HomeMy Public PortalAbout6225 ROWLAND AVE_Building__ SIGN OF BUILDING AND SA 9� "WILDING
went of County Engineer 1
bounty of ]Los Amgeles
M. J. FOX, COUNTY ENGINEER APPLICATION
FOR APPLICANT TO FILM. IN FOR OFFICE USE ONLY
DISTRICT N0. PLAN CK.OR RED.No. PERMIT NO.
BUILDING
ADDRESS ?�� G7
a
LdOALITY FIVE Y DATE OF APPL. DATE ISSUED
�AK d �G.. t l�'
C�Ru68 sT. (t- �4. Hul {NO // +� c::3
ADDRESS (p G Z �pd.�,G
OWNER ,�X04 f to d$
MAIL LOCALITY
ADDRESS <Q 7NZARBST
/� / f�p CROSS ST. b
CITY V /1' �1 I 4 NO. Air / Q ZFIRE NO.OF ONE I PLA 0 !� I E CROUP
ARCHITECT OR TEL •�/�'
ENGINEER NO. BLOB. DRD. NO.
A
ADDRESS
SETBC/K�LINE � /�/o•�'
TEL apNE// APBY PROVED DATE
CONTRACTOR ,-Af( �- NO. ° HOUSE NUMBERING
ADDRE138 MAP NUMBED -2-12'55 NO. ASSIGNED BY
LEGAL
DESCRIPTION/ LOT NQ �� BLOCK CORRECTIONS
TRACT j( Q O -a'
NO. DIF BLDB
SIZE OF LOT N�0sW ON LOT S.
Oa
EX8TINGBLDG. .UVYCr /. /N GJ . FA►fiUSE OF I NCL�Es
DESCRIPTION OF WORK A
v
NEW ALTERATION ADDITION Z
D
r
REPAIR DEMOLITION /
9 Z
E Q ROOMS (p STORIESEXT.WALL DEW
fI
COVERING 's" U�.0 O I COVERING WA
USE OF STRUCTURE
i L
17- L '9- ;:;-r ZoYAn
INSPECTION FOR APPROV4'LS
OCCUPANCYAB INSPECTOR'S SIGNATURE DATE
FOUNDATION:LOCATION T
rI7RM8,
MATERIALS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PL
P-
PLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAME: FIRE STOPS,
CORRECT. BRACING,BOLTS ,7.Qss.sC 1�a �-
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES F`LIRNACE: LOCATION, r
AND STATE LAWS REGULATING BUILDING CONSTRUOTION. BAS VENT,DUCTS _
SIGNATURE. Q LATH, INT.
PERMITTEE
6— LATH, EXT. G5r/-7-
ADDRESS
yADDRESS
PLASTER, INT.
AUTHORIZED ABT.
)I PLASTER, EXT.
J. �(��q FEE HOUSE NUMBER COR-
VALUATION
PORTED
VALUATION / .1/ c c
FEE « FINAL
76A639A D139 3 1-63 �
WORKERS' COMPENSATION DECLARATION
hereby affirm. that I have certificate of consent'to self APPLICATION FOR BUILDING PERMIT.
insure, or a'certificate bf Workers' Compensation Insurance, `,• ,
Or'a certified copy thereof(Sec. 3800, Lab. C.). I COUNTY"OF LOS ANGELES BUILDING AND SAFETY .
+ policy Na.1046140 company State fund
❑ Certified copy is hereby furnished. .:FOR APPLICANT TO FILL INTADDREss
6225 No. Rowland T.Cy. 91780
® Certified copy-is filed with the county building inspec- BUILDING
tion department. ADDRESS
' pate 11-1-90 Applicant Randol Roofing. crT T.,Cy. ZIP 91780L- -r�17Y OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT . CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL.
OWNER Adeline Cmeri No. 285-0454 USE ZONE MAP
I certify,that in the performance'of the.work for which this NO..
l
Rowand SPECIAL" >_
permit is'issued, I shall not employ ariy.p'erson in any manner I ADDRESS 6225 No. - o_
sops to become subject to the Workers'Com ensation'Laws. CONDITIONS � O
' 7-12-90 � • " Randol lgo0fing CITY Temple City ZIP 91780
Date Applicant - ARCHITECT OR TEL. tY
NOTICE TO APPLICANT:,I& after makinb this Certificate of ENGINEER I NO DISTRICT GROUP I TYPE FIRE RO SSED BY
O
Compensation
o
Exemption, you should become- subject to
the. Workers' �J� roNS7.Tj' rzoJlE /I LU
Coro ensation provisions of the Labor Code, you must-forth- ADDRESS ((WW�M `'-Is( 6/•/}
with comply with such provisions or this permit shall be TEL• S7ATIS.TICAL CLASSIFICATION A,. CONDO. N
deemed revoked. I CONTRACTOR Randol RoofingNo. 288-4040. z_
LICENSED CONTRACTORS DECLARATION • LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of.Chapter 9 ADDRESS 929 E. Valley-...Blvd NO. 451937 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business clrY ' San Gabriel, Ca. LIC. C-39
and Profession's Code,and my license is in full force•and'effect. BK.' PG. VALIDATION'
SQ. FT. NO.OF NO.OF CHECK
License Number- 451937-• tic. class C=39. ) SIZE STORIES FAMILIES ONE
VALUATION.,
Contractor' Randol ROOfinate 1-31-92=' i I DESCRIP ION.OF WORK Rerroof house ari NEW ❑
!
garage with GAF`Timberline -ADD Li $ 2950.00
g ►
❑I am exempt under S&
ALTER ❑
B.BP.C. for this.reason I fiber las shingles. Class A. REPAIR. $
Date: USE OF Roof.
. I EXISTING BLDG. Sfd I DEMOL ❑
Signature APPLICANT - TEL 'FINAL .'
OWNER-BUILDER DECLARATION (PRINT) 'NO. 9AR-JLDATE.
I hereby affirm that I am exempt from the Contractor's License 529 E. Valle -Blvd. S.G. 91776 r `
Law"for the following reason (Section 7031'.5, Business and ADDRESS y :FINAL;• y
Professions Code): PRESENT _ By ACCT°A
ElI; as owner of the ro err or-m employees•with BUILDING ,
P P Y.' Y em to P Y ADDRESS :.- I
wages as their sole compensation,will do the work and i�l;It �(Q% �v + :z 07 y ° i
�
the structure isLOCALITY not intended or offered for sale(Section 1 ITEMS
.� �'`' �•t :,- - -
7044, Business and Professions Code.) I MOVING TEL.
CONTRACTOR NO.
❑ I;as owner of the property,am exclusively contracting : TOTAL ,���
With licensed contractors to construct the project (Sec-
tion 7044, Business and Professions Code.) . • ADDRESS -,'••••• CHECK 82.130
I REQUIRED. A
TOTAL SETBACK FROM. • EXIST.
CONSTRUCTION LENDING AGENCY I SET.BACK YARD HWY' PROP. LINE WIDTH +`' CHANGE
°00
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 0000-00V71' _.�10
P.L. +
Lender's'Nanie.
1987 1 AM1o�
S P.C. Fee$ Permit Fee 69.00 Ref. #
Lender's Address
I certify that 1'•have read this application-and state that the Issuance Fee 13.00 -CDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
ordinances and Stgle laws relating to building construction, oral Fee 982.00 CDMA Perm. # ,
_ and SW7au ri repr sg1vthis County t entern th E entio spec' pr +
o � .. •SEE REVERSE FOREXPLANATORY.LANGUAGE
Signature of Applicant oDa ! '