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Home My Public Portal About6059 AGNES AVE_Building__ r — WORKERS COMPENSATION DECLARATION insureborafc'ertificatefrm thatlofWorkeseColmpensotfonInsuraconsent ncesolr APPLICATION FOR BUILDING PERMIT a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY I U Policy No Company _❑ BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec e BUILDING i rf C tion department ADDRESS �J01-5 N LOCALITY 11 Date t ApplicoAt I CITY _T L� lT ZIP 6 V CROSS NEARESTT CERTIFICATE OF EXEMPTION FROM WORKERS �y NO OF BLDGS — ASSESSOR s r COMPENSATION INSURANCE } SIZE OF LOT SOX IjZ NOW ON LOT MAP BOOK I PAGE PARCEL - (This section need not be`completed if the permit is for one l U E O E MAP Yhundred dollars ($100) or less ) TRACT �! BLOCK Of NCT V NO y >_ TEL SPECIAL CL ^ OWNER /1,/ j NO�� dZ CONDITIONS ; Q I certify that in the,performance of the work for which this DISTRICT GROUP TYPE FIRE PR CESSE BY V permit is issued I shall not employ any person in any manner ADDRESS �OS b ' S O y7 CONST Z02 d; so as to become subject to the Workers Compensation Laws J 1 a t CITY -Zla fe ZIP injl?ed Date Applicant STATISTICAL CLASSIFICATION APT CONDO V ss ARCHITECT OR /1 TEL Jr t� W 1 NOTICE TO APPLICANT If after making this Certificate of ENGINEER 0A C / NO Wv 2.37 O CLASS NO DWELL UNITS Exemption you should become subject to the Workers o7' N Compensation provisions of the Labor Code you must forth i ADDRESS O dam �� 'Os 40%10 SEWER MA Z awith comply with such provisions or this permit shall be s 3- r c deemed revoked Z TEL" BK VALIDATION CONTRACTOR~ Af p/�/C. NO LICENSED CONTRACTORS DECLARATION LIC + I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC / 5 (, O Professions Code and my license is in full force and effect CITY CLASS $ SQ FT 7 NO OF I NO OF / CHECK License Number y t Lic Class SIZE 7 / STORIES ` FAMILIES ONE I — ❑ $ Contractor Date DESCRIPTION OF WORK NEW I am exempt from the licensing requirements as I am a 105.EENC 1OS _PAT#a ADD ® r licensed architect or a registered professional engineer r ALTER FINAL acting in my professional capacity (Section 7051 EO�ILowr� RP?6A1eFi91 Oa!"'� REPAIR DATE Business arid Professions Code) USE OF „ a - FINAL EXISTING BLDG a10E.JC DEMOL I By Lic or Reg No _Date APPLICANT ��n111 CJ ALI�� NO y OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor s License i^ ° Law for the following reason (Section 7031 5 Business and ADDRESS Pro essions Code) r PRESENT ✓ BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work and the structure is not intended or offered far sale(Section LOCALITY 7044 Business and Professions Code) MOVING TEL " I as owner of the property am exclusively contracting CONTRACTOR NO J with licensed contractors to construct the project (Sec tion 7044 Business and Professions Code) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY ' SET BACK 'YARD HWY PROP LINE WIDTH _ 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 ) t SIDE ;?200 1 A � PL i I Lenders Name # a a o Ole 1 P C Fee$ Permit Fee tJ 2 e o 3(�Q 0 Lender s Address w I certify that I have read this application and state that the Issuance Fee 7r o a e 3 IL 0 0� above information is correct I agree to comply with all County Investigation Fee 0 aupth and State lows relating to building construction Total Fee U authorize lepresenes of this County to enter 4 8 a bove mentioned ��9p ty for spection purposes l SEE REVERSE FOR EXPLANATORY LANGUAGE ` Signature of Apphc t Agent Date ._ r Oa COUNTY OF LOS ANGELES Y TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0506 0508190017 PHONE (626) 285 0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS TR 6561 LT 55 SQ FT STORIES TYPE 6059 AGNES AV STRUCTURE 25 VN TEMP CA 917801708 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET GARIBALDI 5385 027 001 THOMAS PAGE 597 GRID A2 LOCALITY TEMPLE CITY C TENANT EXIST BLDG USE RESID USE ZONE R 1 ISSUED ON PROCESSED BY EXPIRES ON EXIST OCC GRP 08/19/05 JK 08/14/06 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINATE FINAL BY CODE JACKS DENNIS A CAROL L (626) 287 5564 6 500 LTJ\{J 6059 AGNES AV 1 TEMP 917801708 FEES PAID DES(:;RIPTION OF WORK TEAR OFF WOOD COMPOSITION SHINGLES RESHEET 7/16 OSB SHEATING y FEE DESCRIPTION QUANTITY UOM AMOUNT 40 YEAR COMPOSITION G A F APPLICANT TEL NO HARRIS PAUL (909) 394 9520 AA BLDG PERMIT ISSUANCE 27 75 741 BELLEVIEW AVE AC STRONG MOTION RESID 6500 00 VAL 0 65 SPECIAL CONDITIONS SAN DIMAS CA 91773 D2 PERMIT W/O EN HC 6500 00 VAL 166 20 TOTAL FEES 194 60 CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE P H ROOFING (909) 394 9520 741 BELLEVIEW AVENUE LIC NO i LOCATION AND SETBACKS SAN DIMAS CA 91773 851584C 39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS LIC NO SLAB/UNDER FLOOR 4 RAISED FLOOR FRAMING r� MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 150H269 3 01 FLOOR SHEATHING NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS n NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS ' M AIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD HWY PROP LINE WIDTH FRONT PL INSULATION/WEATHER STRIP SIDE PL INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS ,. .._ T BAR CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO BS0508