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Home My Public Portal About4847 ARDSLEY DR_Building__ WORKE.S' CGMPENSATION DECLARATION +• I hep y affirm that I have a certificate of consent to self �' ��'®•� ' -B I IN •PERMIT insure;'or a certificate of Workers' Compensation Insurance, APP �� ora certified ct)py thereof (Sec. 3800,Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY: Policy No. Company + ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN . BUILDING _ ADDRESS Certified copy is filed with the county building inspec- B ILDING LZOZIX /�e tion department: RESS' T [J Date Applicant 1 /•y - 'ZIP LOCALITY c CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT �_ CROSS ST. �—� (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or.less.) �TRACT A J BLO�CKco 7 LOT NO. MAP BOOK PAGE PARCEL 1(NER �/v�/ U//✓ TEL 0. MAZ USE ZONE P j U"Cf_ F / I certify that in the performance of the work for which this NO. 7 7 (� permit is issued, I shall not employ any person in any manner �J�J / �( Q 1 SPECIAL } so as To become subject to the Workers'Co;_gsa ' tjo�nLaws. DRESS S q�/��//lF�� sL1J/� 7 y ~/ CONDITIONS O eiKi�+ �?^7 I Y/`—,l/��C�� C jY ZIP Date Applicant D= NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL.fi�dd/f DISTRICT GROUP TYPE FIRE CESSED BY Exemption, you should become subject to The Workers' ENGINEER NO CONS ZONE r V Compensation provisions of the Labor:Code, you must forth- ADDRESS •moi�D 3 l%!�` ` W with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. COCONDO. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. �� DWELL.'UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ ADD F-1I am exempt under Sec. _ _ — / ALTER ❑ l J B.BP.C. for this reason REPAIR $ Date: USE OEXISTI F BLDG. DEMOL ❑ APPLICANT TEL. # o 8 7 7.5 A Signature PRINT � TEL.'NO. FINAL - 0 0 0•o,1 OWNER-BUILDER DECLARATION 1 DATE, I hereby affirm that I am exempt from the Contractor's License J a,1 2 LI,8 8 Law for the following reason (Section 7031.5, Business and ADDRESS Fl a a 1 2 LI,8 8 5 Pr essions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS Q 1.:1 4' 81 8 wages as their sole compensation,will do the work and The structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name _ LDMA Ref. # m P.C. Fee$ Permit Fee - Lender's Address q g I certify that I have read this application and state that the Issuance Fee — ^� LDMA P/C# ; above information is correct. I a agree to comply with all County Investigation Fee of 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm:# R and hereby authorize representatives of this County to enter upon th above-m ntioied property for inspection purposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date WORKERS COMPENSATION DECLARATION;I hereby ' M' insure.oraa,c'ertif cote'of Worke s.' Compensat on f ate of eInsurance, I nt'to-self /1-�X �L/�� O LI V 0M, LPJ 'or a,certifiecl copy thereof (Sec.'-3800-,Lab.'C ) " IV83-2251 Fremont IndemnityCOUNTY OF LOS ANGELES . BUILDING AND SAFETY Poli"y No: mpany BUILDING' Certified copy is hereby furnished. t FOR.APPLICANT TO FILL-.1N ADDREss'' � n Certified copy is filed with.the county building inipec- BUILDING �' .a,tion department. ADDRESS . 4$47 N'o:ArdSle LOCALITY' c�^✓� NEAREST ba4e 9./21/83 `Applicant Virgin Roof Co. CITY Temple Clty',.: •ZIP CROSS ST', loor CERTIFICATE'OF:EXEMPTION'FROM WORKERS' 'Z. NO. OF BLDGS. ASSESSOR 1. rr E OF LOT NOW ON`LOT MAP BOOK, PAGE PARCEL COMPENSATION INSURANCE SIZ ',(This section•need;not be completed if.tl a permrt.is for,one USE ZONE MAP. hundred-dollars ($100)-or•less.)' TRACT BLOCK LOT NO. NO.' "• TEL SPECIAL I certify.That,in the performdnce of the wok-for., this OWNER NO: CONDITIONS . permit is issued,'I shall not employ any person.in,any manner ADDRESS 4$47 No YArdSle DI CONST' ZONE STRICT GROUP PROCESSED•BY 'so M's to become subject to the Workers.''Compensation Laws. L V = CITY' .; Temple City ZIP t0 "NOTICE''TO APPLICANT:rafter making this Certificate of NO: CLASS NO. N, APT. CONDO: F®. ENGINEER OR. a / LU Date P Applicant STATISTICAL CLASSIFICATIODWELL. UNITS '` " ' Exem tion, you .should become subject ,to the Workers 1� C Compensation provisions of the Labor.Code you:must forth- ADDRESS SEWER MAP • -' with comply-with