HomeMy Public PortalAbout4836 ENCINITA AVE_Building__ DEPARTMENT ,..DING AND SAFETY I APPLICATION FOR PERMIT
COU O LOS ANGELES 8 / 1 L ® I G y-
WM. J. FOX. CHIEF ENGINEER �.�1.51-
FOR APPLICANT TO,FILL IN FOR OFFICE USE ONLY
BUILDING // DITNO. PLAN CK.NO PERMIT NO.
ADDREBB 31p .E�
LOOALIT`YTJFMPLF CITY REG I D BY AVEr.9APP DATE ISSUED
"EA
REST
CROSS BT
OWNER 5 ADDRESS .l�C.�M'✓ W- CJC.Jv't'
i
MAIL LOCALITY
ADDREBB
T > NEAREBT
CITY N� t CROSS ST.
FIRE
e �� OF
TEC'e ZONE PLN
ENGINEERiy AL v,aNnrpTOP (7. ,ARCHI
�TYP
BLDG. ORD.NO
ADDRES L SETBACK LINE
APPROVED
TEL. .,� „Z BY DATE I
CONTRACTOR NO
USE R + PPROVKD
ADDRESS M ZONE BY DATE
LEGAL i' Q 0 CORRECTIONS
DESCRIPTION
. LOT NOBLOCK !�
TRACTF'
Zy4 Cp
_SIZE OF LL3TAJ801 �s I NOW ON LOTS ow i;
USE OF�NO.OF�No OF
EXISTING BLDGEXISTING BLDG h�FAMILIEe ROOMBROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION O i
A
REPAIR MOVING DEMOLISH
SONO OF '`'+ Z _
51ZE ROOMS 9T9 D
WALL ROOF r
COVERING COVERING
USE OF NEW
BUILDING
�I HEREBY- ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT II PEC R DATE _
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION
AND STATE LAWS REGULATING BUILDING CONSTRUCTION FORMS.MATERIALS
FRAME: FIRE STOPS .s
SIGNATURE OF BRACING,BOLTS Te I IAS�L
PFRMITTEE
� LATH, INT.
AUTHORIZED AOT ATH, EXT.
e
76AG38A-3 2-50 $ P C.av 0, PLASTER. INT. r
3500`0 �� FEE PLASTER,EXT.
VALUATION-- FINAL ,�,pyPw'�.J
FEE
tit • " �
I� WORKERS' C'OMPENS'ATION DECLARATION w a1 ���•�;' a 1 ti_i - _, _
heru{�y affirm car that I have rkers'_Come of consent r self .a YAPPLICATIOIeI '*FOR; BUILDING_' PERMIT
` insure, or a certificate of Workers' Compensation Insufance, C
or a certified copy thereof Sec 3800, ab C " ' ' - W ,
_ COUNTY"OF LOS ANGELES - 1 BUILDING�AND SAFETY
Policy No � 1-3 thereof
-
- a ^ Certified copyZ is hereby furn+s ed FOR APPLICANT JO FILL INBUILDING' ",/ t / {
i ADDRESS (p
'Ce�t&fi Wcopy isliled`with`the couniy build'ing'inspec- "' BUILDING 0` - r
%'tion-department It ;a- `a� ADDRESS
Date• ,. �X, Applica 1 * +^a CITY - (-� ZIP'-� �- LOCALITY
'lCERTI ICATE OF EXEMPTION FROM"WORKERS' ' ' -" -*-NO.OF BLDGS - - - - NEARESTa
o tOMPENSATION•INSURANCE ' <, SIZE OF LOT ". 'NOW ON LOT CROSS ST
< .� ASSESSOR " t t t
. (This'sechon need not+be�completed'if the,permit is=for"one - - - - T -- r-'--�
-hundred dollars ($100)or,less ) ,,rte', TRACT' BLOCK LOT NO' MAP BOOK ' f �._ _ PAGE' PARCEL
+` - - , �- ---
M x e i
OWNER;A0, NO USE NE MAP , f t f
I certifyath it,,+n the performance of the work for which this, NO t3 .
