Loading...
HomeMy Public PortalAbout4830 HALLOWELL AVE_Building__ i WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to Self APPLICATION FOR BUILDING PERMIT insure, or o certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) i COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicIYIGA87492 Company Republic Indemnity ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING �� ADDRESS © Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 4$ Date 11-1-87 Applicant Randol Roofing CITY Temple City ZIP 91780 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF 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 W.R. Skeels TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER N0448-4474 No. a permit is issued, I shall not employ any person in any manner ADDRESS 4830 N. Hallowell SPECIAL so as to become subject to the Workers'Compensation Laws. Q 10-6-87. Randol Roofing CITY Temple City ZIP 91780 U Date Applicant NOTICE TO APPLICANT: If, after making'this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRO ESSED BY Q Exemption,' you should become subject to the Workers' ENGINEER NO. r CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS1j LtJ with comply with such provisions or this permit shall be D.: deemed revoked. CONTRACTOR Randol Roofing TEL CLASSIFICATION APT. NDO.STATISTICAL CLASN No 288-4040 'f�/� LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 529 E. Valle Blvd NO. 451937 (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY San Gabriel Ca. CLASS C-39 BK PG VALIDATION SO. FT. NO. OF NO. OF CHECK License Number 451937 Lic.Class C-39 SIZE STORIES FAMILIES ONE ❑ VALUATION +i Contractor Randol Roofing Date 10-6-87 DESCRIPTION OF WORK Re-roof house & NEW $ 990.00 ❑ 1 am exempt under Sec. ara a 'with fiber lass ADD 1:1E]ALTER Class A. Roof. REPAIR ❑X B.BP.C. for this reason $ Date: USE OF Same DEMOL ❑ EXISTING BLDG. Signature APPLICANT TEL. FINAL PRINT / OWNER-BUILDER DECLARATION andol N0. — DATE G 1 hereby affirm that I am exempt from the Contractor's License ADDRESS 529 E. Valley Blvd. S.G. 91776 FINAL $Jr ], ]ALaw for the following reason (Section 7031.5, Business and Professions Code): PRESENT BY #.a o_o 0 0,1 ❑ BUILDING v I, as owner of The property, or my employees with ADDRESS wages as their sole compensation,will do the work and 0 '64 0, the structure is not intended or offered for sale(Section LOCALITY ' o.0 0 (� Q 0 7044, Business and Professions Code). MOVING TEL. ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. I 21 4 -87 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACKK YARD HWY FROMRQDTOTAPROP.ACK L NE WIDTH I hereby affirm that there is a construction lending agency for LInvestigation the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name $30•00 LDMA Ref. # Lender's Address Permit fee ' 3 0 1 certify that I have read this application and state that the Issuance Fee $10•50 LDMA P/C# above information is correct. I agree to comply with all County ee S ordinances and State laws relating to building construction, Total Fee $40.50 LDMA Perm. # and reby uthori epresentatives of this County to enter u n oned p y for inspect'on ur ses. e f1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent tDote COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0501030003 PHONE: (626) 285-0488 EXT: DUPLICATE LEGAL ID: NO. OF CONST NEW BUILDINGADDRESS: TR: 13645 LT: 10 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 4830 HALLOWELL AV STRUCTURE: 644 1 VN R3 TEMP CA 917803456 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: LOWER AZUSA 8585-017-013 OTHER: THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE -ONE: ISS ED ON: PROCESSED Y: EXPIRES ON: EXIST OCC GRP: 03/14/05 .!K 03/09/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FIW TE� FINAL BY: CODE: TREN, ANNA (626) 641-3815- 53,320 cy 4830 HALLOWELL TEMPLE CITY CA 91780 FEES PAID B—ESC-FIPTION OF WORK ADD 1 MASTERBED, 2ND. BEDROOM, & 1 FULL BATHRO M:--- FEE DESCRIPTION: QUANT)TY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - B1 PLANCHECK W/ENERGY 53320.00 VAL 785.82 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 53320.00 VAL 5.33 B2 PERMIT W/ENERGY 53320.00 VAL 924.50 TOTAL FEES 1,743.40 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL / ARCHITECT OR ENGINEER: . NO: - FOUNDATION/TRENC FORMS LIC. NO: SLAB/UNDER FLOOR (v RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: C14p: UNDERFLOOR INSULATION 3 01 ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: _ FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE-DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 R0UTE�(3:-BS05O8� �� (plo