Loading...
HomeMy Public PortalAbout4935 ENCINITA AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL N (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS sL ' iii v�ti- DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION CITY 44' ZIP O SIZE OF LOT jAI err% NOW ON LOTS ADDRESS - 3Slilvn � � . TRACT BLOCK I LOT NO. LOCALITY TEL NEAREST OWNER I/-� �yyj NO. �yl - CROSS ST. V_ - / ASSESSOR ADDRESS dj-/¢' id; 10z Irl?JtiT' MAP BOOK PAGE PARCEL r^1 DISTRICT GROUP TYPE FIRE ROC SED BY CITY ' �� ZIP f 7 �Y' `"`jjjjp /�—^ CONST, ZONE ARCHITECT OR TEL. / 64( 5 / Z .� ENGINEER NO. Y—�GlG�I STATISTICAL CLASSIFICATION SEWER MAP S^ ADDRESS 7J CLASS NO. _OWELL,UNITS BK PG CONTRACTOR TEL. (� USE ZONE MAP NO NO, iL LIC. _J SPECIAL ADDRESS NO. J CONDITIONS CITY LIC. CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH LDG.SETBACK FROM RONT PROP.LINE OF (STREET) >_ ADDRESS CITY c- IGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING U SO. FT. NO. OF NO. OF CHECK FRONT PROP, LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE = + - CD DES'CRIPT N OF WORK �Jl�Y'( NEW 1:1V ADD ❑ BLDG.SETBACK FROM (STREET) tt� SIDE PROP.LINE OF ALTER ❑ TOTAL SETBACK FR TYPE OF EXISTING REPAIR _ HIGHWAY + YARD = SIDE PROP. LINE IGHWAY WIDTH USE OF NG BLDG, ltJj6 DEMOL + EXISTING APPLICANk ,{ j� -r^ TEL CORNER CUTOFF YES ❑ NO ❑ (PRI NT) .- A ,1.L D. S/�{- ]•,C NO.�}-T�G ;r BY (SIGNATURE) �n/�� �TT/t IN OPEN SPACE YES ❑ NO ❑ Q (Q�/LLL�' �L/(] ��[��! IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ � //,w- 00 CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF II]_ - PERMITTEE '� D_ ,7yy���r ADDRESS J �- 4 ' ,!! 7Z�Ov%"'� 7/^ /f+ 4 FINAL 7 Z BY CITY 7,GJr✓/ - NO... DATE I ✓ / i� 11,IKL' CHOCKS PAYA131-E '1,0: P.C. s PMT. Q FEE FEE •I' HARVEY T. SRANDT, COUNTY ENGINEER U O© PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VAL ATION CK. M.O. CASH 76A638A CE#803 12/72 11*1! K-, 2 5 69'13 AUG 2 1 D S 0,04 WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) ,-'3T�F61�� /���� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Compan Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS L/ Certified copy is filed with the county building inspec- BUILDING �f A tion department. ADDRESS 3S c.: i/ Vg Date Applicant CITY %!q" (711 rr ZIP /? c� 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 ASSESSOR TRACT BLOCK LOT NO. MAP BOOK GE PARCEL hundred dollars ($100)or less.) TEL USE NE MAP _ I certify that in the performance of the work for which this OWNER OL, NO. NO. permit is issued, I shall not employ any person in any manner – SPECIALt so as to become subject to the Workers'Compensation Laws. ADDRESS 1 CONDITIONS U CITY ZIP Date Applicant ARCHITECT OR TEL NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GR UP TYPE FIRE PRO S,SED BY O Exemption, you should become subject to the Workers' !� CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. t6NDO. Cn deemed revoked. CONTRACTO NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. WELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. / (commencing with Section 7000)of Division 3 of the Business and LIC. R SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS e> BK PG VALIDATION SQ.'FT. NO.OF NO.OF CHECK License NumberA Lic.Class SIZE STORIES FAMILIES ONE VALUATION K" _ //II^ NEW 2 8 5 6,5 A Contracto0awlt 0 �• Date DESCRIPTION OF WORK ADD $ # PALR-rl T t oA s --� , o o a s2 3 I am exempt under Sec. ALTERO I o o57,38 B.BP.C. for this reason Q REPAIR $ l / Date: USE OF DEM OL a o'o57.385 EXISTING BLDG. Signature APPLICANT TEL. CWhYJFINAL 1 21t1 ,1�8 7 PRINT NO. OWNER-BUILDER DECLARATION ®� AY/ DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY ❑ 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 for sale(Section LOCALITY t o 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). REQUIREDTOTAL SETBACK I CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I 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.). SIDE P.L. Lender's Name LDMA Ref. # m P.C. Fee$ r Permit Fee. ' Lender's Address 3 o I certify that,l have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee o ordinances and State laws relating to building construction, Total Fee LDMA Perm. # 6 and hereby authorize representatives of this County to enter upon the above-mentioned prorty for inspection purposes. a /pt —//-0-7 SEE REVERSE FOR EXPLANATORY LANGUAGE ature Applicant or hgent Date