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HomeMy Public PortalAbout4943 ENCINITA AVE_Building__ TEMPLE CHTY 76,eSOA CEso, 1-61APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS , • BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OF BUILDING CROSS ST D15T4)aT NGROUP TYPE P C D Y FOR APPLICANT TO FILL M _ O S coNsr BUILDINGn STATI ICALCLASSIFICATION SEWER MAP ADDRESS e i oC CL �/ � BK PG � ASS NO ayl_DWELL UNITS LOT NO i VP ,4/, O"r- BLOCK WATER NOT REQUIRED RECEIVED (' CERTIFICATE CK 7 J TRACT , Z MAP _ HIGHWAY NO OF BLDGS NO (CIRCLE) STATE MAJOR SECON LOC,KL'� SIZE OF LOT + I NOW ON LOT USE ZONE SPECIAL USE OF �I CONDITIONS EXISTING BLDG P lLVQY7 0�- e- , r TEL OWNER O J� NO BUILDIN EXIST // //ff SETBACK YARD HWY STREET NAME WIDTH ADDRESS O(! /7 /' FRONT _ R, TEL P L `- / SIDE � S 077o ORt-f0dT ClaD 4,'Aii- ocal P L a TEL oN. INSPECTION RECORD O CONTRACTOR NO 1 �7 ADDRESS d' DESCRIPTION OF WORK O V W CL NEW XADD ALTER REPAIR DEMOLISH -, V) SONO NO OF NO OF Z IZE STORIES FAMILIES USE OF cft, el. ' STRUCTUR POS I !N V_ .4 SIGNATURE OF APPLICANT VALUATION$ UU°" + v APPROVALS DATE INSPECTOR SSIGNATURE PC PMT FOUNDATION LOCATION FEE $ FEE $ FORMS MATERIALS FRAME FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY IWILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN&SC EZON INSJJ N LATH,EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL CLYDE N DIRLAM, PRINCIPAL STRUCTURAL EN R ), PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION cic mo CASH y"o' ,t , E00954 -0 AIPR12 1 D 4.00 M APR 2'41959 78A898A CE#809-8-87 APPLICATION FOR BUILDING PERMIT v COUNTY OF LOS ANGELES ADILDING DRESS Q DEPARTMENT OF COUNTY ENGINEER 3 BUILDING AND SAFETY DIVISION LOCALITY a JOHN A LAMBIE,COUNTY ENGINEER NEAREST CASSATT D GRIFFIN,SUPT OF BUILDING CROSS ST }- ac- DISTRICT NO GRO P TYPE SEWER MAP I j FOR APPLICANT TO FILL IN K P CONST Z BUILDING 2 t- 14 = `'I, n STATISTICAL CLASSIFICATION a ADDRESS J L {V 1. Y EY ��/f 41 CLASS NO_/j6_DWELL UNITS m LOT NO a- BLOCK MAP p STATE H YES NUMBER .LGA" HWY O TRACT USE ZONE SPECIAL NO OF BLDGS -CONDITIONS SIZE OF LOT NOW 2N LOT �/ 1 N USE OF EXISTING BLDGI BUILDING YARD H STREET NAME EXIST Q. SETBACK 1 WIDTH OWNER R ti C'� ?.��� `' FRONT MAIL1� P L 12 ADDRESS i q b� - Af VQ SIDE ` t u -P L CITY . 4 y L !1, C\ { G NO �-i{ l�C�� INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO ADDRESS >• - /� TEL CONTRACTOR 0-CA_JN—1't Q.)n J NO 1 'r ADDRESS _ DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ FT / A / NO OF NO OF ,raj ��,� -_ a SIZE 3��.�1 STORIES FAMILIES USE OF STRUCTURE APPROVALS SIGNATURE OF APPLICANT d _1 q � I DATE INSPECTO TURE ADDRESS �,�,� A ALI�,�X�,A, FOUNDATION LOCATION FORMS MATERIALS O UFEE $ DI FRAME FIRE STOPS '� BRACING BOLTS VALUATION S Ei'C� FURNACE LOCATION GAS VENT DUCTS / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION LATH EXT SIGNATURE O HOUSE NUMBER COR- gr RECT AND POSTED 6, ! ADDRESS - FINAL 1 JOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM PRINCfPAL STRU TURAL N (NEER PLAN CHECK VALIDATION CK Id 0 H PERMIT VALIDATION K M O CASH 1.��'0 1 8 2 AR 2 4 1 6 A 8.0�0 A :9 ,ACO 0--7 2 4 09 MAY 9 1., A 16.0 0 � ..�'WORKERS' COMPENSATION DEc SARA!ION A t�;, 'I herpby affirm that 4 have a certificyte of consent to self e insure, or a Fertificate of Workers' C peof con Insurance, A P P L CsATiO N FmO BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) '+' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Flo. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING / � J ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS A)I ✓ Date Applicant CITY e�/ ZIP LOCALIT Pp NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT X NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR 2 a 0 (This section need not be completed if the permit is.for one TRACT BLOCK LOT NO. MAP BOOK �,J 0 ' PAGE�3 PARS hundred dollars ($100) or less.) TEL. OWNER USE ZONE MAP / / I certify that in the performance of the work for which this /y� SPECIAL >_ permit is issued, I shall not employ any person in any manner ADDRESS ,-J 1' !I-At '�/ V ' CONDITIONS 0- so so as to become subject to the Workers'Compensation Laws. 0 CITY 4/t C- ( ZIP el(7 8 0 Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE -PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. E U Exemption, you should become subject to the Workers' w Compensation provisions of the Labor Code, you must forth- ADDRESS SO/ ✓ Y o- with comply with such provisions or this permit shall be - TEL. STATISTICAL CLASSIFICATION APT. I CONDO. Z deemed revoked. CONTRACTOR NO. / — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. a J 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 LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK 4J PG. VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK ' -e? NEW $ ADD ❑ / CJ!