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Home My Public Portal About5953 TEMPLE CITY BLVD_Miscellaneous__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 r= RISCEL.L-ANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS �MP 0508 9904080001 " BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 — PHONE: (626) 285-0488 EXT: LEGAL 1D: NO. OF CONST NEW ..BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 953 TEMPLE CITY.BL STRUCTURE: 1 VN B TEMP. CA 91780 ASSESSOR INFORMATION BER: NEAREST CROSS STREET: EXIST BLDG USE: THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY EXIST OCC GRP: USE ZONE: TENANT: SSE 0 PROCESSED EXPIRES 0 LDGS. NOW ON LOT: VALUATION: 04/08/99 UT 04/08/00 0 OWNER: TEL. NO: FINAL DATE FINAL BY: ODE: CHANG, BOB C (818) 289-4088- LISTITEMS: 238 S. ATLANTIC BLVD 1 ALHAMBRA, CA 91801 GRIPTION_OF WORR TEMPORARY PERMIT FOR CONSTRUCTION RA ER OCCUP LOAD EXIST: -- APPLICANT: N OCCUP LOAD NEW: MADISON PAVING, INC. (213) 562-2560- 4820 CECELIA ST. PARKING SPACES REQU.I:RED; SPECIAL CONDITIONS: .• CUDAHY, CA PARKING SPACES'o_ROV DED. EXIT H D�/�R_E:�ELE� CO(/ CONTRACTOR: TEL. NO: LIMITED TIME USE MADISON PAVING, INC. (213) 562-2560- NBR 0 E S: FROM TO 4820 CECELIA ST. #A LIC. NO 717 ... CUDAHY, CA 90201 549272 f FES o \ APPROVALS DATE INSPECTOR SIGNATURE FEE ESCR� TI QUANTITY: UOM: AMOUNT: ARCHITECT OR ENGINEER: TEL. NO: - , 1 TRAILER USE 01� PERMIT IS$UA CE I 27.75 LIC. NO /08 NtAiiE I VE Tlp R 1111111 (154.15 SAFETY PERMIT L T L FEES 81.90 P. STRUCT. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: C P.f URBC U WO EMP. STR CT. REMOVED RK 0. OF FAMILIES: DWELLYNG S: APT/COND: S ATC SS\_" o NO ` C/p 0 SCHOOL WITHINH A Z DO S ! 3, 'V rt . k AIR QUALITY: 1000 FEET MATERIALS �,., v o f' NO NO NO El REQUIRED TOTAL SETBACK RO E IS 445 - 0 SETBACK YARD: HWY: PROP LINE: WIDTH: IpFRONT �erViC4;"ThatvV SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508 I` WORKERS'COMPENSATION DECLARATION 76M444 ?. , CE 875(11-84) MISCELLANEOUS APPLICATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. Policy No. CADDRESompany FOR APPLICANT TO FILL IN BUILDINGS ✓t� Certified copy is hereby furnished. BUILD IN �- [^- LOCALITY ADDRESS ,—. T'C Certified copy is filed with the county building inspection NEAREST LOCALITY department. Cly f CROSS ST. Date Applicant NEAREST4'�'e^� �r DISTRICT NO. GROUP TYPE P ESSED BY CROSS ST. i✓V CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION I 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 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 C:) permit is issued,I shall not employ any person in any manner OWNER l so as to become subject to the Workers' Compensation Laws. MAIL AD IL ` OCCUPANCY GROUP o ES _ ~ Date Applicant Say` ' NOTICE TO APPLICANT: If,after making this Certificate of CITY TEL 301-BaZ OCCUPANT LOAD 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 USEGEOLOGY INSPECTION ❑ deemed revoked. ❑ ❑ No Spec. Knowl. OCCUPANCY INSPECTIO Panic Devices LICENSED CONTRACTORS DECLARATION ;i . 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 n e s e .nd Professions Code,and my license is in full force and �� G ViX� �U� PARKING REq'D PROVIDED QnSPACES LL�� License Number Lic. Class Q LIMITED TIME USE Contractor Date DATE DATE El FROM: TO: I am exempt from the licensing requirements as I am a , licensed architect or a registered professional engineer SIZE OP NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). �• 1 erg PRESENT USE OF BUILDING FINAL APPROVAL I O(,(�6 Lic.or Reg.No. Date Eqs NO FEE 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 LIIt00-X1901. 