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Home My Public Portal About6003 AGNES AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING J /; FOR APPLICANT TO FILL IN ADDRESS BUILDING ADDRESS C .0 LOCALITYc- NEAREST CITY pP mp . City, Calif IP 91780 CROSS ST. tf /N O.OF BLDGS. ASSESSOR SIZE OF LOT � 2.J NOW ON LOT MAP BOOK PA PARCEL DISTRICT GROUP JCTOYNSE FIRE SSED BY TRACT ., ) BLOCK T. ZONE TEL. .. �C/ it d• '•'OWNEFtIrs. Ratkovich NO. 285-4840 STATISTICAL CLASSIFICATION SEWER AP ` ADDRESS 6003 Aprnp.,qCLASS NO. .�^�DWELL,UNITS BK PG Temple CITY T City ZIP 1780, USE1ZONE NO. 2•-Ucj ARCHITECT OR TEL. SPECIAL ENGINEER NO. °V`'u CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONTRA CTO( lhambra Rooflnl? NOL 28219 8 BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS 71? p NO,2 HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING CLASS FRONT PROP. LINE HIGHWAY WIDTH CITY Alhambra, Calif. CONSTRUCTION LENDER } NAME AND BRANCH BLDG.SETBACK FROM (STREET) CD PROP.LINE OF ADDRESS CITY V NO. OF NO. OF CHECK HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. _ SIZE STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH O Re } = LaJ DESCRIPTION OF WORK Re-roof TiTe NEW ❑ a- section W 90# roofing; and ADD ❑ CORNER CUTOFF YES ❑ NO ❑ z reset Tile, ALTER IN OPEN SPACE YES ❑ NO ❑ REPAIR USE OF NG BLDG. DEMOL ❑ IN COASTAL PERMIT ZONE YES 11N0EXIST ❑ _ ' APPLICANT TEL >«�••' (PRINT) NO. BY (SIGNATURE) LRE EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ALL ORDINANCES AND LAWS REGULATING BUILDING CON- S ON- ION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED v �° P��iY�✓]9� I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE CODE M THE STATE R CALIFORNIA IN RELATING TO �1 a � EN'S COMPE NSA ON IN UR CE. G�c� 0 G URE OF ---•.-rangy t'oulk FINAL �' ,(� ��^�'"�- 14*,J PERMITTEE-TTEE O�c r BY �1 Y4/ G <�% A �,i DATE -7 ADDRESS 7 C .YIG 2--1 Alhambra, Calif. v TE L. P.C. Fee$ Permit Feeg-gE}, a Issuance Fee TION 540'00 Total Fee 'AffO SH PERMIT VALIDATION' cK. M.O. CASH C-a� 4 3 4 OCT 12 1 1) 1 2.0 0 e POLICY HOLDER.- , _F,. WORKERS'_COMPENSATION DECLARATION ;r ��'' M•,, insure bor a certificate of Workers' Compensation Insuranc`% A P P L I CAT 10 " ,,�F.O R B U L c9 PERMIT or a certified copy thereof (Sec. 3800, Lab. C.') COUNTY OF LOS O igtsELES BUILDING AND SAFETY Policy No. Company BUILDING ElCertifiedcopy is hereby furnished. FOR'APPLICANT TO FILL IN ADDRESS D ❑ Certified copy is filed with the county building inspec- BUILDING /�1� /� C tion,department. ADDRESS ( / / f(l,J f CITY" l ZIP LOCALITY J �v Date Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT - NEAREST COMPENSATION INSURANCE CROSS ST. ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE e� 7� / PARCEL p� hundred dollars ($100) or,less.) TEL OWNER , Np. USE ZONE MAP NO. -D. o I certify that in the performance of the work for which this � yd SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS CONDITIONS d so as to become subject to the Workers' Compensation Laws. 1 y O CITY i J�` ZIP U Date Applicant ARCHITECT O TEL. of r/ i NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO / DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the.:Workers' /�� CONST. `ONE ♦— Compensation provisions of the Labor Code, you must forth- ADDRESS / �/�}/� ,/v ' �J 5tA) U with comply with such.provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. to deemed revoked. CONTRACTOR O. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 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 LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK. AE7 PG./ VALIDATION SQ. FT. I NO. OF NO. OF ff CHECK License Number Lic. Class SIZE STORIES FAMILIES 1 ONE " VALUATION Contractor Date DESCRIPTION,OF'WORK 54DNEW ❑ QP7 t ADD $ -3 GJ C00 d ❑I am exempt under Sec. 1-1474 ► ALTER ❑ B.