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Home My Public Portal About6309 OAK AVE_Building__ L WORKERS'COMPENSATION DECLARATION 850621 SB hereby affirm that I have certificate of consent to self APPLICATION F®R BUILDING PERMIT � insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NoIV85-2251 mponxremont Indemnity BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS � Certified copy is filed with the county building inspec- BUILDING X tion department. 1 ADDRESS 6309 N. Oak Temple City Date 11/27/95 Applicant_ Virgin Rnr\f C CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM R ERS' NO.OF BLDGS. t.NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSORhundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER Mr• & Mrs. Molette NO USE ZONE MAP I certify that in the performance of the work for which this NO. > permit is issued, I shall not employ any person in any manner as above SPECIAL IL so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS CITY ZIP ! Date Applicant O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT OUP TYPE FIRE P ESSED BY Exemption, you should become subject to the Workers' ENGINEER NO. �- CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS �� ' with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. deemed revoked. CONTRACTOR Virgin Roof Co NO 287-050 C DO. LICENSED CONTRACTORS DECLARATION p 0 BOX J LIC' 160650 CLASS NO. _DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY San Gabriel CLASS C39 BK PG VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number 160650 Lic.Class C39 SIZE STORIES 1 FAMILIES ONE VALUATION Virgin Roof Co 11/27/85 DESCRIPTION OF WORK Re-roof house NEW Contractor g Date ADD ❑ $ 126.3.00 ❑ I am exempt under Sec. with Class A fiberglass shingles ALTER E] oil B.BP.C. for this reason 14 squares REPAIR ❑ $ Date: USE OF dwelling DEMOL EXISTING BLDG. Signature APPLICANT T FINAL 1 3 6 5 p A PRINT Virgin Roof Co 187-0507 OWNER-BUILDER DECLARATION DATE / 1 hereby affirm that I am exempt from the Contractor's License # 0 0 0 0 0 1 Law for the following reason (Section 7031.5, Business and ADDRESS P O BOX J, San Gabriel FINAL Professions Code): PRESENT By l o o49.88 ❑ BUILDING ` I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and o 0 - 41.9.887 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 1 212-85 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). CONSTRUCTION LENDING AGENCY SETQBACK YARD HWY TOTAPRETBACK OP.LINE WIDTH I 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 LDMA Ref. # Lender's Address 'P.C. Fee$ Permit Fee 39.38 p I certify that I have read this application and state that the Issuance Fee 10.50 LDMA P/C# Pilo above'nformation is correct. I agree to comply with all County Investigation Fee ordina ces and State laws relating to building construction, Total Fee 49.88 LDMA perm. # i and h reby authorize representatives cM this County to enter 3 up a above-mentioned pr rty f e];��4 " + SEE REVERSE FOR EXPLANATORY LAWGUAGE Si tura of App scant or Agent t WORKERS'COMPENSATION DECLARATION #880250SB insure,hereby afcertif caaffirm rte of Workers'tCompensation Insuranceificate of consent to , APPLICATION F R BUILDING P E O T or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. W0007146 Company Beaver Ins, BUILDING Pol Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS .�O aG E] Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 6309 Date 7-1-88 Applicant V 0 rQ i n Roof Co. _ CITY ZIP 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 TEL. USENE MAP I certify that in the performance of the work for which this OWNER NO. � NO. permit is issued, I shall not employ any person in any manner 01 SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS 6309 nak Aus- CONDITIONS CITY ZIP V Date Applicant ARCHITECT OR TEL. NNNNEEEE NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROU CONST. 2O PROCESSED BY V Exemption, you should become subject to the Workers' ENGINEER NO. C Compensation provisions of the Labor Code, you must forth- ADDRESS 'J M A-3 W with comply with such provisions or this permit shall be 0.. deemed revoked. TEL• STATISTICAL CLASSIFICATION APT. C DO. (q CONTRACTOR NO. v LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. Z DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO-360650SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY San Cm1hrIP11 CLASS BK i� VALIDATION 160650 SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class C39 SIZE SI I FAMILIES ONE VALUATION Contractor Virgin Roof Co.Date 6-30-89 DESCRIPTION OF WORK NEIN ❑ $ 2000.00 ADD ❑ I am exempt under Sec. MER ❑ 1110 B.BP.C. for this reason REPAIR ❑ $ USE OF Date: EXISTING BLDG. DEMOL ❑ ;29633A Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT NO. FINAL # I hereby affirm that I am exempt from the Contractor's License 0 0 0 0 0 1 Low for the following reason (Section 7031.5, Business and ADDRESS FI Professions Code): PRESENT ❑ BUILDING ( o o49.88 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY o o o49.885 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. , 9`$8 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). -� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAPROP.pLINE ER WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name - LDMA Ref. q Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee 10.50 LDMA P/C q 01 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, g Total Fee LDIOW Perm. q d and hereby authorize representatives of this County to enter S upon the above-mentioned property for inspection purposes. 