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HomeMy Public PortalAbout6046 AGNES AVE_Building__ { r TEMPLE CITY 76A638A CE#803864 APPLICATION FOR BUILDING PERMIT" COUNTY OF LOS ANGELES BUILDING 0 �/ DEPARTMENT OF COUNTY ENGINEER ADDRESS T 1 BUILDING AND SAFETY DIVISION LOCALITY J JOHN A LAMBIE COUNTY ENGINEER NEAREST / COLEMAN W JENKINS SUP T OF BUILDING CROSS ST DIS�CTO-NO_ K GROSJ.P TYPE C E BY PRE APPLICANT TO FILL IN /Jy �-fT� CONST STATISTICAL CL SIFICATION — SEWER MAP 604//6 N Agnes CLASS NO DWELL UNITS `BKPG �(./ (✓ �� BLOCK USE ZONE MAP i �^ N O ��-) I SPECIAL L M r NO OF SLOGS CONDITIONS NOW ON LOT I-XISTI BLDG SETBACK FROMret McLeod TEL FRONT PROP LINE OF — (STREET) NO TYPE OF EXISTING SETBACK HIGHWAY YARD — TOTAL ADDRESS 6046 N. Aines H W YWIDTH FROM C L CITY Temple City + ARCHITECT OR TEL BLDG SETBACK F ENGINEER NO SIDE PROP LINE OF (STREET) TYPE OF EXISTING SETBACK XI Y + YARD = TOTAL ', ADDRESSS,�� HIGHWAY WIDTH FROM C L CL CONTRa� Mfg Company TEL 263-5181 + - u ADDRESS837 S Woods Ave• NO 159496 I CORNER CUTOFF YES - NO O Los Angeles LIc C 39 ~ g I SEE REVERSE SIDE FOR SPECIAL APPROVALS W DESCRIPTION OF WORK N X Z NEW ADD ALTER REPAIRDEMOLISH SQ FT NO OF NO OP SIZE STORIES FAMILIES USE OF STRUCTURE reroof SIGNATURE OF APPLICANT VALUATION$ 300 00 APPROVALS DATE INSPECTOR 991GNATURE P C PMT FOUNDATION LOCATION FEE$ FEE$ / FORMS MATERIALS FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THOLAIB R CODCOF THE STATE O CALIF RNIA RELATING TO WORCOMPENSAT N�ySUR EEXT iIGNATU H USE NUMBER COR / P MIT'TEE RE AND POSTED I ADDRESS F I N A L 9 � cK� ��� 7/JOHN F LEWIS PRI CIPAL ST URAL ENGINEER PLAN CHECK VALIDATIO PERMIT VALIDATION cK M O CASH Lkos aA1 1�2 JUM26 1 D 9.00- v 1 { r �n WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self I �i insure oria certificate of Workers Compensatiorllif urance f r A W L I CATION FOR BUILDING PERMIT or a certified copy thereof (Sec 3800 Lab C ) i 1 COUNTY OF LOS ANGELES ti BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN - ADDRESS roaqlG � Certified copy+is filed with the county building ins'�nec BUILDINGA♦ , 's tion department t l 1 ADDRESS O 1 A 0IVES VC LOCALITY 76M RE 01 / r NEAREST Date Applicant _ CITYTem L' r C ZIP Q CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS OF BASSESSOR SIZE OF LOT D NOW ONLDGS LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE (This section need not be completed if theyermit is for one 11 USE ZONE MAP hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO �? TEL , SPECIAL , >- OWNER �NO 2 - CONDITIONS a I certify that in the performance of the work for which this a AA II t ' I/c DISTRICT GROUP TYPE w a FIRE PROCESSED BY O permit is issued I shall not employ any person in any manner ADDRESS60 V6 /V� {t/ES; l�G, J CONST ZO tj 0 so as to become subject to the Worke o ensu Law _ _ Date _v�LApphc AIRCHITECET OR TY— ML4 ZIP TEL ~ STATISTICAL CLASSIFICATION APT JCONDO NOTICE TO APPLICANT If offer m mg This ertificate o ENGINEER NO ' CLASS NODWELL UNITS Exemption you should become subject to the Workers EL Compensation provisions of the Labor Code you must forth ADDRESS - s€ SEWER MAP with comply with such provisions or this permit shall be , deemed revoked ti CONTRACTOR µ NO _TEL BK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS y NO VALUATION e (commencing with Section 7000)of Division 3 of the Business and LIC /�� /-� Pribfessions Code and my license is in full force and effect CITY CLASS $ w(J V00 SQ FT AMMEKJNO OF v NO OF CHECK x License Number - Lic Class SIZE STORIES FAMILIES ONE r `^ ontractor - Date DESCRIPTION OF WORK.AM7:kAj $F NEW 4 I am exempt under Sec Q@ S , ADD 04 ALTER FINAL B&P C for this reason DATE f REPAIR � Date USE OF EXISTING BLDG �- DEMOL FINAL FI By Signature APPLICANT OWNER BUILDER DECLARATION PRINT aadb I hereby affirm that j am exempt from the Contractors License 6 A/ 0C-4 Law for the following reason (Section 7031 5 Business and _ ADDRESS ,V w5 -T Professions Code) PRESENTCG�[� r ° BUILDING _ I as owner of the property or my employees with ADDRESS / wages as their sole compensation will do the work and + // `� � ri 2 5 P t the structure is not intended or offered for sale(Section _ LOCALITY I 7044 Business and Professions Code) kADDRE TEL I as owner of the property am exclusively contracting CONTRACTOR NO, � r _ with licensed contractors to construct the project (Sec 2 ° tion 7044 Business and Professions Code) _ ,4 YARD HWY TOTAL SETBACK FROM dEX o 1 Q CONSTRUCTION LENDING AGENCY PROP