The URL can be used to link to this page

Home My Public Portal About4930 HELEO AVE_Building__ WORKERS'COMPENSATION DECLARATION hereby certificate Selfinsureoracertifcate of WorkesCompensalonInsuraneOFO� � � M 0 d D 0[ C p C L3G�v 0 or a certified cop.yy.thereof.(Sec. 38 b. C.) c c 2 U,-14 2-•10 6 3 Ar.g.oTier COUNTY OF LOS ANGELES BUILDING AND'SAFETY Policy No. Company copy v FOR APPLICANT TO FILL IN oBo�Ress p Certified co is hereb furnished. �t� ( :. Certified copy,is filed with the countybuil ding inspec- BUILDING tion department. ADDRESS 4 9 3 O. H.e.l e O LOCALITY T e.m 1 e.' C i-t 91,7 8 O. NEAREST . Dae 11..--1—$ pican,Randol Roofin>? & cITY P Y� ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' C 0 EU NO.OF BLDGS.- " ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one .3 _ USE ZONE MAP hundred dollars($100)or'less.) TRACT BLOCK LOT.NO. NO. TEL.: •; SPECIAL''„; OWNER' H:a r r y. M c-Croft NO 2 8 6,5 4 7 9_ CONDITIONS 9 I certify that'in the.performance of the work for which.this DISTRICT GROUP TYPE FIRE PRO ESSEDBY O. permit is issued, I shall not employ any person.in any manner 4.9.4 6. H.e.l e0 CONST. ZONE t ADDRESS so as to become subject to the Workers'Compensation Laws. . • - _ ,r Ran'dol Roofing .& `Con 'Te'm le Cit 91780. • "3 /U—�ycz -� 8=10:=8` AM 3 urY P Y�. zip - _ O" Date –Applicant STATISTICAL CLASSIFICATION APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS LU Exemption, you should become subject to the Workers'' N Compensation provisions of.the Labor.Code, you must forth- ADDRESS SEWER MAP 'with comply with such provisions or this permit shall be- deemed revoked. CONTRACT$n d O l .R o o f in g &., ExEt t 2 8 84F4O BK. L.PG, VALIDATION LICENSED CONTRACTORS DECLARATIONLIC.'. I hereby affirm that I om licensed under provisions of Chapter 9' ADDRESS 5'2 9 E. V a l le .- NO.. 18 6.0.8 6. VALUATION. (commencing with Section 7000)of Division 3 of the Business and- S_a n Q ab.r te.1 LIC. Professions Code, and my license is in full force and effect. CITY CLASS' C-`39 $ _. ,7 9.0.. 00 D 41 8 6:0.8 6. C e 3 9 SQ. FT. NO. NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE $ R an d o l R o o f'i.n g i.n & :Cons"t g�,1 O--8 3 DESCRIPTION OF WORK'. _ NEW El Contractor Date ADD am exempt under Sec. w_1_t h- S h.l rL g 1 e 8. ALTER ❑ FINAL / �7 B.BP.C. for this reason REPAIR ® DATE " USE OF DEMOL FINAL Date: EXISTING BLDG. S F D ❑ By cf' SignatureAPPLICANT- - - _' PRINT R an d'o l Roofing. No TEL. 2.8 84 0 4 0- -.. . OWNER-BUILDER DECLARATION. . E. Valle ;an 6; F I hereby affirm that 1 am exempt from the Contractor's.License Y a D �V Law for the following reason (Section 7031.5; Business and ADDRESS # �• Professions Code): PRESENT v BUILDING a I, as owner of.the property, or my employees with ADDRESS •wages as their sole compensation,will do the work and i7 the structure is not intended or offered for sale(Section LOCALITY Llf 5� J 7044, 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). REQUIRED. TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HwY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT. D the performance of the'work for which this permit is issued "P.L.. p (Sec. 3097,.Civ. C.).': SIDE �— G Q Lender's Name P:C. Fee$ Permit Fee 3 O.. 0.0_ Lender's Address I certify that 1 have read this application and state that theIssuance Fee 1 0.'. 