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Home My Public Portal About5812-5814 TEMPLE CITY BLVD_Miscellaneous__ WORKE'RS'COMPENSATION DECLARATION CE eie4(11-84) M ISCELLANEOUS APPLICATION I hereL', ft;iriif that 1 have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, o a certificate of Workers'Compensation Insurance,or fl a cert copy thereof(Sec. 3800,Lab.C.). Policy No. Company , FOR APPLICANT TO FILL IN BUILDING ADDRESS LVA FlCertified copy is hereby furni e . BUILDING •I t ADDRESS -t -1 C 1 LOCALITY L.. ❑ Certified copy is filed with the c unty building inspection LOCALITY- NEAREST department. 7'� CL CROSS ST. Date ApplicanNEAREST DISTRICT NO, G U TYPE ��J� PR ESSED Y CROSS ST. La /V( S PG/l+ lJXr/ + CONST. 1( CERTIFICATE OF EXEMPTI N FROM WORKERS' LEGAL � — L • COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLDGS. NO. (CIRCLD) (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this �-�--& o permit is issued, I shall not employ any person in any manner OWNER U 1� C Ce so as to become subject to the Wor ers' Compensation Laws. MAIL J C� OCCUPANCY GROUP U I—AADDRESS Date Applicant v LLI NOTICE TO APPLICANT: If, aft r making this Certificate of CITYLm � -- 3 �� OCCUPANT LOAD 0- 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 OI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices 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 effect. I SPACESG REO'D DT PROVIDED License Number Lic. Class ' 141 _ LIMITED TIME USE Contractor Date DATE DATE ElI am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO.OP NSPE CTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES I ATU iness and Professions Code/, 1Pn Lic.or Reg.No. �� Date PRESENT USE OF BUILDING FINAL APPROVAL lqqv// / P� `v HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS pipe o ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi j�( 11 —I,. 1]� 12/11/89 ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED AN 8:25 7�O�Ii structure is not intended or offered for sale (Section 7044,Business and Professions Code). N CONSTRUCTION LENDING AGENC PROPOSEPD USE OF BUILDING �� I hereby affirm that there is a constriction lending agency t: O for the performance of the work for which this permit is issued(Sec. 3097,Civ.Q. (" Lender's Name PROPOSED MAX. OCC. y Lender's Address I certify that I have read this application and state that the PERMIT FEE J� 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 CQ UD p e above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 9 -S .8 Signature of Permittee Date WORKERS'C034PENSATION DECLARATION a CE 875(11-84) MISCELLANEOUS APPLICATION • CE 87 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 BUILDING �} ADDRESS Certified copy is hereby furnished. ` AUILDIN sa o2 LOCALITY 0 Certified copy is filed with the county building inspection OCALITY �� NEAREST department. CROSS ST. Date Applicant NEAREST Q� DISTRICT NO. GROUP TYPE P ESSED BY pP CROSS ST. �� v _ CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. (CIRCLE) NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT __:�lUSE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) USE of SIZE OF LOT EXISTING BLDG. /Ar Gr I certify that in the performance of the work for which this o Qa permit is issued, I shall not employ any person in any manner wNER �o ,u�_ so as to be ome subject to the NEorke ' Compensation Laws. MAIL OCCUPANCY GROUP O �- ADDREs " �rnrQ� '- Date Applicant _ �s LW TEL NOTICE TO APPLICANT: I ,after making this Certificate of CITY �`i�' NO. �S�a OCCUPANT LOAD z 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 oI this permit shall be TRAILER USEGEOLOGY INSPECTION ❑ E] E] No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION E] Panic Devices 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 PARKIN_ effect. �/�7d'C_ PACES REq'D PROVIDED License Number Lic. Class Pi pST� a5121fX-1 II��J LIMITED TIME USE Contractor Date DATE DATE FROM: TO: I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF NO. OF 1 sI TOWS acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). USE FINAL APPROVAL PRESENT E OF BUILDING Lic.or Reg.No. Date vv HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUIL Gs US � �19� � �v` �� ,1�1�► i ON LOT AND USE �I I I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency es GJ for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. 7 7'9/ Lender's Name PROPOSED MAX. OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize re resentatives of this County to enter TOTAL FEE gp upon the above-men ' od p rty kr inspecti9n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1VORKEIt5-CO1viPENSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance, e,or a certified copy thereof(Sec.3800,Lab.C.). Policy No. Company FOR APP LI CANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is hereby furnished. 11 BUILDING ' r 7 LOCALITY ADDRESS S Z l�• C Zy �./{ IiV ✓�C ❑ Certified copy is filed with the county building inspection LOCALITYp r //gyp NEAREST department. � M LE 04 CROSS ST. Date Applicant NEAREST �Q� M�L3 1 t ��C DISTRICT N . GROUP TYPE RO ESSED BY CROSS ST. hlvf 41 ` ,S !O� �f� CONST.