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HomeMy Public PortalAbout6644 CLOVERLY AVE_Building__ 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 1202150055 PHONE: (626) 285-0488 EXT: (LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I. ON FILE I SQ. FT STORIES TYPE I 6644 CLOVERLY AV 1 (STRUCTURE: 1800 V-B 1 ARCD CA 910077715 (ASSESSOR INFORMATION NUMBER: 1 NEAREST CROSS STREET: 15382-010-0251 I THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: I IEXIST OCC GRP: 102/2.5/12 SR I I I I I 10WNER: TEL. NO: 'IBLDGS. NOW ON LOT: VALUATION: 1 INAL DATE FINAL BY: CODE: I ISTOREY, GLENN 6,200 I 16644 CLOVERLY AV I I (ARCD 910077715 1 FEES PAID 16ESCRIPTION OF WORK I I 1TEAR.OFF EXISTING COMP ROOF TO WOOD SUBSTRATED REPLACE W/30 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IFIBERGLASS SHINGLES I (APPLICANT: TEL. NO: I I I (FISHER, THERESE (951) 990-3157- IAA BLDG PERMIT ISSUANCE 27.80 I I JPO BOX 4134 IAB STATE GREEN BLDG FEE 6200.00 VAL 1.00 1SPEC�AL CONDITIONS: I ISAN DIMAS CA 91773 IAC STRONG MOTION RESID 6200.00 VAL 0.60' I 1 I ID2 PERMIT W/O EN-HC 6200.00 VAL 166.60 1 I I _I TOTAL FEES 196.00 ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I IBIENEK ROOFING CONSTRUCTION INC. (800) 499-1340- I 1 I 19707_PINEWOOD AVENUE LIC. NO I ILOCA'14ION AND SETBACKS I I I ILOS ANGELES, CA 91042 885157C-39 I I I I I I I (SOILS ENGINEER APPROVAL I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I 1 LIC. NO: I (SLAB/UNDER FLOOR I I I I I IRAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP?I ( (UNDERFLOOR INSULATION I I I156H265 3 00.1 I _I IFLOOR SHEATHING I I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I _ I I I I I 0 NO 21 I IROOF(SHEATHING I I I II SCHOOL I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I 1. 1-1 I NO NO NO 1 1FRAME' INSPECTION 1 1 I IFIRE�SPRINKLER HANGERS 1 1 I - (INSULATION/WEATHER STRIPI I I I IINTE(21_OR LATH/DRYWALL I I I 1 I (EXTERIOR LATH I I 1 1 I IRATED FLOOR/CEIL ASSEM. I I I I 1 IRATED WALL ASSEMBLIES I 1 I I IRATED SHAFTS/OPENINGS I I I I I I I I I I IT-BAR CEILINGS I 1 I I I I I I I I ILOT DRAINAGE I 1 1 I I I I I I 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I 1 1 I I I I I I '.,W,CRKERS' COMPENSATION DECLARATION 'I hereby affirm that I have a certificate of consent to self /Cl\P I���� AU E O�102,r o insure, or a certificate of Workers' Compensation Insurance, [r�u Li CAU R or a certified copy thereof (Sec.•3800, lab. C. ` 'COUNTY.OF L08 AWGELES BUILDING AND SAFETY Policy No. Company BUILDING.. J ❑, Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN' ` ADDRESS CQ ' LQ(/�ie ❑ •Certified copy is filed with the county building inspec- BUILDING ©. �r=i n Q�a,p 1 -• ADDRESS ,G tion department. /1 _ -�51M,919_ � Date A licdnt CIN' 2 f. ZIP I LOCALITY• / 51M 1� e ' PP NO. OF BLDGS. NEAREST ����/ f CERTIFICATE OF EXEMPTION FROM WORKERS' '_ SIZE 0E-10T S/(1 - NOW ON LOT CROSS ST. 'Iti �ti�( - �A l9Q'f2�E• COMPENSATION INSURANCE ASSESSORLtr,' (This section need not be crim 'completed if the is for one TRACT' BLOCK LOT.NO. MAP BOOK PAGE PARCEL -1_2J hundred.dollars.($100) or.-less.) TEL. /, n OWNER �! ':'' L.�S NO.,el S� �i�� USE ZONE NO. A�{� I certify:-that in the performance of the work for which thisSPECIAL- >_ permit is issued, I shall not employ any person in any.manner ADDRESS=U6 r(/yLO(/FlL�E '�/ CONDITIONS o•• \ so as to-b am subject to:the rker ' C s tion L s. _ n 0 \\ CITY ^A/2 CA, , ZIP -' 91007- Date 7. Date Applica 'ARCHITECT OR' TEL. 'DISTRICT. .GROUP. TYPE FIRE PROCESSED BY ., t� NOTI TOA PLICANT: If r making this- ertificate of ENGINEER' _ NO. �J CONST. ZONE ' UUJI, Exem tion, you•should a me subject to`the, Workers' fJ, ` / U Compensation.provision of he Labor Code;you must.forth- ADDRESS _ �' �L/ 3 :(f.. a_ with comply with-such ovisions or .this permit shall be / TEL. STATISTICAL CLASSIFICATION- APT. I'CONDO. Z deemed revoked. CONTRACTOR Lf/ lvrc �>�L�Mfk NO. r.73 /� ' _ -LICENSED CONTRACTORS,DECLARATION LIC. CLASS NO.�DwEu..UN1T5 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7 3 Z �• (, ��y NO C2 SEWER MAP , (commencing with Section 7000)of Division 3 of the Business n, LIC. CITY /9Q(�i¢�/A �A - CLASS and Professions Code,and my license is in full force and.effect. BK. PG. VALIDATION SO:-FT.`. q NO. OF NO. OF. CHECK License Number Lic. Class SIZE- .70/ STORIES FAMILIES ONE Contractor Dare DESCRIPTION OF WORK NEW ❑ VALUATION / / ADD a ❑1 am exempt under Sec. �AJCI OS IST/ t: ❑, . ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF �:. EXISTING BLDG. DEMOL'❑ Signature ` APPLICANT _�r J +/ TEL. FINAL OWNER-BUILDER.DECLARATION (PRINT) "�I`CnS I•]A." Mgtd .