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HomeMy Public PortalAbout5837 SULTANA AVE_Building__ WORKERS'COMPENSATION DECLARATION I hereby affirm that I have certificate of consent to self j L I ��O Ei��`�,� FOR BUILDING UIL I PERMIT R I pJi insure, or a certificate of Workers'Compensation Insurance, I Ll or a certified copy thereof(Sec. 3800, Lab. C.) 1046140 State Fund ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company f�AD7DRESS9 "; BUILDINGCertified copy is hereby furnished. IAPPLICANT TO FILL IN * ADDRESS 3® Certified copy is filed with the county building inspec-tion department.Date 11-1-88 Applicant Randol Roofing' ity, Ca. ZIP 91780 LOCALITY CERTIFICATE.OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ;.NEAREST COMPENSATION INSURANCE I `SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one c D 'r ASSESSOR hundred dollars($100)or less.) TEL. 'TRACT �J BLOCK LOT NO. NAP BOOK PAGE PARCEL OWNER James Angevine No,288-4040 b.USE ZONE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner i SPECIAL 9f,. so as to become subject to the Workers'Compensation Laws. ADDRESS 5837 No. Sultana CONDITIONS 0 Date 2-15-88 Applicant Randol Roofing CITY ZIP Q1 7AQ NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. 3DISTRIGROUP TYPE FIRE PRO ED BY Q ENGINEER NO• CONST. ZONE I-' Exemption, you should become subject to the Workers' p/Compensatin provisions of the Labor Code, you must forth- ADDRESS P- y � with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFIC TION APT. NDO. a" deemed revoked. CONTRACTOR Itaudol Roofing NO. — N LICENSED CONTRACTORS DECLARATIONLIC.b CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 529 E. Valley Blvd NO,451937 (commencing with Section 7000)of Division 3 of the Business and LIC, SEWER MAP - y Professions Code, and my license is in full force and effect. ". CITY San Gabriel Ca. CLASS C-39 BK r-__PG5Z�— VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number 4519.37 Lic.Class r-3A SIZE STORIES FAMILIES ONE F. VALUATION Contractor R.aSan1 ROOfingDate 9-19-98 DESCRIPTION OF WORK Re-roof garage NEW ❑:` $ 627.00 ADD I am exempt under Sec. only with fiber las shingles ❑`' ' - ALTER ❑�' B.BP.C. for this reason C1aSS A. Roof. REPAIR $ Date: EXIs�NG BLDG. SFD Same DEMOL ❑�;. .: Signature APPLICANT TEL. FINAL ,+ (�' OWNER-BUILDER DECLARATION PRINT NO. — DATE '-Z ,��J g 919.8 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESSF A # 0 0 0 0 0 1 Professions Code): PR J" YI a a 3� 0 0 ❑ BUILDING I, as owner of the property, or my employees with ADDRESS = wages as their sole compensation,will do the work and ,;, 0 0 03300C.) 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. + 0318-88 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). ;) i CONSTRUCTION LENDING AGENCY SEETT BACK YARD HWY TOTAPRREOP LINE F 0M WIDTH 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.). I SIDE P.L. Lender's Name ,..,,. LDAkA Ref.q °o P.C.Fee S Permit Fee Lender's Address r-P I certify that 1 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 - j ordinances and State laws relating to building construction, T I Fee $33.00 LDAAA perm.,q and her by uthor' a re sentatives of this Count to enter ,. upon�dntio prop ty f inspect n urpo s. n r SEE REVERSE FOR EXPLANATOIRY LANGUAGE Signature of Applicant or Agent Da i T M. ti. 76A638A CE#8032-83 APPLICATION •FOR BUILDUNG"'.. PERMIT' • •-•�:� .. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS..= ' BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY.ENGINEER NEAREST WILLIAM A.JENSEN. SUPT OF BUILDING CROSS-ST.•. _ D.IST.R CT N.: GROUP TYPE SSED BY FARCHITECT OR APPLICANT TO FILL IN �j �--'• CONST. NG STATISTICAL CLA SIFICATION E ER MAP SS. CLASS. NO. DWELL.UNITS . BLOCK WATER NOT REQUIRED' RECEIVED ❑ CERTIFICATE: MAP HIGHW�IY STATE MAJOR SECOND, OCAL NO.OF BLDGS. NO'. ICIiiCLET LOT NOW ON LOT USE ZONE SPECIAL CONDITIONS- NG BLDG. lip O. BUILDING YARD HWY TREET E EXIST. SETBACK WIDTH SS FRONT ECT OR T P• L•ER NO. SIDE P. L. I ADDRESS CONTRACTO I^ ADDRESS ® l• — '�• OO DESCRIPTION OF WORK. J I ! a NEW A Z ALTER REPAIR DEMOLISH �' ...SQ.FT. �f NO.OF' NO. OF SIZE / STORIES FAMILIES USE OF STRUCTUR SIGNATURE OF APPLICANT VALUATION 5 d APPROVALS DATE INSPECTOR'S S GNA E FOUNDATION: LOCATION /7 FEE S 1' FEE'$ FORMS, MATERIALS.