111/231/591 ness and Professions Code): NO. PARKING I, as owner of the property, will do the work and the SPACES PROVIDED 168 1 PM 4:08 structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF HUILDINGUe,•E(Z; — FoCcjt-. I hereby-affirm that there is a construction lending agency Ck O for the performance of the work for which this permit is I� issued(Sea 3097,Civ.Q. �7Ti11 Lender's Name /IJ PROPOSED MAX. OCC. Lender's Address PERMIT FEE I certify that I have read this application and state that the above information is correct.I agree to comply with'all County I ISSUANCE FEE i ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter TOTAL FEE up n the above-mentioned property for inspe�tion, rposes. S REVERSE FOR EXPLANATORY LANGUAGESignature of Permitt e WOR il'RS'('ttltl'INSATIONDFCIARIL1'10N CE 875(2-80) MISCELLANEOUS /'1��`I�/'1 APPLICATION i M hereby I' ert that I have certificate of cement to COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION nsr e, or •i Lartifialt.of Workers'Compen%.Ition Insurance,or � a certified L,py thereof(Sec.3800,Lab.C.) Policy No. __Company BUILDING FOR APPLICANT TO FILL IN r-1 , ADDRESS V� Certified copy is hereby furnished. °on DMG Ess rj7S' LOCALITY �� F-1 (ertlf zd copy is filed with the county building in%pectiorl NEAREST department. LOCALITY � �! GROSS ST. Date— Applicant NEAREST DISTRICT�. G J.0 j TYP PROCESSED BY CROSS ST. 00 /Q(�r� r9YJ1 CO ChR fIFICATF OF I:XFNIPTION FROM WORKFRS' LEGAL CONIPENSA'IION INSURANC'L DESCRIPTION I LOT NO. BLOCK MAF HIGHWAY No. (CIRCLE) STATE MAJOR SE D LOCAL CL NO. OF BLOGS. (This %(ction need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS U by the permit is for one hundred dollars (8100) or less.) use OF IZE PF LOT EXISTING BLDG. I certlfv that in the performance of the work for which this s� Q permit Is issued, I shall not employ any person in any manner WNER &I Al !•/�W so a% to become subject to the Workers'Compensation Laws. AIL P s OCCUPANCY GROUP W ADDRESS��■J �LSHnQF /j�a. �j`S� CL Da,l•- Applicant _ ��//�J '/ TEL. NOTICL TO APPLICANT: If, after making this Certificate of ITY/S�t/Eey,L //,"s a No. 6s3 #-7-/ OCCUPANT LOAD Exem)tion, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: Com,ensatlon provisions of the Labor Code, you must forth- , with comply- with such provisions or this permit shall be TRAILER USE GEOLOGY INSPECTION El deep ed revoked. El No Spec. Knowl. LICENSED C'ONTRAC'TORS DECLARATION OCCUPANCY INSPECTION❑ Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ❑ Q (.ommencipg with Section 7000) of Division 3 of the Busi- tie , and Professions Code,and my license is in full force and effect. SPACESG• REQ'D O PROVIDED D I.I,ense Number Lic.Class LIMITED TIME USE Contrdctor Date ' Dare owre FROM: TO: t 1 am exempt from the licensing requirements as I am a licensed architect or a registered pnJfesslonal engineer s zEOF NO. OF INSPE TOR'S acting in my professional capacity (Section 7051, Bus- IS TING BLDG. STORIES SI ATo RE iness and Professions Code). PRESENT USE OF BUILDING FINAL APPROVAL i l.ic.or Reg.No. Date AfW So.J HOME MNER-13I,11 DFR DFCLARATION NO.OF EXISTING BUILDINGS ON LOT AND USE I herehy affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- nes%and Professions Code): NO.PARKING 7 8 9.5 A SI-ACES PROVIDED �.�}} RR QQ ❑ I, as owner of the property, will do the work and the ti °o °D °D o° H H N structure h not intended or offtred for sale (Section z i 7044, Business and Professions Code). —87 ROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is i%saed(Sec.3097.Civ.C.). Lender's Name _ PROPOSED MAX. OCC. ` (� Lender's Address _-- PERMIT FEE v� I Lettlfy that 1 have read this application and state that the above information is correct.I agree to comply with all County ISSUANCE FEE ordinance% and State law,; relating to building con%tructlon, and hereby authorise