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Home My Public Portal About4880 ARDSLEY DR_Building__ WORKERS'COMPENSATION DECLARATION insureboraafcertif cafirm tharte of Workers' Compensation eInsuran e, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NopC 975 SRS:ompanyPt— lir r =nApmn-i ty EJ Certified copy is hereby furnished, FOR APPLICANT TO FILL IN ADDRESS OCertified copy is filed with the county building inspec- BUILDING Tion department. ADDRESS., 4880N. Ardsley LOCALITY 11-1-86 R'andol Roofing' NEAREST . Date Applicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one US NE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. / NO. TEL SPECIAL Y I certify,thot in the performance of the work for which this OWNER DorotY y. Smith NO CONDITIONS� CONDITIONS a permit is issued, I shall not employ any person in any manner DISTRICT PG OUP TYPE FIRE PRO SSED BY O so as to become subject to the Workers'Compensation Laws. ADDRESS 4880 N. ArdSle ' CONST. ZONE Date 8-28-86 Applicant Randol Roofing CITY ZIP O ARCHITECT OR TEL. STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after making this'Certificate of ENGINEER. NO. Exemption, you should become subject to the'Workers' CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP H with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR TEL'NO. _ BK.(;;- PG, VALIDATION LICENSED CONTRACTORS DECLARATION 529 E. Valle LIC 451937 I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS y NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY San Gabriel CLASS C-39 s1688.00 ►SQ. FT. NO. OF NO.OF CHECK License Number 451 9'17 Lic.Class C-39 SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK Re—roof house & NEW El $ Contractor Randol Roofing' Date f;-28-86 Q = ADD M I am exempt under Sec. "A" — ALTER FINAL ®_ n ® - p B.&P.C. for this reason glas shingles. DATE Date: USE OF DEMOL FIN EXISTING BLDG. SFD By Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT).Randol NO 2R _ I hereby affirm that I-am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS 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- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT �5 3 7,3 A the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE o Lender's Name Lender's Address P.C. Fee$ Permit Fee 39.38 I certify that I have read this application and state that the Issuance Fee 10.50 . l above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee 49.88 ` s u and hereby authorize'representatives of this County to enter m upon rth4 enti ned roperty for inspection purposes. < ONa SEE REVERSE FOR EXPLANATORY LANGUAGE. 8-28-86 ignature of Applicarf or Agent Date - ®s COUATY 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 91780 BL 0508 9901260064 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 14647 LT: 41 SQ. FT STORIES TYPE OCCUP GROUP 4880 ARDSLEY DR STRUCTURE: 595 1 VN R3 TEMP CA 917803801 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: TEMPLE CITY BLVD. 8590-016-005 OTHER: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXP ES ON: EXIST OCC GRP: 01/27/99 UT 01 7/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: LEE; BORNE (626) 285-3326- 1 44,000AA S 4880 ARDSLEY DR `- TEMP 917803801 FEES PAID DESCRIPTION OF WORK / ADD 1 BEDROOM,BATH AND NEW FAMILY R OM FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: ,LAI (626) 442-6718- AA BLDG PERMIT ISSUANCE 27.75 3535 TEMPLE CITY AC STRONG MOTION_RESID 44000.00 VAL 4.40 SPECIAL CONDITIONS: ROSEMEAD, CA AX BUILDING REVtEW=FEE_ 54.70 B2 PERM IT�WANERGY pD��l L��T TA��EES VAL 788.21 CONTRACTOR:MIU TEL. N281 3881 APPROVALS DATE INSPECTOR SIGNATURE 1715 SIERRA VISTA AVE. LIC. NO LOCATION AND SETBACKSLX ALHAMBRA, CA 91801 755456 B _ ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FSS LIC. N0: / 1111111 SLAB/UNDER FLOOR IL , RAISED FLOOR FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-_ n n QO �� 0 �K 8 UNDERFLOOR INSULATION j I' �I�JJ O ST LEVEL FLOOR SHEATH,,,- NO. HEATHiNO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:— NO LASS:NO 21 \� p _;I ND LEVEL FLOOR SHEATH ni res SCHOOL WITHIN HAZARDOUS T* ROOF SHEATHING- AIR QUALITY: 1000 FEET MATERIALS ❑ �}, NO NO NO FIRE DEQ FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST ��O ®dam BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: 0 �" FRONT PL- ° �'rvoce��4i SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP J61, INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE 11 SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508