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HomeMy Public PortalAbout5947 AGNES AVE_Building__ CORKERS COMPENSATION DECLARATION T ` ' 1 r + >I by cif£rm that I have a certificate of consent to self r APPLICATION FOR BUILDING PERMIT c �sur� or a certificatg of Workers Compensation Insurance Y or a certified copy thereof (Sec 3800 Lab C ) � - 4 COUNTY OF LOS ANGELES t BUILDING..AND SAFETY T Policy No Company + _ i - - - ET BUILDING copy is hereby furnished> i FOR APPLICANT TO FILL IN BUILDING � ' ADDRESS � r � ❑ Certified copy is filed with'thE�county building inspec BUILDING j /7 J�!r //��}/�^ tion department t ^ ADDRESS 5 402MRS S / 1 V I✓ Date a Applicant Y 1F-e CITY TEM irG (: 11 T ZIP cl 7 U 0 LOCALITY > CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT �r� 1�0 NOW ON CROSS T COMPENSATION INSURANCE , ,i 1 � t (This sectiontneed notAbe completed if the permit is for one TRACT G�� ` BLOCK A LOT NO G ASSESSOR - c hundred dollars ($100)or less ) _ MAP BOOK I PAGE PARCEL t` /� , J/I }� TEL USE ZONE MAP I certify that in the performance of the work for which this OWNER tl"I VfR p 7 j�jJ NO (, NO �Q permit is issued tl shall not employTany person in any manner ADDRESS-5q'47 e A G G-5^" fi VE, '/ SPECIAL I - so as to become subject to the Workers Compensation Laws CONDITIONS f r 4 .. . i. r y i 1 4 t +. CITY /L�/�/ 6 1yZIP / / Date Applicant r ARCHITECT OR TEL Y O NOTICE TO APPLICANT If after making this Certificate of _ DISTRICT GROUP TYPE' _ ) FIRE PROCESSED BY r r __ ENGINEER NO CONST ZONE V Exemption, you should become subject'to the Workers P Y 1 � 3 ✓ 3 - 1 W Compensation provisions of the Labor Code you must forth ADDRESS - �v ' - H with comply with, such provisions or this permit shall be ^ - TEL - STATISTICAL CLASSIFICATION f APT I CO DO Z deemed revoked h a #r S r s^, � CONTRACTOR NO - 2 1 � _ LICENSED CONTRACTORS DECLARATION - --- - - - LIC -� , 'CLASS NO �C 1 DWELL UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Division 3 of the Business and _ - LIC a SEWER MAP Professions Code and my license is in full force and effect CITY CLASS BK 60 VALIDATION `I r _ SQ FT NO OF _ NO OF CHECK t License Number 5 Lic Class T f SIZE �� STORIES FAMILIES m ONE t t a * VALUATION Contractor Date DESCRIPTION OF WORK - - NEW $ �ji© - �i�ADD _ _ t ❑ IA K/`am exempt under Sec - / iALTER ❑ B 8P C for this reason O - REPAIR ❑ $ USE OF Date EXISTING BLDG DEMOL E] Si nature n APPLICANT �i II TEL (yam g __ - r PRINT) ( VV J NO�lJJ ICI , FINAL _ #,11666 OWNER BUILDER DECLARATION _ DATE Z - ; �-1 hereby affirm that I am exempt from the Contractor s Licensed - Y - - � Law for the following reason (Section 7031 5 Business and , ADDRESS a -1 a b �� /4 L' i FIN =` s " r 1 0�t1 3 - Prof Bions Code) "' PRESENT By - e BUILDING w I as owner of the property or my,employees with ADDRESS 34 m L __ _ ° ° 1 0 6i 1 3 1 wages as-their sole compensation will do the work and the structure is not intended or offered for sale(Section LOCALITY { 03 1 1 y$5 ' c 7044 Business and Professions Code) K MOVING TEL r ❑ I as owner of the property am exclusively contracting CONTRACTOR - NO with licensed contractors o construct de'prglect (Sec tion 7044 Business and Professions Code) ADDRESS REQUIRED TOTAL SETBACK F 1 " S CONSTRUCTION LENDING AGENCY SET BACK YARD TOTAL PROP LINE WIDTH 1 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 - r�i 1 (Sec 3097 Civ C ) SIDE f - - A PL - -- Lender s Name $ Y Y LDMA Ref # P C Fee$ ter- - Permit Fee I Lender s Address t .T t > . 