5-10-88 SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT COUNTY OF LOS A yr -, BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDINGJkDDIRESS BUILDING ADDRESS ,0 G I hereby affirm that I have a certificate of consent to self insure, �jc%= or a certificate of Workers'Compensation Insurance,or a certified copy.thereof(Sec.3800,Lab.C.) CRY /e.vvpc-,1;l ZIPL' J 2� LOCALITY oej Policy No. Company SIZE OF LOT (/ 0.OF BLDGS.NOW ON LOT �U ❑ Certified copy is hereby furnished. l NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP fx department. ® i Date Applicant ASSESSOR P B PAGE PARCEL e917 Qel,( SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ) '' IL 4A TEL NO. YES NO COMPENSATION INSURANCE '�,`�'� WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS U �7 A! ,p dollars($100)or less.) f s'r' , /�V r DISTRICT GROUP TYPE ST. FIRE ZONE PR ESSED BY I certify that in the performance of the work for which this permit CITY % i�� ZIP^ �� />,_ - , is issued, I shall not employ any person in any anner so as to (� i C3. 1�1/' /V/ become subject to the Workers'Compensation s. ARCHITECT ENGINEER TEL NO. 7 STATISTICAL CLASSIFICATION APi CONDO v Date/ �Applicant :J ADDRESS CLASS NO. Q / DWELL UNITS NOTICE TO APPLICANT If, after maki this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become su ' Ct to the Workers' CONTRACTOR J TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor de, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CRY UC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.F NO.OF STORIES NO.OF FAMILIES NEW ❑ BK PG CL C Professions Code,and my license is in full force and effect. C License Number Lic.Class DESCRIPTION OF WQRK. ADD ❑ VALUATION Contractor Date ALTER ge ❑ 1 am exempt under Sec. J REPAIR ❑ $ _ �� CA BAP.C.for this reason � y / � GZ�� ,MOL El — LDMA PP//C# Date: USE OF EXISTING BLD URM ❑ gnature APPLICANT(PRINT) TEL NO. LDMA Perm# iv " I,as owner of the property, or my employees with wages as ADDRESS ZO t'_ � their sole compensation, will do the work and the structure is �'� ` not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) " t] WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL To OR GREATER THAN THE Q i licensed contractors to construct the project (Section 7044, FINAL BY AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? > �,_ a Business and Professions Code.) YES NO ElA10"CU j R s qq WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING .j 1Lf RSL OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR .1.—iq- GUIDELINES _ tf_i!� I hereby affirm that there is a construction lending agency for YES❑ No❑ W the performance Of the Work for which this permit Is issued(Sec. [HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING TOTAL AL 2 16 o 78 3097,Civ.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, �j 't y TITLE 2.CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS CHECK s.11 o Lender's Name MATERUILS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 0 L-�Address Ssi�F)itii}� 0 ONNER OR AGENT o .1 certify that 1 have read this application and state under Penalty P.C.FEE of perjury that the above information is correct.I agree to comply PERMIT FEE E:�_ N with all county ordinances and State laws relating to building �Jd SIE)Li�l�til 'tet] 77�5 s� construction, and hereb authorize representatives of this County ISSUANCE FEE y�/ 62-22 I � =R W 6 O5I _su J1 m to enter upon the abo mentioned property for inspection 'puurrpose ,24 m 7•-2-f INVESTIGATION FEE TOTAL FEE ' /� Spsalaa a AyWtan or Agan ono SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF IAS 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 0802270012 PHONE: (626) 285-0488 EXT: NO. OF CONST BUILDING ADDRESS: 1LEG ONIFILE SQ. FT STORIES TYPE 6309 OAK AV 1STRUCTURE: 1800 V-B I TEMP CA 917801336 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15382-017-041 1 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY: EXPIRES ON: (EXIST OCC GRP: 102/27/08 SR 08/25/08 OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL JDATB BY: CODE: CHIN, LUCY (626) 285-2932- 1 4,500 1 16309 OAK AV I DDD I ITEMP 917801336 I FEES PAID ID SCRIPTION OF WORK 1 ITEA�R OFF & REROOF HOUSE & GARAGE INSTALL OSB PLYWOOD INSTALLI IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IGAF 30 YR COMPOSITION SHINGLE INSTALL BUILD IIP MODIFIED MATE( (APPLICANT: TEL. NO. I I I ISUNSHINE ROOFING (626) 581-7688- IAA BLDG PERMIT ISSUANCE 27.75 I I 1516 N. DIAMOND BAR IAC STRONG MOTION REBID 4500.00 VAL 0.50 ISPECIAL CONDITIONS: IDIAMOND BAR CA 91765 ID2 PERMIT W/O EN-HC 4500.00 VAL 132.60 I I TOTAL FEES 160.85 I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 ISUNSHINE ROOFING INC (626) 581-7688- 1 1516 N DIAMOND BAR BLVD #183 LIC. NO I LOCATION AND SETBACKS IDIAMOND BAR CA 91765 755126 C39 1 I I ISOILS ENGINEER APPROVAL 1 I I (ARCHITECT OR ENGINEER: TEL. NO: - 1 IFOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLAB/UNDER FLOOR 1 I 1 .I IRAISED FLOOR FRAMING 1 I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( 1UNDERFLOOR INSULATION I I I 1153H265 3 011 1 1 I I 1FLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I I I NO 21 1 IROOF SHEATHING I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS 1AIR QUALITY: 1000 FEET MATERIALS 1 I I I I 1 NO NO NO 1 [FRAME INSPECTION I I I IREQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I I I FRONT PL- 1 (INSULATION/WEATHER STRIPI I I SIDE PL- [ I -1-1 I IINTERIOR LATH/DRYWALL I I I [ 1( I I I EXTERIOR LATH IRATED FLOOR/CEIL ASSEM. I I I I I1 1RATED WALL ASSEMBLIES I I I I � (RATED SHAFTS/OPENINGS I I 1 IT-BAR CEILINGS I I I I* ADDITIONAL DATA ON FILE I ILOT DRAINAGE 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I I