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Home My Public Portal About4846 HELEO AVE_Building__ WORKERS'COMPENSATION DECLARATION 850598,,SB,• I hereb 4,-.. « - y affirm,that I.have,at certificate of cons0 ent to self � D O � D O� M D O nn insure, or a certificate of Workers Compensation Insurance, �� O O LJ c a'certified copy thereof (Sec.-3800 La6r"C.') - . ._ .. z, COUNTY,OF LOS ANGELES _ BUILDING AND SAFETY _ o,�y NaIompony V85-2251'SE+ Fremont:Indemnity_" .. - Certified copy is hereby,furnlshed,. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy'is filed with the county building inspec- BUILDING _ � r ' tion'department.'.' -" ADDRESS Mix 4846 N. Helen •.:. . ,.:• ,. ._. . - . •"Temple 'City......__ . .-_ _, . ,.. . Date+•.'1 1•/t8/85 •Applicant Virgin Roof Co:. . CITY ZIP LOCALITY • NO:OF BLDGS.- NEAREST•i 'CERTIFICATE'OF EXEMPTION'FROM,WORKERS' � - • "- - -- ^- COMPENSATION INSURANCE .-: •,'.' SIZE OF LOT NOW ON LOT CROSS ST. (This section Heed•not.be completed-if the permit.,is for one -•- --•- ASSESSOR • . hundred dollars ($100)or,less.) TRACT BLOCK LOT NO. MAP BOOK, PAGE PARCEL I certify that in'the performance of The work for whlch;,ihisON- TEL.. - P / OWNER' Stanley Henney. NO. USE per6t is'issued; I shall'notemploy any person in any manner 484.6 D1.. ele0 � SPECIAL NO - SPE f� so ps'to become subject to.the Workers'Compensafiori Ldws. ADDRESS CONDITIONS V Date APpllcant . cITY. Temple City. NOTICE'1T6 APPLICANT: 'If, after making this Certificate of ARCHITECT.OR TEL DISTRICT GROUP TYPE # FIRE' PROCESSED BY ENGINEER NO �(/' Lu CONST ZONE Exemption, you"'should •become subject to the Workers' d �j Compensation provisions.of-the Labor Code,you must.forth ADDRESS / _;� „.� L with,comply withi,such -provisions or,This:permit•shall be - TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revokedL - . ,• CONTRACTOR Virgin ROOF CO NO 287-0507 LICENSED CONTRACTORS DECLARATION_, _ _. __.._.LIC CLASS NO. 2 DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOX J NO. 160650 commencin with Section 7000 of Division 3 of the Business and SEWER MAP (... 9 )I`, - .' _ `- LIC.- Professions Code,'and my license is i,n'full force and effect. CITY San Gabriel 9'1778 CLASS C19 EK --r VALIDATION ' SQ. FT NO. OF NO. OF CHECK License Number 1'60650 ' 'Cc.Class' C3•p` SIZE 2600" STORIES` 1 " FAMILIES ' ONE." VALUATION. Virgin Roof CO �1`1�18 85 DESCRIPTION OF WORKRe—roof -house & - •- NEW- •a ❑ _ Contract or g Date Q m $ 1964.00 D ❑-1 aexempt uSec.c. attached garage with Class A. ADD 11 , . composition shingles:• 26 sqs. .ALTER [:] ) B.&P.C. for this reason REPAIR'--El $ — _ Dated' USE OIFGBLDG: dwellingDEMOL ❑ t, EXIST z351,34 _ Signature Virgin Roof Co 287-050 FINAL APPLICANT TEL. OWNER-BU ILDER-DECLARATION PRINT) NO. DATE # o o_o«o o _ I.hereby 6ffirm that.I am exempt from-the Contractor's:License - • ' ; i . Law for the followin -'reason Section 7031.5, Business and ADDRESS PO BOX J San Gabriel FIN' ' g ( . ' •`, 1•m a 49,:;88 Professions'Code); . ..,.,.. .. .,. PRESENT' - "By By - - - BUILDING - O U, ❑ 1, as owner of the property, or my employees with ADDRESS - 49.8 wag-es as their'sole compensation,will do the work and 0 0 R the structure is not intended or offered for sale(Section LOCALITY D ; 1 1.20:8 5 7044,-Business and Professions Code). " MOVING -TEL I I, as'owner of the property,.am.exclusiyely contracting CONTRACTOR NO. ' --with licensed contractors to construct-the project (Sec- tion 7044; Business and Professions Code). ADDRESS REQUIRED_ TOTAL SETBACK FROM.