4 I certify that I have read this application and state that the - - Issuance Fee Sa} CDMA P/C# , j- r - - a above information is correct I agree to comply with all County Investigation Fee 1 ,7 4, ' g _ordinances and State laws relating to building construction Total Fee or -CDMA Perm # v and hereby authorize representatives of this County to enter upon the above mentioned property or inspection purposes h SEE REVERSE FOR EXPLANATORY LANGUAGE ' 1 Signatureao Appllca Yor­Age-nZf Date - - - ^- - ". - ` �- 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1201250058 PHONE (626) 285 0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ITR 6561 LT 63 SQ FT STORIES TYPE 5947 AGNES AV I STRUCTURE 1152 V B TEMP CA 917802218 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LAS TUNAS 18587 026 003 THOMAS PAGE 597 GRID A2 LOCALITY TEMPLE CITY Cl TENANT JEXIST BLDG USE RESID USE ZONE R 2 IISSUFD ON PROCESSED BY EXIST OCC GRP 101/25/12 SR OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL ATE F NAL BY CODE ICUMMINGS ELLIOTT TERRI (626) 524 8321 1 6 000 1 15947 AGNES AV 1 1 TEMP 917802218 FEES PAID ID-$S IPTION OF WORK ITEARr7FF REROOF WITH COMPOSITION SHINGLES REPLACE EVE BOARD I _IFEE DESCRIPTION QUANTITY UOM AMOUNT IS 'lc 4OVE STUCCO AND INSTALL SIDING ON N/SIDE OF HOUSE 1 (APPLICANT TEL NO I I SAME AS OWNER IAA BLDG PERMIT ISSUANCE 27 80 1 IAB STATE GREEN BLDG FEE 6000 00 VAL 1 00 (SPECIAL CONDITIONS 1 IAC STRONG MOTION RESID 6000 00 VAL 0 60 I 1 ID2 PERMIT W/O EN HC 6000 00 VAL 149 70 I I 1 _I TOTAL FEES 179 10 (CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER I I LIC NO I ILOCATION AND SETBACKS I I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I I I I LIC NO ISLAB/UNDER FLOOR I I I I IRAISED FLOOR FRAMING IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I IUNDEFFLOOR INSULATION I I I 115OH269 3 001 I I I I IFLOOP SHEATHING INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I--- 0 _- 0 NO '1 I IRO- �tIEATHING SCHOOL WITHIN HAZARDOUS I SHEAR PANELS N (AIR QUALITY 1000 FEET MATERIALS I I I NO NO NO I IFRAMF INSPECTION I I 1 IFIRL SPRINKLER HANGERS I - (INSULATION/WEATHER STRIPI II I IINTFRIOR LATH/DRYWALL I I I (EXTERIOR LATH I RATED FLOOR/CEIL ASSEM I IRATED WALL ASSEMBLIES I I IRATFD SHAFTS/OPENINGS I I I I I I IT BAR CEILINGS I ILOT DRAINAGE IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I 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 0302210015 PHONE (626) 285 0488 EXT L ID NO OF CONST NEW BUILDING ADDRESS �IfR 6561 LT 63- SG FT STORIES TYPE OCCUP GROUP 5947 AGNES AV STRUCTURE 230 1 VN U1 TEMP CA 917802218 ASSESSOR INFORMATION NORBIR GARAGE NEAREST CROSS STREET WOODRUFF 8587 026 003 OTHER THOMAS PAGE 597 GRID A2 LOCALITY TEMPLE CITY TENANT EXIST BLDG USE USE ZONE ISSUED ON PROCESSED EXIST OCC GRP 02/28/03 JK 02/23/04 OWN TE N BL GS NOW ON LOT VALUATION FINAL DARPM&A&L BY COD CUMMINGS ELLIOTT,TERRI (626) 309 0013 3,600 5947 AGNES AV ED TEMP 917802218 FEES PAID DESCRIPTION OF WUK& NEW FRONT PORCH (PREVIOUS FELL DOWN) FEE DESCRIPTION QUANTITY UOM AMOUNT APPLICANT TEL 0 SAME AS OWNER AA BLDG PERMIT ISSUANCE 27 75 AC STRONG MOTION RESID 3600 00 VAL 0 50 SPECIAL CONDITIONS D1 PLANCHECK W/O EN HC 3600 00 VAL 98 43 D2 PERMIT W/O EN HC 3600 00 VAL 115 80 TOTAL FEES 242 48 CONTRACTOR TEL _ APPROVALS INSPECT GNATUR SAME AS OWNER LIC NO LOCATION AND SETBACKS + SOILS N ER APPROVAl- ARCHITECT OR ENGINEER TEL NO - A OR LIC NO SLAB/UNDER FLOOR RAISEDG MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 3 01 NO 1ST LEVEL FLOOR SHEATH 0 FAMILIES A LAS ` NO 21 2ND LEVELFLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY 1000 FEET MATERIALS NO NO NO FIRE DEPT FRAME INSPECT i REQUIRED TOTAL SETBACK INSPECT SET BACK YARD HWY PROP LINE WIDTH FRONT PL SHEAR PANELS SIDE PL INSULATION/WEATHER INTERIOR LATR/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES IRE DEPARTMENT APPROVAL REPORT ID DPR261 ROUTE TO BS0508