rpermrt is issuedTl shallnoT erriploy"ariy person i`ri any manner _ SPECIAL - - - -- - ' _' - - t .�p,
so as to become subject to'the Workers"Compensation'Laws ADDRESS �,� - CONDITIONS ;� f - i O'
o_
t.i'• '' r`t, 1-4. sit ,t . _ _ CITY_. -� _
Date `Applicant`
ARCHITECT OR TEL _PROCESSEDi O
NOTICE TO'APPLICANT'`If, ciftervmakirig'this'Cert+ficate,of p e _,,,,DISTRICT _GROUP' TYPE FIRE BY t G
Exemption,',you should become subject' to the Workers' ENGINEER Y�(�— NO CONST ZC`�N�E
Compensation provisions of'the Labor Code; you must forth---' ADDRESS �! 5� � _ l _V.-_ . ;'•✓ _ _ #LU
with comply.with, such provisions or„this permit shall
be-
Exemption,,
___ _ y I
deemed-revoked TEL STATISTICAL CLASSIFICATION APT CO O• Z
1'F $spa t CONTRACTOR NO F +
LICENSED CONTRACTORS DECLARATIONF,r s -- w-• - LIC - CLASS NO'- � 'DWELL UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO CC
`PO'
with Seciiori 7000)of-Division 3'of tFie Business and _ SEWER MAP
Prof...Ons Code, and'rny license is in full force and effect - A' /_�---+ - --
t n a ,^ CITY CLA55 MBK -PGw� • - VALIDATION-,
6 ^��i � SQ FT NO OF NO OF
License Number �J Lic Closs== _L SIZE STORIES FAMILIES- ONE i
_ r I
Contractor DESCRIPTION OF WORK - NEW— $ -
❑ _ e'x..w v, „• _ ADD O
I am exempt under Sec - `
_a .� ,.,,. - .. 2 i� .o„t• te t,iyr „ ALTER O
t '
B 8P C for this reason _ REPAIR ❑ $ -
- a,teA- ' USE OF. ' DEMOL ( +
EXISTING BLDG -
Signature X ' ' ”" l - c APPLICAN - - TEL i IF
Sign e',
OWNER-B I ILDER D LARATION.' s PRINT NO _w _ Y _ ✓
_ _ _ _ _ _ DATE?_
n I hereby affirm that Ilam exempt from the Contractor's License _ w ` {T '- t ti +•=
Law for the following reason'(Section 7031 5, Business and ADDRESS ) FIN
c .t
Piofessiori"s Code) _ PR - B`y =- `r_ "-
BUILDING ( :'
I, as'owner of the property, or my employeesiowith ADDRESS _ +
wages as their sole com ensahon;will do the work and
the structure is not intended or offered for sale(Section LOCALITY y �1 5-1-471
r)
7044,-Business and Professions Code)' T` MOVING �-"^- - TEL #,• oo`.o • _
` Y CONTRACTOR '� NO
I, as owner of the property, am exclusively contracting � a J Y ^m __ � ,1 - N- .L_T a"r5 'l �" �+�' - y - ` ! e • ���8�'`
with licensed contractors to-construct the-project (Sec- r 1U �� 0729-86 -
tion 7044, Business and Professions Code) -, ^ ADDRESS
y _ ___ REQUIRED TO SETBACK
- CONSTRUCTION LENDING AGENCY" , SET BACK YARD HWY' PROP LINE WIDTH'
I hereby affirm that there is a construction lending agency for FRONT 9 6r. �� /
the performance of the work for which this permit,is issued" - P L•- 3/_ �
(Sec 3097, Civ C ) " SIDE. it 3
-
Lender's Name
._ _ ...,__ LDMA Ref #
Lender's Address w - PC Fee S' - - -- Permit Feel-
I.,certify that I have read this application and,state that the _ _ Issues ce Fee 1' LDMA P/C
above information is correct I agree to comply with all Count
a 9 P Y Y
Investigation Fee '
ordinances and State laws relating to_building construction, - _ �0 S ,
r 'i- -t•'^^ F^ _ Total Fee•-- l LDMA Perm #�
u and hereby authorize representatives of this County to enter ° +
a upon ! ve nh ed property for inspection purposes t
`- SEE REVERSE FOR EXPLANATORY LANGUAGE S h r t
a e
�-�Signature of Applicant or Agent -t - Date