iepresentatrves of this county to enter TOTAL FEE up n t e eve mentioned p rperty for in%peLtI0II purpows• SEF. REVERSE FOR EXPLANATORY LANGUAGE. gnaturc of Fermi teems Date /�4,v,Q6 IKA-lf l�C. ' 4 • WORKERS'COMPENSATION DECLARATION CE 875(1 1-84) MISCELLANEOUS APPLICATION I hereby affirm that'I have a certificate of consent to self -insure, bi a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION �J a certifie4l cop3nhereof(Sec.3800,Lab.Q. i Policy 1qCompany FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is hereby furnished. , BUILDING JT 3 TEM ZE: CI L p ADDRESS i LOCALITY Certified copy is filed with the county building inspection/ L department. ocwLITY `T��E c IT cRoss ST. Date Applicant NEAREST / DISTRICT NO GROUP TYPE P ES D BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJORS 'GOND LOCAL NO. (CIRCLE) NO. OF BLOGS. (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 ($100) or less.) USE OF SIZE OF LOT I EXISTING BLDG. O}.. I certify that in the performance of the work for which th' c permit is issued,I shall not employ any person in any manner OWNER I LD y so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP CD ADDRESS 23$ S, ATLI)I&IC LVO V Date Applicant � 1,•J NOTICE TO APPLICANT: If,after making this Certificate of CITY L NO. O/6 —¢Q� OCCUPANT LOAD y Exemption, you should become subject to the Workers' z Compensation provisions of the Labor Code,you must forth- ; APPLICATION FOR I EXIT HARDWARE: with, comply with such provisions or this permit, shall be TRAILER use b GEOLOGY INSPECTION ❑ I No Spec. Knowl. deemed revoked. Panic Devices LICENSED CONTRACTORS DECLARATION OCCUPANCYN INSPECTIO I hereby affirm that I am licensed under provisions of Chapter SAFETY PER ❑ (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 �)(' �1'y'( �` D effect. LLQ N/�i�� PARKING REq' PROVIDED I I SPACES License Number'' Lic. Class iP,411,DA )= HE L�Al' _r -.Tu�v4 %7 u � LIMITED TIME USE Contractor Date OATS DATE 0.1 am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer SIZE OF I NO.OF PROM. TO. INSPECTOR'S acting in my professional capacity (Section.7051, Bus- EXISTING BLDG. STORIES 1 SIGNATURE inessand Professions Code). FINAL APPROVAL PRESENT USE OF BUILDINGqn Lic.or Reg.No. Date S��rCE 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+- �� .— �� 11/270/89I, as owner of the properf will do the work and the QVID•ED 1 structure is not intndd or SPACES PR offered for sale (Section 13895M11!5 7044,Business and Professions Code).' A/ CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I hereby affirm that there is a construction lending agency I for the performance of the work for which this permit is 1 ® j �� issued(Sec.3097,Civ.Q. oil it r Lender's Name ' PROPOSED MAX. OCC. Lender's Address PERMIT FEE, � 19 I certify that I have read this application. and-state that the above information is correct.I agree to comply with all County 4 ISSUANCE FEE ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter I TOTAL FEE! =24YO the above-mentioned property for inspection purposes. I TSEE REVERSE NON EXPLANATORY LANGUAGE I Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION !76M445 MISCELLANEOUS APPLICATION CE 875(11-84) I hereby affirm that I have a certificate of consent to self � insure, or a certificate of workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. "' 'fl Policy No. Company BUILDING FOR APPLICANT TO FILL IN ADDRESS Certified copy is hereby furnished. ILDING � _ i ADDRESS ��{ nwit LO+CA LITY Certified copy is filed with the county building inspection OCgL1TY C i NEAREST department. l CkOSS ST. Date Applicant oPMAREST DISTRICT NO. GROUP TYPE / P OCE SSED BY CROSS ST. �/J/' CONST. CERTIFICATE OF EXEMPTION FROM WORKERSLEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK NOP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLOGS. (CIRCLE) (This section need not be completed if the work involved TRACT NOW ON LOT USEZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) uSEE of j XISTING BLDG. SIZE OF LOT I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner o OWNER y so as to become subject to the Workers' Compensation Laws. z • MAIL OCCUPANCY GROUP o Date Applicant ADDRESS CFS TEL. LU NOTICE TO APPLICANT: If, after making this Certificate of CITY NO. OCCUPANT LOAD D_ Exemption, you should become subject to the Workers' a Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: _ With comply with SUCK proV1s10IIS OI this permit shall be deemed revoked. TRAILER USE ❑ 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 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. low, SPACESG REq'D PROVIDED License Number Lic. Class I 'LIMITED TIME USE Contractor Date I DATE DATE I am exempt from the licensing requirements as I am a FROM: TO: licensed architect or a registered professional engineer SIZE OF NO. OF -INSPECTOR'S acting in.my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FINAL APPROVAL 2'��'!.3 PRESENT USE OF BUILDING 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 �113—lill'I 1 ,_ License Law for the following reason (Section 7031.5, Busi 7-1 ness and Professions Code): NO. PARKING {� [t 1:a 4.., I, as owner of the property, will do the work and the sl�l0 SPACES PROVIDED 1 Phi. structure is not intended or offered for sale (Section ; 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOS USE OF BUILDING 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.Q. + Lender's Name Lender's Address PROPOSED MAX. OCC. PERMIT FEE B'p I certify that I have .read this application and state that the 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 upon the -mentioned roperty for i pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date 1 01 i WORKERS'COMPENSATION DECLARATION MISCELLANEOUS APPLICATION .CECE 8 875(11-84)75 I hereby a certificate that I have a certificate of consent self COUNTY OF LOS-ANGELES BUILDING AND SAFETY DIVISION insure or a certrt ificate of Workers'Compensation Insurance,e,or , a certified copy thereof(Sec.3800,Lab.Q. _ Policy No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS �G - Certified copy is hereby furnished. BUILDING LO CA LIT Certified copy is filed with the county building inspection LOCALITY NEAREST department. LL- C.t C. U cRoss ST. Date Applicant NEAREST DISTRICT NO. GROUP TYPE OC E55ED BY CROSS ST. ®� CONS CERTIFICATE OF EXEMPTION FROM'WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY STATE MAJOR SECOND LOCAL NO. OF BLD GS.. NO. (CIRCLE) (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 OFQ SIZE OF LOT EXISTING BLDG. I certify that in the performance of the work for which this fie CD permit is issued,I shall not employ any person in any manner WNER Of' Dai I ; LO LT so as to become subject to the Workers' Compensatidn Laws. MAIL OCCUPANCY GROUP o Date Applicant ADDRESS 23Q� 5• T L FIT1 �1-U 9 ' NOTICE TO APPLICANT: If,after.making this Certificate of CITY�L ,C NO. $la - r` - OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: GEOLOGY INSPECTION No Spec Compensation provisions of the Labor Code,you must forth- with comply with such provisions or this permit shall be TRAILER USE ❑ deemed revoked. ❑ ❑ . Knowl. LICENSED CONTRACTORS DECLARATION I OCCUPANCY INSPECTION❑ Panic Devices I hereby affirm that I am licensed under provisions of Chapter ! 