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Home My Public Portal About5007 ENCINITA AVE_Miscellaneous__ WORKERS'COMPENSATION DECLARATION CE 875(2-80) MISCELLANEOUS APPLICATION I herab3r.5ffu*m t4at P have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800,Lab C) Policy No Company FOR APPLICANT TO FILL IN BUILDING �DD 7 ADDRESS ❑ Certified copy Is hereby furnished ADDRESS UILDING 0") LOCALITY f ❑ Certified copy Is filed with the county building Inspection - NEAREST department LOCALITY 1 8 CROSS ST Date Applicant NEAREST 1 DISTRIC NO GROUP TYPE R ESSED BY CROSS ST CONST CERTIFICATE OF EXEMPTION FROM WORKRS' LEGAL E DESCRIPTION LOT NO BLOCK MAP (CIRCLE) HIGHWAY COMPENSATION INSURANCE STATE MAJOR SECOND LOCAL NO OF BLD GS no IRc�e) tZ (This section need not be completed if the work involved TRACT NOW ON LOT USE ZONE SPECIAL CONDITIONS by the permit is for one hundred dollars ($100) or less) I USE OF SIZE OF LOT EXISTING BLDG I certify that in the performance of the work for which this OWNER 0 permit Is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws OCCUPANCY GROUP 0- MAIL r� w ADDRESS �1 n- Date Applicant V to NOTICE TO APPLICANT If, after making this Certificate of CITY (f NOL OCCUPANT LOAD z Exemption, you should become subject to the Workers' APPLICATION FOR EXIT HARDWARE _ Compensation provisions of the Labor Code, you must forth- with comply with Such provisions or this permit shall' be TRAILER USE GEOLOGY INSPECTION _ No Spec Knowl ❑ deemed revoked LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices El I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT �-7 (LIST ITEMS BELOW) No of Exlrs 9 (commencing with Section 7000)<of Division 3 of the Busi- ness and Professions Code, and my license is In full force and a3 { effect PARKING SPACES REQ"D E:= n�P$OVID License Number LIc Class LIMITED TIME USE Contractor Date DATE iPJ_I_'—LILP 'SATE , s FROM TO ❑ I am exempt from the licensing requirements as I am a r licensed architect or a registered professional engineer SIZE OF NO OF - IN GN TOiQ's=°�— aLtmg In my professional capacity (Section 7051, Bus- EXISTING BLDG STORIES SIGNATURE iness and Professions Code) PRESENT USE OF'BUILDING I NAL APPROVAL LIc or Reg No Date— HOME ate HOME OWNER-BUILDER DECLARATION NO of EXISTING BUILDINGS ON LOT AND USE tet, I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Busi- NO PARKING ness and Professions Code) SPACES PROVIDED -` ❑ 1, as owner of the property, will do the work and the structure Is not Intended or offered for sale (Section 7044, Business and Professions Code) PROPOSED USE OF BUILDING CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency ',for the performance of the work for which this 'permit is Issued,(Sec 3097,Civ C) Lender's Name I PROPOSED MAX OCC Lender's Address PERMIT FEE 0'0 I certify that I have read this application and state that the above Information is correct I agree to comply with all County ISSUANCE FEE ordinances and State laws relating to building construction, TOTAL FEE QO and hereby authorise representatives of this County to enter upon the above-mentioned property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur f Permitte Date 0� LOS ANGELES TEMPLE %ilr t_t_ANEOUS PERMIT DF' .iMENT OF PUBLIC WORKS 9701 LAS INIAS ;uS 0410150004 BUILDING A14D SAFETY J LAND DEVELOPMEN' TEMPLE :A 141780 PHONF. '�Z6) 285-0488 EXT: _- i _ D--. ID: i0. OF CONS -- — BUILDING_ - - I ON FILE S0. FT STORIES TYPE P� 5007 EN=.: STRUCTURE: 1 VN R` TEMP CA 1ASSESSOR INFORMATION ;v'�=S : NEAREST �r�SS STREET: LA ROSA !3388-009-005 1RIST BLDG USE RE ;r` j",`' THOMAS ��..t 59`. GRID: J5 LOCnL �: CITY, C -,EXIST CCC GRP: R3 USE ZONE: TENANT: —.-- — -----— - SSUED ON: ..'2 27SS BY: n, :C-a .,.. LDGS. NOW ON LOT: VALUATICl=: - 10/15/04 4K 04/:'/05 FINA' DP. E _.— (Ir:t;L. Bl': t:CaE: 1POYNTER ROBERT L;MARGARET R (626) 286-6390- ;LIST ITEMS: 17007 ENCINITA AV / C/ �'["t 917803708 I S , = -- i"-'�•' i CES I ON Of tRK LEG LIZE EXISTING"PA_ iN THE REAR OF THE _SI :=!: "_)CCUP LOAD EXIST: 'APPL'CANT: y IrCCUP LOAD NEW: SAME AS OWNER f — PARKING SPACES I5PECIAL CONDITi ?dl—'1 :— !FARKING SPACES Pkt."':J D: I — JcAif HARDWARE: !-.�..— :HCTOR: TEL. NO "_. ._. =D T'tSE USE SAM AS OWNER - '422 OF EXITS: - µ — FR0,6 TO L 1 C. NO — FEF.;; PAID _ APPRC' DATE INSPEC �R S.GN",T'SRE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT'1 TIT C7 OR ENGTNEEnR'.--- _TEL- .T USE PERiiiT ISSUA`r :.7.75 4!O 01 ^R'M uCCI!'fiE " 145.9570 1 TOliA �AFC',Y FE ! _ ;_— —__ i NAP NO- SEWER MAP BOOK: PAC=E: TIRE ZONE: -v CMP T -`=A it '-"--- - ----- EMF STRUCT. R..i 7 ED - - W777 FAMILIES: DWELLING UNITS: APT/T-0—ND—STAT miff.- NG -- f ' SCHOOL WITHIN HAZARDOUS A.IR QUALITY: 1000 FEET MATERIALS � I NO P30 NO -.-_-- i , �ReQO TOTAL SETBACK FROM _cvw ,SET BACK. YARD: !.5"'. PROP LINE: 4:v1i1: I FRONT PL- _.__—.I -------_------ i SIDE PL- I I � ;REPORT ID: OPR267 ROUTE TO: BS05;;� --