£ NO. .?3 7 ' I hereby affirm that 1 am exempt from the Contractor's License DATE Law for the following reason,(Sect 7031.S;.Business and ADDRESS l L VU. � FINAL Professions Code): PRESENT . __.__. .. :`. BY _ 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 inte'nded.or offered for sole.(Section LOCALITY 044, Business and Professions Code.), MOVING TEL. as owner of the ro erT am exclusives contractingCONTRACTOR NO. P P Y,. Y r,_; -with licensed contractors^to.construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. t. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY ' PROP. LINE WIDTH. I hereby affirm that t_here.is.a construction lending agency for FRONT ,. :� ': c 4 ' , ,_I1 'the performance of the work for which*this permit:is issued P.L. _ (Sec. 3097, Civ: C.). SIDE s; sr `�a_.a P.L. Lender's Name A1/� �f' 1 f'` s LUX r P.C..Fee,$ Permit Fee Ref. # int- LDMA 22 Lender's Address / f o I certify that I have read this application and state that the Issuance Fee 2`S' �� LDMA P/C# D •o above information is correct. I agree to comply with all County Investigation Fee d . ordinances and.State-laws relating to building construction, '� Total Fee LDMA Perm. # �-•f!�' • a and hereby authorize representatives of this County to enter _ up e a ove- niton grope 'for inspection pose L SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure•of Applicant or Agent Date !% 'WORI.ERS,COMP' SATION DECLARATION G�pI�dO���Do� �O� C�M���OMG pCRMV I hereby affirm hat I hove a certificate'of consent to self D O D D insure, Sc';a certticate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.'C.)' COUNTY OF LOS ANGELES BUILDING'AND SAFETY Policy No. •. Company. t •� Certified,copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING I " 7 • 44 tion dep rQtment. ADDRESS Date I U Applicant. CITY ZIP LOCALITY C RTIFICATE hF EXEMPTIOJ FROM WORKERS' . NO.6F 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 BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL.q4'`�� USE NE MAP I certify that in the performance of the work for which this OWNER NO. NO. �24 permit is issued; I shall not employ any person in any manner s / SPECIAL. 8fi so as to become subject to the Workers Compensation Laws. ADDRESS ��,��� CONDITIONS CITY ZIP V Date_ Applicant ARCHITECT OR TEL. -NOTICE TO-APPLICANT: If, after making this'Certificote of ENGINEER. NO. DISTRICT GJ�OUP TYPE FIRE PROCESSED Y 0 Exemption, you �should become subject to the Workers' 5 Q� /�j 2 CONST.' E �// U Compensation provisions of-the Labor Code, you must forth- ADDRESS y//Sl J W. with comply with such provisions or this permit shall be �- deemed revoked. TEL U3 f ° STATISTICAL CLASSIFICATION APT. ONDO. to CONTRACTOR` -- l? L NO. O IG' 2 Z LICENSED CONTRACTORS DECLARATION - LIC. CLASS NO. DWELL. UNITS I hereby offirm.that I am licensed under provisions of Chapter 9 ADDRESS' NO. SEWERP (commencing with Section 7000)of Division 3 of the Business and LIC. Profess ions,Code, and my license i1s in full force and effect. CITY ® CLASS BK PG , VALIDATION J' SQ:FT., / NO. OF NO.OF CHECK License Number:31 Lic.Class SIZE % STORIES FAMILIES ONE ❑ NEW VALUATION l DESCRIPTION OF WORK Contractor >✓^-�� Date ADD am exempt under Sec: ALTER B.BP.C.for.this reason REPAIR $ DUSE OF Date: DEMOL EXISTING BLDG. o APPLICANT' TEL. z 8 4 Q 3 A Signature FINAL OWNER-BUILDER DECLARATION PRINT NlO"// /((j DATE z`z� $� I hereby,offirin that I am exempt from the Contractor's License (l ps� FI I 00, 12 o55 9,'2 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PR B m o 0 5 9..2 5 u BUILDING I,'as owner of the property, or my employees withADDR ESS 2 wages as their sole compensation;will do the work and (/ D Q-8 7 the structure,is not intended or offered for sale(Section LOCALITY 7044i-Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec ADDRESS tion 7044, Business and,Professions Code). CONSTRUCTION'LENDING AGENCY. - REQUIRE YARD- HWY TOTAL SETBACK FROM WIDTH I hereby affirm that there'is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name P.C. Fee$. Permit Fee t 73 LDMA'Ref..# Lender's Address I certify that I have read this application and state that the Issuance Fee U e !S� LDMA P/C# D above information is correct. I agree to comply with all County ` Investigation Fee . 0 ordinances and State laws relating to building construction, Total.Fee / LDMA Perm. # 6 and reby a rize representatives of this County to enter upo th abqlva entioned property for inspection purposes. ' n e SEE REVERSE FOR EXPLANATORY LANGUAGE r ignoture of Applicant or Agent Date