LOT NO V NO IcoiCui STATE MAJOR SECOND LOCAL (This sxxtion need not he completed If the work Involved ASSESSOR MAP BOOK PAGE PARCEL VSE 20NE SPEGIwL CONORKJNs I% by the permit m for one hundred dollen ($100) or less) 9 I certify that In the performance of the work for which this r er TELNO 8/ permit is issued 1 shall not employ any person In any manlier 4ill0 La lcl Z 3K. so as to become subject to the'Yorkers Compensation Laws ADDRESS OCCUPANCY GROUP N Date Applicant Cm ZIP ? NOTIC O APPLICANT after ma Ing this Certificate OCCUPANT LOAD of Exemption you should ecome subject to the Workers APPLICATION FOR Compensation provisions of the Labor Code you must forthwith EXIT HARDWARE comply with such provisions or this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION No Spec Know] ❑ ' revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION lI Panic Devices ❑ 1 hereby affirm that 1 am licensed under provisions of Chapter SAFETYPERMIT❑ Iuerr 11MLOwi NO OF 9(commencing with Section 7000)of Division 3 of the Business and Professions Code and my license is In full force and effect �0 e8/C NC ZQ fMRKING RED D PROvaen License Number 7463 64 LIc Class eAP C SPACES I Contractor/CC11,146- "e Date QAz,-3 LIMITED TIME USE ❑ I am exempt from the licensing requirements as 1 am a FROM DATE TO DATE licensed architect or a registered professional engineer acting in my professional capacity (Section 7051 Business nzE of NO of INSPECTOR S and Professions Code) OtIBT1l1G BLDG �� !C SrORIEA BiOiATURE. LIc or Reg No - Date PRESENT USE of BUILDING C/,f C mow—/ FINAL APPROVAL V l et 0 f< �{j HOME OWNER-BUILDER DECLARATION NO OF E ISTMN BUILDINGS ON LOT AND UTE I hereby affirm that I am exempt from the Contractor s License Law for the followmg reason (Section 70315 Business and Professions Code) NO PARKING i ElI 95 owner of the property will do the work and the SPACES PROVIDED structure is not intended or offered for sale(Section 7044 1 PROPOSED USE DF BUILDING ��/(-C��/L,�J-�,ys.✓ Business and Professions Code) ✓� s/�� _ _ CONSTRUCTION LENDING AGENCY - 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) PRaPDSED"x Oce Lender's NameAPPLIUNr rRsrri TEL NO 2 _, 11 1f__+lS 2es- lenders Address ADDRESS I certify that I have read this application and state that theO 7 Ed O/L 7�iL aaf_1VF?94 P/9. above Information is correct. I agree to comply with a0 County PERMIT FEE Ordinances and State laws mlatmg to building construction end a hereby authorirepresentatives of this County to enter upon WSUANCE FEE t I the above-mentioned property for ction purposes TOTAL FEE — p3�� 03 SEE REVERSE FOR EXPLANATORY LANGUAGE gnemre of Pcrmmee Dote