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HomeMy Public PortalAbout5911 TEMPLE CITY BLVD_Building__ BUILDING r �- ADDRESS -1 A-6 BUILDING APPLICATION LOCALITY DIVISION OF BUILDING AND SAFETY NEAREST CRO88 8T. Department of County Engineer DISTRICT NO. RECEIPT NO. PERMIT NO. County of Los Angeles 6 pr 3 11 WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED CASSATT D. GRIFFIN, SUPT OF BUILDING Ir/ % FOR APPLICANT TO FILL IN TYPE CONST. RECEIVED BY IBS ED BY OWNER s MAP �� STATE YES V MAIL: d7 r NUMBER &0 HWY ADDRE88ZE OSE ZONE SPECIAL CITY ' NOL. �� CONDITIONS ARCHITECT TEL. ENGINEER NO. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS T FRONT CONTRACTOR NO / SIDE E ADDRESS P. DATE CORRECTIONS INSPECTOR - BUILDING ADDREau LOT NO. .S BLOCK es;e I z _ t PM1 s AQ f- TRACT b� NO.OFOLD GB. �' SG./�Y/lbt rT 11-P<A//7FD Ii or LOT S'�X110 I NOW ON LOT USE OF 1A•-!A i!//oo/Ull n/7T EXISTING BLDG. DESCRIPTION OF WORK N �Jo t.o,yFd� ��Er D NEW ADD ALTER REPAIR DEMOLISH Z Bq.FT. NO.OF / -NO.OF c �Fo MI Nor oNISNCO P_ r SIZE /�yr�� STORIES ! FAMILIES _ USE OF STRUCTURE -ro PatioIo-12 171�111_'Alrl ill-WI, "'AMA) IAI ,dl ArF. 4//L/. Ao"vi..v M. Ste o&f J No-or O.OF /^C 4/7,-l Ai r_ lAtAP EMPLOYEES /Q-�!f _��ll71211 e S h����'� Ada/' I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- y./ ,p�V(� PLICATION AND STATE THAT THE INFORMATION GIVEN li APPROVALS INSPECTORPBSIGNATURE DATE CORRECT. 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMB,.MATERIALS FRAME: FIRE BTOP8, SIGNATURE OF BRACING,BOLTS PERMITTEE FURNACE: LOCATION, ADDRESS GAB VENT,DUCTS LATH, INT. AUTHORIZED ADT. LATH, EXT. IS P-C.S ' HOUSE NUMBER COR- F EE RECT AND POSTED VALUATION �'!�©t) FEE d J FINAL l /�: 76A638A DB9 3 12-53 WORKERS'COMPENSATION DECLARATION 1� 850633 SB I herebyaffirm affcertif certificate of Workers' t Compensaon insurance, APPLE CAU�� FOR 9 I�M j IR or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES 1 BUILDING AND SAFETY +� Policy No.IV85-2251 C3mpany Fremont Indemnity BUIL ADDRESS Certified copy is hereby furnished. ADDRESS FOR APPLICANT TO FILL IN ® Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 5911 N. Temple City Blvd. Dote 12/6./85 Applicant Virgin Roof Co CITY Temple City ZIP ,LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL' USE ZONE MAP I certify that in the performance of the work for which this OWNER Mr. Del Valle NO. 9 NO. permit is issued, I shall not employ any person in any mannerSPECIAL A.O so as to become subject to the Workers'Compensation Laws. ADDRESS 424 N. Lake CONDITIONS DCITY Pasadena ZIP Date Applicant �s NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT G OUP TYPE FIRE PRO SED BY p� Exemption, you should become subject to the Workers' ENGINEER NO. _ / I CONST.,/ ZONE 14 Compensation provisions of the Labor Code, you must forth- ADDRESS 5` V� ✓ with comply with such provisions or this permit shall be NO• 287-0507 STATISTICAL CLASSIFICATION APT. NDO. deemed revoked. CONTRACTOR Virgin Roof CO LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS P 0 BOX J NO 160650 (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code,and my license is in full force and effect. CITY San Gabriel CLASS C39 BK PG VALIDATION S .1.60650 C39 SIZE S ORIOE-Onix FAMILLIIES CHECK ONE "' License Number Lic.Class VALUATION Contractor Virgin Roof 12/6/$5 DESCRIPTION OF WORK Tear off 3 roofs NEW ❑ $ 2688.00 ❑I am exempt under Sec. and re—roof with #30, #15 ADD ❑I ALTER ❑i B.BP.C. for this reason and #72. 15 squares REPAIR E: $USE OF 3 6S 2 A Date: Commercial DEMOL ❑ EXISTING BLDG. # 0 0 0 0 0 1 APPLICANT TEL. Signature PRINT Virgin Roof Co No• 287-0507 FINAL OWNER-BUILDER DECLARATION D;M�r I hereby affirm that I am exempt from the Contractor's License ADDRESS P 0 BOX J, San Gabriel 91778 FIN 1 o o 5 9 2 5 Law for the following reason (Section 7031.5, Business and 7...: ., Professions Code): PRESENT By . P_:I, as owner of the property, y employees BUILDING o 0 0 5 9.2 5 C p p ty, or m em to ees with ADDRESS wages as their sole compensation,will do the work and 1212-85 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. with licensed yontractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL.SETBACK FR CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE EXIST. 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 $ P.L. Lender's Name e i LDMA Ref,ti Lender's Address P.C.Fee$ Permit Fee 48.75 r I certify that I have read this application and state that the Issuance Fee 10.50 LDMA P/C R 3 above information is correct. I agree to comply with all County Investigation Fee 9 ordinances and State laws relating to building construction, Tota l Fee 59.25 LDMA Perm. # and h reby authorize representatives of this County to enter upon eabove-mentioned roper for inspection purp es. . e 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Sin ure of Applicant or Agent Date