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Home My Public Portal About5623 CAMBURY AVE_Building__ fis.... APPLICATION FOR . BUILDING PERMIT 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER nDDaess BUILDING AND SAFETY DIVISION LOCALITY t JOHN A. LAMBIE.COUNTY ENGINEER NEAREST. CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTFII(',y'NO. GROUP TYPE E55 61 BY FOR APPLICANT TO FILL'IN S coNsr BUILDING •� STATISTICAL CLASSIFICATION . 15 KR MAP ADDRESS Q r•�. �&d p57 �1D l_+S/ ��/ 'J BLOCK CLASS. NO. ' y DWELL. UNITS IX LOT NO. i a� MAPSTATE f� NUMBER HWY. YES O TRACT �1 J 7 US-ZONE SPECIAL /" NO.OF BLDGS. / CONDITIONS SIZE OF LOT 4 J I NOW ON LOT - USEOF 0. 1 EXISTING BLDG. % C BUILDING - EXIST.' SETBACK YARD HWY STREET NAME WIDTH ' OWNER % FRONT MAIL 2 B. L: n 'ADDRESS TE F.L. CITY L TV' I INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS TEI. CONTRACTOR NO. ; � • ADDRESS DESCRIPTION OF WORE hI . -Tn ' NEW DD ALTER REPAIR DEMOLISH - / - •�- So FT. //,, NO.OF ) NO.OF G-/9!// _D- ll) �IAAAirio r7 r, SIZE �� oo STT ES / FAMILIES I ASCl/ / - Tn/n irI'fli�i'fT LISFjpF Sj RX D�]f)Ri�Y�� litL7� _• - - �(] eal-ncrt,te W if/n,P7-50V. SIGNATURE OF ' APPROVALS CY . f C,-_Ar APPLICANT DATE INSPECTOR'S SIGNATURE •", ADDRESS �� I FOUNDATION: LOCATION $ ORMS.MATERIALS �L�S�"I Y�/J GXIYO 3�6 / P. G S RAC: FIRE STOPS. CJ FEE Cl BRACING, BOLTS VALUATION S py FURNACE: LOCATION. FEE I GAS VENT• DUCTS ✓ JA I HEREBY ACKNOWLEDGE THAT I HAVE EAE THI5 AP- LATH.INT. PLICATION AND STATE THAT THE ABOVE CORRECT AND AGREE TO COMPLY WITH ALL COU ITY DI ES AND LATH, EXT. /1 ' STATE LAWS R dLATING U IN O CT]ON. SIGNATURE OF HOUSE NUMBER COR. PERMITT �/•J RECT AND POSTED ADDRESS �^ / FINAL II'�8�59 1/W/jYGGGC(A�' CLYDE N. DIRLAM. PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION crc. M.o. CASH LtICO 5 7 2 0 nFRP 7 l q ' 15.00 M ®. kZ/GW�"vvLr - 76A638A CE0803 B-63 APPLICATION FOR BUILDING PERMIT" COUNTY OF LOS ANGELES: BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 5623 No CnMhury BUILDING AND SAFETY DIVISION LOCALITY Temple Cit JOHN A. LAMEIE, COUNTY ENGINEER NEAREST I WILLIAM A. JENSEN, SUPT OF BUILDING. CROSS ST. DISTRICTN}7I G�P TYPE P OCE D BY O FOR APPLICANT TO FILL IN m ' \88%% coNsr. BUILDING STATISTICAL CLA ICATION SEWER MAP ADDRESSo. City ' BK PG CLASS. NO C ELL. UNITS I LOT NQS 5J. - BLOCK WATER NOT REQUIRED a RECEIVED ❑ TRACT - CERTIFICATE: Ilii rr NO. OF BLDGS. NQ __ OO.' faRCLEI HWAY STATE MAJOR SECOND OC SIZE OF LOT NOW ON,LOT USE ZONE SPECIAL USE..OF CONDITIONS ' EXISTING BLDG. f� 1 TEL. R OWNERMrs- O. BUILDING EXIST. / SETBANr CK YARD HWV STREET�NAME WIDTH ADDRESS 62 No.' Cambur Temple Cit FRo . ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. ADDRESS O CONTRACTOR Virgin Roof CO. TEL NO. 287-050 - V ADDRESS 00 SO• San Gabriel Blvd., San - 0 DESCRIPTION-OF WORK- -w NEW. ADD ALTER REPAIR rooE2AOLISH Y / - / / GAJ .,..�-'� Z SO. FT. NO OF NO. OF SIZE STORIES FAMILIES USE OF STRUCTURE Reroof house & att. gar. SIGNATURE IAPPLICANTOF VIRG 1 ROOF CO VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. O FOUNDATION:- LOCATION FEE 3 FEE $80.00 FORMS. MATERIALS _ FRAME: FIRE STOPS, HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .FURNACE: LOCATION. - WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGU EATING GAS VENT. DUCTS BUILDING CONSTR CTION. I CERTIFY THAT IN DOING THE WORK AUTRORIZED HERE Y WILL NOT EMPLOY ANY PERSON IN VIOLA- -LATH INT TION OF,THE LABO E;D OF THE STATE OF CALIFORNIA RELAT- _ ING TO WORKMEN'S yr+TiµSq{Ir (LIF ISO. LATH. EXT. SIGNATURE O VISSL\JJ Li HOUSE NUMBER COR. PERMITTEE RECT AND POSTED ADDRESS Marcia Madden, ect•y. FINAL ^ • u Sa}� Ga ie• JOHN F. LEWIS.'PRINCIPAL STRU