The URL can be used to link to this page

Home My Public Portal About5019 ENCINITA AVE_Building__ t � C;WERS'COMPENSATION DECLARATION ( ' nsur'e, oraafce of caorm rte of hove orke s'Compensation a certificate of consent Insurancef APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab C. Policy No.4,/,W_eCompany COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished: FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed.with the cou ty building inspec- BUILDING tion department. ADDRESZ,� LOCALITY ,f NEAREST Date / d' Applican CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP p nl hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. 90 TEL. SPECIAL � I certify that in the performance of the work for which this OWN NO. CONDITIONS 0 permit is issued, I shall not employ any person in any manner DISTRICT G OUP TYPE FIRE PR CESSED BY so as to become subject to the Workers'Compensation Laws. ADDRES ^z CONS ZONE , YA� 0: Date Applicant CITY ZIP STATISTICAL CLASSIFI ATION APT. JCON0. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. 9L UNITS 9L Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be z deemed revoked. TEL. BK. PG, VALIDATION CONTRACTOR NO—Z&— LICENSED CONTRACTORS DECLARATION LIC. J� I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ® NO VALUATION (commencing with Section 7000)of Division 3 of the Business and . LIC. �3 Professions Code, and my license is in full force and effect. CITY / 742:2-1,04 CLASS $ y , SQ: FT. NO. OF NO.OF .�. CHECK License Number —Z Lic.Class A SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ $ ;21 23,8A Of Contractor Date ADD # 0 0 0 0 2 3 I am exempt under Sec. • ALTER E] FINAL � o321.30 B.&P.C. for this reason 46,4W A01'. REPAIR E] DATE USE OF Date: EXISTING BLDG DEMOL ❑ By APPLICANT TEL. Y d o - 321.305 Signature PRINT NQ. OWNER-BUILDER DECLARATION Pill. t �V 217-84 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT El1, I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and1 7 6 2 A the structure is not intended or offered for sale(Section LOCALITY ' z 7044, Business and Professions Code). • MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. # 0 0 0 0 0 1 with licensed contractors to construct the project (Sec- ADDRESS V- 3 8&5 0 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. o 0 3 8 a 5 0 F5, 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. 0 a 2 9—8 5 (Sec. 3097, Civ. C.).. SIDE P.L. o Lender's Name- f] Lender's Address P.C:Fe e•$ Permit Fee C I certify that I have read this application and state that the Issuorice Fee o,�t/ above information is correct. I agree to comply with.all County Investigation Fee ¢¢ r g ordinances and State laws relating to building construction, Total Fee 0 J u and hereby autho ize representatives of this County to enter upon the ove entioned property for inspection purposes. 1 a � _ SEE REVERSE FOR EXPLANATORY LANGUAGE \ ®s Signature of Applicant or Agent Date u APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY _ WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR SS Ehlo BUILDING ADDRESS ' _ I hereby affirm that 1 have a certificate of consent to self insure, � D/°I V�INI Z11or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3600,Lab.C. ��i j ZLOCALITY IP Policy No.l0�93r7Company - T�97- FUAIP m c 0 SIZE OF LOT�t NO.OF BLDGS.NOW ON LOT Certified copy is hereby furnished. .0±AOMIT 1 NEAREST CR ❑ departmnCertified copy is filed with the county building inspection TRxA/CT0 Z-,?3`� BLOCK LOT NO. USE ZOMAP NO. /y N� Date t.� Applicant /��• ASSESSOR MAP BOOK PAG GE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWN RTEL.NO. COMPENSATION INSURANCE 3 AI_SE CWVI-14*/ ' WITHIN 1000 FT.OF SCHOOL? Yes No ADDRESS (This section need not be completed if the permit is for one hundred 1`p 1/q L/ /L wG/A1f Tib DISTRICT GROUP TY ST' ST.' FIRE ZONE OC SSED dollars($100)or less.) CITY ZIP 0 I certify that in the performance of the work for which this permit c,L GIT?' is issued,'I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Co7pensation Laws. ATISTICAL C IFICATION / A CONDO Date Applicant�//O�gz!