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Home My Public Portal About8615 ROCCUS LN_Building__ i6A688A CENSO. e-e3 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN,SUPT OF BUILDING CROSS ST. DIST gLNO. GROUP TYPE P D Y FOR APPLICANT TO FILL IN , CONST. BUILDING` STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �/ dL BK PG CLASS.NO.- DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED11RECEIVED ❑ 1 CERTIFICATE: TRACT MAPHIGHWAY STATE MAJOR SECOND LOCAL NO.OF BLDGS. IV (CIRCLE)o. SIZE OF LOT NOW ON LOT „8` USE ZONE SPECIAL USE OFCONDITIONS EXISTING BLDG. OWNER T �r�� NO 7-0 BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH ADDRESS F.. &g&&g&a 1,41 7. FRONT ARCHITECT OR TELP. L. ENGINEE S NO&� SIDE ADDRESS &I/ p �• Gr TEL f '. / ✓� i� _II �1 Q CONTRACTOR gagZ �T! NO. ADDRESS o DESCRIPTION OF WORKIL l DD ALTER REPAIR DEMOLISH s y SQ.FT. %,,/ NO.OF NO.OF •�A .I a—'w' >,. -03 SIZE STORIES FAMILIES/ USE OF STRUCTURE i,� '!• /Jr�fil,i•�..J/.A. . �?.i�.� / / F SIGNATURE OF r fk/4.A/t.t.+ GAP, !? VALUATION APPLICA $ AS 8ft J APPROVALS DATE iNspECTo S SIGNATURE O f-09Vtl PMT.$ FOUNDATION: LOCATION- GFORMS, ;+ r"aS FEE 'MATERIALS , . . .HLsPC FEE $ Q FRAME: FIRE STOPS; ' y 'y} r I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS 7 .+ AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. +� ��••�/f r �dl�j WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. v✓�� `bL• ' TION OF THE LABOR CODE, OF THE STATE OF CALIFORNIA RELAT. yq� /� INC TO WORKMEN'S C�6 ENSATION INSURANCE. LATH.EXT. �e f r"y ,/f • s'I�P'� i✓'Lbw• 1. ltl�.'••Y.- . 19^• SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL r r JOHN F. LEWIS:PRINCIPAL STRURAL ENGINEER PLAN CHECK VALIDATION CK. M.C. CASH -PERMIT VALIDATION CK.` M.O. CASH UiL;D,l 1";6 31'a- JUL 10 2...3 A 30-�95 e - LAUa2 5'7 .5%0ilU913 1 A 6 4.00-. Y WORKERS'COMPENSATION DECLARATION / l C r. hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) i COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No).V83-22515bompany Fremont 1 nclPmn 1 t BUILDING Certified copy is-hereby furnished. y FOR APPLICANT TO FILL IN ADDRESS ® Certified copy is filed with the county building inspec- I BUILDING tion department. ADDRESS 861 RO C Date 5131/84 Applicant V i r9I n Rnn f ( n^ I CITY San Gabriel 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.) 1 TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP [ I certify that in the performance of the work for which this OWNER Joe Osborne NO. NO. 7 >, permit is issued, I shall not employ any person in any manner ADDRESS 861 5 ROCCUS Lane / SPECIAL ps so as to become subject to the Workers'Compensation Laws. ! �• CONDITIONS - i CITY San Ga b r i e f ZIP _ % cc Date Applicant ' ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT' GROUP TYPE FIRE PRO ESSED BY ENGINEER NO. CONST. ZONE E' Exemption, you should become subject to the Workers' _� y 4J Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be # `� d H deemed revoked. TEL STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTOR V I r I n Roof Co NO. 1287- LICENSED 128 - CLASS NO. DWELL. UNITS LICENSED CONTRACTORS DECLARATION I':` LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOX J NO. 1606 0 (commencing with Section 7000)of Division 3 of the Business and LIC. SEWER MAP Professions Code, and my license is in full force and effect. CITY San rahripl CLASS 7120 BK PG 33 VALIDATION SQ.FT. NO.OF NO.OF HECK License Number 160650 Lic.Class C39 SIZE ISTORIES FAMILIES ONE 1. I VALUATION Contractor V i rq i n Roof CO.Date 5/31`�84 DESCRIPTION OF WORK Re-roof with 00 NEW E] 46 i • ❑I am exempt under Sec. class A Fiber 1 ADD El $ 00 RAR loll B.BP.C. for this reason Flat area with 30# 15# fi rock( REPAIR Q $1 Date: USE OF reDMOL G 0 8.2 A EXISTING BLD 27 squares DE MOL ❑r Signature , APPLICANT TEL. FINAL �^- 2 0 o-61.75 OWNER-BUILDER DECLARATION PRINT) Virgin Roof CO No._ 28 - DATE '7— /// I hereby affirm that I am exempt from the Contractor's License P.O. OX J $a G b j O o,O 6 1,7 5 EE Law for the following reason (Section 7031.5, Business and ADDRESS P. . BFINAL _C�i- te„4�.*� ' Professions Code): - PRESENT - By �" 0'6 1 9-8 4 ❑ BUILDING v I, as owner of the property, or myemployees with ADDRESS c' wages as their sole compensation,will do the work and /V 7 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). ) MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors'to construct the project (Sec- I ADDRESS tion 7044, Business and Professions Code). T. CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTA SETB LINE CK F OM WIDTH I hereby affirm that there is a construction lending agency for FRONT PROP. the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). i SIDE o P.L. Lender's Name P.C.Fee$ Permit fee 51 .25 LDMA Ref. # Lender's Address ' @ I certify that I have read this application and state that the Issuance-Fee 10,50 LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, I Total Fee 61 • LDMA Perm.# and reby authorize representatives of this County to enter upo he above-mentioned open fgr inspection purposes. - � i SEE REVERSE FOR EXPLANATORY LANGUAGE Si ture of Applicant or Agent Date 0