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Home My Public Portal About4949 DOREEN AVE_Building__ APPLICATIONFOR BUILDING PERMIT COUNTY OF LOS AN ` BUILDING AND SAFETY 'i WORKER'S COMPENSATION DECLARATION FOR APPLICANT Y0'FILL iN BUILDI BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, 4949 Doreen Avenue or a certificate of Workers' Compensation Insurance,or a certified - copy thereof (Sec.3800,Lab.C.) ICITY ZIP91780 REP Fund em le City LOCALITY Policy NO.��d Compan�#•a SIZE OF LOT NO.OF BLDGS.NOW ON LOT G - ❑ Certified copy is hereby furnished. NEAREST CROSS ST OkQ)enified copy is filed with the county building inspection TRACT _ BLOCK I LOT NO. ' department. - USE ZONE MAP NO. Date 991 4Ilcant Monarch Roofing ASSESSOR MAP BOOK PAGE PARCEL PP SPECIAL CONDITIONS ' CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE Mrs . Preston WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS it DISTRICT GROUP TV DNST. FIRE ZONE PROCESSED BY dollars($100)Or less.) a I certify that in the performance of the Work for which this permit GIT Temple City ZIP 91780 is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER TEL NO. d become subject to the Workers Compensation.Laws. STATISTICAL CLASIF DATION APT CONDO Dale Applicant ADDRESS CLASS IN DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTORSET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Monarch Roofing 9T�- 191 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS IC. P L LICENSED CONTRACTORS DECLARATION 2412 W. Walnut, $lll f'P391983 SIDE _ CITY .LIC.CLASS P L - I hereby affirm that I am licensed underprovisions of Chapter 9 Pasadena (,--JSEWER MAP a r (commencing with Section 7000)of Division 3 of the Business and SO.FT. NO.OF STORIES NO OF FAMILIES Professions Code,and my license is in full force and effect.. ,C27 NEW ❑ BK PG � License Number 391983 Lic.Class C-39 DESCRIPTION OF WORK ADD ❑ VALU ON (7 D OF Recover roof of house '� - ContractpMOriarch Roofb1W 10/25/94 applying 20 year fi erg 66iER ❑ $ - DID ❑ I am exempt under Sec. REPAIR ❑ $ GO z B.BP.C. for th' reason DEMOL ❑ LDMA P/C+ IV -4et /' USE OF EXISTING BLDG. URM ❑ _ Residence 1 Signature APPLICANT(PRINT) TEL N0. LDMA Perm a ❑ I,.as owner of the proper or y empl ees with wages as — 191 z �{(.C� .r their sole compensation, will-do the work and the Structure is Q %-;_1 not intended or offered for sale (Section 7044, Business and nut Suite D Pasade FINAL DATE CC�� Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I q�g� �..��G"�' OR MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE HAZARDOUSHAZARDOUS _ ❑ 1, a5 owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDED FINAL BY > C licensed contractors to construct the project (Section 7044, TOTAL � y}" •_ YES El ND ElBusiness and Professions Code.) ` —_ WILL THE INTENDED UI THE CONSTRUCTION BY THE APPLICANT OR FUTURE E SOUTH `'HE,"` OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH E CONSTRUCTION LENDING AGENCY COAST AIR OUAUTY MANAGEMENT DISTRICT ISCAOMOI SEE PERMITTING CHECKLIST FOR CHANGE ° II . GUIDELINES I hereby affirm that there is a construction lending agency for VES❑ No❑ the performance Of the Work for Which this permit is issued(Sec. I HAVE READ THE HAZARCOUSMATERIALSINFORMATION GUIDE AND THE SCAOMO PERMITTING i ( m 3097, Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. 00130-130131 1I0T.�647i Y W TITLE 2.CHAPTER 220 SECTIONS 2.20.100 THROUGH 220 14C CONCERNNG HAZARDOUS °, �� 3 Lender's Name MATERIAL G A 0 FOR oeArAINING RMIT FROM T SCA D 741,6, 1 AM �: 'J c Lender's Address 4414 awxER OR eneR 0 t S I certify that I have read this application and state under penalty 1 0 of perjury that the above information is correct.I agree to CORI P.C.FEE PERMIT (1 N with all county Ordinances and State laws relating to building m Con rUC1i0n, and Hereby authorize representatives. -of this County ITRSUANCE FEE LLv t ent �a n the above-me �N d property for inspection rpo es. a o 7 S Q INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE 1� 76A690A CE#.09-10-96APPL• ICATION FOR BUILDING PERMIT -BUILDING AND SAFETY DIVISION BUILDING w ADDRESS 4 Deportment of County Engineer _ County of Loa Angeles LOCALITY r JOHN A. LAMBIE. COUNTY ENGINEER NEAREST - CASSATT D. GRIFFIN. SUPT of BUILDING CROSS ST DISTRIOT NO. GROU TYPE SEWER.BK MAPPG- FOR APPLICANT TO FILL IN CONST. BUILDINGJJ / �f STATISTICAL CLASSIFICATION ASD DR-E/}5�S !/ so / _ •� CLASS. NO. DWELL. UNITS LOT NO. YC'e N H eL BLOCK MAPSTATE �/1 yyL J VES TRACT ,q�/L $ CONDITIONS p U E ZBE E SPECIAL HW NO OF SIZE OF LOT 7�X 7-1.� I NOW ON LOT USE OF EXISTING BLDG. BUILDINGYARD HWY STREETNAME EXIST. / p .SETBACK - WIDTH OWNER t/"U G �� FRONT MAIL Y CC Q I (. ' P. L.E ADDRESS � � ��Jdl{ r♦ Q .'E.' SID TEL. P. L. _ CITY -1J. �J/{y) ) NO. I��'7d51/ INSPECTION RECORD ' ARCHITECT OR TEL. ,tom ENGINEER NO' •/1 /Y i i� / J ��'.- �s �Ri.4L r-. ADDRESS p - TEL. ))AA •^y�} "'� "/ CONTRACTOW}L/B^ �F C�'NO. r/U.�IJ/ q fat - ADDR E53 )2 2' DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH_j Jn �� ^a •�� h // SO..FT. J NO. OF NO. OF SIZE STORIES / ��5/ ' USE OF STRUCTURE �PS .I� �(♦E9� . .vol d - RIIG l✓ / / '� :/-' / / APPROVALS SIGNATURE OF , APPLICANT > •- ��JLLL///J DATE INSPECTOR'S SIGNATURE ADDRESS / / �� j•—S• ��"< ql'. FOUNDATION: LOCATION f/'/,i j //�^M"m _ FORMS. MATERIALS FEE 6 / ^ BRACING. BOLTS VALUATION a ,S Q FURNACE: LOCATION. W FEE GAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AN. / AGREE TO COMPLY WITH ALL COUNTY ORDINANCE5 ANXLATH.'EXT. �J STATE LAWS REGU G BUI ING ON U TI NUMBER SIGNATURE OF HOUSE RECT AND POS EOR PERMITTEE - / ADDRESS 2 Z.L ._s..�4 '�"�• FINAL //'1J JS7 !//GGvvt�✓`4 JOHN A. LAMBIE, COUNTY ENGINEER, CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CR. W.. A.6 PERMIT VALIDATION y� m.o. cAsk 07411 JUL29 1 6 7.75A4 �L ro7jui3.0 1 D33:7550 �I . .