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Home My Public Portal About5622 CLOVERLY AVE_Building__ 76AG8,¢A DDS 3 12 54 APPLICATION - FOR BUILDING PERMIT ,DIVISION OF BUILDING AND SAFETY BUILDING 02� Deportment of County Engmeer ADDRESS + County of LOB Angeles LOCALITY WM J FOX COUNTY ENGINEER CASSATT D GRIFFIN SUP T OF BUILDING NEAREST CROSS ST DISTRICT NO GROUP - SEWER MAP FOR APPLICANT TO FILL IN T PEEK PG BUILDING !� CONST i� ADDRESS MAP 16 7 -STATE YES �O 1 NUMBER CJ HWY LOT NO S r �/ 2� BLOCK USE ZONE SPECIAL • �.., CONDITIONS TRACT - ,y,,,, ,ti Q NO OF BLDGS t-�Q . SIZE OF LOTa V O I NOW ON LOT BUILDINGEXIST USE OF - SETBACK YARD HWY STREET NAME WIDTH EXISTING BLDG FRONT00' P L /o /J OWNER ' SIDE v MAIL cf2��l�A P L ADDRESS ! - - �+ TEL ' DWELL 1 UNITy 5 INDUSTRIAL CITY v NO 2 DUPLEX-UNIT 6 PUBLIC BLDG ARCHITECT R TEL ENGINEER NO 3 APT UNITS 7 ADDN ,ALT, ETC ADDRESS 4 COMMERCIAL 8 MISCEL ' TEL CONTRACTO 0 INSPECTION RECORD ADDRESS - ` e 9 9AZ / DESCRIPTION OF WORK �v� J NEW ADD ALTER REPAIR DEMOLISH SQ FT /r' NO OF / NO OF SIZE J STORIES ` FAMILIES USE OF STRUCTURE �&Io._ TRUCT RE _ _ Bim'� i SIGNATURE O APPLICANAPPROVALS ADDRESS DATE INSPtIECTOR.S SIGNATURE fFOUNDATION LOCATION (1 , 5 ` . /� P C. S DG FORMS MATERIALS ,{Iw , .S� lnnYa FEE FRAME FIRE STOPS 1 VALUATION f d"B BRACING BOLTS FEE !' FURNACE LOCATION F v GAS VENT DUCTS 1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT AND STATE LAWS REGULATING BUILDING CONSTRUC- TION - LATH, EXT a' SIGNATURE OF HOUSE NUMBER COR- PERMITTEE �V'� IRECT AND POSTED 'ADDRESS FINAL WM. J. FOX. CcuNTY F_NGINESR VALIDATION v 4-1 6 1.5 0-0 e ® _ oIY5-2 w 14- - 1 3 2.0`0 UT v^ DEPUTY z4UT R�- BY BY r ® l DEPUTY DEPUTY WORKERS COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate ofCm �Workers Compensation Insurance or a certified copy thereof (Sec 3800, Lab C ) Policy No416 347-8ompany 'State FundCOUNTY OF LOS ANGELES BUILDING AND SAFETY,, BUILDING ❑X , Certified copy is hereby furnished r FOR APPLICANT TO FILL IN ADDRESSc3o Certified copy is filed with the county building inspec- BUILDING ' tion department ADDRESS 5338 'Cloverl Ave. LOCALITY Date 6/14/85 ApplicanT CEDAR DMFS M-, CITY 'ZIP 917 CROSSSST j J CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR U COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK I PAGE PARCEL (This section need not be completed if the permit is for one r US Z NE MAP TRACT BLOCK LOT NO l hundred dollars ($100)or less ) - �� NO' TEL I SPECIAL } -I certify that in the performance of the work for which this OWNER Vesse NO 287-0852 CONDITIONS' r^ d permit is issued, I shall not employ any person in any manner DISTRICTn� o GROUP TYPE FIRE PROC SSED BY O so as to-become subject to the Workers' mpe tion aws ADDRESS _ j�� CONST V/ Z E s ec i CITY 1 1 ZIP 1 C O Date Applicant STATISTICAL CLASSIN TION APT C U NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR - TEL Exemption, you should become subject to the Workers ENGINEER NO CLASS NO DWELL UNITS IT Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP- with comply with such provisions or this permit shall be deemed revoked CONTRACTOR f NO2 4- 1 BK PG _ VALIDATION EL LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO 15761 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 Alharn tra 1 'CLASS —tSQ FT OF NO OF C,License Number 1 57613 Lic Class C—_19 SIZE RIES One FAMILIES ONE $ C Contractor EA r BMfc; Cn.Date 6/14/85 DESCRIPTION OF WORK reMVe eX],Sta_ncrNEW ❑ I am exempt-under Sec fin.g & re—roof