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Home My Public Portal About6231 OAK AVE_Building__ WORKERS'COMPENSATION DECLARATION I / L e, hereby affirm that I have a certificate of consent to self I APPLICATION FOR U I L D I N G PERMIT insure,or a certificate of Workers'Compenstion Insurance,or I a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES I BUILDING AND SAFETY Policy No. 230770 Company State Comp ❑ Certified copy is hereby furnished. BUILDING 3 ® Certified copy is filed with the county building inspec- BUILDING FOR APPLICANT TO FILL IN ADDRESS tion department. ADDRESS 6231 N. Oak Twe. LOCALITY Date 7/9/81 Applicant As.Ontebe110 Rfq, CITY Tem le Cit ZIP CROSS IST. 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 MAP aQ hDndred dollars($100)or less.) TRACT BLOCK LOT NO. NO. - SPECIAL TE ®, OWNER Schmidt NCIl,,,, f- permit CONDITIONS 1 certify that in the performance of the work for which this �O permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PRO SSED BY ADDRESS 6231 N. Oak Ave. -- �/ CONST. ZONE + so as to become subject to the Workers'Compensation Laws. / ;5,� 3 @S CITY Temple City ZIP �' Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. V ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. CONTRACTOMontebello Rf .e NE. -6975 BK. 6PG. / VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 868 Truck ti ay No. 248852 VALUATION (commencing with Section 7000)of Division 3 of•the Business and LIC. Professions Code, and my license is in full force and effect. CITY Montebello CLASS C-39 $ ;1-949,7-7r 248852 C�39 SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE I -�,pv0 Montebello Rig 7/9/81 DESCRIPTION OF WORK P.er6of existing Nbadcf];° $ Contractor sate ❑ I am exempt from the licensing requirements as I am a wl as-ohalt shinales ADD ❑ licensed architect or a registered professional engineer ALTER ❑ FINAL !�✓ ! acting in my professional capacity (Section 7051, 2EPAIR DATE Business and Professions Code). USE OFFIN �^ EXISTING BLDG. dwellingAL DEMOL ❑ FI Lic.or Reg.No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT) JyJnT1J-phpJ In PfCl, NO. —6975.: I hereby affirm that I am exempt from the Contractor's License ADDRESS 868 Truck ;day (F Law for the following reason (Section 7031.5, Business and Professions Code): - PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS d wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section' LOCALITY 7044, Business and Professions Code). MOVING TEL. # rl, I, as owner of the property, am exclusively contracting CONTRACTOR NO.i El I with licensed contractors to construct the project (Sec- ADDRESS U tion 7044, Business and Professions Code). i REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH �� f/�.Z I hereby affirm that there is a construction lending agency for FRONT 1 the performance of the work for which this permit is issued P L (Sec. 3097, Civ. C.). SIDE - P. Lender's Name �- t '34, 0 Lender's Address P.C. Fees Permit Fee 27.00 ' I certify that I have read this application and state that the Issuance Fee 7.00 !1 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee 34.00 ASigynrV.0iyfpn&p1ic.n.rc by authorize repesentatives of this County to enter s aboe-metoned property for inspection purposes. t ( Pres. 7A SEE REVERSE FOR EXPLANATORY LANGUAGE o r Agent Date ®s DEPARTMENT OF COUNTY ENGINM DMSION OF BUILDING AND SAFETY ` COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER APPLICATION F� CASSATT D.' GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ' BUILDING / _ ,[ DISTRICT NO. PUN CK.on Rim No. PERMIT NO. _ ADDRESS c-5 LOCALITY ,, 7 rr F�C./U C/ - /REECEIVE BY y�� DA7E OFAPPL. D 1tISS ED CNEAREST ROS ST. f�� mJ Lam" /✓� �0 � v 7, E 7 y� BUILDING W2,3 ) / OWNER • C�: /l/i� ,/:l, �I/ ADDRESS ! r MAIL �� f �/I ACL �� LOCALITY C ADDRESS /' TEL. A 7 t CRONEAREST SS ST. CITY S 4 A4 lG -4-'6 THE •DT / -• -zld L j ARC ENGINEER OR NO Q ZONE I PLANS I PIKE NO. OF TY, �, I f BLDG. -—1 40 O D O ADDRESS' SETBACK LINE r e TEL. U36 ACTOR NO. q/ APPROVED�� D CONTRZONE/7 BY'• _ DATE ADDRESS HOUSE NUMBING LEGAL / MAP NUMBER NO. ASSIGNED BY__AC J DESCRIPTION I LOT NO. BLOCK t f Z COBRECTIONS f / TRAM /. ,CJ. t� Vly % \: r � j��' G�4 r ! fa SIZE OF LOT d::V �Q Q I •NO.OF BLDGB.: NOW ON LOT USE OF NO. OF EXISTING BLDG. I FAMILIE6 S /V r7-rl DESCRIPTION OF WORK .y�j; -/3 7 0 - RE AIR I DEMO(TION ,I ADDITION z ALTTION I I Y SQ. FT. y,�! NO.OF `p. � r SIZE ��'7��•+I�J7 // -ROOMS STORIES V COVER NG ,�7_aK,_ 4 I COVERING�SAIIXIIC4 f/ ,-� �f. ?-1-p /i1f/)7`•f USE OF STRUCTURE 41 4.w [it ! yC =+,�� ``LS ,cc - (' I A4! �/� ✓�O APPROVALS INSPECTOR'S SIGNATURE ' DATE FOUNDATION:LOCATION. //�}�`tkit) g (�/ FORMS, MATERIALS / }•;f , ) (J. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ'THIS AP- FRAME: FIRE STOPS, v PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. FURNACE: LOCATION, I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF `� / 1 � �� LATH, INT.., PERMITTEE //`. L' y,✓' r'�`�t�-Vim' � LATH. EXT. 1 ADDRESS PLASTER, INT. AUTHORIZED AGT..' 7-= PLASTER, EXT.P. - ,(� CJS C. S/ �.�f HOUSE NUMBER COR- FEE'• RECT AND POSTED VALUATION. a G FEE ,��-- FINAL '�i` •sawaenw nna a men _ .