The URL can be used to link to this page

Home My Public Portal About5635 SULTANA AVE_Building__ DIIPASTbUM OF COUM IIPODP= Y DIVISION OF BUILDING A=ND �/� c o BUILDING COUNTY OF LOS AN6Pi� Y 2 t_5 , 1 WILLIAM J FOX COUNTY ENGINEER APPLICATION CASSATT D GRIFFIN, Burr Or BUIL JNG FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ABUILDDDRESS �� DIBTRI _VO PUN CK OR R¢c No 8RM 1{O� •M•L RBCEIIV BY DATE F A Dl/B ISWUUURD NEAREST Z s3 5 C /•• BUILDIN OWNER Aa ADORE89 .}./7 MAIL LOCALITY ADD �i� C i. A NEAREST CITY TEL _ ur3 CROSS Br .S ARCH OR ` TEL FIRE NO I D HNGI EER N ZONE PLANE / YBLOCJ ADD ESB SETBACK LINE CON NEI" UDE APPROVED ZON • BY DATE HOUSE NUMBERING ADDRESS LEGAL MAP NUMB O ASSIGNED BY DESCRIPTION I LOT NO BLOCK CORRECTIONS TRACT Q�GJ O OFBLDOB SIZE OF LOT97� NONW ON LOT e USE OPNO OF TI - -- EXISN B - DESCRIPTION OF WORK D - a HW lzf.AL T ADDITIO S ZE- O 2 REPAIR �7 DEMOLITION E ZQ FTE / 70 ROOMS STORIES �r MEN= ROOF' COVERING COVERING USEOFSTRUCTURE APPROVALS INSPECTOR SSIGNATUR D FOUNDATION LOCATION PORMS MATERIALS 1 HEREBY ACXNOWLSOOE THAT 1 HAVE READ THIS AP- FRAME PIREBTOPS PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING BOLTS CORRECT 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION GAS VENT DUCTS SIGNATURE hu� LATH INT PmTM ADD LATH EXT 10 1 _ PLASTER, INT AVTXORIZm AGT S OHO Y QC C S (JOG PLASTER P� HOUSE NUMBER COR COR- RECT AND POST® V A1 FINAL DMSION OF BUII.DING AND SAF B , e e De= of 00mcr >mpGDE[ 6i 1 _ _ Oomty of I," AnsD1OB WM. J. FOX, COUNTY ENGINEER 1 ,APPLICATION 1 FOS APPLICANT TO FILL IN FOR OFFICE USE-ONLY DISTRICT N6 P,OR-OR R. NO PERMIT N0. BUILDING 56 3 Gtr mn�. 5 `-' , ADDRESS /r �°' LOCALITY Tern p l e/ (�� \/ JR [O[IVLD By DAT[O►APPL DAT[ISSUED I _ c p - S CROURNZARCMT w 'LD MAIL LOOALY� IT ADDRESS NEAREST I OROBB BT. Q eNOL FIRE NO Or t _ TYPjTy_ GROUP 293N[ I PLANS ARCHITECT OR TEL _ ENGINEER N0. SETBACK LIN[ 2 DRESS US[ r PROVED AP ' 1 2OUN[ 1 - BY DAT[ CONTRACTOR e. No. I HOU E NU RI 1 I ADDR P MANUMBFD '-QQ!R ( NO ASSIGNED SV DESOgIPT10N LOT NIL 13 ■LOOK I CORRECTIONS- 1 TRACT J2 12 It k I e-w N06 Or BLOMIL O eliE Dr LCT NOW ON LOT &L UBE OF NO. O( Or i IRTING SLOG DESCRIlMON OF WORK a° 0 NEW ALTERATION ADDTON REPAIR DEMOLITION r Sq R. N0.Or BI2[ ROOMS STORIES EXT WALL Roar DOVER NO ACLS O COVERING V G UBE Or GTR OTURE _ C4 115% INSPECTION rOR APPROVALS OCCUPANCYAB INSPECTORIBBIONATUR9 DATE FOUNDATIONI LOCATION fOgMB, MATERIALS I HEREBY ACKNOWL[DG[ THAT 1 HAVE READ THISP- A PLICATION AND BTATE THAT THE INrORMATION GIVEN IS FRAMs rIR[BTOPS, CORRECT BRACING,BOLTS 1 �\GR[[ TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION. AND STATE LAl//W(��E REGULATING /BUILDING CrOONN/SX-TRUUCTION GAS VENT DUCTS SP[RNITT[[OF/11 W"'L. ^i/ /P• / �// LATH. INT. ADDRESS�Ea Sol. f T/. h 61 I LATH. GCI'. ` PLASTER, INT. AUTHORISED APT PLASTER, EXT. ® ` P D • GLZ HCUSENUMBERCOR- /Z 8'Od F[E 1 REOT AND POSTED VALUATION S GC ►[[ 2 Q � FINAL _ 7M Di s 1-101 ' 1 DIVISION OF BUILDING AND SAFETY BUILDING t D.F�•a, Bt EnAl Ebg—W WM ,1COPo�cCOUNTY ENGINEER I APPLICATIONUILDING t FOR APPLICANT TO FILL IN - wDDREBB Jr BUILDING ADDRESS LOCALITY 1 �- NEAREST LOCALITY CR08S 6T NEAREBT DISTRICT NO PLAN C[ R REe No PERMIT NO OWNER RC EIV L BY DATE OF APP1 DATE 1SISSUED8V MAIL - 3 ADDRESS max KI NO OF GRg_gp FIRE ZONE CITYf No ', //F�' y PLANI= ARCHITECT OR TEL / 1 _ ZONING ENGINEER NO BUILDING /V SETBACK LINE i Vzm TEL AFFROVao 1 i I Dw CONTRACTOR NO BY, l 1 HOUSE NUMBERING 1 AO LOO � } L66AL MAP NUMBER NO ASSIGNED 1 BY DESCRIPTION LOT NO BLOCK �\ DATE CORBECTIONS I INSPECTOR TRACT SIZE OP LOT 2 NO OF BLDGB 1 f.. _ _ _ _ _ _ _ •_ NOW ON LOT UHH OF NO OF FAMILI O DESCRIPTION OF/WORK - - 20- i NEW ALTERATION ADDITION REPAIR DEMOLITION Bq PT NO OF I v / SIZE ROOMS STORIES EXT WALL ROOF COVERING COVERING UBH OF STRUCTURE 1 26: V 0� AgP�OVALS IN PECTOR'88IGN TUR DATIS, FOUNDATION LOCATIO ,✓ FORMS MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AFS FRAME TIRE STOPS, / PLICATION AND STATE THAT THE INFORMATION 61VEN IS CORRECT BRACING BOLTS 1AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION GAB VENT DUCTS SIGNATURE O LATH INT PERMITTE � ,�11 ADDRESS 3 K IV4-1fL� LATH EXT AUTHORIZED AGT PLASTER INT r H PLASTER F [ S FHourANGEXBTHSED- r 2v clij 0-) "- FEE FEE FINAL )MeaeA OE�� 1-ea _ \ . • .w.N4 ul t• dc., . ti v .._.... .. .