/ , ❑I am exempt under Sec. ❑ - ALTER B.&P.C. for this reason REPAIR ❑ ; Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL- FINAL OWNER-BUILDER DECLARATION (PRINT)P P- Q .jN AVJ. L O. / _lleosw DATE 1 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. n.r = BUILDING ��"-'=' JFJ� I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and _. , • - the structure PIP.is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. 3, ❑ 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 TOTAL SETBACK FROM EXIST. 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. # F •3 P.C. Fee$ _LJ Permit Fee Lender's Address pool a 1 certify that I have read this application and.state that the Issuance Fee o� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee Q 1_3„`•„•� t„•:'•• r rr 6 ordinances and State laws relating to-building construction, Toral Fee ✓ LDMA Perm. # ~ a and hereby authorize representatives of this County to enter r3rFrF - u the above-mentio d property for inspection purpo s. a �p SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dat „ WORKERS;COMPENSATION DECLARATION r ��fx APPLICATION FOR BUILDING PERMIT I-hereby affirm that I,have a certificate of consent-to self , <' , insure, or a'cerhficate of-Workers'Compenshori,lnsurance,'or� ti - , a certified,copy thereof (Sec 3800,.Lab'C ) i tPolicyNoCS51695OUpanyMaryland Casualty COUNTY OF LOS ANGELES BUILDING AND SAFETY Cert fled copy is hereby fuFnished _ FOR APPLICANT TO FILL IN BUILDESSING L13 ADNESS INCertified copy is filed with the county building inspec- BUILDING 4943 Encinita tion department ADDRESS LOCALITY Ci Date 11/6/81 Applicant American Builders CITY Temple City ZIP 91780 � CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' 9O S 2 MAP BOOK PAGE PARCEL ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 75X1NOW ON LOT '(This section need not be completed if the permit is for one USE ZONE MAP 1I hundred dollars ($100)or less ) TRACT BLOCK, LOT NO NO T TE p / SPECIAL CL I certify that in the performance of the work for which this OWNER�JOse h M.Waterman NO 286-3258 CONDITIONS O DISTRICT GROUP I TYPE FIRE PROESSED BY V permit is issued, I shall not employ any person in any manner so as to'become subject to the'Workers'Compensation Laws ADDRESS 4943 EncinitaCONST ZONE cc i` i CITY Temple City ZIP 91780 V - `3 - 00 Date Applicant STATISTICAL CLASSIFICATION APT CONDO V NOTICE TO APPLICANT' If, after making this Certificate of ARCHITECT OR TEL W Exemption, you should become subject to the Workers' ENGINEER NO CLASS NO DWELL UNITS N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with.comply with such provisions or this permit shall be ericanLli Builders TEL m deemed revoked BK //( PG VALIDATION 1 CONTRA TOR NO I LICENSED CONTRACTORS DECLARATION 019k Temple CityB 804325 - I hereby affirm that I am licensed under provisions of Chapter 9 ADDR ALUATION - (commencing with Section 7000)of Division 3 of the Business and LIC --- / Professions Code, and my license is in full force and effect CITY Temple City CLASS B-1 SQ FT - STORIOES 1 AMILNO OF 1 ONE neeNiypbeL ie 325 Lic Class Bel SIZE $ Cont atll_Lerican BuiWters 11/6/81 DESCRIPTION OF WORK lcl NEW I am exempt from the licensing requirements as I am a Office Addition and ADD licensed architect or a registered professional engineer ALTER FINAL 49 acting in my professional capacity (Section 7051, Kitchen RemodelDATE Business and Professions Code) USE OF REPAIR EXISTING BLDG Dwelling DEMOL FINAL Lic or Reg No Date APPLICANTT L By OWNER-BUILDER DECLARATION, (PRINT) American Buildera 287=974 I hereby affirm that I am exempt from the Contractor's License ADDRE555819 Temple City Blvd T•C Law for the following reason (Section 7031 5, Business and / Professions Code) PRESENT ❑ BUILDING c 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and I the structure is not intended or offered