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Home My Public Portal About5633 A, B, C SULTANA AVE_Building__ >-A---ACE#-o-`%s- APPLICATION FOR BUILDING PERMIT 1 BUIIDING AND SAFEfY DIVISION BUILDING Department of County Englnsse ADDRESS - 1 County of Loa Angelos LOCALITY L JOHN A AMBIE. COUNTY ENGINEER NEAREST CASSATT D GRIFFIN. Bu!T OF BUILDING Cp H FOR APPLICANT TO FILL IN DISTRICT NO GROUP' TYPE BHWEK MAP BK PG CONST BUILDING ADDRESS _ STATISTICAL CLA9HIFICATI ON LOT ry+ xa + L BLOCK CLASH NO UNIT �DW ELL MAP STATE YES O TRACT UMBER HWY G USEZONE SPECIAL NO OF BLDG .7 3 CONDITIONS SIZE OF LOT NOW ON LOT )IF •7 USE OF _ EXISTING BLDG BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT MAIL P L ADDRESS ' SIDE _ CITY C TE P L " INSPECTION RECORD ARCHITECT ENGINEER ADDRESS A n CONTRACTOR ' e-11 NO OL `IIG _ �NG ADDRESS DESCRIPTION OF WORK NEW �AOO ALTER REPAIR DEMOLISH HO FT NO OP NO OF IIpp SIZE STORIES FAMILIES USE OF S URE SIGNATURE OF APPROVALS APPLICANT ATE INSPE TOR 5 SIGNATURE ADDRE9 FOUNDATION LOCATION 1q� FORMS MATERIALS $ / P C S e7vi FRAME FIRE STOPS d d FEE •� BRACING BOLTS VALUATION , f FURNACE LOCATION FE! AB VENT DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH EXT STATE LAWS MGULATING BUILDING CONSTRUCT[ N SIGNATURE OF �T HOUSE NUMBER COR- PERMITTE �` RECT AND POSTED ADDRESS FINAL JOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGIN ElR PLAN CCC[ VALIDATION 4 .0 No CASH PST VALIDATION ® No CA-H � 8643- My 2g 16 1 7 0 0 A m M9223L JM13 1 3400 111 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN a Ess I hereby affirm that I have a certificate of consent to self InsureIND ESS or a certificate d Milkers Compensation Insurance or a certified 33 copy thereof3 00 tab C) CN ( ° man, �,OTir / VWP Ifi, C ,ia 760 OCA SIZE OF LOT NO OF SLDG5 NOW ON LOT Certdled Appy a hereby furnished I NEAREST GROSS ST ❑ Certded copy is filed with the c0 my bulldlrq In eGt TRACT BLOCK LOT NO I dePar Want USE ZONE MAP Rao Dat Applicant ASSESSOR MAP BOOK PAGE PARCEL i SPECIAL CONDITIONS RTIFICATE OF EXEMPTI FROM WORKERS R / COMPENSATION SURANCE — �� v76 WRFON 1000 FT OF SCHOOL' YES No (This section reed not be completed it the permit 0 for One hundred dollars($100)or less) _ �PROCESSEDBY ^ ,� v lr DISTRICT GROUP E CONST FIRE ZONE- p I certify that In the performance of the wF work for which this permit ZIP Is issued I shall not employ any pera0n In any manner so as to became subfect to the Workers Compensation Laws mECT OR ENGINEERTEL NO STATISnCAL CIASSI TION APT CONDO Date Applicant DRESS CLASS NO F DWELL UNfTS NOTICE TO APPLKANT If after making this Cemhcate Of 7 /� ) REWIRED TOTAL SETBACK FROM EXIST Exemption you should beccinla sub)ect t0 the Workers CO � TEL SET BACK YARD HWY PROP LIKE WIDTH Compensation pru nslons of the Labor Code you must forttwath ;7 comply with such pm ions or this pertmt shall be deemed revoked ESS UC NO FRONT L22 q10/27 PL LICENSED CONTRACTORS DECLARATION SIDE UIYC OSS hereby affirm that 1 am licensed