9 (commencing with Section 7000) of Division 3 of the Busi- ness usi I SAFETY PERMIT ❑ (LIST ITEMS BELOW) NO. OF EXITS ness and Professions Code,and my license is in.full force and ll�A�',r effect. ;Nl�l' + 1-5S PARKING REQ'D PROVIDED SPACES License Number Lic. Class 0 h'l O er�R-R� LIMITED TIME USE Contractor Date f DATE DATE F1I am exempt from the licensing requirements as I am a I FROM: To: INSPECTOR'S licensed architect or a registered professional engineer I SIZE OFNO.OF SIG TURE acting in my professional capacity (Section 7051, Bus EXISTING BLDG. STORIES iness and Professions Code). FINAL APPROVAL PRESENT USE OF BUILDING 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's11 �. t�l�fil _i��J Sf yi 41/9License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING ��:� �,t t 7. 0 I, as owner of the property, will do the work and the SPACES PROVIDED 7 9O�- � Prl1.:0 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 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 ; I certify that I have read this application and state that the PERMIT FEE 0 5. 00 above information is correct.I agree to comply with all County ISSUANCE FEE 1 orAinances and State laws relating to building construction, and hereby authorize r eintatives of this County to enter TOTAL FEE O upon the above-merpdxeeperty for inspection purposes. 0 u . 2� Sig `�p',SEE REVERSE FOR EXPLANATORY LANGUAGE =of ermittee Date 1�` C ! j WORKERS'COMPENSATION DECLARATION I fUM444DPW12/90 • MISGE•L.LANEOU-� APPLICATION �" ,..; I I hereby•affirnt that I have:.a certificate bf consent to self •COUNTY OF LOS'ANGELES " ' BUILDING:AND SAFETY DIVISION"Yo urnslrre,or a cetTificate of,WcjsT ers'Compensation Ins urank or �;f• _ I f • { .h Certified copy thereof(560.3800, Lah C)�' _ (� FOR APPLICANT TO FILL IN BUILDING Policy•Na Corttpany. j H _ BUI I GADDRESS ADDRESS Certified copy.is.hereW.furnished L LOCALITY Certified copy is filed'with the county building insp6piion CITY zip ( ' 1 department '• M C/1 C�q 1��i7 cRO3s sr. Date _Applicant I. slzE of LOT NO.OP BCDGS•NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY Q CERTIFICATE OF •EXEMPTION FROM WORKERS') TRACT BLOCK LOT NO CONST. ( I COMPENSATION INSURANCE MAP NIctIWAY L •' I NO. (CIRCLE) STATE MAJOR SECOND LOCAL.. (This section need not be completed if the work involved ASSESSOR MAP BOOK PAGE PARCEL USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less.) I.certify that in the performance,of the work for which' this 3i �I er NO' s •z 1G, Ci I'l ads t 2 2d' — fid' a permit is issued.I"Shall.not employ"any person in any manner T I so as to become subject to the Workers' Compensation Laws ADURt" OCCUPANCY GROUP t!: i 23 IC L Z ( i Date Applicant . I. CITY ZIP �' NOTICE TO APPLICANT: If: after making this Certificate V ' of Exemption, you should become subject to the Workers' OCCUPANT LOAD Compensation provisions of the•Ialior Code.you must forthwith APPLICATION FOR EXIT HARDWARE: comply with such provisions or'this permit shall be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec.Knowl. ❑ l revoked. ❑ OCCUPANCY INSPECTION C$ I Panic Devices LICENSED CONTRACTORS DECLARATION i I I hereby affirm that I am licensed Under provisions Of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) ' NO.OF EXITS a t I 9(commencing with Section 7000)of Division 3 of the Business and Professions Code•and my license is iri full force and effect. .,Name o us ess I License Number Lie.Class BPACESG• REO'D PROVIDED I I i Contractor— Date ` LIMITED TIME USE i ElI am exempt from the licensing requirements as I am a i DATE DATE ' licensed architect or a registered professional engippeer {.FROM: To: acting in my professional capacity(Section 7051,Busilness SIZE OF NO.OF INSPECTOR'S and Professions Code). (`'! I EXISTING BLDG. STORIES SIGNATURE. i PRESENT USE OF BUILDING ' Lim or Reg.Na_ Date e5toliwr� • FINAL APPROVAL S ' HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS I' I ON LOT AND USE I hereby affirm that I am'exempt from the Contractor's License Law for the following reason (Section 7031.5• Business .and I Professions Code): I NO.PARKING SPACES PROVIDED i ❑ I, as owner of the property, will do the work and)the structure is not intended or offered for sale(Section 7044, PROPOSED USE OF BUILDING Business and Professions Code). ( i I. CON:IRUCTION LENDING AGENCY _ j' 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.). I PROPOSED MAX.OCG i Lender's Name_ APPLICANT IOWNT TEL NO.' Lender's Address ' ADDRESS �rT j I certify that I have read this application and state that)the above information is correct. I agree to comply with all Coulity t 9n PERMIT FEE ordinances and State laws'•elating to building construction, d A=. .� hereby authorize representatives,of this County-to enter upon' ISSUANCE FEE -�s the above-mentioned property for inspection purposes. i• - -• r• I:•�• '� _ I TOTAL FEE 1 .. SEE REVERSE FOR EXPLANATORY LANGUAGE- r Signatu a or Permittee Date " I WORKERS'COMPENSATION DECLARATION 176M"4.- MISCELLANEOUS:APPLICATION }CE CE 875 876(11-84) � I''hereby affirm that I have a certificate of conseVkt to self, i' insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION a certified copy thereof(Sec.3800,Lab.Q. 10 9 Policy No. Company i BUILDING FOR APPLICANT TO FILL IN ADDRESS + FICertified copy is hereby furnished. F` nooRess !eg /V"Ir. GIT rile• LOCALITY Certified copy is filed with the county building inspecti LOCALITY i67106 NEAREST department.• I�iT 19M Cl 1 C-9 r 0o C. ST. Date Applicant NEAREST DISTRICTN G OUP TYPE //jj OCESSED BY CROSS ST. I '�• D� CONST CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAB HIGHWAY STATE MAJOR SECOND LOCAL NO.�. NO.OF SLOGS. (CIRCLE) (This section need not be completed if the work involved .I 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 I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any m " OWNER of building SAL f,wrl- INC. L�i�il o so as to become subject to'the Workers' Compensation La r 2 / OCCUPANCY GROUP04 ,\ MAIL o) !S Y A'T IAtM�� D Date Applicant y ADDRESS 0(/ ' p� V NOTICE TO APPLICANT: If,after making this Certificate of CITY �� NO. �ll�, .r Q i+ OCCUPANT LOAD Exemption, you should become subject to the Workers Compensation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE: with comply with such provisions or this permit shall be ,j TRAILER USE❑ GEOLOGY INSPECTION❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION El Devices I hereby affirm that I am licensed under provisions of Chapter S, 1 SAFETY PERMIT ❑ (LIST ITEMS BELOW 9 (commencing with Section 7000) of Division 3 of the Busi- 'j y NO. OF EXITS ness and Professions Code,and my license is in full force 3. effect. Name of busin��/es'fs�/ PARKING REq•D ==T PROVIDED 1 1 T'�r l v SPACES License Number Lic.Class 96-w ., LIMITED TIME USE Contractor Date i DATE DATE I am exempt from the licensing requirements as I am a t PROM: TO- licensed architect or a registered professional engineer I' SIZE OF No.OF I INSPECTOR'S SIGNATURE acting in my professional capacity (Section 7051., Bus- EXISTING BLDG. STORIES ll-- A / iness and Professions Code). ! F1NAL APPROVAL Lic.or Reg.No. Date PRESENT USB OR BUILDING Ij 14- HOME OWNER-BUILDER DECLARATION NO.OF EXISTING BUILDINGS ?