HomeMy Public PortalAbout5827 TREE ROSE TER_Building__ TeaeaeA GEReoa °-°'APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDREssr
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMB]E, COUNTY EN-INEER NEAREST
COLEMAN W JENKINS, sur T OF IUILDIKG CROSS ST
DISTRICT NO GROUP TYPE PROCESSED BY
FOR APPLICANT T FILL IN CONST {�
Print., . GDI ) JL.
BUILDING STATISTICAL CLASSIFICATION EW MAP
AODRES65 `CG C rh'QC CLASS NO.- 0 DWELL UNITS BK PG
LOT NO BLOCK USE ZONEI MAP
�7 NO
TRACT a SPECIAL
u '^ NO OF BLDGS CONDITIONS
SIZE OF LOT H 43lIg' 13 T NOW ON LOT M
USE OF
EXISTING BL G BLDG SETBACK FROM
OWNER C Y NOL Z '� FRONTPROP LINEOF -(STREET)
•�+ p / TYPE OF 1D(ISTING SETBACK HIGHWAY } YARD - TOTAL
ADDRESS 2L— /G Ie HIGHWAY WIDTH FRpA' L
BLDG SETBACK FROM
TEL 510E PROP LINEOFARCH /CO C
(STREET)
ENGINEER NO
TYPE OF (STING SETBACK HIGHWAY } YARD = TOTAL
A DO RE55 HIGHWAY WIDTH FROM C L
TEL } = Y
CONTRACTOR 12 NO ao
ADDRESSoovy NO Z Ulu CORNER CUTOFF YES ElNO ❑ U
CC
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK a
N
2
NEW ADD ALTER REPAIR DEMOLISH
SNO OF NO OF
SIZE FT �(— STORIES FAMILIES
J
USE OF
STRUCTURE ,*
SIGNATURE OF
APPLICANT /rt
VALUATION f
APPELOCATION
DATE Ina PECTOR•$ SIGNATURE
P C PMT AA FOUNDATION
M
FEE .a FEES GAC
FRAME FIR _/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING OAND STATE THAT THE AwvE IS CORRECT AND AOR[[ TO COMPLY FURNACE f�./WrtH ALL Cou NTY oROI nANc[E AND STAT[ LAIN° REGuuTINO GAS VEN �/� -� //BUILDING CONNPLJCTIOM I CERTIFY THAT IN DOING THE WORKAUTHOR'CED HEREBY I WILL NOT EMPLOY ANY PER ON IN VIOLA LATH INT TION OF THE LABOR CODE OF THE STAT[ OF CAL. RN RELAY O.nc ro woRKMeN a co no BURAnc LATH EXT
SIGNATURE O , HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED -
ADDRESS FINr IfAL 1,.-
JOHN F LEWIS PRINCIPAL STR)kGTURALI ENGINEER
PLAN CHECK VALIDATION cK Mo CA. - PERMIT VALIDATION « Mo CASH
LAC,05 4 8 4i3 AL16 2 3 A 5 520 ••�
- - Uj,o 58� AJG12 1 A 92.00— Q /
FVUusb4 BG -
WORKERS' COMPENSATION DECLARATION
i_here,y_a certificate ,�_�,h,,�_nsatio In,_ra»�e,f APPLICATION,FOR BUILDING PERMIT
insure, or a certificate of Worker Compensation Insurance, � ,
or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES t '- BUILDING AND SAFETY
Policy No PC997500 Company Rap +hit i r Tndrmnity
ElBURRING /J
Certified copy Is hereby furnished FOR APPLICANT TO FILL IN ADDRISS �' 2t�
® Certified copy is filed with the county building Irtspec- BUILDING -
tion department ADDRESS
Dare 7-1-91 Applicant Virgin Roof Co, m` ZIP 7 LOCALITY NO Op7rDGS NEAREST
!ter_
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ONL
LLOT
COMPENSATION INSURANCE CROSS ST
ASSESSOR
(This section need not be completed if the permit is for one TRACT - BLOCK LOT NO ,NAP BOOK PAS - e PARCEL
hundred dollars ($100)W less ) Tn
OWNER NO ' ' 'I USE ZONE MAP / s
I comity that In the performance of the work for which this (c
perms is issued, I shall not employ any person in SPECIAL any manner ADDRESS 5827 Tree Rose Terrace �- CONDITIONS
so as to become subject to the Workers'Compensation Laws I _ _ -_ O
CITY ZIP
Date Applicant ARCHITECT OR TEL _ K
NOTICE TO APPLICANT If, after making this Certificate of - ENGINEER _ _ NO _ ' DISTRICT GROUP T• Z E PROCESSED BY rOr
Exemption, you should become subject to the Worker
Compensation provisions of the Labor Code, you must forth- ADDRESS
N
with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICP,TION APT CONDO Z
deemed revoked CONTRACTOR NO - -�71/—
UCENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNrTS
I hereby affirm that I am licensed under provisions of Chopter 9 ADDRESS P.O. Box J NO 160650 1
SEWER MAP ,
(commencing with Section 7000)of Division 3 of the Business LIC
and Professions Code,and my license is in full face and effect CITY CLA55 BK PG ��./ _ VALIDATION
160650 sa FT No OF No OF CHECK
License Number Lic Class C39 SIZE 38 S $TORIES 1 FAMILIES ONE
El vuuAnoN -
DEsanPTION OF WORK Tear off then {
Contractor Virgin Roof Co.pate 6-30-91 _ _ �" � f 9481.00 1
❑1 am exempt undo sec Medium SHakea. 38 s s. ALTER ❑ ACCT.`
r
B 8P C for this reason REPAIR ❑ f _ ,33307 - 1633.67
Date EXI�ISTIOFNGBLDG DwellingDEACx. ❑ ' 1 ITEMS '
Signature (PaiNT) Vir in Ro f NNRo - ,DATE ' TOTAL 163 . 67
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor s License ADDRESS P.O. BOX J San Gabriel 91778 CHECK 163.67
Low for the following reason (Section 7031 5;Business andFIN
Professions Code) NT - eT
❑ 1, as owner of the property, BUILDING
pr pe ry, or my employees with ADDRESS
wages as their sole compensation,will do the work and - iocAury - _ - -
the structures not intended or offered for sole(Section , �� [100[1-QQQ 1 11/15�9CI
7044, Business and Professions Code ) MOVING - TEL
❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO 33265 1 PM 97 17
with licensed contractors to construct the project (Sec- ADDRESS ,
tion 7044, Business and Professions Code )
REQUIREDCKCONSTRUCTION LENDING AGENCY SET ACK YARD Myy TOTAL SEP LINE ROM WIDTH
IST - �• >
I hereby affirm that there u o construct on lending agency for FRONT
the performance of the work for which this permit is issued PL
(Sec 3097, Civ C) SIDE
PL
Lender's Name
150.67 LD'MA Ref N
Perrino Lender a Address
P C Fee S Pers Fee Opp. ,
2 _ ,-
a I certify that I have read this application and state that the Issuance LDMA P/C N
above information r correct I agree to comply with all County Investigmion Fee _ _ t
ordinances and State jaws relotirp to budding construction, Total Fee LDMA Perm N
Q and hereby authorize representatives of this County to enter ,
g8q upon the abo o-mentioned property for Inspection purposes
11-14-90 _ s[E REVERSE FOR EXPLANATORY LANGUAGE
rwtwe of Applicant or Agent Date