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HomeMy Public PortalAbout5218 ENCINITA AVE_Building__ 7GAGSBA CE#6086-88 APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. i DISTRICT NO. GROUPITYPE .O-EBBED BY FOR APPLICANT TO FILL IN _ i CONST. BUILDING "'"' S WER MAP - STATISTICAL CLASSIFICATION ADDRESS � � BK PG '� ( CLASS.NO.—I DWELL. UNITS— I" LOT NO. o BLOCK MAP STATE YES O u NUMBER S HWY.. TRACT / 7 USE ZONE SPECIAL NO OF SLOGS. ,,��11 A—/ CONDITIONS SIZE OF LOT �C i X / CO® I NOW ON LOT V USE OF _EXISTING BLDG. �I `�f J� / BUILDING YARD HWY STREET NAME EXIST. OWNER J►`J ,yr �/'r �? /`c-1y /RIO ( /l/�/GL's SETBACMAILK WIDTH ADDRESS / 26.) L...3l c�"t_�!I /P:f � P.L. SIDE 'L (_�•J�. TEL. P.L. CITY NO. INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. 1� ' 1 SOS T ADDRESS4 CONTRACTOR /LU�{�S < C„ TEL./ ADDRESS`�lri/ � �f���i�'��.�,� //lL7oJ/r �!� \."'•L _ ��_ �E�G �� DESCRIPTION OF WORK d NEW ADD ALTER REPAIR DEMOLISH SQ.FT. f NO.OF NO.OF SIZE /� STORIES FAMILIES USE OF ST UTURA SIGNATURE OF ,//� APPROVALS APPLICANT � � DATE INSPECTOR'S S.GNATURE ADDRESS '��^.r e J i>' FOUNDATION: LOCATION FORMS,MATERIALS 1.�1 �J $ dy P.C. $ - FRAME: FIRE STOPS. - !� FEE BRACING, BOLTS VALUATION $ FURNACE: LOCATION. o FEE GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND y AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH,EXT. STATE ,LAWS REGULATING BUILDING .CONSTRUCTION: SIGNATURE O �Q //,)� HOUSE NUMBER COR- SIGNATURE �' ��ti RECT AND POSTED ADDRESS �y FINAL CLYDE N.DIRLAM, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION K. M.O. CASH PERMIT VALIDATION j M.O. CASH A.AGo 6 8 0 0 u NOV 18 2 3 A 1 9.5 0 A UCO 6 9 4 1t-r) NOV 2 4 1 A 3 9.G 0 a; 76A.638AeC`2' 91303 3-69 ' + APPLICATION FOR BUILD RIXIT F o . COUNTY"6LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS oC (J BUILDING AND SAFETY DIVISION LOCALITY , JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN °I> c�NO G�uP' TYPE PR C Y (PRINT OR TYPE ONLY) �/ L BUILDING STATISTICAL CLASSIFICATION SEW R MAP ADDRESS 2�� gAlC /�f CLASS N0. DWELL.UNITS BK PG LOT N0. BLOCK It USE ZONE MAP "7� O / C. NO. C:12, WT TRACT SPECIAL N0. OF BLDGS. COND TIONS SIZE OF LOT I� NO W ON LOTUSE OF Q�(G EXISTING BLDG. I[,� ��%l� BLDG. SETBACK FROM TEL.�� - �y. FRONT PROP. LINE OF (STREET) OWNER - 1L �j• 10. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS L'i( �n 6 j-5tV e,i Nt rA. HIGHWAY WIDTH FROM C.L. CITY OF C L1 ARCHITECT OR TEL. BLDG.SETBACK FROM (STREET) ENGINEER NO. SIDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL TEL ADDRESS HIGHWAY WDTH FROM C.L. + "p . �y _ } CONTRACTOR jL rL�A�� N0. �3-•S'�3S(� d ADDRESS rj - /�L LI 26_C. CORNER CUTOFF YES ❑ NO ❑ 0 ` CITY (. �nJ100, �' L�F, CLASS I SEER VERS f SIDE FOR S CIAL APPROVALS 0 01-1 CONSTRUCTION LENDER } NAME AND BRANCH (,I.ucLL D f /J V ✓ �� ADDRESS�J /4Nd7 �Ojf.410AA PO Q 22-6 z_ SQ. FT. NO. OF N0. 0 ❑ SIZE I C2 STORIES FAMILIES NEW ^ USE OFADD STRUCTUREi pEA.+G_ iL ALTER ❑ O REPAIR ❑ SIGNATURE OF DEMOL ❑ APPLICANT 1 00 ' VALUATION $ O00 f APPROVALS rPATE E, 7� INSPECTOR�S�GN�q`�T Uy P.C. PIVIT TIN: LOCATION FEE $ _ FEE $ ( FO FORMS,MATERIIALS .7iif1�'R'� ✓_P i+" `` FRAME: FIRE STOPS, `P r IHEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, _ WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING To,WORKMEN'S COM- PENSATION INSURANCEA r LATH, EXT. SIGNATURE OF - ^� / / HOUSE NUMBER CORRECT PERMITTEE 1 / -� AND POSTED ��(6 ADDRES ©� FINAL C=P ' `� JOHN F. LEWIS, PRINCIPAL STRUCSURAL ENGINEER !PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION . M.0. CASH t, {�^ 4 ti 7 7i AF 1li k D 1 ( 2 5 g Y1 �I 76A638A CE *803 4/70 APPLICATION FOR BUILDIN PERMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST 67 Print ort a onl CROSS ST. BUILDING DISTRICT NO. G4LLUP TYPE ./ F2 ESSED BY ADDRESS CONS STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO, I . OWELL.UNITS BK PG TRACT USE ZONE MAP NO.OF BLDGS. NO. (cj SIZE OF LOT NOON LOT / SPECIAL USE OF _ CONDITIONS EXISTING BLDG, TEL. OWNER NO.; BLDG.SETBACK FROM ADDRESSFRONT PROP.LINE OF (STREET) TYPE OF E TING SETBACK HIGHWAY } YARD = TOTAL CITY HIGHWAY WI FROM C.L. ARCHITECT OR TEL. t = ENGINEER NO. BLDG,SETBACK FROM ADDRESS SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } = TOTAL CONTRACTOR HIGHWAY WIDTH FROM C.L. L C..')