/1��• �/m�• ADDRESS CLASS NO. ELL UNITS ,VI NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, I CONTRACTOR TEL.NO. p you should become subject to the Workers' r'A J ��lr � ��p� �%� SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /i J� �O FRONT comply with such provisions or this permit shall be deemedrevoked. ADDRESS LIC.NO. P L 04 5- Alm, 30W 3 SIDE LICENSED CONTRACTORS DECLARATION CI.Ty, LIC.CLASS �1 P L o I hereby affirm that I am licensed under provisions of Chapter 9 � AJle C4 I �—1 SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES I NO.OF FAMILIES Professions Code,and mylicenseis in full force and effect. NEW ❑ BK PG , V License Num5e Y••3 / 6.3 Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATI ' a W a Contractor Date sm ALTER ( z A/17 REPAIR 11 — ❑ 1 am exempt under Sec. $ - B.BP.C.for this reason DEMOL . ........ .. LDMA P/C H USE OF EXISTING BLDG. Date: URM ❑ A�. T Signatur@' APPLI ANT(PRINT) ,I TEL.NO. LDMA Perm p 1"+ • 1 s a ❑ I, as owner of theproperty, or m employees with wages as N/�/. �riDA- 2 — 3 Z 0— 3307 z] �i� their sole compensation, will do the work and the structure is ADR S ✓ not intended or offered for sale (Section 7044, Business and 1'76 MA1 A✓ lklf C4 9/74-51". FINAL DA /� Q ..ITEMS Professions Code.) 1 5 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEAHAZARDOUS MATERIAL� J ''"�'C7' g OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q i E i TOTAL ��—� m "" ❑ I, as owner Of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYr� . CE licensed contractors to construct the project.(Section 7044, YES❑ NO 11 – CHECK 128 o:0 Business and Professions Code.) MA� WILL THE INTENDED USE THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHANE __, .00 OCCUPANT REQUIRE PERMIMI T FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - � � "' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I ❑ C3hereby affirm that there is a construction lending agency for YES NO the performance of the work for which this permit is issued(Sec. j jp�i-0 3/30/910 3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE ANGELES PERMITTING CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES i � a y6 COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING 9*8 i 1 w Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address OWNER onAGENT o I certify that I have read this application and state that the above P.C.FEE PERMIT FEE information is correct. I agree to comply with all county ordinances and State laws relating to building construction,and 115,5 0 a. hereby authorize representatives of this County to enter up ISSUANCE FEE the ab ention d property for inspection purpose . 13,00 n � O INVESTIGATION FEE TOTAL FEE ` sgrmtuI an or t !/ SEE REVERSE FOR EXPLANATORY LANGUAGE. WORKERS' COMPENSATION DECLARATION insureboraafirm certif cane of Workers' Compensation I have a certificate of Insuran e, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES . BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ` ❑ Certified copy is filed with the county building inspec- BUILDING ��Cf�� AS ��— tion department. ADDRESS-60/,? LOCALITY - L Date Applicant CITY ZIP CROSS ST. NEAREST �//� � CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK I PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE [SP P hundred dollars ($100)or less.) TRACT BLOCK LOT NO. TEL. CIAL S= I certify that in the performance of the work for which this OWNER � NO. JNDITIONS 0- permit is issued, I shall not employ any person in any manner A/^ 1,o0V1 - ,/L- DIST R T GROUP TYPE FIRE PROC SSED BY 0 ,so as to become subject to the Workers'Compe tion Laws. ADDRESS CONST.GZO ` ' N L /1 Date '_Applicant _ CITY ZIP A� STATISTICAL, LASS CATION ON O. Y NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS UJ Exemption, you should become' subject to the Workers' D Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be SEWER MAP Z deemed revoked. N BK PG VALIDATION CONTRACTOR NO. S- LICENSED CONTRACTORS DECLARATION IIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 2 V / NO. V UATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS �o , SQ. T. NO.OF z NO. OF C ECK License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK i� NEW ❑ $ ❑ I am exempt under Sec. ' S gDDR E] FINAL ® B.BP.C. for this reason DATE REPAIR ❑ USE OF Date: EXISTING BLDG. B c DEMOL//❑ N APPLICANTvw-411 A, PR NTL o7G �3 N . Y Signature �— OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License sZ ^ /Gr7 t✓ Law for the following reason (Section 7031.5, Business and ADDRESS iy z Fy , Professions Code): PRESENT ❑ BUILDING. 