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- ness usiness and Professions Code): NO.PARKING SPACES PROVIDED I, as owner of the property, will do the work and the ti structure is not intended or offered for sale (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING I i I hereby affirm that there is a construction lending agency ` A44 AW l , for the performance of the work for which this permit is issued(Sec.3097,Civ.Q. Lender's Name t PROPOSED MAX.OCC. Lender's Address I certify that I have read this application and state that the PERMIT FEE t ;.: rill above information is correct.I agree to comply with all County 1 ISSUANCE FEE ordinances and State laws relating to building construction, and hereby suit orize representatives of this County to enter TOTAL FEE 25.'00 � on fire bove npntioned property for inspection purposes. I. SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Pertnittee Date '' `'n WORKERS'C'OMPEIVSAf1ON DECLARATION zouol;anPwlz,,flo 19V. SCELL.ANEOU,)S APPLICATION 1 hereby affirm that I have a certificate of consent It. sell' COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure,or a certificate or Workers'Compensation Insuran e,or a certified copy thereof(Sec.3800, Lab.C) )� Policy No..— - Company FOR APPLICANT TO FILL IN 'BUILDING BUILDING ADDR SS hh 11WADDRESS I Certified copy is hereby furnished. TQ 10Ci , ¢ 1t7 Cr LOCALITY Certified copy is filed with the county building inspection CITY zip, '•� i department. NEARESTCROSS ST. ! Date•—_- .-.- Applicant _ - �' SIZE OF LOT. NO,OF BLDGS.NOW ON LOT DISTRICT NO. GROUP TYPE PROCESSED BY CONST. I' CERTIFICATE OF EXEMPTION FROM WORKERS'' C TRACT BLOCK LOT No. COMPENSATION INSURANCE I MAP HIGHWAY L: NO.' (CIRCLE) STATE MAJOR SECOND LOCAL (This section need not be completed if the work invilived ASSESSOR MAP BOOK PAGE PARCEL by thepermit is for,one hundred dollars ($1000 or'less.) USEZONE SPECIAL CONDITIONS 1 certify that in the performance of the work R)r which this owNI;R" Q�9 �' � permit is issued, I shall not employ any person Til any manner — --� 1,- so as to become subject to the Workers' Compen,ati(111 Laws. ADDRE s ` / OCCUPANCY GROUP • 235 S �f�awf. C �3�� / � I-ra a. Date Applicant . ... :.__..._....... _ .II CITY ZIP�/ nU NOTICE TO APPLICANT: IC alter making this Certificate �J OCCUPANT LOAD of Exemption, you should become subject to the Wol'kers' APPLICATION FOR ! Compensation provisions of the Labor Code.You must forthwith EXIT HARDWARE: ! comply With Such provisions or this permit %Mill be deemed TRAILER USE❑ GEOLOGY INSPECTION❑ I _I i revoked. y No Spec.Knowl. OCCUPANCY INSPECTIONS y Panic Devices ' LICENSED CONTRACTORS DECLARATION ,l 1 1 I I hereby affirm that 1 am licensed under provisions of C hlipter SAFETY PERMIT❑ (LIST ITEMS BELOW) 'Ind Mill Section 7000)of Division 3 of the Business - NO.OF EXITS L and Professions Code,and my:license is in hill force andeffect. AI�� ♦ tislnt&5� 1• 1 '� PARKING• REWD D PROVIDED D ' I License Number Lic.('lass SPACES` x _-�q'vt Ni �Q , . � ) I Contractor Date ' --- - —!I LIMITED TIME USE i I DATE DATE ❑ I am exempt from the licensing requirements as I �m a FROM: To: licensed architect or a registered professional engineer F - acting Ill my professional capacity(Section 7051. 11119:[less SIZE OF NO.OF INSPECTOR'S EXISTING BLDG. STORIES SIGNATURE and Prolcssiuns Code). ) _ Lie or Reg. NaDt1tL T USE OF BUILDING 3.FINAL APPROVAL O ! .---._....-_.. .._--.--.• -- - •�� PRESEN11„�,,,� ! (Z - 1 HOME OWNER-Bl11LDER DFULARAI•ION l NO.OF CXISTING BUILDINGS 1 I ON LOT AND USE - ) hereby affirm that I am.exempt frons the C'ontractor's Licmisc — Law for the following reason (Section 7031.5, Business and Professions Code): NO,PARKING , SPACES PROVIDED iEl 1. as omner of the property, will do the work ani the - 4 structure IS not intended or offered 1m sale(SeeflUll�7t)•I•l, PROPOSED USE OF BUILDING I Business and Professions Code). :.I I I�Sfi�,Ya�lfi CONSTRUCTION LENDING AGE'NC'Y 1 hereby affirm that there is a construction lending,agene3y lir the performance of the work lir which this permit is i:sucd V ! (Sec.3097,Civ.C.). PROPOSED MAX.OCC. Lenders Name _.