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Home My Public Portal About5671 LOMA AVE_Building__ WORKERS'COMPENSATION DECLARATION -I_hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certifiedcopy thereof (Sec. 3800, Lab. C.) PC 975585 Republic Indemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN_ ADDRESS •= Certified copy is filed with the county.building inspec- BUILDING tion department. ADDRESS ' 5671 N. Loma LOCALITY JpAwiil 11-.1-•85 Randol Roofing Temple Cit 91780 NEAREST . t Date Applicant. CITY P y ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' 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 USE ZONE ESPECIAL Q hundred dollars ($100)or less.) TRACT BLOCK LOT NO. i//� TEL R!•1 OWNER Flora KOndriS Not 8 6—0 13 8 1` NS IL certify that in the performance of the work for which this DISTRICT GROUP TYPE FIRE PR SSED BY O permit is issued, I shall not employ any person in any manner ADDRESS 5671 N. Loma, T. Cy . 91780 CONSTZONE so as to become subject to the Workers'Compensation Laws. .e 11—•19-8a Randol Roof i.ng CITY ZIP — O Dat iapplicant STATISTICAL CLASSIA TION APT. CONDO NOTICE To APPLICANT: If, after making this Certificate of ARCHITECT.OR TEL. Exemption, .you should become subject to the Workers'' ENGINEER NO. CLASS I DWELL. UNITS LU Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. . CONTRACTOR O• _ BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 1 herebyaffirm that I am licensed under provisions of Chapter 9 ADDRESS P • O•BOX 3 0 3 . S .G . NO 4 S 19 3 7. P P VALUATION (commencing*with Section 7000)of Division 3 of.the Business and San G Ab r i e 1 LIC. C-39 1 , 300 . 00 Professions Code, and.my license.is in full force and effect. CITY CLASS $ Poo. FT. NO. OF NO.OF CHECK License Number 4 E;1 9 3 7 Lic.Class_ c-39 SIZE STORIES FAMILIES ONE Randol RoofinW 11-19'-84 DESCRIPTION OF WORK Re-roof house NEW ❑ $ @.1=15,5A Contractor ate ❑ and garage with- Randol 'sigrm ElI am exempt under Sec. - •# o o ® o .0 1 ALTER ❑ FINAL DATE A ° o'4 9,8 8 B.&P.C. for this reason C4904 12 Q REPAIR 4 9 $8= Date: USE OF S DF DEMOL . FIN o'o. o c6 EXISTING BLDG. (3 Signature APPLICANT andol Roofing TEL Y ;I 2�3.=84 OWNER-BUILDER DECLARATION PRINT NO. hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and, ADDRESS P Q q _G __- 91778 Professions Code): PRESENT BUILDING 1,1, as owner of the property, or'my employees with ADDRESS wages as their sole"compensation,will do the work and •the`structure isnot intended or offered for sale(Section kADDRE Y 7044, Business and Professions Code). TEL. ❑ I, as owner of the property,'am exclusively contracting CTOR NO. with licensed contractors to construct the project (Sec- ADDRESS `tion 7044, Business and Professions Code). ED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING.AGENCY• CK YARD' HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for Tthe performance of:the work for which this permit is issued(Sec. 3097, Civ: C.).Lender's Name $ Permit Fee _$39 • 38 — Lender's Address $10.. 5.00 I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with,all County Investigation Fee. $ ordinances and State laws relating to building construction, Total Fee .$49 . 88 v anreby author presentatives of this County to enter m o t5b -m ti ed pl p ty for on inspectiurpos p ��- SEE REVERSE FOR EXPLANATORY LANGUAGE , Signatur of Applicant or Agent to ®s ORR DEPARTMENT OF BUILDING—AMI) SAFEf"Y E L'APPLICATION FOR PERMIT �. COUNTY OF LOS ANGELES 1>t� °J �j WM. J. FOX, CHIEF ENGINEER `� ! FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY /—�7 DISTRICT NO. PLAN CK. NO. PERMIT NO.BUILDING ADDRESS 67 /„ - ( RECEIVED BY DATE OF AF3PL. DATE•ISSUED 1 LOCALITY NEAREST A- CROSS ST. .(�s�.a��..L.P BUILD'NG �� - ADDRESS I Q M A OWNER MAIL I ,� LOCALITY _ —7—, G,. ADDRESS ��Vit(` �, NEAREST �,._� CROSS ST. CITYr ! !e q7 � FIRE I NO. F . I TYPE I GROUP NO < ARCHITECT OR JK TEL. ZONE PLANS Gam' ENGINEER / �„)�,� _>t> NO. BLDG. ORD. NO. SETBACK LINE W"`•' U`4 ADDRESS APPROVED ' TEL. BY DATE y CONTRACTOR NO. USEAPPROVED ' ZONE BY DATE ADDRESS ' HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. I BLOCK MAP NUMBER FIELD CHECK BY _ TRACT / / - �y j� NO. ASSIGNED BY � DATE J-41 �/ QQ p NO. OF BLDGS. CORRECTIONS �{ J— SIZE OF LOT / I NOW ON LOT �-- USE OF I NO. OF _ EXISTING BLDG.. d”' FAMILIES '-- T`� DESCRIPTION OF WORK ter! NEW I x I ALTERATION 'I I ADDITION I U b D REPAIR , I I.DEMOLITION SQ. FT. - n NO. OF D SIZE ROOMS STORIES - Z a EXT. WALL ROOF r COVERINGS I COVERING,�1„�-Q ,,,....