--.I., IST. _ _— CONSTRUCTION'LENDING AGENCY SET BACK "YARD HWY+ PROP. LINE WIDTH 1 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 r 39.38 LDMA Ref. # _ _ .. . - .. . ._ . . - -_ •- P.C.,Fee$ - .. Permit Fee Lender's Address .11 I certify that-I have read this application and:state that the ._ .. _. ..-_ Issuance Fee - 10.50 LDMA P/C N• --- =- D above information is correct. I agree to comply with all County Investigation Fee _ordinances and State laws relating to building construction, ,_ Total Fee--- 4-9,88.- and LDMA Perm. # ---• v hereby authoriie'representatives of this County to enter up the above-mentioned pr }y for inspection purposes. Idoae SEE REVERSE FOR EXPLANATORY LANGUAGE' nature of Applicant or Agent Date-- I v I COTS 76A688A C6#803 2/60 808260 A PLRC..' ATI®N FOR BUILDING UILDIq . ERpA .. .. .. ..COUNTY OF LOS ANGELES' BUILDING- DEPARTMENT- OF COUNTY ENGINEER ADDRESS BUILDING-AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST ' WILLIAM•A. JENSEN SUPT OF BUILDING CROSS ST: 'T� - ''b' DISTRICT NO. GROUP MpSS ED BY FOR APPLICANT TO FILL'IN. ... rYPE ' 7-�.15 ' BU L IISS �- �L— l' STATISTICAL CLASSIFICATION S MAP � BK PG • ..i CLASS.NO. DWELL.UNITS—I •f. LOT.NO./l BLOCK MAP 7r` -` STATE •YES O •NUMBER mac✓ HWY. '- - TRACT USEZONE SPECIAL NO.OF,BLDGS.' a CONDITIONS SIZE OF LOT - X Z� I'NOW ON LOTr! USE OF EXISTING ll BLDG.' /I. t- 4--lA,3A05. BUILDING EXIST. 'WIDTH SETBACK YARD HWY TREET NAME' F OWNER NELFRONT. P ADDRESSl!zL) SIDE �;,ARCHITECT OR TEL.. P.L. ENGINEER /i/�i t- NO, . INSPECTION RECORD_ - ADDRESS - - ' CONTRACTOR &k NO. ADDRESSI/41� f1-I✓� - DESCRIPTION OF WORE' EVALIATIDN D ALTER REPAIR DEMOLISH NO.OF NO.OF - STORIES F,04 ILFES USEOF EOF [�S/d-CIS/ iE r ICJ f.� ` OF/ Q, T - $ n* •.,, I APPROVALS DATE INSPEE•bR SSIGNATURE P.C. J - PMT. j•EE FEE $ FEE FOFORMS�MATER QLSON •'� r/ $� 7� ' HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FR RAC FIRE STOPS, P BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, ' AGREE-TO.COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. I' CERTIFY THAT IN DOING THE WORK AUTHORIZED I . , WILL NOT EMPLOY NY PERSON 1 .VIOLATION O THE LATH, INT. ✓ /R' - - `s WORKMEN'S C017 N TION OF CA IFR LATH,EXT: SIGNATURE OF HOUSE NUMBER COR- f� PERMITTE RCCT AND POSTED ! r ADDRESS- FINAL o�I CJ �`✓� 'CLYDE N. DIRLAM, PRINCIPAL STIR URAL ENGINEER PLAN CHECK VALIDATION cK. M.0. CASH PERMIT VALIDATION CK. M.O. - CASH ' ; 8 ' --' APR ®� 850598',,SB. WORKERS''COMPENSATION DECLARATION w I hereby affirm•that I h6ve a,certificate of consent to self O O O O D msure, or'a certificate of Workers'Compensation Insurance, 111 �,� �/rU� .O LI V OORDI. D G1 C . p I•MG�v or'a certified copy there6f (Sec.'3800',--Lob. C.) t.- Pol cy NoIV85-',Z2 25 15&ompany Fremont .Indemnity_, . COUNTY ,OP LOS ANGELES BUILDING AND SAFETY ... furnished FOR APPLICANT TO FILL IN BUILDING Ll Ceitified co PY is hereb Y• ADDRESS Certified copy'is filed with the county building ihspec-, BUILDING - tion department. '< :_ ADDRESS Mix 4846 N. Heleo ,, .... -.•. . . ,. , .. . _ _.