50. above information is correct. I agree to comply.with.all County Investigation Fee, g ordinances and State laws relating to building construction, Total Fee 4'0..:5.0. . d and here y authorize re sentatives of this.0 unty to ter U t ave-menti d prop r or ins ion pu ase . – a __ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant or gent Date ®_ 40: 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 1311120067 PHONE: (626) 285-0488 EXT: , ILEGAL ID: NO. OF CONST I BUILDING ADDRESS: ITR: 13329 LT: 31 SQ. FT STORIES TYPE 1 4930 HELEO AV I (STRUCTURE: 1400 V-B I TEMP CA 917803822 (ASSESSOR INFORMATION NUMBER: - I NEAREST CROSS STREET: LOWER AZUSA 18590-022-007 I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY CAI I I- 1 ITENANT: 1EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 11/12/13 SR I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFMNAAE FIAL BY CODE: 1 IMYCROFT BEATRICE (626) 285-1564- I 5,000 I ' I 14946 HELEO AV I _ ITEMP 917803822 I FEES PAID IDLNENRIPtIdN 6F WORK I I I IREMOVE EXISTING ROOFS, INSTALL 30 YR SHINGLES 1 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I I (APPLICANT: TEL. NO: I I ISLUKA, JERRY (626) 646-9316- IAA BLDG PERMIT ISSUANCE 27.80 1 11117 WINGATE STREET IAB STATE GREEN BLDG FEE 5000.00 VAL 1.00 .1SPECIAL CONDITIONS: ICOVINA CA 91724 IAC STRONG MOTION RESID 5000.00 VAL 0.50 ID2 PERMIT W/0 EN-HC 5000.00 VAL 132.60 TOTAL FEES 161.90 I ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE ISHAW HOMES AND REMODELING (626) 646-9316- 11117 WINGATE STREET LIC. NO I (LOCATION AND SETBACKS 1 I ICOVINA CA 91724 856346 1 I I ISOILS ENGINEER APPROVAL I 1 1ARCHITECT OR ENGINEER: TEL. NO: 1 IFOGNDATION/TRENCH FORMS I 1 I 1 LIC. NO: 1 (SLAB/UNDER FLOOR I I I I I IRAISED FLOOR FRAMING I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 1UNDERFLOOR INSULATION I I 3 001 1 -I I 1 IFLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APN/COND: STAT CLASS: I O 21 1 (ROOF SHEATHING I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS II / I (AIR QUALITY: 1000 FEET MATERIALS I I__. I I I 1 NO NO NO 1 IFRAME INSPECTION I I I I - IFIRE SPRINKLER HANGERS I I I I I I (INSULATION/WEATHER STRIPI I (INTERIOR LATH/DRYWALL I I I I I I 1EXTERIOR LATH I 1 I IRATED FLOOR/CEIL ASSEM. I I 1 IRATED WALL ASSEMBLIES I 1 1 IRATF.D SHAFTS/OPENINGS I I I IT-BAR CEILINGS I I I I I I ILOT DRAINAGE I I I I I I IREPORT ID: DPR261 ROUTE TO: 9S0508 I I I I I I I I I 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 1209120087 PHONE: (626) 285-0488 EXT: _ ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 13329 IT: 31 1 SQ. FT STORIES TYPE 1 4930 HELEO AV 1 STRUCTURE: V-B TEMP CA 917803822 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 18590-022-007 1 1 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl TENANT: 1EXIST BLDG USE: RESID USE ZONE: R-1 11SSUED ON: PROCESSED BY: (EXIST OCC GRP: 109/12/12 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: IMYCROFT BEATRICE B TR (626) 285-4564- 3,900 14946 HELEO AV (TEMP 917803822 FEES PAID (DESCRIPTION OF WORK (REPLACE WINDOWS (18) 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( 1APPLICANT: TEL. NO: I (SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 1 IAB STATE GREEN BLDG FEE 3900.00 VAL 1.00 (SPECIAL CONDITIONS: IAC STRONG MOTION RESID 3900.00 VAL 0.50 ID2 PERMIT W/O EN-HC 3900.00 VAL 115.80 IFR INV WORK W/O PERMIT 166.40 DOL 166.40 CONTRACTOR: TEL. NO: I TOTAL FEES 311.50 APPROVALS DATE INSPECTOR SIGNATURE (SAME AS OWNER - I I I LIC. NO I (LOCATION AND SETBACKS I I I I I I I ISOILS ENGINEER APPROVAL I I I I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I 1 LIC. NO: 1 ISLAB/UNDER FLOOR I I I I I I IRAISED FLOOR FRAMING I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I EXPIFIED 'O` � JUNDERFLOOR INSULATION I I144H269 3 001 I I IFLOOR SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I 1 0 NO 21 1 IROOF SHEATHING I I I I I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I 1AIR QUALITY: 1000 FEET MATERIALS NO NO NO I FRAME INSPECTION I I I I I I I,FIRE SPRINKLER HANGERS I I I I I I I I (INSULATION/WEATHER STRIPI I I I I I 1-1 I I (INTERIOR LATH/DRYWALL I I I I I I I I I I (EXTERIOR LATH I I I I I I I I I IRATED FLOOR/CEIL ASSEM. I I I I I I IRATED WALL ASSEMBLIES I I I I I i I I I IRATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS ILOT DRAINAGE 1I I I I (REPORT ID: DPR261 ROUTE TO: BSO508 I I I I I I