for sale(Section LOCALITY n 7044, Business and Professions Code) MOVING TEL �2 3,7,9 A 1, as owner of the property, am exclusively contracting CONTRACTOR NO r # o`0 0 0 0 1 with licensed contractors to construct the protect (Sec- � ADDRESS hon 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST r 2''0 1 69,00 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH i I hereby affirm that there is a construction`lending agency for FRONT e o = the performance of the work for which this permit is issued -p L 1 6 9,0 0 (Sec 3097, Civ C ) SIDE 2 18,-81 PL Lender s Name Lender's Address P C Fee$ Permit Fee 1 certify that j have read this application and state that the Issuance Fee d �a above information is correct I agree to comply with all County Investigation Fee ordinances'and State laws relating to building construction, Total Fee � and hereby authorize representatives of this County to enter upon thkabovei tiff gr�ra fg gspection purposes Ll ll C1e L S t SEE REVERSE FOR EXPLANATORY LANGUAGE i Si re of)*I;Plt or Agent Dote ' Os i�O'�CFWS'COMPENSATION DECLARATION ;dl su rebo affirm ifica I have r certificate s consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers7-Compensation Insurance, P, or a certified copy thereof (Sec 3800, Lab C ) P 34985 Ohio Casualt COUNTY OF LOS ANGELES BUILDING AND SAFETY � Policy N ompany y _ ❑' Certified copy is hereby furnished \`� FOR APPLICANT TO FILL IN ADDRESS -3 a © Certified copy is filed with the county building inspec- BUILDING tion department Cit CALITY Don' E. Hatfieldx ` NEAREST Date 1.0/30/86-Applicant ' lder CITY Tem le City zIP91780 cRosssT CERTIFICATE OF EXEMPTIO S NO OF BLDG ASSESSOR COMPENSATION INSURANCE , SIZE OF LOT19OX7 5 NOW ON LOT 2 MAP BOOK PAGE PARCEL ;(This section need not,be completed if the permit is for one TRACT BLOCK LOT NO USNE� OP �.�� hundred dolWs ($100)or,less ) r - 5 ��/VVVVVV SPECIAL 7 } I cern that in the performance of the work for which this OWNER Mr. Joseph Waterman CONDITIONS 0. p DISTRICT GROUP TYPE FIRE PR SSED BY O permit is issued, I shall not employ any person in any manner ADDRESS 4943 Enc ini to Temple Cit CONST- ZONE r V so as to become subject to the Workers'Compensation Laws ��Q /�A./ De Tem le Cit 91780 fir// ,-1 1 CITY P y ZIPO Date icant ARCHITECT OR TEL STATISTICAL CLASfSIFI TION APT JCONDO- 4p, H NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO CLASS NO ` DWELL UNITS j L11 Exemption, you should become subject to the Workers' A Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP to with comply with such provisions or-this permit shall be r Z deemed revoked CONTRACTORAmerlcan$ulld'ers TEL BK PG,(� VALIDATION LICENSED CONTRACTORS DECLARATION L 1043 2 5 I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS10642C LowerAZus a Jd VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC �^ Professions Code, and my license is in full force and effect CITY El_ Monte CLASS B-1 $ �✓ Jia , 104325 s-y-1 SIZEF�� ST OF NO OF CHECK License Number Lic Cla STORIES FAMILIES ONE Ame_ican Bui1C�, s 10/30/86 DESCRIPTION OF WORK Single Car NEW ❑ $ ContractorAmerican I am exempt under Sec Ja Garage W/Attached ADD ] ALTER ❑ FINAL B&P C for this reason Workshop and Bath REPAIR ❑ DATE USE OF Date EXISTING BLDG I)we l lin & Office DEMOL ❑ FIN By Signature APPLICANT TEL 44 OWNER-BUILDER DECLARATION - , I hereby affirm that I am exempt from the Contractor's License 1 Law for the following reason (Section 7031 5, Business and ADDRESS Aztlqand Ca. Professions Code) PRE IENT 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 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) 2583.7A REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH �' 1 0 o e • 0 1 ' 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 " Al a 1 8 1. 1 3 (Sec 3097, Civ C ) SIDEFD PL ` ', • • 181. 131 Lender's Name , V �� _, } 10.31 -86 7lJ.P C Fee$ Permit Fee Lender's Address 1. I certify that I have read this application and state that the Issuance Fee r above information is correct I agree to comply with all County Investigation Fee tQ t +1 ordinances and State laws*relating'to 6uildmg construction, g Total Fee d and hereby authorize representatives of this,County to enter upon the above-mentiQ pro erty for inspection purposes Amer a � � ! O B ' , SEE REVERSE FOR EXPLANATORY LANGUAGE n Signature o pplicant or Agent Date