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HomeMy Public PortalAbout5340 ENCINITA AVE_Building__ Ir 7B�SSA OBS-3 12-54 APPLICATION FOR` BUILDING PERMIT g y DIVISION OF BUILDING AND SAFETY BUILDING ADDRESS Deportment of County Engineer County of Los Angeles- LOCALITY WM J FOX, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUPT OF BUILDING CROSS 1001, ST Zve DISTRICT NO GR UPI SEWER MAP FOR APPLICANT,TO FILL IN TYPE BK PG NG BUILD] �y/ ,,,, CONST ADDRESS / MAP O I - STATE, YES NO NUMBER / HWY LOT NO BLOCK USE ZO�IE SPECIAL �� CONDITIONS TRACT- Al SIZE OF LOT ('�o NO OF S �A I NOW ON LOTC/ BUILDINGEXIST USE OF SETBACK YARD HWY STREET NAME WIDTH EXISTING BLDG FRONT OWNER YJ • SIDEMAIL ADDRESS �/ �� �� / J�/O�if� /- ��1"7L P L _ - A TEL DWELL I UNIT 5 INDUSTRIAL CITY ,4 � fby� NO L&33( 2 DUPLEX UNIT— 6 PUBLIC BLDG ARCHITECT OR TEL ENGINEER NO 3 APT UNITS 7 ADDN ,ALT, ETC ADDRESS 4 COMMERCIAL 8 -MISCEL TEL CONTRACTOR e_64./ n� NO INSPECTION RECORD ADDRESS DESCRIPTION OF WORK NEW -ADD ALTER REPAIR DEMOLISH _ SO FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE p _ SIGNATURE OF �I APPROVALS APPLICANT AP ADDRESS U DATE INSPECTOR S SIGNATURE FOUNDATION LOCATION +U (� 9 $ Q"�a Q,Q P C. $ FORMS MATERIALS �✓� V.-N� IL, a/f FEE /Tr` FRAME FIRE STOPS, J 1 - 5 BRACING, BOLTS VALUATION i FEE FURNACE LOCATION, GAS VENT, DUCTS 1 HEREBY AC�JNIK THAT 1 HAVE READ THIS A APPLICATION ANpF T THE ABOVE IS CORRECT ��+t AND AGREE TO COWITH ALL COUNTY ORDINANCES LATH, INT c' AND STATE LAWULATINGBUIL�ca TION LATH. EXT hL u SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS �mzFINAL WM. J. FOX. CouHTY Er+cal arm VALIDATION 31 -1 6 4.0 0 •,� ? 2 5 -.4-� APR 12 1 3 2.0 0 �+ DEe U;1Y n DEPUTY 00, BY BY ® DEPUTY DEPUTY VYORKERS' COMPENSATION DECLARATION I nh6 eby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insGre, or a certificate of Workers' Compensation Insurance, 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 ADDRESS tion department. Date Applicant CITY q.� ZIP LOCALITY r. v OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT OW ON LOT CROSS ST. COMPENSATION INSURANCEASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE I PARCEL hundred dollars ($100) or less.) RX TEL' USE ZONE MAP OWNEty NO. NO 7 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any mannerADDRESS U� �/h - SPECIAL CONDITIONS d so as to become subject to the Workers' Compensation Laws. O CITY ZIP ) U Dat Applican ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE ZPROCESSED BY 0 NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO. CONST. SONE U Exemption, you should become subject to the Workers'Compensation provisions of the Labor Code, you must forth- ADDRESS �� � with comply with such provisions or this permit shall be /�' f TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR Oetee 7LL'�� NO. — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL.ADDRESS NO. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 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/z/ PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE ❑ VALUATION Contractor Date DESCRIPTION OF WORK NEW $ _� �r-v"-t� c�D ► I C/�C El am exempt under Sec. ADD ALTER B.&P.C. for this reason �� V��`� REPAIR ❑ $ Date: USE OP DEMOL EXISTING BLDG. Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. 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 Prpfgssions Code): PRESENT BY ,=q property, employees t I, as owner of the ro ertY or my em to ees with ADDRESS BUILDING n 1 F7�•4• �•s wages as their sole compensation,will do the work and , ^���, the structure is not intended or offered for sale(Section LOCALITY , tt +��0. Sri.$t 7044, Business and Professions Code.) MOVING TEL 1 •f rt t;^ ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1 ICI VE with licensed contractors to construct the project (Sec- ADDRESS TOTAL 1-+=-2 tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. �•A: CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CHANGE the performance of the work for which this permit is issued F.