URAL ENGINEER PLAN CHECK VALIDATION. CK �;. ABH PERMIT VALIDATION CK. M.O. CASH ;6;1 0<i{ g 'NDV3'0 1 D 8.00— V 9 1 - WORKERS'COMPENSATION DECLARATION } 840577 RL _ '� I hereby affirm that I'have o certificate of consent to"self O D �/(,�. //p�� I��ry�p� �r�} O �r;�( 1p' ��I�p�[/�� r�y��r�} D �r��L//AL� insure, or a certificate of Workers' Compensation Insurance, • _ - (/1l P P L `y(/"L\T O 0 II y Il OR I URDI�I1 V G ll ER L7 U� r or a certified copy thereof (Sec. 3800, Lab. C.) Policy N6V-84±225170Hmpany Fremont Indemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY - BUILDING . Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 64 2 ® Certified copy is filed with the county building inspec- BUILDING .tion department. ADDRESS - 5623 N. Cambury-Ave. LOCALITY. . ` Date 11/9/84 'APPlicant Virgin Roof Co. CITY Temple City ZIP _ NEAREST T.' - .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 _ USE ZONE MAP hundred dollars ($100)or less.) • TRACT BLOCK LOT NO. NO. .0/1 O Q Mrs. Violet Godfrey'TEL' —1 SPECIAL > certify that in the performance of the-work for which this OWNER Y NO. CONDITIONS LL permit is issued, I shall not employ any person in any manner ^ - - DISTRICT GROUP TYPE FIRE PRO ESSEDBY C) sous to become subject to the Workers'Compensation Laws. ADDRESS 5623 N. Cambur Ave. CONST. ZONE V 5 �Y3 C CITemple Cit zip O Date - Applicant STATISTICAL CLASSIFICATION APT. CON H NOTICE TO APPLICANT: If, after making this Certificate'of ARCHITECT OR '. - TEL _ - -- V Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.-.1_DWELL. UNITS_ a. Compensation provisions of the Labor Code, you must forth- - - ,., _ _. _ - Z CONTRACTOR Virgin ROOF NO. 287-0507BK.' with comply with such provisions or.,this Permit shall be ADDRESS SEWER MAP 'deemed revoked. I>O. TEL' - PG, I2-1 VALIDATION LICENSED�CONTRACTORS DECLARATION - LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOX J NO. 168650 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 91778 C1A5S C $ 2417.00 D SQ. FT. NO.OF - NO.OF - CHECK _ License Number 160650 - Lic.Class C39' . SIZE STORIES FAMILIES ONE 'Contractor Vir9 inRoof kDate. -Co. 11/9/84 DESCRIPTIONOFWORK Re-roof house b NEW $ - ❑ 1 0 9 7 A - ADD- ❑ �_ _ ' FiI am exempt under Sec. ciarage with Class & "Al` CM -' -"--"- '• e s e'e E] - ' ALTER FINAL Q # ,1 B.BP.C. forthis reason shingles. 23 sGse Flat area h0 • -❑, DATEJill 'S�Q I e e 59.25 ' ' Date: . _ Drmpf W an grave REPAIR FIN EXISTING BLDG. _ _ DEMOL .❑ APPLICANT TEL By e e e 5 9 2 5 5 Signature -OWNER-BUILDER DECLARATION PRINT Virgin Roof Co. _ No. 287-0507' - - I hereby affirm that l am exempt from the Contractor's License .. 91778 '+ '1.20-84 Law for the following reason (Section 7031.5, Business'and ADDRESS P.O. Box. J. San Gabriel D ' Professions Code): PRESENT I, as owner of the property, or my employees with BUILDINGADDRESS 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. .. F-1. 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 SETBACK YARD . HWY PROP. LINE WIDTH. _ I hereby affirm that there is a construction lending agency for .FRONT.the performance of the work for which this permit is issued P9 I. (Sac 3097;Civ. C.). - - .SIDE - ..... . . - PA. Lender's Name' - p Lender's Address- P.C. Fee$ Permit Fee 48.75 •- _ I certifythat I have read this a licatian and state that the - - PP - Issuance Fee 10 O ' above information is correct. I agree to comply with,all County Investigation Fee ordinances and State laws relating to building construction, Toral Fee 59.25 - b and ereby authorize representatives of this County to mer up n the,ab'ove;mention. operty f r( coon cur�o/ses SEE REVERSE FOR EXPLANATORY LANGUAGE -Sig/.,e of Applicant o ent - Date. ®t