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Home My Public Portal About4911 ENCINITA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILD L WM 'J. FOX, CHIEF ENGINEER ING FOR'APPLICANT TO FILL INFOR OFFICE USE ONLY DISTRICT NOS PLAN CK NO PERMIT NO BUILDING - ,[� _ 7 -9 ADDRESS 9i ' �, �, N�//V/ _r.9 Y9 v E _ _ v o RECEIVED BY DATE OF APPL DATE ISSUED NEAREST LOCALITY TEM P`e � l f%'T7y C/��,1 FOR W1 - t lQE/VO y /r BUILDINGS d CROSS ST � w' ADDRESS R / �/�/C/4/ /7 //��1 OWNER /"l1 L'H E aPGA/tS Je AIVIF MAIL �[ w, /� /� LOCALITY ?� / ADDRESS 79// /►p, r NGS/^v/ T A /7 ✓ NEAREST n CROSSST .4`/ �L'e'swa It)At CITY TC--M C E (� /7- ✓ NO R r_ - 6o FIRE NO OF TIP GROUP r ARCHITECT OR O TEL ZONE I:PLANS ENGINEE -I E / I R �/- 9 SETBACK LINE 7--4 )/ / Lam/ %-�K- ADDRESS kill- APPROVED TEL BY DATE ' CONTRACTOR NO USE APPROVED ZONE BYDATE ADDRESS HOUSENUMBERING LEGAL �J �] DESCRIPTION I LOT NO - MAP NUMBER`a/ Z '--FIELD CHECK BY I TRACT �•S Z 3 NO ASSIGNED BY DAT i ,cam NO OF BLDGS CORRECTIONS SIZE OF LOT I 0 NOW ON LOT —,� ,_, = �� / ', USE OF NO OF EXISTING BLDG E'S/ G� V GE FAMILIES DESCRIPTION OF WORE �� C L NEW I I ALTERATION I I ADDITION REPAIR I' I DEMOLITION SQ FT -�f�/O NO OF SIZE oc 7 ROOMS STORIES / O ✓ D EXT WALL ,SC L'E ROOF /7 ✓mos f' COVERING ,5$raCcV I COVERING eoMP USE OF STRUCTURE , �C �E Al ?D Rcm APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS , tba �,,....¢.✓ LAWS REGULATING BUILDING CONSTRUCTION FURNACE LOCATION, SIGNATURE OF iyyJ.t.0=`GGr J�LLY✓� GAS VENT, DUCTS PERMITTEE q ADDRESS �� lf/1/, LATH, INT �/�� f _ LATH, EXT AUTHORIZED AGT PLASTER, INT 78A838A DHS3 10-80 $ P C $ ® /`, FEE `�""� PLASTER, EXT f VALUATION FEE $ Z � FINAL RTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT LINTY OF LOS ANGELES ��1') 271911 � � � � � ® � WM. J. FOX. CHIEF ENGINEER II"" FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY-7,,) 43� DISTRICT NO PLANCK NO PERMIT NO. BUILDING ADDRESS LOCALITY / RECEIVED BY DATE OF APPL DATE ISSUED NEAREST '.``� - CROSS ST c- / fib _ / / BUILDING E /v r C� AJ T OWN R ADDRESS �.�'+ ,p MAIL �Q�� I— Q�� v A-v LOCALITY / V' ADDRES �.7 �J _ NEAREST TEL CITY (� ,U� /�• NO CROSSST :5 FIRE NO OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANE ENGINEER NO BLDG ADDRESS SETBACK LINE Ey+t•/ , AA ! A) g APPROVEDtiI Y L' , .J�^�^�— CONTRACTOR TENpJ / yJ BY DDATETE I USEAPPROVED r ADDRESS ZONE � / BY DATE LEGAL r CORRECTIONS DESCRIPTION I LOT NO BLOCK n / 7— TRAC v A NO OF BLDGS r � SIZE OF LO �UI NOW ON LOT UBE OF NO OFNO OF EXISTING BLDG FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION D A REPAIR MOVING DEMOLISH SQ FT NO OF SIZE .S ROOMS e� STORIES Z D WALL ROOFr COVERIN[3'briLsAa2. ,I COVERING i. USE OF NEW BUILDING ..1~= 2 o� o � I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION.: LDCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS (� AND STATE LAWS REGULATING BUILDING CONSTRUCTION �•IN IO 3 y / `�� FRAME FIRE STOPS, ,1 /Q, f> -(�{ SIGNATURE Or—y► �$Sj /f.,�J � BRACING,BOLTS PERMITTEE _ LATH, INT << G• - Y/"yf AUTHORIZED AOT LATH, EXT. JOF 76AB3BA MSE OOPLASTER,INT. DBS-3 6OM BETS7 $ PLASTER,EXT. VALUATIONms' FINAL APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN Bul ING ADDRE I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ` ne-e7,, or a certificate of Workers' Compensation Insurance,or a certified 4911 N. ENCINITA copy thereof 13800 Lab STATE FUND cI. TEMPLE CITY ZIP 91780 LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROS T EkCertified copy is filed with the county building inspection TRACT BLOCK LOT NO. de tm nt. USE ZONE MAP NO. Date i� —95 Applicant PWDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL S' OWNER SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERTEL NO. COMPENSATION INSURANCE ELIZABETH SYLVESTER 2853545 WITHIN 7000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ApDRESS 4911 N. ENCINITA DISTRICT GROUP TYP ONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CIT I certify that in the performance of the work for which this permit TZIP TEMPLE .CITY . 91780 , is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLA�S}SIF/ICATION APT CONDO Date Applicant ADDRESS CLASS NO._L DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED' TOTAL SETBACK FROM EXIST Exemption, you should become Subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL .ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION 529, E. VALLEY BLVD. 451937 SIDE CITY LIC,CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 — SEWER MAP } (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG ® Ov License Number 45193. 7 Lic.Class C-39. DESCRIPTION OF WORK I ADD ❑ VALUATION O Contractor RANDOL ROOFING Date _1-31'-96 REROOF HOUSE & GARAGE WITH $ 2,000.00. ALTER ❑ 20—YEAR CLASS A FIBERGLAS REPAIR CY ❑ 1 am exempt under Sec. $ N BAP.C.for this reason SHINGLES OVER EXISTING ROOFING DEMOL ❑ .,;.._ .... ` 3 LDMA P/C# ,I . = i Date: USE OF EXISTING BLDG. URM ❑ ---. - ? _, ry1`'z.'j"•a"g"` SFD Signature APPLICANT(PRINT) TEL NO. LDMA Perm# (•-�-';:}'s-�-r ❑ I„as owner of the property, or my employees with wages as EANDOL ROOFING 9AR-4040Z IJ their sole compensation, will do the work and the structure is ADDRESS `t fj�='�i'='rj 1;'r, ':''``+ not intended or offered for sale (Section 7044, Business and 529. E. VALLEY BLVD. , FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /7/ •� _ a :i 1,.::A;;;; OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I, as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES ElNO 11Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 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 'YES❑ NO❑ N the performance Of the Work for Which this permit Is•issued(.Sec. IHAVEREADTHE 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CL Lender's Address O ;'OWNER OR AGENT o I certify that I have read this application and state under penalty o, of perjury that the above information is correct.I agree to comply P.C.FEE - PERMIT FEE 78.90 N with all county or antes and State laws relating to building m construct'n, n r by autho e r ,esentative*tupo ISSUANCE FEE to enter o e-mentio pr ert for inS2ro.40 a /) INVESTIGATION FEE TOTAL FEEt A 1 105.30 SEE REVERSE FOR EXPLANATORY LANGUAGE