1, 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 :' 0.6 4,6'A 7044, Business and Professions Code). MOVING TEL. ❑ CONTRACTOR NO. f' c o o:o o I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS 2 0 71.7 5 tion 7044, Business and Professions Code). . , REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 0 17 1.7 5 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. Poo. 0 (1 2,0—8 4 (Sec: 3097, Civ. C.). SIDE ,o P.L. Q Lender's Name Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application'and state that the Issuance Fee G above information is correct. I agree to comply with.all County Investigation Fee g ordinances and State laws relating to building construction, % r u and hereby authorize representatives of this County to enter Total Fee up n the above- .Rntioned property for inspection purposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Sign Lure of pplicant or Agent Date APPLICATION FOR BUILDING PERMIT ] COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDY RE --.,) 1 47 1 hereby affirm that I have a certificate of consent to self insure, ,/►�,', or a certificate of Workers' Compensation Insurance,or a certified JLJ 1 IL.t�vl copy thereof (Sec.3800,Lab.C.) CITq ZIP LOCALITY Policy No. Company SIZE OF LOT NO,OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished. y S� NEAREST CROSS STf 67 ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. '—' 1 15P 1�u SE ZONE MAP N Pp ASSESSj1FypA�VOK PAAISE ` PARCEL J H Date Applicant �� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NER _ TEL NO. �( COMPENSATION INSURANCE M WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred AD KESS DISTRICT GROUP TYPE ONST. FIRE ZONE PROCESSED.BY dollars ($100)or less.) CdW-• Zip ' I certify that in the performance of the work for which this permit `O is issued, I shall not emplo any person in any manner so as to �, / EC INEER O become-Sub theWor r o p/nsation Laws. �.�.. STATISTICAL CLASSIFICATION APT CONDO Date Applicaq p CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, afte mak i his Certifica -te of 6r14REQUIRED TOTAL SETBACK FROM EXIST _ Exemption, you should become ect t0 the Workers' TRAC OR > TEL _ • SET BACK YARD HWY PRQP,LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /W L IX FRONT - " comply with.such provisions or this permit shall be deemed revoked. A)p C,S _ -.NO. /y �/ P L / S� � �►��J .L/66 7 rl SIDE LICENSED CONTRACTORS DECLARATIONSQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES v L LASS P L • c��7-i I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and / _ .�:_';•�. Professions Code,an e se is in full force and effect. NEW ❑ BK 112 PG TOT , r.i ,• License Nu r Lic.Class S IPI NOF WORK ADD ❑ VALUATION , =' = _— - 00 Contractor Date ALTER P #- '== El REPAIR ❑ "( O I am exempt under Sec. ` $ V BAP.C. for this reason DEMOL ❑ LDMA P/C# 0 Date: USE OF EX-17TING BL es" 0- _ i Signature fr _ Z APPLICANT(PRINT) TEL NO. LDMA Perm# w"�I_j•`• •I. His :p=•_�'t ❑ I, as owner of the property, or my employees with wages as OZ f"1':'.• their sole compensation, will do the work and the structure is ADDRESS '_.. E ~ `.'3• •j s ; not intended or offered for sale (Section 7044, Business and FINAL DATE Q -- Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ( 7�i_M` OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '^ " ' L7 I, as owner of the property, am exclusively contracting with Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, YES No FINAL BY / l > #*=Ts'_ -�-•.� y gi Y 0 El and Professions Code.) �F WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING t.I i_f 1 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH -• -'••• CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)'SEE PERMITTING CHECKLIST FOR �}r. GUIDELINES. i,; 2 T1_ _ •I3"i I hereby affirm that there is a construction lending agency for YES❑ NO❑ N the performanceof the work for which this permit is issued(Sec. . m (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE; TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS U"JU LN- .—•-+.-'`t' Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. _ CL Lender's Address I'�Y' r O OWNER OR AGENT o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE �r m,�j PERMIT FEE !' N with all county ordinances and State laws relating to building 40. 7 construction, and hereby authorize representatives of this County ISSUANCE FEE 0 er o th above-mentio�nedproperty for inspecti purybses. INVESTIGATION FEE TOTAL FEE / O of A2I ..j SEE REVERSE FOR EXPLANATORY LANGUAGE