HomeMy Public PortalAbout6322 AGNES AVE_Building__ _ APPLICATION FOR WIL. bI&PE I
FOR APiSLICANT TOFILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING
ADDRESS 6322 Agnes 91780 DEPARTMENT OF COUNTY ENGINEER
CITY Zlp BUILDING AND SAFETY DIVISION
NO OF BUILDING
SIZE OF LOT NOW ONN LOT LOT 1 ADDRESS
TRACT " BLOCK LOT NO LOCALITY
OWNER Jack Folsom No 287 300 NEAREST ST -
ASSESSOR
ADDRESS "745 Calita St. , MAP BOOK a PAGE PARCEL
CITY-- Arcadia Ca. - ZIP 1006 DISTRICT GROUP TYPE FIRE PROCESSED BY
CONST / ZON ^ �/
ARCHITECT OR TEL .0 �- V j/
ENGINEER " NO STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS _ CLASS NO DWELL UNITS BK PG
CONTRACTOR Lytle Roofing NOL 7925171 USENop 2-0U
LIC l
ADDRESS t� •o
.Box 5327 NO 186303 SPECIAL
CITY " Pasadena, Ca 91107c ASS C 39 CONDITIONS _ r
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO
CONSTRUCTION LENDER ❑
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT NO OF 1 NO OF 1 CHECK HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
SIZE - STORIES FAMILIES ONE }
DESCRIPTION OF WORK Repair roof NEW ❑ + O
with Com osl ion Shin es ADD ❑ BLDG SETBACK FROMcc
P g SIDE PROP LINE OF (STREET) O
reroo • ALTER [Ell TOTAL SETBACK FROM TYPE OF EXISTING w
HIGHWAY + YARD = SIDE PROP LINE IHIGHWAY WIDTH %
USE OF - REPAIR ® Z
EXISTING BLDG residence DEMOL 1:1 +
AP%CANT)NT Z lel Roofin TEL NO 792517 CORNER CUTOFF YES ❑ NO ❑
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION $ 1157-00
a
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF „
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE
SIGNATURE O �N�S/���T/(�/�/ �'-/ /:J�) S T�C� In
PERMITTEE
ADDRESS- 2948 E. Walnut Ste
CITY BY
Pasadena, Ca No 7925171 DA EL r��/
MAKE CHECKS PAYABLE TO - FEE $ FET
L L HARVEYT BRANDT COUNTY ENGINEER r
'PLAN CHECK VALIDATION Co- CK - MO ,CASH Pu: y PERMIT VALIDATION_ cK M 0 CASH
_ �`
Faf" 1^51 I _ ��/ (..`4L % / /'" � «ice .,
®f 76A638A CE#803,3751 .1 \1 �-A :c � .-e.
APPLICATION F`SR BUILDING PERMIT
COUNTY OF LOS ANGELte BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO,FILL IN BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ✓ - �7 p�
or a certificate of Workers' Compensation Insurance,or a certified
copy thereof (Sec.3800,Lab.C.) CITY e /� ZIP q`� 6
T11 (_r LOCALITY � '
Policy NO. Company SIZE OF LO NO.OF BLDGS.NOW ON LOT ,w d '
❑ Certified copy is hereby furnished. NEAREST'CROSS ST.
9 Certified Copy is filed with the C ty bU In I spection TRACT BLOCK LOT NO.
aepa''r)tment. �t` USE ZONE MAP NO.
Date 4� 1� Applicant ASy�SSO �d�BOOK P E PARCEL
`' 'S 'Z SPECIAL CONDITIONS /�� /J—O/
OWNER TEL NO. (�
CERTIFICATE OF EXEMPTION FROM WORKERS' WITHIN 1000 FT.OF SCHOOL? YES NO
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred ADDRES
3�'�f � _� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100)or less.) c \!'1�"1 wr—
CITY ZIP
I certify that in the performance of the work for which this permit U `
is issued, I shall not employ any person in any manner so as to O
ARCHITECT C5R ENGINET L NO.