�Tei*lple City - -. - Date•,'.'1 1J 1,8,/85 • Applicant Virgin Roof Co:. CITY ZIP LOCALITY r.. ... _ _. NO:OF-BLDGS.. .. NEAREST,. I �J.._ CERTIFICATE OF EXEMPTION FROM`WORKERS' -SZE OF LOT NOW ON LOT CROSS ST. (2 COMPENSATION INSURANCE ASSESSOR (This section.need=not.be completed if the permit;is for one TRACT BLOCK y LOT NO. MAP BOOK' PAGE PARCEL' hundred dollars ($100_)or.less.) ,i TEL.' ° OWNER _ Stanley_ Henney. _ NO. USE ONF� MAP f1 r71/ " I certify that in the performance of the'work for which�,this NO. SPECIAL.... permit is issued, I shall'notemploy any person m any manner .4846. N.._13eleo 0 so os'to become subject.to the WorkersF Compensation taws TIONS i V ADDRESS CONDI CITY.. Temple_City Date ` Applica'nt _ ARCHITECT OR TEL S TYPE FIRE PROCESSED BY 0 NOTICE+TO APPLICANT: "If,- after mdking this Certificafe of DISTRICT - GROUP _ ENGINEER NO. Exemption, -you-should •become r subject to the Workers r CONST f ZONE U (J B Gompensation provisions of the Labor Code, you must,forth ADDRESS ----- - �' with.comply with%such -provisions or;this,permit-shall. be __:.. _ - A TEL. STATISTICAL CLASSIFICATION APT. CONDO J deemed revoked.,,., . <• CONTRACTOR Virgin Roof Co NO. 287-0507 LICENSED CONTRACTORS DECLARATION.., - - - - --- --- LIC. CLASS NO. � DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. Box J No. 160650 commencin vi th'Section 7000 of Division 3 of the Business and _. SEWER MAP ( . 9 ) P,rofessio"ns Code,'and my license is in full force and effect. CITY Sari Gabriel 9 1 778 CLASS C39 "" VALIDATION SQ. FT NO. OF NO.OF CHECK BK. PG. License Number 160650 ' Cc.Cldss' C3'9'' SIZE 2600 STORIES ' ] FAMILIES ' ONE VALUATION- _ VLrgin Roof CO 1'�1 18/85 DESCRIPTION OF WORK Re-roof -house -&-- - ,NEW w O ]'964,OO _ ^ ' Contractor Date $ El am exempt under sec. attached -garage -with Clas.s A. AODR composition shingles.. 26 sqs. B.BP.C. for this reason REPAIRUSE OF Date. EXISTING'BLDG: dale l ling DEMO% ❑ 3 5 1.3-A - Signature'. Virgin Roof Co 287-050 FINAL . APPLICANT TEL. OWNER-BUILDER DECLARATION - PRINT) NO. DATE # o o-a 0 0 l •.I.hereby.affirm.that..1 am exempt from.the Contractor's:License Law for the following-reason (Section 7031.5, Business and ADDRESS PO Box J,4 San Gabriel FIN' 4i9.8,8_. Professions Coder - PRESENT BUILDING o .0 049,8 8U El I, as owner of the property, or my employees with ADDRESS wages as t1i'eir-sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY1 2 U 8,5 7044;$osiness and Professions'Code). MOVING.'' " TEL. _ I, asowner of the property,am.exclusiyely contracting CONTRACTOR NO. ; -=with•licensed contractors to'construct-the project (Sec- tion 7044, Business and Professions Code). ADDRESS ` REQUIREDTOTAL SETBACK.FROM CONSTRUCTION-LENDING AGENCY SET BACK "YARD HWY PROP. LINE WIDTH 1 hereby affirm thatthere is a construction lending agency for FRONT the performance of-the work for which'-this-permit is issued - --P.L. (Sec: 3097, Civ. C.). SIDE: - P.L. Lender's Name 39.3838 LDMA Ref. # m. __ _. _ P.C.-Fee$ _ Permit Fee - Lencler's Address - ° 10.50 1. I certify that I have-read this application and.'state that the Issuonce Fee - %DMA P/C# - < above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to•building construction, -; Total Fee-- - 4.9.88.- %DMA Perm. # ` v ond-hereby authorize'representatives of this County to enter up the above-mentioned pr rty for in purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE , -..... nature of Applicant or Agent -. Date--