HomeMy Public PortalAbout5743 - 5745 - 1/2 CLOVERLY AVE_Building__ 76AS:IPA4013B-3 3-58
APPLICATION FOR BUILDING PERMIT �.
DIVISION OF BUILDING AND SAFETY BUILDING
ADDRESS fr
Department of County Engineer
County of Los Angeles LOCALITY if
WM.J. FOX, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST.
DISTRICT NO. TYPE SEWER MAP
FOR APPLICANT TO FILL IN G OUP� )LDING ) �y CONST
TATE
ADBU'DRESS 0 N MA ER C+G_Op SHWY YES NO
� y` USE ZONE SPECIAL
- '
LOT NO. O, e BLOCK
CONDITIONS
TRACT - y V L°L
SO /� �QI NO. OF SLDGS. BUILDING EXIST.
SIZE OF LOT NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH
USE OF
EXIST,NG BLDG. Wo& T_f gdj�-t ) FRONT /�, ,
P.L. Cl C�
OWNER SIDE
(/ P.L.
ADDRESS� � �,•�U �/ O TRACT DW L. I UNIT
5 INDUSTRIAL
/� TEL. �,.y 1 DWELL. 1 UNIT
CITY }f�iL6-CZ NO.t� le .J�71f!x - 6 PUBLIC BLDG.
ARCHITECT OR TEL, 2 DUPLEX 1 UNIT 7 ADDN.. ALT.. ETC.
ENGINEER NO. 3 APT. UNITS
8 MISCEL.
ADDRESS 4 COMMERCIAL
CONTRACTOR NO' INSPECTION RECORD
ADDRESS 12 hedd" gTai x
y ,DESCRIPTION OF WORK
NEWS ADD ALTER REPAIR DEMOLISH
SQ. FT. NO. OFNO. OF
SIZE STORIES FAMILIES
USE OF R C URE _ f
SIGNATURE OF ..fir
APPLICANT APPROVALS
ADDRESS DATE INSPE TOR'S SIGNATURE
FOUNDATION: LOCATION
$ I P. C. °J FORMS, MATERIALS
76 AJ V FEE FRAME: FIRE BRACING. BOLTS S ap sa 1 f N t
VALUATION $ /1
FEE v` FURNACE: LOCATION,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
GAS VENT,DUCTS I
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. a� ✓ t t,,,+(I
AND STATE LAWS REG ATING BUILDING CONSTRUC-
TION. LATH, EXT. 8{ V
SIGNATURE OF ./�/ HOUSE NUMBER COR- M1nJ
PERMITTEE RECT AND POSTED l �7 _r4LA_
Yv
ADDRESS FINAL 4
WM.J. FOX,COUNTY ENGINEER VALIDATION C. N. DIRLAM, CHIEF BLDG. INSPECTOR
LAC,0 4 ,0- 5 0- JAN 10 1 6 1 0.q1 9 2- JAM 16 2 0.0 0
: e
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self A P P L I CAT I0 N FOR BUILDING P ERM I T
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. 101+hl40 Company -State Fiord '
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN aooREss 7A 3
r> . ?A
0 Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS 5743-45—% Cloverl T.C. . 91780 C
t
O
Randol Roofing CITY T'Cy. ZIP G j
LOCALITY
Date-111-1—W1 Applicant' g NO. OF BLDGS.
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF..LOT . NOW ON LOT NEAREST
CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK - LOT NO. MAP BOOK PAGE 'PARCEL
hundred dollars:($100) or less.) TEL.
OWNER. George Pettet NO 443-49.17 USE ZONE MAP
I certify that,in the performanceof the work for which this SPECIAL
permit is issued, I shall not employ any person in any manner - ADDRESS 10106 Landseer SPECIAL
CONDITIONS
so as to become subject to the Workers' Compensation Laws. CITY T.Cy' ZIP 91780 OU
10-26-89 Randol Roofing U
Date Applicant ARCHITECT OR TEL. DISTRICT G TYPE FIRE ' ROCES ED B
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CON r O
Exemption, you should become subject to the Workers' ADDRESS /� S1 a
Compensation provisions of the Labor Code, you.must forth- w
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT: CONDO. N
deemed revoked. CONTRACTOR NC.288-4040 z
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
ADDRESS 529 E. Valley Blvd No 451937
1 hereby affirm that I am-licensed under provisions' Chapter SEWER MAP
(commencing with Section.7000)of Division 3 of the Business LIC.
CITY San Gabriel, Ca.. CLASS C-39
and Professions Code;'and my license is in full force and effect. BK. PG. VALIDATION
45.1937 (,-39. SO. FT. NO. OF NO:OF CHECK
License Number Lic: Class SIZE STORIES FAMILIES ONE
Re—roof houses VALUATION
Contractor Randol Roofing Date I-30-90 DESCRIPTION OF WORK NEW ❑
garage and s.hed with irescree DD ❑ $ 2945.00 ►
❑1 am exempt under Sec.
#220. fiberglas shingles. Class�ALP
B.&P.C. for This reason AI 0]REPAIR ® $
ff
Date: USE OF , •
EXISTING BLDG. SFD DEMOL ❑
Signature APPLICANT TEL.
g (PRINT) Randol Roofing NO. 288-4040 FINAL
OWNER-BUILDER DECLARATION ---DATE
I hereby affirm that I am exempt from the.Contractor's License 529 E. Valley.Blvd. S.G i 917.7.6 , V 1 y
Law for the following reason (Section 7031.5, Business and ADDRESS IF
Professions Code): PRESENT. -'By 11A_/_
_ a'•t'•� a
BUILDING Fid• I°g
❑, ,,I,.ias owner of the property, or my employees with ADDRESS a --t -,_j
wages as their sole compensation,will do the work and �!� - i 7 330 :r7°t•.
The structure is not intended or offered for sale(Section LOCALITY ii ITEMS 7044, Business and Professions Code.) MOVING, TEL 1 1{Gi S
El 1, as owner of the property, am exclusively. CONTRACTOR NO.contracting TOTAL 59. 25
with licensed contractors to construct the project (Sec- ADDRESS c ❑ -c
tion 7044, Business and Professions Code.) �•r�E�•4! :t%°.:.•.t
REQUIRED TOTAL SETBACK FROM EXIST. �•LL.�� {�
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 5alANGE °00
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 �-y {
Lender's Name,
°c3
V Lj 1 �{ °LDMA Ref. #
P.C. Fee$ Permit Fee ._r
Lender's Address ,
0 1 certify that I have read this,application and state that the Issuance F 0 LDMA P/C#
above information is correct..'agree to comply with all County Investigation Fee
8 ordinances and State laws relating To building construction, al Fee 59.25 LDMA Perm. #
a and h by authprizje repr totives f 1 is County to e ter
up th ov ntion pert or.' spection/pJurp se
(/ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Ap icant or Agent ate -