such provisions or. this per-mit shall'be "z ., deemed revoked. TEL. BK. PG;',. ' - VALIDATION CONTRACTOR NO. — LICENSED CONTRACTORS DECLARATION LIC. hereby affirm that 1 am licensed'under provisions of Chapter9 ADDRES�b 0. Box J.. -:NO. 160650 VALUATION . (commencing with Section 7000)of Division 3 of the:Busmess*d LIC. - Professions'Code, and my,license is in full force and effect..: CITY $ LASS' S '.1.689.00 .SQ. FT. .' NO. OF NO. OF CHECK .License Number i i;nr,5o Lica Class q39, 1 SIZE STORIES FAMILIES ONE D Contractor V#gin- Roof Cil Date 9T1/R3' DESCRIPTION OF WORK Re-roof house' & "E� ❑ ADD RI am exempt under Sec arae `_Jr b 0'.6 A' } ALTER' FINAL , . �.. B.&P.C. for this reason Class .A Com osition shin les. R ; fa o 0 o b DATE Date: REPAIR USE OF. E XISTINCrBIDG. L APPLICANT TEL. D O EM FINAL ...Signature , OWNER,-BUILDER DECLARATION' (PRINT)Virgin-Roof Co : _NO. 287-050 I hereby affirm that I am'exempt from the Contractors License. '. ADDRESS P• Oo BOX"J .Sc'i11 Gabriel 9 1770 Law for the following reason (Section,7031.5,Business and Professions Code): ' PRESENT 2 ° ° 4 9 8-8 . . .. BUILDING ' I, as'owner of The property, or my employees with ADDRESS 0 ° ° 49,886 wages'as their-sole compensation;will do the work and the,structure is not intended or offered for sale(Section LOCALITY o 9,27, 7J 2044, Business and:Professions Code).' MOVING TEL. �. with, r of.the property;.am exclusively contacting CONTRACTOR, '. NO. 1, a5 owner r• sed„contractors'to construct the project.(Sec- ADDRESS tion 7044, Business.and Professions Code). v:REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING.AGENCY •SET BACK' YARD HWY PROP. CINE WIDTH I hereby affirm thatthere;is a construction lending agency for FRONT D the performance of the work for which this,permit is issued. P.L. (Seca 3097;,Civ..C.). SIDE. Lender's Name $ - ” P.C:.Fee$. permit Fee _.Y:39 e38: Lender's Address 1 certify that I'have read ihis'.applcation and state that.the Iss'u'ance fee ..10 above'information is correct I agree to comply.with'.all County Investtgatwn'F'ee49 - . ordinan' s and',State;laws:relating•to'Building construction, Total Fee;:: o Ug and.he eby authorize representatives of this County.to emery $$.` I :upo eteabove-mentioned pro ty for nsp_ction purposes. y Q - • SEE,REVERSE FOR EXPLANATORY LANGUAGE' , Sign` u e of Applicant orAgeni Date ` ®S A COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 92780 BL 0508 0608220049 - PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 14647 LT: 30 SQ. FT STORIES TYPE OCCUP GROUP 4847 ARDSLEY DR STRUCTURE: 190 1 VN R3 TEMP CA 917803802 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: TEMPLE CITY 8590-017-024 OTHER: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C TENANT: - EXIST BLDG USE.: USE ZONE: ISSUED ON- PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/05/07 JK 12/31/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI AL JATFIN CODE: YOUNG ISAAC;ESTHER J (626) 285-8842- 25,000 l ,/ 4847 ARDSLEY DR TEMP 917803802 FEES PAID DE CRIPTION OF WORK .ADD 190 S.F. TO ENLARGE EXI T. BEDROOM, ADD NEW BATHROOM & FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CLOSET AND ENLARGE EXIT. KITCHEN APPLICANT: TEL. NO: PERALTA (818) 523-3373- B1 PLANCHECK W/ENERGY 25000.00 VAL 438.14 7318 VALIAN AVE AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: VAN NUYS CA 91406 AC STRONG MOTION RESID 25000.00 VAL 2.50 B2 PERMITW/ENERGY 25000.00 VAL 515.46 TOTAL FEES 983.85 CONTRACTOR: - TEL. NO.: APPROVALS DATE INSPECTOR SIGNATURE A & WORKERS ASSOCIATES (818) 982-7904- 13141 HARTLAND ST. LIC. NO LOCATION AND SETBACKS NO. HOLLYWOOD, CA 91605 697160 B _ SOI:.S ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: - FOUNDATION/TRENCH FORMS .ry LIC. NO: - SLAB/UNDER FLOOR a _ RAISED FLOOR FRAMING - MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: -' UNDERFLOOR INSULATION 3 01 1ST LEVEL FLOOR EAT - NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: - 1000 FEET MATERIALS NO No NO - FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK. YARD: HWY: PROP LINE: WIDTH: ' FRONT PL- - SHEAR PANELS SIDE PL- _ ell n/,,p.�,, - INSULATION WEATHER STRIP ef a� pc�/V �, INTERIOR LATH RYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508