The URL can be used to link to this page

Home My Public Portal About5837 AGNES AVE_Building__ J �. ,"WORKERS CQMPEN.SA�ION DECLARATION "hereby affirm that I have a certificate of consent to self irsure or a certificate of Workers Compensation Insurance A P P L I A N F O R U I L D I N G PERMIT or a certified copy thereof (Sec 3800 Lab C ) d COUNTY OF LOS ANGELES ° BUILDING AND SAFETY " PolicyNoCompany BUILDING ❑ Cei+nfied copy is hereby furnished FOR APPLICANT TO FILL IN,+ ADDRESSS937 S r ❑ Certified copy is filed with the county building inspec BUILDING tion department ADDRESS � w CITY , C y ZIP LOCALITY Date Applicant . . NO OF BLDGS NEAREST- CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT' NOW ON LOT CROSS ST 'COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK P GE PARCEL hundred dollars ($100) or less ) TEL _ r OWNERS Z n/S -NO ZONE NO I certify that in the performance of the work for which this (fl permit is issued I shall not employ any person in any manner ADDRESS r US SPECIAL a CONDITIONS so as to become subject to the Work rs Compensation Laws , O CIN L ZIP Date,Apphcan ARCHITECT OR TELPE W NOTICE TO APPLICANT If 'after making this Certificate of ENGINEER NO DISTRICT GROUP CONST ZONE PROCESSED BY' O Exemption you should become subject to the Workers ry U Compensation provisions of the Labor Code you must forth ADDRESS a with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT I CONDO Z deemed revoked CONTRACTOR NO _ LICENSED CONTRACTORS DECLARATION LIQ, CLASS NO DWELL UNITS I hereby affirm that lam licensed under provisions of Chapter 9 ADDRES O (commencing with Section 7000)of Division 3 of the Business LIC SEWER MAP and Professions Code and my license is in full force and effect CITY CLASS BK PG VALIDATION SQ FT NO OF NO OF CHECK , License Number Lic Class SIZE �7 h STORIES FAMILIES ONE VALUATION -+ Contractor Date DESCRIPTION OF WORK NEW 1:1� � _ f ADD ❑I am exempt under Sec A , s ALTER ❑ B&P C for this reason i REPAIR ❑ $ Date USE OF EXISTING BLDG t DEMO, ❑ r Signature APPLICANT N a � � p O (PRINT) FINAL -OWNER BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor s License I + - - - Y t Law for the following reason (Section 7031 5 Business and ADDRESS FINAL_ - 1 Pr fessions Code) PRESENT, - By Y a I as owner of the property or my employees with ADDRESS - ' �� - � l ACCT.. wages as their sole compensation will do the work and " -f1 �c� the structure is not intended or offered for sale(Section LOCALITY, , � �! - 2M- 7044 Business and Professions Code ) w MOVING ---s- - TEL i J T I as owner of the property am exclusively contracting CONTRACTOR NO Tf� 1 1 with licensed contractors to construct the project (Sec ADDRESS - �a. TOTAL 290 .25 tion 7044 Business and Professions Code ) >> r- FF�Lv� Q{t -REQUIREDu TOTAL SETBACK FROM EXIST "° w { ` CHECK ?90.x`_ CONSTRUCTION LENDING AGENCY ^ SET BACK YARD HWY PROP LINE WIDTH x„ I hereby affirm that there is a construction lending agency for FRONT 1 `-. ` NAN1� y Al the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) SIDE ` PL Lenders Name '0000-+��1 6I 5/59 LDMA Ref # Lender s Address PC Fee$ Permit Fee J ® 769 1 AM 9:(11 I certify that I have read this application and state that the Issuance Fee / )i LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee_ Q' R ordinances and State jaws relating to building construction Total Fee 1 LDMA Perri # a and hereby authorize representatives of this County to enter upon a ab ve mentioned property for inspection purposes a a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date l rJ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0901210003 PHONE (626) 285 0488 EXT ILEGAL ID 1 NO OF CONST NEW 1 BUILDING ADDRESS ITR 6561 LT 436 SQ FT