HomeMy Public PortalAbout5644 SULTANA AVE_Building__ L"TM�SION OF BUILDING AND SAFETY
�TlparA z Df County P�glneer t BUILDING
OD®ty of Los ADgeles
COUNTY ENGINEER 3 APPLICATION
FOR APPLICANT TO FML IN FOR OFFICE USE ONLY
DISTRICT N4 PU CIL GR R[o No PERMIT No.
ACD DR[BB �Y�c� O C/l y S J'A
RECEIVED BYDAT[OF MPL DAT[I®ULD
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NGREST i-�J
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ADDRESS
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MAIL / LOQALITY i}I v
ADDRESS
ORO®R A
N FIR[ N0.OF TYPE CROUP
ARONir[OT TEL ZONE PLANSLf
[NOIN[ Na BLOB. ORD ND
ADO SETBACK LIN[
Usc _ 3 APPROVED
CONTRACTOR HDL !`1t zow[ BY DATE
{ l HOME NUMBERING
DD � MAP NUMBER-112-0 b NO ASBI ONEO SY
Ls�L
DESCRIPTION LOT NO BLOCK CORREMONS
TRACT
SIz[ OF LOT Z D MOW O LOT "' �OY/F/�Cp Ow�C4 /Z Y/Z F-me?'
Use of `JO. Or �`�b /'>- �u rn C
IXISTINB SLDO � . rZ,iu" /cp o
DESCRIPTION OF WORK
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ADDITION
a
RQAIR DEMOLITION
B0.FT. NG of
SI[[ Q ROOMS STORIES / I I? I I nlS
XXr
COV[RIANS COVKRINS
UBE OF RUCTURE
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INSPECTION ran APPROVALS
OCDUPANOVAS INSPECT WSSICNATUR[ DATE
F NDATIONTICK
FORMS, MATERIALS
I HERBY ACKNOWLEDD[ THAT 1 NAVE READ THIS AP
PLICATION AND STATE THAT THE INFORMATION DIVEN 18 FRANKI ►IREBTCPB.
CORRECT BRACIN0. BOLTS
IAOR[[ TO C PLY TH ALL COUNTY ORDINANCES FURNACE LOCATION.
AND STAT[ LA ECU r
INC SUILDINB OONSTRUCTIO OAS VENT DUCTS
SISNATUR[ OF LATH. INT. 4
P[RMITT[
LATH, Olr.
ADDR
PLASFIS, INT.
AUTHORIZED AOT
d P 41 1 W CLr.
/� F[
HOUSE NUMBER COR-
....
OR-
49-1 RCCT AND POSTED
VALUATION FEE FINAL
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DIVISION OF SUILDIING AND SAFETY BUIL ® i N G
pepBrtmeut of County Engineer
County of Los ABgelm APPLICATION
WM. J. FOX, COUNTY ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY 'O
DISTRICT N0. PUN CIL OII RED No PERMIT N0.
BUILDING
ADDREBB
/ R[O[IV[D w DAT[Or APPL. DAT[IBSUM
LOCITY '
AL1-
N`AR`K �O -ru H-S
BT BUILDING 6�
CWN[R
E ADDRESS
LOCALITY
ADDRteB give NEAREST
DI 6 V N O zI�7 F R 0 NO or TYPE `��' °ROU%y
ARCH T[OT OR TEL ZONE PLANS V
[NOIN[[R N6 BLDO. NO
B[TBACK LIN[ I
° UB[ APPROVED
TEL ZQN[
CONTRACTOR N0. BY
/, HOUR[ NUMBERING DAT[
ADD MAP NUMBER `� Q NO ASSIGNED BY
DMORILZOM LCT L 1 ■LDCX CORRECTIONS
TRACT y� �j/�
Biu or Lar D O !-6/ NNOOW DN LOLT '?
0 Or N0. Or $
IXILS NG BLDG. FAMIUMI
DESCRIPTION OF WORK °a
0
NEW ALTERATION ADDmON =
s
REPAIR DEMOLITION r
B1 C 'O Or
SII[ (/ 'OOMB BTORI6B
EXT WA L ROOF
COVERING COVERINO
BL FBTRUOTUp[
INBPEOTIDN rOR _ APPROVALS
OOCUPANOYAB INSPECTORIBBIGNATUR E DAT[
FOUNDATION LOoATICN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- F° 4 MATERIALS
PLICATION AND BTATE THAT THE INFORMATION GIVEN IB FRAMER r1RESTOP8.
CORRECT BRACING.BOLTS
I AGREE TO COMPLY WITH ALL COUNTY ORDINANOEH FURNACE LOCATION.
AND STAT[ LAW R[OU TING BUILDING CONBTRU DN
I GAS VENT DUCTS
SISHATURE or LATH. INT
PERMI
AODR[ �(/ LATH. GIT.
AUTHORIZED AOT PLABT[R. INT.
PLART[R. EXT.
HOUB[NUMBER COR-41 so
REOT AND POSTED
VALUATION oe
FEE FINAL ydP
TIMA'iA oma 1-e2
_ _ r . _ _ ___._._ .WORKI ERS'C1. OMPENSATION ... Y 'tO lH7,O3,IO BG-� _.. ' •„ '
hereby affirm that I have arorhftcate of carisent to self --~-- - APPLICATION FOR-BUILDING -PERMIT - �l
insure, or a cendicate of Workers Compensation Insurance `
or a certified copy thereof(Sec 3800-Lob 'C )" "' ' • - " -_ '-"- - - - ' - —' ' ' I _ _• _
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy _907 146 ` Compony Beaver Ins.
El Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING J '
1�{ 'Certified copyIs filed with the'coun buildingm _ Am�� 1
u + hon departent '^ '" •1 spec ADDRESS 5644 Sultana '
Date,%9/10/H7 Appl¢ant Vlrgjn Roof Co CITY Tem leCit ZIP LOCAL] Y
CERTIFICATE OF EXEMPTION FROM WORKERS ' ' - -- NO OF&DGB - - NEAREST
' COMPENSATION INSURANCE++ SIZE OF LOT NOW ON LOT CROSS ST
(This section'r,"d not be completed if the permit is for one --- TRACT - BLOCK - - LOT NO 't ASSESSOR _ - _
hundred dollars ($100)or less ) r, MAP BOOK - PAGE PARCEL
TEL
OWNER-Mrs. Gilbreath NO - , USE ZONE MPP ; ,
I comfy that in the performance of the work for which this , NO r
permit,is issued, I shall not employ any person in any manner _ ADDkESS_ -$63H -Sultana - - _a �� SPECIAL-
p _ - R
so as to become subject to"the Workers Comensation Laws CONDITIONS 'O
+ _ Cm Temple-Cit _ZIP
Date l Applicant '__ -
NOTICE'TO APPLICANT If aher,makmg'this Certificate of ENGIERTEL ARCHITECT _ DISTRICT - GROUP TYPE FIRE D BY_ 1
Exemption you should 'become wbject ao the Workers -- ��� CONST E
Compensation provisions of the Labor Code you must forth- a 3. _ _ __ J,16 W
with comply,with such provisions or,this permit shall be - --- - - ---- - -- - - - - -
TEL` STATISTICAL CL
STATISTICA$$IFKATgN { APT ONDO,
deemed revoked ,, ., ,, , s CONTRACTOR Virgin Roof Co NO 287-0507 _
LICENSED CONTRACTORS DECLARATION - - - - -- LIC _ -MSS NO �/I DWELL UNITS^
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS PO Box J NO 160650
(commenting with Section 7000)of Division 3 of the Business and _ __ _ __ _UC _ _ SEWER MAP t '
Professions Code and my license is in full force and effect CITY San Gabiiel CLASS C39 - BK LFG Y V/LLTDA710N -
` ` _ 50 FT NO OF _ NO 11 _ _ CHECK _
Lmerrse Number ' '160650 'Uc'Class 'C39 SIZEV STORIES 1�' FAMILIES ONE 1 r
a 11
t - - DESCRIPTION OF Wane Tear off 2 -layers- NEW ..vat1340
Comncd« ' 'YirQ1R Roof, Data ' 9/'10/87 $ 1340 00
I am exempt under Sec 6- re-roof flat_roofs at rear ADD
BIi&P C for thireason - with 1 630, 1' # 15 6 1 #72. 7 s ALTER
6
-- _- - Dale USE OF
_ EXISTING BLDG dwel L ing DMEMOL C3
'Signature - - - APPLppjCANT
Virgin Roof Co ro287-0507 N��z—//� - ` -, -- - - •�
OWNER BUILDER DECLARATION _ _ _ _ _ DATi 6!
I hereby affirm that I am exempt from the Contractor s License PO BOR .T San Gabriel, CA 9 17TH
Low for the following reason (Section 7031 5 Business and ADDRESS °
Professions Code) -' --•^_ _ _ __ ., _ PRESENT
'BY
I, as owner of the o Y employees with A_ - -
_ BUILDING
Property, or m em toe _ _ �__ - _ ___ _ _ _ _ _ _ _ '
'wages as thea sole compensation will do the work
k and _ � -;2 8'2�S 2 A-
the
the structure is not intended or offered for sale(Section LOCALITY ` ` 111.
7044 Business and Professions Code) - - ' ' MOVING- - - _ - TEL- - -' - ' - -- ` - -- # e • e-e,e `
I, as owner of the property am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- -- ADDRESS
tion 7044 Business and Professions Code)
' CONSTRUCTION LENDING AGENCY'- _REQSETBACK FROM EXIST
SET USI _ YARD HWY -- PROP UNE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
-the performance of the work for which this permit Is issued --PL -- -- -- - - - - ----- - - I- - -- I �, -2 p '
1 U
(Sec 3097, Civ C ) SIDE _ 1 `
PL .-
Lenders Name T
39.3H _ IDMA Ref I '
lenders Address P C-Fee S--_ _ _ _ pe,,,Fee
� I certify that I have read this application and state that the ._ _ _ __ _ _ _ _ laavonce Fee ]O.50 P2•
above information is correct 1 ogres to comply with all County InveNipohon Fee
ordinances and State jaws relating to building construction, -- Totol Fee 49.88 t
and alit'authonze representotrves of ilio Count'to enter
- - - - IiVAA Perin Y )
$ opo gbove-menyoned rty or ma Faction rpo
0 SEE REVERSE FOR EXPLANATOR's LANGUAGE ,
o1 Applimm m Agent _ _ __ _ Da1e