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HomeMy Public PortalAbout6302 AGNES AVE_Building__ — } TEMPLE CITY 1 79ASS&A CE#1103 1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING Z3/r DEPARTMENT OF COUNTY ENGINEER ADDRESS 1Y, BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST FOR APPLICANT TO FILL IN DISTR NQS ROUP -EYP P SSED BY v CONST 2 BUILDING__630,7— ? STATISTICAL CLASSIFICATION S ER MAP ADDRESS �/J aJ . K CLASS NO DWELL UNITS LOT NO '�� BLOCK WATER NOT REQUIRED RECEIVED CERTIFICATE TRACT MAP q �/ HIGHWAY STATE MAJOR SECONDLO NO OF BLDGS / NO _2_t, Lr (CIRCLE) SIZE OF LOT NOW ON LOT / USE ZONE SPECIAL USE CONDITIONS EXISTING BLDG TEL O OWNER NO BUILDING YARD HWY S EET NAM EXIST SETBACK WIDTH ADDRESS © FRONT ARCHITECT OR TEL P L ENGINEER SIDE P L ADDRESS TEL INSPECTIO HEC/OET , CL O CONTRACTOR NO ADDRESS �— l/ s i J 1�l�5( � `T Kyr O cz DESCRIPTION OF WORK UJ a NEW ADD ALTER REPAIR DEMOLISH SQ FT NO OF NO OF z f� ,.� ,Gt.�'Gj G✓1_ Z_ IZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT 4 VAL ATION$ Q 00 4 A APPROVALS DATEE` INSPECTOR S SIGNATURE P CPMT Q FOUNDATION LOCATION FORMSMATERIALS z' FEE FEE $ FEE $ J �� FRAME FIRESTOPS �// I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS f BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR C E OF THE STATE OF ALIFORNIA RELAT J ING TO WORKMEN S ENSATION INSUR E LATH EXT i I i SIGNATU OUSE NUMBER PERMITT OF HRECT AND POSTEDR J{ /�j�_ ,_/ �1�isj��f ,�, !/i�► ADDRESS FINAL ��/V V /_.(5' ✓i// J PLAN CHECK VALIDATION CK N O ems„ CLYDE P RFM VALIDATIOW CKruRMO eN�H R 3 3 9 : :,LP '7 1 a 3 0 v ) I W 76A638A CE#803 3 66 APPLICATION FOR BUILDING PER COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS C/ t BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST _ COLEMAN W JENKINS SUP T OF BUILDING CROSS ST DISTRICT-Ng-_.,j GP T E P O S B FOR APPLICANT TO FILL IN O NST r BUILDING STATISTICAL SSIFICATION ,� SEW R MAP' ADDRESS BK I PG f CLASS NO DWELL UNITS H LOT NO BLOCK 71 USE ZONE MAP ` NO TRACTSo l SPECIAL / NO OF BLDOS / CONDITIONS SIZE OF LOT �7^Q NOW ON LOT USE OF _ \ NG BLDG S D4;�e-,C- BLDG SETBACK PROM TEL _ FRONT PROP LINE OF - (STREET) OWNER TYPE OF EXISTING SETBACK HIGH AY + YARD — TOTAL ADDRESS �j� ♦ 5SRV, HIGHWAY WIDTH FROM C L CITY BLDG SETBACK FROM ARCHITECT TEL SIDE PROP LINE OF (STREET) ENGINE E NO TYPE OF EXISTING SETBACK HIG AY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L TEL + D I = O l CONTRACTOR NO y, LIC ADDRESS NO CORNER CUTOFF YES NO c C CITY CLASS L SEE REVERSE SIDE FOR SPECIAL APPROVALS c DESCRIPTION OF WORK (/�� J� /J�� � y m C.; NEW DD A-LITER REPAIR DEMOLISHSQ F SI ET SOTORIE S � FAMIOF NOO IFSUSE OF STRUCTURE //� SIGNATUREtIF C(` APPLICANT O O VALUATION � QQ APPROVALS DATE INSPECT94 SSIGNATURE P C PMTFOFORMS UNDATION LOCMATERIALSON A,/,�• FEE$ � � FEE$ 5 FRAME FIRE STOPS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTh AND STATE THATHE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION T y) �j WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS kl-I l f 9UILOI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA REL ING TO WORKMEN S C SATION INSURANCE LATH EXT SIGNATURE OF �) /lam:_ HOUSE NUMBER COR PERMITTEE 'Ly/�L RE AND POSTED ADDRESS FINAL L JOHN F LEWIS PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M O CASH Eft 6570 DEC 3023 D 2325A L 7 1 9 5- FEB16 1 D 4 6.50~ TT t RKEFS'COMPENSATION DECLARATION ertifica`,-� of co .to self ir inVire ertif carte-of Work s' Compensation entInsuran e, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab.C.) f COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS d�7,_D(J Certified copy is filed with the county building inspec- BUILDING 12 -2 tion department. ADDRESS /p Date Applicant CITY. _ ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one TRACT BLOCK ONO. ASSESSOR LT hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL OWNER N3 USE ZONE MAP l t I certify that in the performance of the work for which this NO. l permit is issued, I shall not employ person in on nner �J SPECIAL I so as to become subject to the W s'ComperM- 4 c ADDRESS / CONDITIONS O Date vApplican CITY ZIP ! ARCHITE T OR TEL. NOTICE TO APPLICANT: If, after mak this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE P SSED BY O Exemption, you -should become su ject to the Workers' (� CONST ZONE H; Compensation provisions of the Labor Code, you must forth- ADDRESS _� 3 �� W.. with comply with such provisions or this permit shall be D.,t deemed revoked, TEL. STATISTICAL CLASSIFICATION APT. CONDO. N CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license_is in full force and effect. CITY CLASS 7 Z VALIDATION SQ, FT. NO. OF NO. OF CHECK BK. PG./ License Number Lic.Class SIZE STORIES FAMILIES ONE t / !E VALUATION ;2 � 41.9 A S 9ilE/e ��j�_ DESCRIPTION OF WORK NEW ❑ # 0 0 ?