STORIES TYPE OCCUP GROUPI 5837 AGNES AV I (STRUCTURE 361 1 V B R3 I TEMP CA 917802216 (ASSESSOR INFORMATION NUMBER I GARAGE 640 1 V B U I NEAREST CROSS STREET LAS TUNAS I 18587 027 009 OTHER I THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY Cl 1TENANT (EXIST BLDG USE USE ZONE (ISSUED ON PROCESSED BY I (EXIST OCC GRP 101/28/09 SR J (OWNER TEL NO 1BLDGS NOW ON LOT VALUATION 1F NAL DATE FINAL BY CODE I ICHEN MR & MRS I 82 960 �� 1 15837 AGNES AV 1 1 (�(�,' I (TEMP 917802216 1 FEES PAID JDES� N OF WORK I 1 (ADD BEDROOM BATHROOM 361 S F AND DEMO (E) GARAGE AND I I _1FEE DESCRIPTION QUANTITY UOM AMOUNT (BUILD ATTACHED 3 CAR GARAGE 1 (APPLICANT TEL NO 1 I 10 LEARY (626) 287 0927 JB1 PLANCHECK W/ENERGY 82960 00 VAL 1 054 25 1 15823 AGNES AVENUE JAA BLDG PERMIT ISSUANCE 27 75 (SPECIAL CONDITIONS I (TEMPLE CITY CA 91780 JAB STATE GREEN BLDG FEE 82960 00 VAL 4 00 I IAC STRONG MOTION RESID 82960 00 VAL 8 30 1 I JB2 PERMIT W/ENERGY 82960 00 VAL 1 240 31 1 1CONTRACTOR TEL NO I TOTAL FEES 2 334 61 JAPPR''VkLS DATE INSPECTOR SIGNATURE J 1TOM 0 LEARY CONSTRUCTION (626) 287 0927 J 1 I 15823 AGNES AVENUE LIC NO I 1LOCATION AND SETBACKS �/ / I (TEMPLE CITY CA 91780 489354 B 1 I 1 T I (SOILS ENGINEER APPROVAL I I JARCHITECT OR ENGINEER TEL NO 1 1FOUNT7 TION/TRENCH FORMS 1 I I LIC NO 1 JSLAB/UNDER FLOOR I I I I JRAIS.D FLOOR FRAMING 1 1 IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I JUNDERFLOOR INSULATION 1 1 3 J11 I I I 1 11ST LEVEL FLOOR SHEATH I 1 1 1NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I 1 NO 21 1 12ND FJEL FLOOR SHEATH I 1 1 I I I I I I 1 SCHOOL WITHIN HAZARDOUS 1 (ROOF SHEATHING 1 I JAIR QUALITY 1000 FEET MATERIALS I I / 1 NO NO NO 1 (FIRE DEPT FRAME INSPECTI,---�I 1REQUIRED TOTAL SETBACK FROM EXIST I JBLDG DEPT FRAME INSPECT( I 1SET BACK YARD HWY PROP LINE WIDTH I 1 1FRONT PL I ISHEAR PANELS 1 SIDE PL 1 1 fl / I I JINSULATION/WEATHER STRIP( 1 11NTERIOR LATH/DRYWALL 1 I I 1 1EXTERIOR LATH II I I 1LOT DRAINAGE 1 I 1 I I I I I I I 1SMOKE DETECTION DEVICES I I I 1FIRE DEPARTMENT APPROVAL( I 1 I JREPORT ID DPR261 ROUTE TO DS0508 1 1 1 1 I I I I I J COUNTY OF LOS ANGELES TEMPLE CITY # 0508 j BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9612100079 PHONE (818) 285 0488 EXT LEGAL ,~N 0 OF CONSTNEW BUILDING TR 6561 LT 436 SQ FT STORIES TYPE OCCUP GROUP 5837 AGNES AV STRUCTURE 0 0 V R3 I TEMP CA 917802216 ASSESSOR0 ON NUMBER GARAGE NEAREST CROSS STREET 8587 027 009 OTHER 120 1 THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY TENANT EXIST BLDG USE USE ZONE ISSUED ON PROCESSED EXPIRES ON EXIST OCC GRP 12/10/96 TC 12/10/97 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE FINAL BY ODE ZIELINSKI STANLEY,VERONICA (818) 309 9249 1 1,000 p 5837 AGNES AV Z-1 Z`p TEMP 917802216 FEES PAIDDESCRIPTION OF WORK spa „ ^ GARDEN SHED 10 X 12 APPLICANT TEL NO FEE DESCRIPTION QUANTITY AMOUNT /1� AMOUNT SAME AS OWNER AA BLDG PERMIT ISSUANCES / 27 75 ` D2 PERMIT W/O EN HC 000-0 -VA 65 '25 SPECIAL CONDITIONS ®C�� TOTAL-FEES 93 0 0 e� CONTRACTOR TEL NO �' APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER 0 LIC NO OQ o LOCA TIONAND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER 0 sm o m on�i�I1 itci FOUNDAT ON R C FORMS LIC NO SLAB/UNDER FLOOR cull QED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CM01 UNDERFLOOR INSULATION �oLEVEL FLOOR S ATH NO OF FAMILIES DWELLING SS NO 21 A ND LEVEL FLOOR SHEATH HAZARDOUSSCHOOL WITHIN \�\� F SHEATHING AIR DUALITY 1000 FEET MATERIALS V _ NO NO NO FIRE DEPT FRAME INSPECT REQUIRED TOTALC 0 EXIST BLDC SET BACK YARD HWY PROP LINE WIDTH FRONT PL SHEAR PANELS SIDE PL INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT,DRAINAGE SMOKE N DEVICES FIRF DEPARTMENT APPROVAL REPORT ID DPR261 ROUTE TO BS0508