With cedar ADD 1 ❑ es pressuretreated. ALTER ❑ FINAL - DATE -� B$P C for this reason USE OF . REPAIR ® # 0 0 10,67 ' � Datre EXISTING BLDG DEMOL ❑ FIN B /7,1Y 11111,420 Signature^/ �L c� L��-C/ APPLICANT o&eir-r �I �TfdN�/STEL OWNER-BUILDER DECLARATION PRINT NO 284-71 j hereby affirm that I am exempt from the Contractor's License y Law for the following reason (Section 7031 5, Business and ADDRESS . Maren Alharibra 508 S Professions Code) ' BUILDING I, as owner of tRe property, or my employees with ADDRESS ' ' 2 3 114 A V wages as their sole compensation,will do the work and . , ` the structure is not intended or offered for sale(Section _ LOCALITY " ,a _ 0 0 0 0 1 . 7044, Business and Professions Code) k MOVING TEL " CONTRACTOR NO I 01,N92 5 9 6 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS o e o. '2 5 tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM• EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 06247 5 I hereby affirm that there is a construction lending agency for FRONT " - the performance of the work for which this permit is issued P L _ - , (Sec 3097, Civ C ) SIDE oil. r Q ,Lender's Name t P L Lender's Address y P C Fee$ Permit Fee 86.25 ' 2 3 1,5 A i 0 I certify that I havereadthis application and state that the Issuance Fee o above information is correct I agree to comply with all County Investigation Fee p b I o 096,75 ordinances and State-laws relating to building construction, Total Fee. and hereby authorize representatives of this County to enter °`0 A U zz�= or inspection purposes �, v = - ° 96,75M c. o � 1p ,-- - SEE REVERSE FOR EXPLANATORY LANGUAGE y = Signature of Applicant or Agent Dat * •' ®s WORKERS COMPENSATION DECLARATION _ -1 hereby affirm that I have certificate of consent to self APPLICATION FOR B U I L D I N G PERMIT insure, or a certificate of Workers' Compensation Compensatton Insurance, "�+ or a certified copy thereof (Sec 3800, Lab C ) r Policy 4r4o 9 7 5 5 8 5 Com%gpub 1 i c Indemnity" 3 - _`COUNTY,OF LOS ANGELES „ BUILDING AND SAFETY +' t k DING Certified copy is hereby furnished - FOR-APPLICANT,TO FILL-IN ADDRESS (� Certified copy is filed with the county building inspec' BUILDING JLJ tion department ADDRESS922 LOCALITY n y 014 IF NEAREST Date 11-1-'85 Applicant Randol Roofing CITY Temple 'Cit Ca , ZIP '91780 CROSSST 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 ,s for,one ' ' USE ZONE MAP hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO TEL SPECIAL' } I certif that in the performance of the work for which this, OWNER NO 287-51 CONDITIONS a permit is issued, hshall not employ a'n erson,m an manner ` D STRICT GROUP ITYPE,',, FIRE PRO ED BY O p P y^ ypyADDRESS 5622 N. Clovbrly CONT ZONE ) U so as to become subject to the Workers Compensation Laws w + ce Date A-5-8 5 Applicant Ra n c3 a 1 R c)n f L n g CITY ZIP STATISTICAL CLASSIFICATION APT C DO + O ARCHITECT OR TEL �7 j NOTICE TO APPLICANT' If, after making this Certificate of ENGINEER - NO " / / U CLASS NO _DWELL UNITS W Exemption, you should become subject to-the Workers' - ' d. Compensation provisions of the Labor Code, you must forth- a ADDRESS - SEWER MAP W with comply with such provisions orrthis permit shall, be RaridO ROO 1rigfEL28_,8-4040 z ' deemed revoked CONTRACTOR '_ NO BK PG + VALIDATION - LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P BOX 303 NO 4 S T 9 3 7 VALUATION (commencing with Section 7000)of Division-3 of the Business and San G a b r i e l C a , ILIO C-39 3728 . 