� ,• F9UUJ93 BG WORKERS' COMPENSATION DECLARATION hereby affirm that I haver certificate of consent to self APPLICATION FOR BUILDING -PERMIT insure, or a cer),ificate of Worker' Compensation Insurance, -• or a cgrtthed copy thereof (Sec 3800, Lab C ) : COUNTY OF LOS ANGELES BUILDING AND SAFETY Pohcy NoRC997500 Company ReDLLblic Indemnity q ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN _ AADIDRRESS ® Certified copy is filed with the county building irapec- `-- BUILDING - tion department I ADDRESS 5635 Sultana Date 7-1-91. Appliaont Virgin Roof Co. CITY Temi3li City ZIP 91780 iOCAUTY NO OF BLDGS NEAREST CERTIFICATE OF D(EMPTION FROM WORKERS' SIZE OF LOT - - NOW ON LOT CROSS Sr COMPENSATION INSURANCE ASSESSOR (Thu section-need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL hundred dollars ($100) or less ) I _ USE ZONE MAP a` i 11 1 1 OWNER rJan Riga NO I certify that in the performance of the work for which this permit a issued, I shall not employ any person in any manner ADDRESS - - .,~ SPECIAL - - .- so as to become subject to the Workers'Compensation Laws CONDITIONS- O CITY Apple Valley ZIP - Date Applicant ARCHITECT OR TEL DISTRICT GROUP IFIRE PROCESSED BY d' NOTICE TO APPLICANT If, after making this Certificate of - LNGNEER - - NO - CONT ZONE O Exemption, you should become subject to the Worker Compensation provisions of the Labor Code you must forth- ADDRESS with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked 1 CONTRACTOR NO - _ LICENSED CONTRACTORS DECLARATION I LIC CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P.O. BOR J NO 160650SEWER MAP , (commencing with Section 7000)of Division 3 of the Business UC and Professions Code,and my license is in full force and effect CITY San Gabriel CLASS 39 BK L PG �a- VALIDATION CHEC License Number 160650 Lic Class ` C39 SIIZEO ORIEES F�AMILOIES ON K ' VALUATION Contractor Virgin Roof CO. Dote 6-30-91 DESCRIPTION OF WORK NEw ❑ - $ 1588.00 ❑I am exempt under Sec a Am ❑ lop. ❑ - - B SP C far this reason Fiber laSS. (10i 8 S. REPAIR Elf Date _ 115E OF - - EXISTING BLDG Dwe n ni;: 0 ❑ SignatureAPPLICANT TEL - -/ - OWNER-BUILDER DECLARATION (PRINT)- NO - FINAL I hereby affirm that I am exempt from the Contractors License1 Law for the following reason (Section 7031 5, Business and ADDRESS P_.Q. Box J. SanFINAL Aft.T.'T Professions Code) - NT _ . - _ i -By - 'V ❑ I, as owner of the property, or my employees with DING CRESS _ 33(17 7CI•�r wages as their sole compensation,will do the work and LOCALITY - - - - i t poll r ' `i ITEMS the structure is not intended or offered for sale(Section TOTAL � 7 704.1, Business and Professions Code ) MOVING TEl _ E] 1, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed044, Bu Business and to construct the project (Sec- ADDRESS CHECK 70.37 hon 7014, Bumneu and Professions Code ) BEIII CONSTRUCTION LENDING AGENCY vARD` HWy O7AL SETBA FROM I _ - CHANGE _ •CG I I herebyaffirm that there is a construction lends agency E ng ager for FRONT the performance of the work for which the perms is issued P L (Sec 3097 Civ C ) SIDE 13000-00131, 12/ 5/QIJ P L 4311 1 FM 4: Lender's Name _ _ - LDMA Ref R Lender s Address ee P C F"$ Permit Fee Pool o I certify that I have read this application and state that the Ivuonce Fee 13.00 LDMA P/C E above information is correct I agree to comply with all County Investigation Fee _ ordinances and State jaws relating to building construction, Totol Fee LDMA Perm E a and hereby authorize repreuntahves of this County to enter - $8 upon the abov est ad property for inspection purposes 19-3-90 _ $EE REVERSE FOR EXPLANATORY LANGUAGE . S nature of Applicant or Agent Date _ ,