Loading...
HomeMy Public PortalAbout9909 WORKMAN AVE_Miscellaneous__ t WORKERS'COMPENSATION DECLARATION I CE 875 (2-80) M I SC E L LA N EO l�5 APPLICATION CE 875 , ) I hereby affirm that I have certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or I a certified copy thereof(Sec.3800,Lab.C.) Policy No. Company FOR APPLICANT TO FILL IN nnoRess C ❑ 7 Certified appy is hereby furnished. wPOR�ss O LOCALITY f ❑ Certified copy is filed with the county building inspection NEAREST departm& i. LOCALITY r` LL C CROSS ST. Date Applicant NEAREST //� ��S DISTRI NO. RO TYPE PROC SED BY CROSS ST. CONST. CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL COMPENSATION INSURANCE I DESCRIPTION LOT NO. BLOCK MAP HIGHWAY Q ( L N CIRCE STATE MA R SECOND LOCAL j NO. OF BLOGS. ) CL (This section need not be completed if the work involved I TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS 0 by the permit is for one hundred dollars ($100) or less.) I V E I , j SIZE OF LOT EXISTING BLDG. 1/ I certify that in the performance of the work for which this US permit is issued, I shall not employ any person in any manner i OWNERQ so as to become subject to the Workers' Compensation Laws. � MAIL OCCUPANCY GROUP W ADDRESS Date Applicant U3 NOTICE TO APPLICANT: If, after making this Certificate of cITYT "'(/ T `— 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 I TRAILER USE GEOLOGY INSPECTION deemed revoked. ❑ ❑ No Spec. Knowl. ❑ LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices ❑ I hereby affirm that I am licensed under provisions of Chapter ' SAFETY PERMIT L I (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 ' effect. IIL-9 PARKING REQ'D PROVIDED SPACES License Number Lic.Class LIMITED TIME USE Contractor Date I DATE DATE FROM: TO: ❑ I am exempt from the licensing requirements as I am a i licensed architect or a registered professional engineer ,I slzE of NO. OF INSPECTOR'S acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. STORIES SIGNATURE iness and Professions Code). FI PRESENT USE OF BUILDING Lic.or Reg.No. Date AL APPROVAL N �357,8A NO. OF EXISTING BUILDINGS ,. HOME OWNER-BUILDER DECLARATION ON LOT AND USE 1 0 0 0 0 C r � i I hereby affirm that- I am exempt from the Contractor's ' .� ° ° 2 ,8 0.50 License Law for the following reason (Section 7031.5, Busi- ness and Professions Code): No. PERKING f L' ) t SPACES PROVIDED �� 0 8 0 5 C H ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ) 0 7, 12-83 7044,Business and Professions Code). PROPOSED USE OF BUILDING �` CONSTRUCTION LENDING AGENCY 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 I PROPOSED MAX. OCC. Lender's Address I 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 ISSUANCE FEE ordinances and State laws relating to building construction, I TOTAL FEE and hereby authorize representatives of this County to enter I u n abKentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 12 L3 i Signature of Permittee Date N COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0010130008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: N0. CONS NE B LDING—ADDRESS- TR: DDRESS:TR: 6561 LT: 416 SQ. FT STORIES TYPE OCCUP GROUP 9909 WORKMAN AV STRUCTURE: 1 VN R3 TEMP CA 917802231 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: AGNES 8587-030-018 EXIST BLDG USE: RESID THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY EXIST OCC GRP: R3 USE ZONE: R-1 TENANT: ISSUED ON: PROCESSED EXPIRES ON: BLOGS. NO ON LOT: VALUATION: 10/13/00 UT 04/12/01 0 OWNER: TEL. NO: FINAL DATE FIN CODE: LANDRUM TIMOTHY J;ANGELINA - LIST ITEMS: 9909 WORKMAN AV ©-1 7- � TEMP 917802231 DESCRIPTION OF WOR TO FINALIZE' EXPIRED PE MIT FOR HEATALATOR FIREPLACE AND OCCUP LOAD EXIST: WALL REPAIR APPLICANT: TEL. 0: OCCUP LOAD NEW: SAME AS OWNER - PARKING SPACES REQ jAED• SPECIAL CONDITIONS: PARKING SPAC OV DEQ EXIT D'ARE:p►��LS Co CONTRACTOR: TEL. NO:-- LIMITED� FRMITIME USE NB SAME AS OWNER - LIC. NO B W EE PKI APPROVALS DATE INSPECTOR SIGNATURE i FE DESG • ' TY: UOM: AMOUNT: RC ITECT OR ENGINEER: TEL. NO: / RAILER USE e0, PERMI 27.75 LIC. NOR-O111 45.95 SAFETY PERMIT FEES 73.70 TEMP. STRUCT. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: O ��i� o W C W 0o luo---,al K S TEMP. STRUCT. REMOVED 0. OF FAMILIES: DWELLING UNITS: PT CO D: STAT CLAS . O ❑ NO r_ O 0 SCHOOL WITHINAZAROOM— AIR DO S cyr yr,. AIR QUALITY: 1000 FEET MATERIALS If{: NO NO NO El REQUIRED —TOTAL SETBACK FROM EXIST �6� El FSET RONTPL- YARD: HWY: PROP LINE: WIDTH: /L+ Service Tha�� SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508