- a4 ow�1 FRAME: FIRE'STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE,READ THIS APPLICATION BRACING. BOLTS _ AND STATE THAT THE ABOVE IS'CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT-IN DOING THE WORK - AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. ' TION'OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT•, r TNG TO WORKMEN'S CO NSTON INSURANCE. LATH.EXT.' % SIGNATURE OF I HOUSE NUMBER COR- PERMITTEE OR- PERMITTEE___; C� RECT AND POSTED JJ ADDRESS 2n rm!e:d- . dT& G'— A... FINAL -11199..l,i i.6 It JOHN F. LEWIS.'PRINCIPAL STRUCTURAL EN R PLAN CHECK VALIDATION. CK. M.O. CASH PERMIT VALIDATION- c,K.• M.O. cnsH H2O .O 3 '1Q :.SEPT' 1;.. 1:...© S:Q 'y 'V TEMPLE CITY 76A638A CE#803 2-63APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING ADDRESSJG-2 DEPARTMENT OF COUNTY ENGINEER 4y BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN. SUPT OF BUILDING CROSS ST. ♦ �, DISTRICT NO GROUCONST. ED BY FOR APPLICANT TO FILL IN ' o T P BUILDING P STATISTICAL C FICATION SEWER MAP ADDRESS ,5 r-BK�Y CLASS. NO. DWELL.UNITS !1� LOT NO. BLOCK WATER NOT REQUIRED V?CI RECEIVED TRACT El CERTIFICATE: C� MAP HIGHWAY STATE MAJOR SECON ,LOCA NO.OF BLDGS. a NO. (CIRCLE) 4 SIZE OF LOT NOW ON LOT• USE ZONE SPECIAL USE OF CONDITIONS EXISTING JLDG. TEL. OWNE O. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS FRONT ARCHITECI OR TEL. P. L. U U ' ENGINEER NO. SIDE a P. L. ADDRESS 0 TEL CONTRACTOR geta -NO.P2,P/ 3 i a ADDRESS l 0 V DESCRIPTION WORK I>L %rz a I � NEW ADC4'6CAAL'VtlEPAI MOLISH SQ.FT. NO.OF NO. OF SIZE D STQ$IE FAMILIES USE OF STRUCTURE t� SIGNATURE OF //� APPLICANT l/�� VALUATION $ O^ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. ` FOUNDATION: LOCATION FEE � FEE $ // FORMS, MATERIALS FRAME: FIRE STOPS. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. /} TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMP NSATION INSURANCE. LATH, EXT. SIGNATURE F QQ���.�r HOUSE NUMBER COR- f PERMITTEE r ' RECT AND POSTED I / ADDRESSr Vq011 FINAL L JOHN F. LEWIS. P,f21NC'lPAL'STRdCTURAL EN PLAN CHECK VALIDATION�7'CK�M.O. CASH _ PERMIT VALIDATION CK. M.O. CA H u': 9830E SEP 5 1 D 1150- . -Temple. City 95AG36A CE#603 1-67- APPLICATION FOR 'BUILDING- PERMIT COUNTY OF LOS ANGELES BUILDING : ' DEPARTMENT OF COUNTY. ENGINEER ADDRESS BUILDING-AND SAFETY DIVISIONLOCALITY JOHN A. LAMBIE.COUNTY ENGINEER -NEAREST - COLEMAN W. JENKINS-SUP'T OF BUILDING CROSS ST. DISTRICT N = OR TYPE . IP Sp W Bt FOR APPLICANT TO FILL IN �r�O CONST. - 8UI'LDING STATISTICAL C' S FICATION SEWER MAP' ADDRESS CLASS NO. 1!7-- UNITS BK PG� LOT NO. BLACK USE ZONE�L_NO- AP'- �1 ho C/ TRACT ,tj Q� ECIAL N0. OF BLDOS. CONDI-TIONS SIZE OF LOT NOW ON LOT USE OF MISTING.ALDO' �•.- ji BLDG. SETBACK FROM. !Gbrdim __ jEL. FRONT PROP. LINE OF (STREET) OWNER p Ave _63TYPE OF EXISTING SETBACK HIGHWAY -YARD: = TOTAL ADDRESS-5837 N. Sultana Ai HIGHWAY WIDTH IFROMC.L.1 CITYc + - ARCHITECT OR TEL. BLDG. SETBACK FROM ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OF 'EXISTING SETBACK HIGHWAY + 'YARD - TOTAL ADDRESS HIGHWAY WIDTH EL. + _ CONTRACTOR TO ADDRESSQE. Np CORNER CUTOFF YES O NO [ y San Gabriel L'C C- SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK j _ 1 NEW ADD ALTER REPAIRX DEMOLISH f <, SQ.FT. NO. OF NO. OF SIZE STORIES FAMILIES- USEOF ` .STRUCTURE Re-roof in SIGNATURE OF APPLICANT VALUATION$600 X00 APPROVALS: _DATE INSPECTOR'SSIGNATURE P'.C. PMT, FOUNDATION, LOCATION FEE$ FEE$ FORMS,MATERIALS FRAME, FIRE STOPS, - I HEREBY ACKNOWLEDGE THAT 1 HAVE'RIIAD THIS APPLICATION BRACING BOLTS AND STATE THAT: THE ABOVE IS CORRECT AND AGREE VC COMPLY F.URNA.CEI LOCATION_ - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING . GAS VENT. DUCTS . 9UILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT: EMPLOY ANY PERSON IN VIOLA- LATH. INT. _ - ' TION OF THE LABOR COD OF E ST, E OF CA IFORNIA RELAT- INCTOWORKMEN'SC M S E. U NCE. LATH. EXT... . SIGNATURE F HOUSE NUMBER COR- ' .PERMITTEE REC -AND POSTED _ /) i ADDRESS 2 E V e FIN A L (s-7 -- JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH•. PERMIT VALIDATION CK. M.O CASH 'D -9.00- 2 0 9 1_� DeC $ 1 �.