___.. .—:....... .. APPLICAN JEWINT) (� R' TEL NO. E Lender's Address ...__. ... -_ I X ADDR s . -��t/ Nl�lv 2 Wr 1 certify that I have read this application and state tI111� the 1 ��° S�U�t A �LL' �� above information is correct. I agree to comply with all C t.)Linty PERMIT FEE I ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE the above-mentioned property for inspection purposes. ' �•• I \ ' TOTAL FEE X SEE REVERSE FOR EXPLANATORY LANGUAGE i of Permits •ate I, -- 1''URI:L'It5'(:OAIPENSATION DECLARATION 'I CE 875(11.1341 M ISCELLANEOUS APPLICATION CE 875 I hereby affirm that 1 have a certificate of consent to selfon insure, or a certificate of Workers'Compensation Insurance,or COUNTY OF LOS ANGELES••• IBuI'LD`tNG ANN I%FfLY-I3LuI:SIdN a certified copy thereof(Sec.3800,Lab.Q. Policy No. Company FOR APPLICANT TO FILL IN /{DDREss � �3 / 01 Certified copy is hereby furnished. `_ it uiyc Q z ( C '1 /J �✓- X} .J NL.dE$$ S IC,l TQC Q I I.�V , e- Q`f'� LOCALITY Certified copy is filed with the county building inspection LOCALITY NEAREST department. ][}:1 CROSS ST. Date _Applicant C'-"'" CROS SR_ LAf 7uh9t li ISO, GROUP CONST. 1paO�CESSED BY CROSS ST. 1 l //rr of/ ITYPE CI-RTIFiCATE OF EXEMPTION FROM WORKERS' LEGAL Co,' COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK M^P HIGHWAY(CIRCLE) STATE MAJOR SECOND LOCAL NO. NOF SLOGS. ('Phis section need not be completed if the work involved : TRACT NOO.W ON LOT U4SE 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 c permit is issued, I shall not employ any person in any manned I. OWNER of building �` Ile 50&o Com 9ELI so as b1 become subject to the Workers' Compensation LaW�_� .. (� y OCCUPANCY GROUPC ADDRESS Z7o , *Aft -tm 8W/ r Date_—. Applicant 11 � NOTICE TO APPLICANT: If,after making this Certificate of I CITY A 01., V9 NO. R-(&- 2_91-�-O OCCUPANT LOAD Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE: ('ompensation provisions of the Labor Code, you must forth- 1 ❑ with comply with such provisions or this permit shall be TRAILER USE❑ GEOLOGY INSPECTION ❑ No Spec. Knowl. deemed revoked. OCCUPANCY INSPECTION❑ Panic Devices ❑ I ICENSE)CONTRACTORS DECLARATION I hereby affirm that I ata licensed under provisions of Chapter SAFETY PERMIT❑ (LIST ITEMS BELOW) 9 (commencing with Section 7000) of Division 3 of the Bus' NO. of EXITS cress and Professions Code,and my license is in full force a effect. a"N me o� business PARKING RXWD � PROVIDED ' I _ SPACES LL�� License Number ____._..._ — Lic. Class (I eh+a7 t7C a ot O LIMITED TIME USE Contractor._—. _.__.—_ Date I i Dwre DArs '' FfIOMI TO: FJ t am exempt from lite licensing requirements as I am a 71 licensed architect or a registered professional engineer SIZE OFF INSPECTOR'S acting in my professional capacity (Section 7051, BUS' EXISTING BLDG. STORIES sl NATURE iness and Professions Code). I FINAL APPROVAL —N,Lic.or Reg.Nu.. ._—_...___ _ Date PRESENT USE OF BUILDING 3` c7 I , a HOME.OWNEF R-i)(1ILDER DECLARATION NO. OEXISTING BUILDINGS n, y^, _ j' 'i r4 ON LOT AND U96 VV � •��,�{- �L� 1 hereby affirm that I :un exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): NO. PARKING 1, 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). ' PROPOSED USX OF BUILDING Ii CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for lire performance of the work for which this permit is issued(Sec. 3097,Civ.C.). Lender's Name ____--_ PROPOSED MAX. OCC. Lender's.Address...... I certify tlwt I have read this application and state that the PERMIT FEE 25.00 .� ` above information is correct.l 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 1 TOTAL.FEE 25.00 iipoir site above-inentionecl property kir inspection pupL I (�SEE REVERSE FOR EXPLANATORY LANGUAGE '