- a ADDRESS N O. / C..')LIC. CITY CLASS CORNER CUTOFF YES ❑ NO ❑ O CONSTRUrTION LENDER H- NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS w a N ADDRESS Z SQ. FT, �j NO. OF NO. OF NEW ❑ y /� SIZE V STORIES FAMILIES USE ADD STRUOCT�URE /��/�J/f��/�G� /`-vO ALTER ❑ REPAIR❑ SIGNATURE APPLICANT .' DEMOL ❑ VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION FEE S FEES FORMS, MATERIALS FRAME: FIRE STOPS, I 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY'I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF T E LATH, INT. LABOR CODE OF THES TE OF AL IFORNIA RELATIN O WORKMEN:S.•COMPENSAT ON INSUR CE. LATH, EXT, 'SIGNATURE HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER( PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M./ CASH 74-_ C WORKERS' COMPENSATION DECLARATION p I hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicyNo.230770 Company Statt- CoMp BUILD NG_ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 5218 Encinita Ave ® Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 5218 Encinita Ave, LOCALITY Temple City NEAREST Dare 1 n/R/A0 Applicant 41 CITY Tem ))le tity ZIP CROSS ST. Broadway CERTIFICATE OF EXEMPTION FROM WORKERS" NO. OF BLDGS. . ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 1 MAP BOOK PAGE PARCEL (This section need not'be completed if the permit is for one USE ZONE MAP / hundred dollars ($100)or less.) TRACT BLOCK LOT NO. 41001 NO. Q >_TEL. SPECIALI certify that in the performance of the work for which this OWNER Branson NO. 287-33 CONDITIONS 0 permit is issued, shall not employ any person in any manner DI RICT GROUP TYPE FIRE PR ES$ED BY U CONST. ZONE ADDRESS 5218 E19ncinita so as to become subject to the Wor s'Compensation Laws. / 0 /Q -i CITY Tem 1 C ' ZIP t 7 V I.- NOTICE J Applicant STATISTICAL CLASSIFICATION APT. CONDO. V NOTICE TO APPLICANT: If, afte making this . rtif' e of _ ARCHITECT OR TEL. ' LU Exemption, you should become .subject to a Workers' ENGINEER NO. CLASS NO. —2/ UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. dG/` �—eemed revoked. CONTRALTO NO. _ BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION $68 Truck Way LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS y No. 248852 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 Montebello CLASS C-.39 $ 2040,00 SO. FT. I NO. OF NO. OF CHECK License Number 24$$52 Lic.Class C-39 SIZE ISTORIES FAMILIES ONE Contractor Montebello Rfte 108 80 DESCRIPTION OF WORK Reroof existingNEW ❑ ❑ ❑ I am exempt from the licensing requirements as I am a bldg. -•C built u ADD licensed architect or a registered professional engineer ALTER ❑ FINAL ,r acting in my professional capacity (Section 7051, roof REPAIR DATE G� .Z�"�� Business and Professions Code). USE OF EXISTING BLDG. dwelling DEMOL ❑ FINAL c.I` Lic.or Reg.No. _Date APPLICANT TEL, By OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License - /• (JE�J Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING I, as ownef 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 2 2 63.9A 7044, Business and Professions Code). MOVING TEL. ElCONTRACTOR NO. I, as owner of the property, am exclusively contracting CO # 0 0 0.0 0 with licensed contractors to construct the project.(Sec- ADDRESS tion 7044, Business and Professions Code). 2 o o Ll.3, 0 0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY ' SET BACK YARD HWY PROP. LINE WIDTH i O o I hereby affirm that there is a construction lending agency for FRONT 70 10i}U( the performance of the work for which this permit is issued P.1. 2� Q (Sec. 3097, Civ, C.). SIDE P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee 36,00 w I certify that I have read this application and state that thessuance Fee 7®00 aabove information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating-to building construction, Total Fee 43.00 E and here y outha ize representatives of this County to enter a upon th bove.- ntion d property for inspection purposes. a $0 SEE REVERSE FOR EXPLANATORY LANGUAGE i lure of Applicant or A nt Date ©s