- I CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL Z 0 COMPENSATION INSURANCE DESCRIPTION LOT NO. LOCK MAP 60 ` Q HIGHWAY No. (gyp_& (CIRCLE) STATE MAJOR SECOND LOCAL NO. OF BLDGS. (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) usBLDG. E OF SIZE of Lor I certify that in the performance of the work for which this EXI571NG CD 0 permit is issued,I shall not employ any person in any manner OWNE J g A til I g (;-1,55 c S' so as to become subject to the Workers' Compensation Laws. AIL OCCUPANCY GROUP10 ® o Date APP hcant ADDRESS ; lo J43 JAotre love', W L. NOTICE TO APPLICANT: If,after making this Certificate of 1, CITY LN y!fjQ NO. OCCUPANT LOAD Exemption, you should become subject to the Workers' — Compensation provisions of the Labor Code,you must forth- zp. 9l70! APPLICATION FOR EXIT HARDWARE: with comply with such provisions oI this permit shall be TRAILER USE GEOLOGY INSPECTION ❑ No Spec. Knowl. ❑ deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ 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 effect. PARKING REq'D PROVIDED SPACES License Number Lic. Class LIMITED TIME USE Contractor Date D ATB OATS PROM: TO: ❑ I am exempt from the licensing requirements as I am a licensed architect or a registered professional en neer SIZE OF NO.OF INSPECTOR'S P � SIGNATURE acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL �„ 1 Lic.or Reg.No. Date P_� ,j_ _ ems ��H,� HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ❑ I, as owner of the property, will do the work and the SPACES PROVIDED structure is not intended or offered for sale (Section 7044,Business and Professions Code). , CONSTRUCTION LENDING AGENCY OPOSED USE OF BUILDING ;25362A I hereby affirm that there is a construction lending agency Fz—gia/L _ a25y,L1tr55 14<1CHI41CIS for the performance of the work for which this permit is G �� # 0 0 0 0 8 8 issued(Sec.3097,Civ.Q. Lender's Name o 0 0 0 0 0 0 PROPOSED MAX. OCC. Lender's Address0094-86 I certify that I have read this application and state that the PERMIT FEE above information is correct.I agree to comply with all County ISSUANCE FE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE upo�ove-mentioned property for inspection purposes. � SEE REVERSE I'-k EXPLANATORY LANGUAGE Z Signature of Permitt Date WORKERS'COMPENSATION DECLARATION 76M444 MISCELLANEOUS �Ll B lid p p fiLp ®�C APPLICATION A T ®A1 CE 875 (2-80) 11�7� I� I! A p�7 S A M 6 1�I A � 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.C.) Policy No. Company FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS Y Certified copy is hereby furnished. BUILDING f e LOCALITY S ADDRES ❑ Certified copy is filed with the county building inspection 1 NEAREST department. I LOCALITY CROSS ST. Date Applicant AEAR EST DIST T N G U-n/ TYPE / PROC S ED BY CROSS ST ,} CONST. ]/ CERTIFICATE OF EXEMPTION FROM WORKERS' LEGA L t V VVV COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK pipp /I M,GHyypy } NO. (/��t�JJ (CIRCLE) STATE MAJOR SECOND GAL a NO. OF BLDGS. O (This section need not be completed if lite work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars ($100) or less.) USE OF ry SIZE OF LO EXISTING BLDG. a I certify that in the performance of the work for which this . O permit is issued, I shall not employ any person in any manner OWNER U so as to become subject to the Workers' Compensation Laws. IMAAL v OCCUPANCY GROUP – Uj '+/ NDate Applicant ADDRESS V_NOTICE TO APPLICANT: If, after making this Certificate of CITY NOL j^� f .. OCCUPANT LOAD Exemption, you should become subject to the Workers' L / gppLICATION FOR EXIT HARDWARE: Compensation provisions of the Labor Code, you must forth- d With comply With Such provisions or this permit shall be TRAILER USE E] GEOLOGY INSPECTION deemed revoked. NO Spec. KnOWI. ❑ Panic DeVIC@S ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ❑ 9 (commencing with Section 7000) of Division 3 of the Busi- ness and Professions Code, and my license is in full force and PARKING. effect. REq'D PROVIDED SPACES License Number Lic.Class LIMITED TIME USE Contractor Date DATE DATE ❑ I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZEOF NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES S NATURE iness and Professions Code). FINAL APPROVAL ESENT USE OF BUILDING l' Lic.or Reg.No. Date ' HOME OWNER-BUILDER-DECLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I hereby affirm that, I am exempt from the Contractor's 2 1 5 2 2 A License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING # o O D 088 SPACES PROVIDED ❑ I, as owner of the property, will do the work and the o 0 0 0 o D O z structure is not intended or offered for sale (Section 7044,Business and Professions Code). PROPOSED USE OF BUILDING 0 21 3-85 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency J for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the ISSUANCE FEE above information is correct.I agree to comply with all County ordinances and State laws relating to building construction, TOTAL FEE and hereby authorize representatives of this County to enter up the above-mentioned pro. rty for ins ection purposes. SEE REVERSE i-OR EXPLANATORY LANGUAGE _V S' ature of Permittee Date