become subject to the Workers'Compensation Laws. 1\�CI = 1 v i•, STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDR CLASS NO. �.� DWELL UNITS
NOTICE TO APPLICANT If, after making this Certificate of � �J a�-e1 �� � REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' C TOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith -Q r tz:, FRONT
comply with such provisions or this permit shall be deemed revoked. AD SS LIC.NO. P L
LICENSED CONTRACTORS DECLARATION ,�� � Z PILE
ClCIT 1� LIC.CLASS P L
I hereby affirm that I am licensed underprovisions of Chapter 9 C. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQq SIhED NO.OF S IES NO.OF FAMILIES
Professions Code,and y licen is in full force a effect. lfJ! NEW ❑ BK PG a
DESCRIPTIO OF K ADD VALUATION , O
License Number Lic.Class _
Contracto��� 1'N ( Date �� V
ALTER ❑
cc
ElI am exempt unJreao
`` REPAIR ❑ $ y_
B.&P.C. for this A 77 DEMOL ❑ LDMA P/C# ;[` '•.: ev d
12
e. USE OF EXISTING BLDG. URM (]
-:•fir.— _[ CD
Signature � "-
AP NT(P IN qTEL�NOO LDMA Perm#. z
❑ I, as owner of the property, or my employees with wages as �V '� L6 Z
their sole compensation, will do the work and the structure is ADQaESS0
not intended or offered for sale (Section 7044, Business and � • FINAL DATE
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
I, as owner of the property, am exclusively contracting with
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _
❑ AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY T
licensed contractors to construct the project (Section 7044, YES❑ NO❑ t r
Business and Professions Code.) y_,_• .�3 _7._ :32
- ��
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING t�3!• L d � �' ''-��••
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES.
I hereby affirm that there is a construction lending agency for VES El No _
the ._'..
performance of the work for which this permit is issued(Sec.
� [HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING
3097, Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS _
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.
M Lender's Address (:-.,4
O OWNER OR AGENT -- tt
o I certify that I have read this application and state under penalty
o P.C.FEE n PERMIT FEE
of perjury hat the abov 'nformation is correct.I agree to comply �" 4(
with al unty �inafc s and State laws relating to building ��v
m
const C a authorizerepresentatives of this County ISSUANCE FEEto t o e -m ed property for inspeeon purpyes. �l`�- ��j": y :.,;< �y. >� a i, ,�',•': -'�C L�'�
=_� �_ `y
/ � INVESTIGATION FEE TOTAL FEE
n. Signature or Applicant or Agent Date D v
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1305070059
PHONE (626) 285 0488 EXT
LEGAL ID NO OF CONST BUILDING ADDRESS
ON FILE SQ FT STORIES TYPE 6322 AGNES AV
STRUCTURE 23 V B TEMP CA 917801401
(ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET ESTRELLA
15383 021 019 THOMAS PAGE 597 GRID Al LOCALITY TEMPLE CITY CAI
T
ITENANT IEXIST BLDG USE RESID USE ZONE R 1 JISSUED ON PROCESSED BY
IEXIST OCC GRP 105/07/13 SR
(OWNER TEL NO (BLDGS NOW ON LOT VALUA'T'ION IFI AI ATE FIN BY CODE I
ISHEN6322 JENNIFER (650) 278 6506 ' 10 950 i���3�
6322 AGNES AV I '�1
ITEMP 917801401 i FEES PAID DESCPIPTIO OF WORK
IHOLSF & ATTACHED GARAGE TEAR OFF ALL LAYERS INSTALL 1/2 OSBI
IFEE DESCRIPTION QUANTITY UOM AMOUNT IPLYWOOD ON OLDER FRONT SECTION TAR PAPER & NEW CLASS A
(APPLICANT TEL NO i 1GAF COMP SHINGLES & RIDGE CAPS 1
ILEVIN CAROLYN (818) 847 0470 IAA BLDG PERMIT ISSUANCE 27 80 1
11951 N ONTARIO ST IAB STATE GREEN BLDG FEE 10950 00 VAL 1 00 (SPECIAL CONDITIONS
IBURBANK CA 91505 IAC STRONG MOTION RESID 10950 00 VAL 1 10 1
'D2 PERMIT W/O EN HC 10950 00 VAL 233 40
TOTAL FEES 263 30
(CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE
ISHEA ROOFING INC (818) 847 0470 I 1-
11951 N ONTARIO STREET LIC NO ILOCATION AND SETBACKS
IBURBANK CA 91505 830563 ( 1-
I ISOIIS ENGINEER APPROVAL
(ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS 1 1
i
LIC NO ISLAI,/UNDER FLOOR
(RAI ED FLOOR FRAMING
I I I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP IUNDPRFLOOR INSULATION
3 001 1-
I
_I IFLOOR SHEATHING 1 1
INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I- 1 1
NO 21 1 IROO SHEATHING
SCHOOL WITHIN HAZARDOUS SHEA-R PANELS 1
(AIR QUALITY 1000 FEET MATERIALS 1 1
NO NO NO IFRAVE INSPECTION 1
1 1FIRF SPRINKLER HANGERS
1INS JLATION/WEATHER STRIPI I I
(INTERIOR LATH/DRYWALL
I
1 IEXIFRIOR LATH 1
1 I IRATED FLOOR/CEIL ASSEM I 1
1 (RATED WALL ASSEMBLIES I
I
IRA-ED SHAFTS/OPENINGS 1 1
IT -,AR CEILINGS 1 1
1LOP DRAINAGE I 1
I IREPORT ID DPR261 ROUTE TO BS0508 I 1
I I I I