HomeMy Public PortalAbout6644 OAK AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES
OF COUNTY
BUILDING PERMIT DEPARTMENT BUILDING AND SAFETY DIVISION ENGINEER
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING
ADDRESS 661.1, T V 4J LOCALITY
NEAREST
CITY Temple city ZIP 91780 CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOJI)) ON LOT MAP BOOK PAGE PARCEL
meq, n., L "It'
M C✓ DISTRICT GROUP TYPE FIRE OC SED BY
TRACT BLOCK OT NO CONST Zp
OWNER F ton NO• 4 -5725 STATISTICAL CLASSIFICATION SEWER`Mf P
ADDRESS CLASS NO.ADWELL.UNITS MB� TPG
CITY ZIP U �ONIMAP, O O
t�f�C, /JARCHITECT OR TEL. IAL
ENGINEER NO• DITIONS
ADDRESS p p ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO[]
CONTRACTOR lhambra Roofing NOL 282-19 U BLDG.SETBACK FROM
LIC. FRONT PROP.LINE OF (STREET)
ADDRESS NO. 1 ,• HIGHWAY + YARD TOTgL SETBACK FROM TIGHWAY EXISTING
WIDTH
CITY Alhambra Cialif0 C ASS FRONT PROP. LIN
CONSTRUCTION LENDER + —
n
NAME AND BRANCH BLDG.SETBACK FROM C
ADDRESS CITY SIDE PROP.LINE OF (STREET) C
SQ. FT.
NO. OF NO. OF CHECK HIGHWAY + YARD - TOT L TBACK FROM TYPE OF EXISTING C
SIZE STORIES FAMILIES ONE I EPFOP. LINE HIGHWAY WIDTH F
DESCRIPTION OF WORK Re-roof Flat NEW ❑ + n
v
8c Shine a sec of Hs w a4o# ADD ❑ CORNER CUTOFF YES ❑ NO ❑
�+ �+
❑
Compo & F t W/ S & 9O# CS LTER r� IN OPEN SPACE YES ❑ NO ❑
REPAIR LJ
USE OF DEMOL IN COASTAL PERMIT Z E YES ❑ NO ❑
EXISTING BLDG. ❑
APPLICANT TEL
(PRINT) NO.
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING Na TO �/���G��/G �f'L'Q�f1��a� (� ,F14✓ >.,
WORKMEN'S COMPENSATION INSURANCE.
SIGNATURE OF f FINAL ,✓V� �� �•�r, BYCG�L
PERMITTEE DATE _
ADDRESS 12 So. Marengo Ave.
CITY Alhambra, Calif.
TE L-2 P.C. Fee$ Permit Fee 12,00
QIssuance Fee
VALUATION�" j� (3
Total Fee 1-2,00
PLAN CHECK VALIDATION CK. M.O. CASH — I CASH
VALIDATION GK. M.O. CASH
v
0 6 2 NJJ14 17 1 0 1 2.0 0 Ali)
76AG38A CEO8038 12/75 —
I L, L-t
4
WORKERS'COMPENSATION DECLARATION
�,sy affirm-that I have a certificate of consent to self D
~1'��n'sure,ar a certificate of Workers'Compensation Insurance, APPLICATION F®R BUILDING PERMIT
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS r
❑ Certified copy is filed with the county building inspec- BUILDING t
tion department. `/ Y.
ADDRESS 4 Z 414 OA le, W10 47
Date Applicantt i 7. "flltlP!i&�J CITY ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' / i NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT /A 3 NOW ON LOT
(This section need not be completed if the permit is for one ' ASSESSOR
hundred dollars($100)or less.) TRACT BLOCK LOT NO. y MAP BOOK PAGE PARCEL
./� TEL. USE ZONE MAP '7
I certify that in the performance of the work for which this OWNER _ NO. NO. —21/9
permit is Issued, I shall not employ any person in any manner ADDRESS e L SPECIAL O
so as to become subject to the Workers'Co �ensotlon Laws. (� " CONDITIONS
Date Applica CITY l�f ZIP c Q'':' U
ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O
NOTICE TO APPLICANT: If, after ting this Certificate Pf ENGINEER NO.
Exemption, you should beco ubject to the Workers' 5/\(/ CONST. ' ZONE f U
Compensation provisions of the abor Code, you must forth- ADDRESS Ud - a
with comply with such provisions or this permit shall be TEL. �/ STATISTICAL CLASSIFICATION APT. NDO. Cn
deemed revoked. CONTRALTO . NO_ 7� "Q
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS. NO
(commencing with Section 7000)of Division 3 of the Business andLIC. SEWER MAP
Professions Code, and my license is in full force and effect. _ CITY CLASS BK PG,L VALIDATION
SQ.FT NO.OF g NO.OF CHECK
License Number Lic.Class__ SIZE Q STORIES / F S ONE Y -2776,� n
n VALUATION ` # 0 0 0 0 ,97
ContractDate DESCRIPTION OF WORK NEW ❑' $<%J{O��J �o7-LIJI
,/! ADD � I o27285
F1 am exempt•under Sec. ' y ALTER
❑ ao2728563
B.BP.C. for this reason Aq:2,ivp /J 1y REPAIR ❑ : $
Date: USE OF . x 8 2 7 8 7
EXISTING BLDG. DEMOL ❑'
Signature APPLICANT .. TEL. C FINAL _ d
OWNER-BUILDER DECLARATION PRINT NO. f d r DATE
I hereby affirm that I am exempt from the Contractor's License ID
Law for the following reason (Section 7031.5, Business and ADDRESS / !G /3 ✓� FIPIAL
i Alt
Professions Code): PR �i By
❑ BUILDING
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 rADDRE
TY ..X ,
7044, Business and Professions Code). G TEL.
❑ ACTOR NO.
I,as owner of the property,am exclusively contracting i;
with licensed contractors to construct the project (Sec- SS $ V�� 11
t
tion 7044, Business and Professions Code). #
IRED YARD WY TOTAL SETBACK ROM
CONSTRUCTION LENDING AGENCY ACK PROP. LINE WIDTH I o 3 31,5.0
I hereby affirm that there is a construction lending agency for NT
the performance of the work for which this permit is issued(Sec. 3097, Civ. C.). 331.5 =O O O5Lender's Name :').. _: 0,23-87
e$ (�r Permit Fee 30� r�� LDMA Ref. a ;�
Lender's Address
I certify that I have read this application and state that the Issuance Fee Or-s� LDMA P/C•# s
above information is correct. I agree to comply with all County Investigation Fee
q ordinances and State laws relating to building construction, Total Fees LDMA Perm. R
and hereby authorize representatives of this County to enter
upon the above-mentioned property for inspection purposes.
� F
r• 23 SEE REVERSE FOR EXPLANATORY LANGUAGE
g at of scant or Agent Dole