- 23 Contractor Date W7 OAC ADD $ "f aI am exempt under Sec. r/J� I oo Qo _ �q� ALTER ❑ y b p I, I j v B.BP.C. for this reason M/0 ❑ $ 006, 0 6 7„1 .A REPAIR _ Date: USE OF EXISTING BLDG. DEMO1 ❑ #.o 0 0 • 23 Signature APPLICANT -�TEL�1P I FINAL ° 20 8,'7 9 OWNER-BUILDER DECLARATION (PRINT) G�►1tffi DATE I hereby affirm that I am exempt from the Contractor's License + //l��Wk 0 0 2.0$ 7 9 Low for the following reason (Section 7031.5, Business and ADDRESS f `� '"�/` FINAL 0914;_88 Professions Code): / FRE5ENT By © BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and. U0 LOCALITY the structure is not intended or offered for sale(Section 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). REQUIRED YARD HWY TOTAL SETBACK F CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH- I hereby affirm that there is a construction lending agency for FRONT o the performance of the work for which this permit is issued P.L. o (Sec. 3097, Civ. C.). SIDE c P.L. G V U Lender's Name 1, 1 6”8 8 l m P.C. Fee$ LDMA Ref. p Permit Fee (J Lender's Address 1 certify that I have read this application and state that the �. t' / Issuance Fee C! LDMA P/C ii loop g above informatippjis correct. I agree to comply with all County Investigation Fee 0 ordinances a ate laws relating to building construction, Total Fee � � r LDMA Perm..tY R and hereby u orize representatives of this County to enter upon the a ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si r ture of k plic t or Agent Date WORKERS' COMPENSATION DECLARATION insure.,hereby, certif caffirm ne of Worke s�Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 1046140 Company State Fund E] Certified Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 6302 No. Anes T. Cy. Ca. ® Certified copy is filed with the county building inspec- BUILDING - tion department. ADDRESS 6302 No. Agnes 11-1-90 Randol Roofing �In. Temple City, Ca. ZIP 91780 Date Applicant LOCALITY / L� NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE 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.) Sammy Tanooka TEL 287-6625 USE ZONE MAP OWNER y NO. I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS 6302 No. Agnes SPECIAL a CONDITIONS so as to become subject to the Workers'Compensation Laws. O Temple City, Ca. 91780 , v 2-20-90 Randol,Roofing CITY _ ZIP M Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR ESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become .subject to the Workers` �v � .:' w � Compensation provisions of the Labor Code, you must,forth- ADDRESS t o N with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. ONDO. Z deemed revoked. CONTRACTOR of tri NO.288-4040 — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS ADDRESS 529 E. Valley Blvd No 451937 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business Sari Ga rle , a. . LIC' C-39 and Professions Code,and my license is in full force and effect. CITY CLASS gK. PG. VALIDATION SQ. FT. NO. OF TNo. OF CHECK License Number 14919-17 Lic. Class f'•—'9 SIZE STORIES FAMILIES ONE 1-31-92 VALUATION Randol .Roofin Contractor g Date DESCRIPTION OF WORK — NEW ❑ $ 7,702.00 ❑I am exempt under-Sec. ara e with Sierra Life Tile. ADD ❑ poll. B.&P.C. for this reason lass A. Roof. ALTER $ REPAIR Date: USE OF EXISTING BLDG. DEMO ❑ Signature APPLICANT TEL. 288-4040 FINAL OWNER-BUILDER DECLARATION (PRINT)RaridOl Roofing NO. I hereby affirm that I am exempt from the Contractor's License 529 E. Valley Blvd. S.G.. 91776 --DATE Law for the following reason (Section.7031.5, Business and ADDRESS FIN A Professions Code): PRESENT By 7y _ BUILDING 1)W ElI, as owner of the property, or my employees with ADDRESS / , wages as their sole compensation,will do the work and s€_€g H 140 - 22 , the structure is not intended or offered for sale(Section LOCALITY E 7044, Business and Professions Code..) MOVING TEL.CONTRACTOR NO. CHECKCHECK ❑ I, as owner of the property; am exclusively contracting / CHANGE ,00 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. `t 5/90CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH 0000-10100 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work*for which this'permit is issued P.L. ��!D � AMI D2>r (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # P.C..Fee$ Per ' Lender's Address e, 0 1 certify that I have read this application and state that the ssuance eF�'` LDMA P/C# above information is correct. I agree to comply with all County nvestigation Fee . 8 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # < and hereby authorizer pres atives of is County t enter upon the ab me perty or spectiogjp r as f SEE REVERSE FOR EXPLAN ORY LANGUAGE Si azure of Applicant or Agent Dat