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Home My Public Portal About5950 AGNES AVE_Building__ 76A638A CE #803 1/71 APPLICATION FOR BUILDI G PERMI COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY"DIVISION BUILDING ADDRESS v COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or type only) CROSS ST. BUILDING DISTRICT N ROUP TYPE P OC S B ,'A ^^,, ��^ CONST. ADDRESS „� rlf V i STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO. DWELL,UNITS PG TRACT �r USE ZONE MA,P NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. T E L.,� OWNER 't �� NO. BLDG.SETBACK FROM ADDRESS �, �p FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CI TY�,- / HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. } _ ENGINEER NO. BLDG.SETBACK FR ADDRESS _ SIDE PROP. I INE OF (STREET) _ y � � TEL � PE OF EXISTING SETBACK HIGHWAY YARD = TOTAL O CONTRACTO NO. - HWAY WIDTH FROM C.L. V ADDRESS ` a NO, ` } — f` CD e • LIC. fcr �t�- CITY i CLASS -.•a CORNER CUTOFF YES ❑ NO ❑ w CONSTRUCTION LEN ER a NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS z ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE ALTER ❑ SIGN REPAIR OF URE APP CANT DEMOL ❑ - VALUATION $ (1 •+�--^ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. ,Q,�� FOUNDATION: LOCATION FEE S FEE $ . !l (/ I FORMS, MATERIALS 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSOfi IN VIOLAT N OF THE LATH, INT. LABOR CODE' OF THE AT OF -CALI RNIA IN SLATING TO WORKMEN'S COMPE T /R�, CE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 1 FINAL JOHN F. LEWIS. PRINCIPq STRUQT AL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALID N CK. M.O. CASH L&o ,- .N FEB 2 4 1 D 2 tG U 7 I DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETYBE m I L[we' l N 'dmb' COUNTY OF LOS ANGELES vff '6 WILLIAM J. FOX, COUNTY ENGINEER I APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDINGDISTRICT NO. PLAN CK.OR REC.No. PERMIT NO. ADDRESS —C• r[7 �l ' � 6 210 LOCALITY _ RECEI ED BY DATE OF, P, DATE ISSUED NEAREST CROSS S F/ BUILDING }y J ADDRESS OWNER 15_71_ �i��! MAIL _ LOCALITY ADDRESS __12e NEAREST'j,. TEL. /�/ y CROSS STC CITY ! ND' U v t ARCK&ECT OR TEL. FIRE NO. OF I TYPE GROUP ENGINEER NO. ZONE PLANS BLDG. ORD. NO. ADDRESS SETBACK LINE + A TIEL + USE APPROVED CONTRACTOR ) tK +J�NO ZONE BY DATE ADDRESS �`T L?.� � HOUSE NUMBERING LEGAL MAP NUMBER NO. ASSIGNED BY DESCRIPTION I LOT NO. I BLOCK CORRECTIONS TRACT NO. OF BLDGS. SIZE OF LOT NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMILIES DESCRIPTION OF WORK oALTERATION J NW - REP IR I� DEMOLITION —I ADDITION I _ 'Z r SQ. FT. NO. OF SIZE ROOMS STORIES EXT. WALL ROOF COVERING I COVERING USE OF STRUCTURE APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT. IAGREE TO COMPLY WITH. ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LA EGU TING BUILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF , /�__� LATH, INT. PERMITTE v��—� ism LATH. EXT. ADDRESS T �� PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. P. C. $ 4 FEE HOUSE NUMBER COR- / (�f _ RECT AND POSTED VALUATION FEE '' FINAL /J -, J n'I f?j 76A688A DESS 9-82 - WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof-(Sec. 3800, Lab. C.) . n COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N� . 7 u I�� Co?pang <-cr,4-1P—uJ Coo.)C Q n� El 'Certified copy is hereby furnished. �1, FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING._ Tion department. ADDRESS �4 DatA�2—��—�� pplicanT• �� CITY e ZIP y a LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION IN URANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER e USE ZONE MAP I certify that in the performance of the work for which this SPE } permit is issued, I shall not employ any person in any manner- ADDRESS S d C S SPECIAL. 0 CONDITIONS so as to become subject to the Workers'Compensation Laws. U CITY g ' ZIP C. Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT:- If, after making this Certificate of ENGINEER NO. CONST. Z NE F- Exemption, you should become subject to the Workers' Compensatin provisions of the Labor Code, you must forth- ADDRESS N with comply with such provisions or this permit shall be TEL- STATISTICAL CLASSIFIC TION APT. CONDO. Z deemed revoked. [EXISTING ACTOR �• NO — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. _DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 S d• NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC /If 17' and Professions Code,and my license is in full force and effect. pyo rOC, GR. CLASS G' BK. PG. VALIDATION 9 NO. OF NO. OF CHECK License NumberC��tT 3 'Lic. Class G STORIES FAMILIES ONE / VALUATION Contractor�C!!!!mac, r9.?9 to 22-_2' �� TION OF WORK �L` „G NEW ❑ $,7-5 / �^ J 0 ✓I'—To �o�- ' ADD ❑ d^C✓ �/ / ► ❑1 gm exempt under Sec. ✓r '� ALTER ❑ B.&P.C. for this reason • �� REPAIR ❑ $ Date: /: BLDG. DEMOL ❑ Signatur �— APPLICANT TEL. FINAL OW -Byl DER DECLARATION (PRINT) NO. I hereby affirm that I am;Ldxempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY BUILDING i 3 3 i� ❑ I, as owner of the property, or.my employees with ADDRESS 71Q wages as their sole compensation,will do the work and , 1 T_g i 0I;(" the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. rE ElI, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- falAGE �I_- ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE 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.). SIDE 'I-* a t 1 I •' P.L. Lender's Name. m P.C. Fee$ Permit Fee LDMA Ref. # Lender's Address , J o I certify that I have read this application and state that the Issuance Fee LDMA P/C# o . above information is correct. I agree to comply with all County Investigation Fee .. oordinances and State laws relating to building construction, Total Fee LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. d SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent 'Date