&P.C. for This reasonREPAIR ❑ $ t;t _s Af � Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TE _ , _ (PRINT) S NO FINAL OWNER-BUILDER DECLARATION DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS v ( r FINAL Professions Code): PRESENT By 2r—1, as owner of thero erT BUILDING. z p p y,;or my. employees with ADDRESS �a3 wages as theirsole compensation,will do the work and , _'" , �1 the structure is not intended or offered for sale(Section LOCALITY t( _ 7044, Business and Professions Code.) MOVING TEL. - ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.SETBALINEFROM WIDTH IST. L t �? I hereby affirm that there is a construction lending agency.for FRONT :';x;:)1;3 the performance of the work for which this permit'is issued R.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name __...._' _.4 m $ 7 LDMA Ref. # � P.C. Fee L Permit Fee =�,�, a „ , _:•t Lender's Address 0 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee /� 6 or inances and State laws relating to building construction, Total Fee r v 1 LDMA Perm. # < d hereby authorize representatives of this County to enter aon the - entioned property for inspection iSEE REVERSE FOR EXPLANATORY LANGUAGE i nat re of Applicant or Agent Date - n WORKER' COMPENSATION DECLARATION W� ry urreeboraafcertif cairm rte ofhave Workers' Compensat on of eInsuran e, A P P L I CAT I O N' 'F O R BUILDING P E RM I T or a certified copy thereof (Sec. 3800, Lab.'C:) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING - .Certified copy is'herebyfurnished.. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the.counfy building in'spec- BUILDING n0 ; tion department. ADDRESS 16003 1J` Date' Applicant. CITY IP LOCALITY CERTIFICATE OF EXEMPTION FROM'WORKERS' c -NO. OF BLDGS. NEAREST. COMPENSATION INSURANCE SIZE OF LOT J NOW ON LOT CROSS ST. (This section need not be completed if the permit is for oneASSESSOR ' hundred dollars ($100)or,less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL ' `u� TEL. LA�' USE ZONE MAP I certify that.in the performance of the *work for which this. OWNER L:Q NO. TI NO. 6® y permit is issued,1 shall not employ any person in any manner `, n y►�� /� r ��- SPECIAL �. so-as to become subject to the Workers'Compensation Laws. ADDRESS p /�/ �t 1 iCs� AV�/^ /// CONDITIONS � CITY ' , ZIP. l O Date Applicant "". 0. ` ARCHITECT OR TEL. DISTRICT GR UP TYPE FIRE _ nPRO ESSED BY O NOTICE TO APPLICANT: If, after'making this Certificate of CONST. ZONE ! ENGINEER NO. R Exemtion, yoshould become subject t� the' Workers' � /� [i', y � Compensation provisions of the Labor Code,.you must forth- ► i!Q //�� 3 with comply with such provisions or, this ADDRESS p y p permit shall be deemed revoked.. TEL. STATISTICAL CLASS FIC TION APT. C O.: Z CONTRACTOR NO. LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO. _L—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 andLIC. SEWER MAP Professions Code' and'my license is in full'foice and effect. CITY CLASS BK VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lid.Class SIZE STORIES I FAMILIES ONE _VALUATION: DESCRIPTION OF WORK NEW D�O00 Contractor Date �n 6 TT� ADD $ ❑ I am exempt under Sec. `�'` c" �V `4-'or ALTER ❑ , B.&P.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. Signature APPLICANT TEL. FIN !L�. '� OWNER-BUILDER DECLARATION (PRINT) NO. DAA ! i I hereby affirm that 1 am exempt from the.Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT BY 11 - 10-6 1 3.-. BUILDING . cis owner of the property, or my employees with _ADDRESS r, - . 106 1 y0 F � wages as their sole compensation,will clothe work and d',I 'i r , the structure is not intended or offered for sale(Section LOCALITY 7044-,'Business and Professions Code).- MOVING TEL. , _ 0213-85 ' I, as owner of the property, am exclusively contracting CONTRACTOR NO. with-licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). ii CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK.FROM EXIST.. SET BACK 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 m P.L. Lender-'s Name m LDMA Ref. # P.C. Fee$ Permit Fee 6 Lender's Address I.certify that I have read this application and state.that the Issuance Fee (j 7 LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee // Q or inances and State laws relating to building construction, Total Fee 46 �3 LDMA Perm. # / a d hereby hor'ze representatives of this County to enter f I u on the ab v ntion property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ± ignaturl o pplica 1 or Agent - Dae Oi