uerprovlscP L ris Of Chapter B •.J SEyfER�P >- hereby with Section 7000)of Division 3 of the Business and SO SIZjD NO OF STORES NO OF FAMILIES 1 Professions Cada and I Is In full face and effect Q NEW ❑ BK ro O License Nu / 7� Lc Clas/s��L�73 RIPTION OF MRK '^/ ADD ❑ wlDN, �j , V Cam Date / VfW ALTER ❑ $- , V O Q ❑ 1 am a under Sec 0 /` 4 REPAIR $ O BAPC for this reasonffprr4 DEMOL ❑ CDMA PTL+ W Date q'' usE of Ezrsn URM 11i ai Slareeae QtC�/ i�i L APPLICANT(PFWT) TEL NO LDMA Perm A ❑ I as owner d th roperty or my employees with wages as z then sole canpensabon will do tie work and the structure Is ADDRESS F 16 1.i7.4i{ rot Intended M offered for sale (Section 7044 Business and =1� ISI PrOfM1es9rons Code) N TIE APRKJAT Ori FUTURE BUILOW oCLIHNT HAIADLE A HAZARDWS MATERUL 1 ITEMS ❑ I re Owner Of the pfapeftY am excl contract) with OR A MXTURE COMAN A IUZAPDg1e MATERUL EQUAL TO 0R GREATER T THE TOTAL 1...5� �� Iprotey � AMOIMM SPECFED ON THE WSA90a11S MATERMLs NEOn 7014 GLIDE+Ilcarlsed caareclae to cOreVuct the proled (Sedron 7044 YES❑ �❑Business anld Professions Coder I_HEICr i 1,77.40 NYL TIE H ,4[,ED USE OF THE BUCIANo BY THE APTJCANr OR RRIIRE eLIDNG OLCIRANI REQUIRE A PERIAT FOR C TRLY:TpN 0R MODFICATIGN Fq THE SOUrH t HANaE CONSTRUCTION LENDING AGENCY COAST Ali pururY uuucEMENT DISTRICT(S DI SEE PERivnTW CIECKUST FOR ,OLI woEVES I hereby affirm that thele e a construction lending agency for �s❑ io❑ _ the performance of the work for which this permit Is Issued(Sec m 3087 CN C) IHAVEIEAD r1EI4VAAWl1a.WTERNLaIIFORNATIORGUIDE AND THE SCIDAO r4RMTTI1q ��``��rFTII�� •7 /G: c1 CHECKLIST I lIfA1ER D ATY REOUREMENTS UNDER THE LOS ANGELES QOLwTY CODE 00W-L1OIJ 1 12/ 9:521 nL �- Lender a Nemo TERUik.S�RE RAW)FOR pew W AA KR�MHi F�TDHE�EwIAADD S 2843 1 AM ]:J+_ Lendera Address o aveRwAn,r � __ 1 certify that I have read this application and state under penalty P d penury that the above Information a correct I long cOmpry C FEE PERAIIT FEE O O with all county ordinances and State laws relaanp too WIIIirq mrm¢L iron ard Breby e f 1 B representatnes 01 this County ISSUANCE FEE ro•`•lJ'_ on t rove-mento PrOPartY for ion purposes INJESTIGATION FEE TOTAL FEE a a Apn � I SEE REVERSE FOR EXPLANATORY LANGUAGE 0900393 BG - t WORKERS COMPENSATION DECLARATION hereby affirm that I have certificate of consent to ,elf APPLICATION FOR BUILDING PERMIT, insure, or a certificate of Workers Compensation Insurance or a cgrtified copy thereof (Sec 3800, Lab C) COUNTY OF LOS ANGELES BUILDING AND SAFETY " Policy No PC997500&mfpny Republic Indemnity ❑ Certified co is hereby furnished FOR APPLICANT TO FILL IN BUILDING PY Y ADDRESS G 3 ® Certified copy is filed with the county building IMpec- - BUILDIhIG- - - non department ADDRESS 5633 Uni Date 7-1-91 Applicant Virgin Roof Co. CITY TemRle City ZIPLOCALITY NO OF BL - - . ST CERTIFICATE OF EXEMPTION FROM WORKERS SIZE-OF LOT Now ON LOT CROSS NEAREST T COMPENSATION INSURANCE ASSESSOR i _ (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOT( PAGE