00 Professions Code, and my license is in full force and effect CITY r CLASS $ 4 519 3 7 C-3 9 SQ FT NO OF - NO OF '�` ` CHECK License Number L,c Class SIZE I STORIES FAMILIES ONE $ Contractor Rando 1 Roof 1 n[56Te_ 9-5-85 DESCRIPTION OF WORK - NEW ❑ ❑ I am exempt under Sec and garage with 3 'D-1`men- ADD - ❑ " - _ slonal fiber g1a's"� ALTEFINAL ❑ B 8P C for this reason - REPDAT 0-6 ,r r AIR Date = USE OF b 1i L 11 DEMOL FIN - EXISTING BLDG - - By Si nature r APPLICANT TEL f _ g PRINT Randol Roofing No 288-404 ` OWNER-BUILDER DECLARATION ty I hereby affirm that I am exempt from the Contractor s License P . O. B o x 3 0-3 . S . G. 91778 n� 2 8 9 2 A , Low for the following reason (Section 7031 5, Business and ADDRESS _ _ e • o`o o Professions Code)' r PRESENT - A t BUILDING _ r o ®l• (� U I,.as owner of the property, or my employees with ADDRESS f o b x wages as their sole compensation,will do the work and 8 5 the structure is not intended or offered for sale(Section LOCALITY 9 �' r 7044, Business and Professions Code) - MOVING TEL " ❑ I CONTRACTOR - NO' - ^ j, as owner of the property, am exclusively contractingt with licensed contractors to construct the project (Sec- ` c tion 7044, Business and Professions Code) ADDRESS. ', CONSTRUCTION LENDING AGENCY i REQUIRED YARD HWY TOTAL SETBACK FRO]3- Lender's SET BACK PROP LINE I hereby affirm that there is a,construction lending agency for FRONT-the performance of the woik for whIC this permit,s,,ssued `Pi'(Sec ,3097, Gv C ) SIDEo PLLender s Name PC Fee$ Permit Fee rj Address ^ $1-I certify thai I have read this application and state that the _ Issuance Feeabov'e information is correct I agree>to,comply with all County Investigation Feeordinances and State jaws relating to building construction, � and y authorize re resentatryTotal Fee es of this County to enter up n abo - enc n d pro�yert or mspection purpo/s s - — SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of pplicant or Agent Date Os COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0506020074 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ON FILE SQ FT STORIES TYPE 5622 CLOVERLY AV o STRUCTURE 3100 VN TEMP CA 917802550 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET BROADWAY 8588-006-006 THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY C TENANT EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY EXPIRES ON EXIST OCC GRP 06/02/05 JK 05/28/06 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE FINAL BY CODE DABROWSKI CAROL A (626) 614-0025- 7 460 ' //y�� % 5622 CLOVERLY AV �``� "_-(2 TEMP 917802550 FEES PAID D CRIPTION OF WORK TEAR-OFF EXISTING ROOFING REROOF HOUSE AND DETACHED GARAGE FEE DESCRIPTION QUANTITY UOM AMOUNT WITH CLASS A BUILT UP FIBERGLAS ROOS SYSTEM APPLICANT TEL NO RANDOL ROOFING & CONSTRUCTION (626) 288-0140- AA BLDG PERMIT ISSUANCE 27 75 2304 TROY AVE AC STRONG MOTION RESID 7460 00 VAL 0 75 SPECIAL CONDITIONS SO EL MONTE 91733 D2 PERMIT W/O EN-HC 7460 00 VAL 183 00 TOTAL FEES 211 50 CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE RANDOL ROOFING AND CONSTR CO INC (626) 288-8080- 2304 N TROY AVE LIC NO LOCATION AND SETBACKS S EL MONTE, CA 91733 451937BC39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS LIC NO SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDER=LOOR INSULATION 147H265 3 01 FLOOR SHEATHING NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD HWY PROP LINE WIDTH FRONT PL- INSUL^TION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR'CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO BS0508