�„yC.1 USE OF STRUCTURE e � �/ V' APPROVALS INSPECTOR'S SIGNATUREf DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- : FOUNDATION: LOCATION PLICATION AND STATE THAT,THE INFORMATION GIVEN IS FORMS, MATERIALS COI AGREE TO COMPLY WITH. THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. - FURNACE: LOCATION, GAS VENT, DUCTS (p S16NATURETE OF'—� 1 �.�- _y1 • j �I }� PERMITTEE tnnn/// ADDRESS ® d� L ( ./�C►=C�� I l `� f LATH, INT. LATH, EXT. •� AUTHORIZED AGT. PLASTER, INT. 7eA638A•.D088 10-80 $ p C $ 09 «>' FEE % yam"•/ PLASTER, EXT. VALUATION l�l - FEE $ O FINAL �. � c o �1-7S� ® 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 0202200007 PHONE: (626) 285-0488 EXT: LEGAL ID:.... N0. OF CONST BUILDING ADDRESS: TR: 16305 LT: 2 Std. FT STORIES TYPE 5671 LOMA AV STRUCTURE: VN TEMP CA 917802451 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5387-022-010 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 02/20/02 JK 08/19/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: F I NA DATE FINAL BY: CODE: TRAN MICHEAL - 1 7,500 5671 LOMA AV TEMP 917802451 FEES PAID DESCRIPTION OF WORK C/O 10 WOOD WINDOWS TO DUAL GLAZED VINYL (SAME SIZES) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SUNSET HOME IMPROVEMENT (310) 640-7300- AA BLDG PERMIT ISSUANCE 27.75 111 MAIN STREET AC STRONG MOTION RESID 7500.00 VAL 0.75 SPECIAL CONDITIONS: EL SEGUNDO 90245 D2 PERMIT W/0 EN-HC 7500.00 VAL 183.00 f TOTAL FEES 211..50 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SUNSET HOME IMPROVEMENT, INC. (310) 640-7300- 111 MAIN ST. LIC. NO LOCATION AND SETBACKS EL SEGUNDO, CA. 90245 354572 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO SLAB!UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP. UNDERFLOOR INSULATION 147H265 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF"SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME. INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES - RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 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 0710010024 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 16305 LT: 2 SQ. FT STORIES TYPE 5671 LOMA AV (STRUCTURE: 1600 VN TEMP CA 917802451 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 15387-022-010 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl (TENANT: JEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 EXIST OCC GRP: 110/01/07 SR 03/29/08 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IF NAL DATE FI AL Y: CODE: ITRAN STEPHANIE V (626) 285-1901- I 3,200 15671 LOMA AV I V (TEMP. 917802451 FEES PAID ESCRI TION bF WORK ITEAR OFF OLD ROOF, INSTALL PLYWOOD, INSTALL COMPOSITION IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ISHINGLES 1APPLICANT: TEL. NO: I I IMICHAEL TRAN (626) 285-1901- IAA BLDG PERMIT ISSUANCE 27.75 I 15671 LOMA AVENU IAC STRONG MOTION RESID 3200.00 VAL 0.50 ISPECIAL CONDITIONS: 1 TEMPLE CITY CA 91780 ID2 PERMIT W/O EN-HC 3200.00 VAL 115.80 TOTAL FEES 144.05 CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE IMICHAEL TRAN (626) 285-1901- STEPHANIE V. TRAN LIC. NO ILOCATION AND SETBACKS 15671 LOMA AVENUE NONE I TEMPLE CITY, CA 91780 ISOILS ENGINEER APPROVAL 1ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I LIC. NO: ISLAB/UNDER FLOOR I I IRAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: J JUNDERFLOOR INSULATION I I I147H265 3 011 I I I 1FL;OOR SHEATHING I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I L , 1 NO 21 IROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO 1 IFRA`iE INSPECTION 1 1 IREQUIRED TOTAL SETBACK FROM EXIST IFIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I I I (FRONT PL- 11NSULATION/WEATHER STRIPI I I I SIDE PL- I I I I _I 11NTERIOR LATH/DRYWALL 1 I 1 IEXTERIOR LATH II I (RATED FLOOR/CEIL ASSEM. I IRATED WALL ASSEMBLIES I IRATED SHAFTS/OPENINGS IT-BAR CEILINGS ILOT DRAINAGE I IREPORT ID: DPR261 ROUTE TO: BS0508 I ( I I I I I i I