LINE c I hereby affirm that there is a construction lending agency for - ® � 2 2 - the performance of ithe work for which this permit is issued(Sec 3097 Civ C ) a L{Lender s Name Lender s Address Permit Fee o e I certify that I have read this application and state that the Issuance Fee r� cN N o o NO above information is correct I agree to comply with all County Investigation Fee y/ N o g ordinances and State laws relating to building construction Total Fee O • D o N d and hereby au honze rep( ntatrves of this County to enter + upon t ntion rop ty for inspection purposes b n CID 0- ° 00 Crl a' o b ° SEE REVERSE FOR EXPLANATORY LANGUAGE, CH W D 7Sigftbture o pp scantr'Zg-N..ffK Date / \� ®s e w I , WORKERS COMPENSATION DECLARATION �^ _I hereby affirm that I have a certificate of consent to self APPLICATION FOR -BUILDING`U I L®I N G` PERMIT insure or a certificate of Workers Compensation Insurance or a certified cop��yttthereof,(Sec 3800 Lab C ) - e h Policy N�04k;?41-&_?Company J COUNTY OF LOS ANGELES r BUILDING AND SAFETY ❑ Cer ified copy is hereby furnished , ,j FOR APPLICANT TO FILL IN BUILDING ADDRESS x ❑ Certified copy is filed with the county building inspec BUILDING' tion department s ADDRESS 1��I I 1/16'1 / Date I Applicant II I. �./1/�Gi� l CITY ZIP LOCALITY * % Y CERTIFICATE OF EXEMPTION FROM WORKERS `t I _-.NO OF BLDGS - NEAREST COMPENSATION INSURANCE - SIZE OF LOT NOW ON LOT I CROSS ST (This section need not be completed-if the permit is for oneTRACT BLOCK y LOT NO ASSESSOR 1 t hundred dollars ($100)or less ) MAP BOOK r PAGE PARCELTEL ° USE ZONE MAP r I certify that in the performance of the work for which this OWNER IICNO NO permit is issued I sFiall not employ any person in any manner s �/ SPECIAL r so as to become subject to the Workers Compensation Laws ADDRESS CONDITIONS M � + i CITY :1 U � ZIP - Date Applicant D' NOTICE TO APPLICANT If after making thin Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE (R,O SSED BY O Exemption you should become subject to the Workers ENGINEER NO r CONST ZONE r I-' 'Compensation provisions of the Labor Code you must forth ADDRESS lJ. I Ld; with comply with such provisions or this permit shall be 0- deemedrevoked STATISTICAL CLASSIFICATION APT CONDO fA CONTRACTOR + Z ^ LICENSED CONTRACTORS DECLARATION �jA LIC CLASS NO !?:Z1 DWELL UNITS T I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Q /t1"1 N �" i " (commencing with Section 7000)6f Division 3 of the Business and EWER MAP e LIC Professions Code and my license is in full force and effect c Gt4TY YCLASS BK ' PG VALIDATION' r �• r ` SQ FT n NO OF r + NO OF > CHECK s =License Numbe + -Lic Class v v SIZE- dr✓� STORIES a - FAMILIES- -ONE- r i �� VALUATION' I DESCRIPTION OF WORK ©�>�' NEW ❑ r { Contractor Date $ + F ra_ ADD ❑ loo. � ❑ I am exempt under Sec J ALTER ❑ - ✓ B&P`C'for this reason y y ull-1, /0- f REPAIR ❑ $ y USE OF Date EXISTING BLDG DEMOL ❑ A Signature + APPLICANT /i - TEL — ;28 8 318 A g OWNER BUILDER DECLARATION PRINT J- `7 _ NO � n FDATEINAL _ # e o 0 0 0 I hereby affirm that I am exempt from the Contractor s License > Law for the following reason (Section 7031 5 Business and ADDRESSBIN • • 4 Q 5 0 Professions Code) - f ❑ BUILDING I as owner of the property or my employees with ADDRESS ; • •r• 4 0 5 0 wages as their sole compensation will+do the work and ' _ Y the structure is not intended or offered for sale(Section LOCALITY ® r 9 1 2 5-8 8 7044 Business and Professions Code) R MOVING r TEL CONTRACTOR _ NO I as owner of the property am exclusively contracting � with licensed-contractors to construct the project (Sec MADDRESS tion 7044 Business and Professions Code) ! r r CONSTRUCTION LENDING AGENCY REQUIRED YARD HWYA- µ,TOTAL ROPSETK SET BACK PROP LINE WIDTH I hereby affirm thatdthere is a construction lending agency for FRONT z a s t the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) ryi SIDE :<� F a 9 r r PLJ a`r Lender s Name y m i LDMA Ref # ` m Lender s Address P C Fee$ d Permit Fee , r _I certify that I have lead this application and state that the r r o , Issuance Fee / +�� LDMA P/C N above information is correct I agree to comply with all County Invests ation Fee �) 0 ordinances and State laws relating to building construction g Total Fee �cJ�/ LDMA Perm M t k� and hereby authorize representatives of this County to enter x u on the above mentioned property for inspection purposes _ ti 4 Adw_/ ��j� ( � rY N SEE REVERSE FOR EXPLANATORY LANGUAGEr Signature of Applicant or Agent - pate 1 E ,