PAROL hundred dollars ($100) or less ) TEL / r OWNER Glen Higa NO USE ZONE MAP ' L.7 I certify that in the performance of the work for which this DD NO permit is issued, I shall not employ any person in any manner - ADDRESS19025 Chole Rd. --- `_ SPECIALCONDITIONS - d so as to become subject to the Workers'Compensation Laws - _ _ _ O CITY ZIP `" r V Date Applicant ARCHITECT O TELchiNOTICE TO,APPUCANT If, after making this Certificate of ENGINEER _ NO_ _ f DISTRICT GROUP I TYPE FIRE PROCESSED BY O CONST Exemption you should become subject to the Workers Compensation provisions of the labor Code, you must forth- - ADDRESS with comply with,auch provisions or this permit shall be TEL STATISTICAL CL459FICATK)N APT CONDO N deemed revoked CONTRACTOR NO — '�J II - Z UCENSED CONTRACTORS DECLARATION LIC CLASS NO�DWE1L UNITS — I here affirm that I am licensed under ADDRESS P.O. BOX NO SEWER MAP by provisions of of Chapter 9 LIC (commencing with e,Section d7000)of Division 3 of the Business CITY San Gabriel CLASS and Profession Code,and my licertae a In full force aril effect LPG 11;2- VALIDATION OF NO OF CHECK License Number 160650 Lic Class C39 SIZZE�K D16 RIES FAMILIES ONE VALUATION Contractor V1rCin RoofCO. lite 6-30-91 DESCRIPTION OF WORK NEW El_ _ ADD ❑ S 1718.00-- ' Poo 1 am exempt under Sec roof a 1 Clas _ - ALTER ❑ B 8P C for this reason REPAIR ❑ S - _ - Date USE OF EXISTING BLDG Dwelling: DEMOL ❑ Signature' APPLICANT - TEL FINAL (PRINT) NO — J OWNER-BUILDER DECLARATION DAA �j—/7 17,3 hereby affirm that I g r exempt from the Contractor s ss n d - - - - - - - Law for the following reason (Section 7031 5, Business and ADDRESS P.O. B X � FINAL Professions Code) _ _ _ _ - By M — ❑ I as owner of the property, or my employees with BUILDINGAHT.ra wagesmthctr solecompensabon,will do thework and ADDRESS - 1-407 the structure Is not intended or offered for sale(Section LOCALITYpool 704 Business and Professions Code ) - MOVING - - - - TEL - - I - 1 ITEM: _ ❑ I as owner of the property,am exclusively contracting CONTRACTOR NO T01AL 70 _ 37 with licensed contractors to construct the project (Sec- ADDRESS - - - - tion 7044, Business and Professions Code ) REQUIRED CHECK 7D.7,CONSTRUCTION LENDING AGENCY SET YARD HWY 7 AL CNEFROM E ID __ "' r_HANGE ,I11 I hereby affirm that there is a construction lending agency for FRONT the performance of the work far which this permit n issued P L (Sec 3ov7, Civ c > PTDE _ _ _ - DDUD—CQIU 1 12/ 500 Landers Name _ LDMA.Ref 4�1D 1 FM 4:25 Lenders Address P C Fes f Permn Fee $57.37 , I certify that I have recd this application and state that the Isaaance Fee LDMA P/C N ' above information a correct I agree to comply with all County Invesngaean Fee - _ ordinances and State laws ielating to building construction, Total Fee LDMA Perm A and hereby authorize representatives of this County to enter up n the above/,Went ent ed property for inspection purposes U 12-3-90 fu RIVERM FOR U(RANATORY LANGUA04 &t of Applicant or Agent Dote