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Nami / LDMA Ref. # P C. Fee S Permit Fee 135fiyM :,arte Lender's Addres# L - 0 1 certify that I have read this application and state that the Issuance Fee C-,�?�T LDMA P/C# , 0 8 above information is correct. I agree to comply with all County Investigation Fee / J! 0 ordinances and State laws relating to building construction, Total Fee r LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property r inspection purposes. r' ��-� SEE REVERSE FOR EXPLANATORY LANGUAGE Signat of Applicant or Agent Date WORKS_ 7N DECLARATION "`* hereby a certificate that f1W7 .rrtificate of consent to self APPLICATION FOR BUILDING PERMIT � insuret'or a certificate of Workers' Compensation Insurance, or a Eertified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY PolicNG y No. Company / ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADIDRLD IESS 7� (� �7.1� `•�L� ❑ Certified copy is filed with the county building inspec- ADDRESS C? —�yt1 ` i tion department. E -Yvl > - Date Applicant CITY A-t "> ZIP G7 -7S(^.) LOCALITY O. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 6C1 yl2 NOW ON LOT CROSS ST. j COMPENSATION INSURANCE ASSESSOR }}�� f (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. �— MAP BOOK PAGE( r PARCEL hundred dollars ($100) or less.) _ TEL. USE ZONE MAP OWNER V--Vt 5 / NO. NO. I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS , V / CONDITIONS so as to become subject to the Workers' Compensation Laws. y O CITY t+,.� L ZIP C, U Date Applicant ARCHITECT OR TEL. 0 PP DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO, CONST. ZFE Exemption, you should become subject to the Workers' / -� w Compensation provisions of the Labor Code, you must forth- ADDRESS 4� . � D __1 ' a with comply with such provisions or this permit shall be 1 TEL, STATISTICAL CLASSIFICATION APT, I CONDO. N deemed revoked. CONTRACTOR �1 NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS ADDRESS NO. I hereby affirm that I am licensed under provisions of Chapter 9 LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. CITY CLASS BK. ''0 PG. -_/,J/ VALIDATION SQ. FT/7,y NO. OF NO, OF CHECK License Number Lic. Class SIZE / / STORIES FAMILIES ONE - VALUATION DESCRIPTION OF WORK 1! J NEW ❑ Contractor Date � � ADD I am exempt under Sec. ALTER ❑ B.&P.C. for this reason r REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ APPLICANT L. r Signature (PRINT "t � NO. �)— v' 1� FINAL r OWNER-BUILDER DECLARATION _( DATE ! - L I hereby affirm that I am exempt from the Contractor's License :•ti•i :g Law for the followingreason Section 7031.5, Business and ADDRESS l' C' / FINAL �ILIt tl . Prbfsssions Code): PRESENT BY i EP' I, as owner of theproperty, or m em to employees with BUILDING 3 �` Y P Y ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , / r I � 402 - 54 ❑ 7044, Business and Professions Code.) MOVING TEL. 1 _ I, as owner of the property, am exclusively contracting CONTRACTOR NO. L'`3'H H J# with licensed contractors to construct the project (Sec- rADDR int •: _3_ tion 7044, Business and Professions Code.) � �� TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued {iCi(J !—),Isli'1(Sec. 3097, Civ. C.). 't Lender's Name jLDMA Ref. #Permit Fee a`... Lender's Address o 1 c6rtify that I have read this application and state that the Issuance Fee LDMA P/C# ► 8 above information is correct. I agree to comply with all County Investigation Fee yy ordinances and State laws relating to building construction, Total Fee Zy moi. LDMA Perm. # Q and hereby authorize representatives of this County to enter Q upon the above-mentioned property fo inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Applicant or Agent Date WORKERS' COMPENSATION DECLARATION F hereoy a certificate that I have a certificate of consent to self APPLICATION -FOR BUILDING P E RM I T ^ ins�i're, pr a certificate of Workers' Compensation Insurance, .,or a certified`copy thereof (Sec 3800; Lab C ) r - COUNTY OF LOS ANGELES BUILDING AND SAFETY ` Policy r4o _--company BUILDING ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS - } El Certified copy is filed with^the county building rnspec- BUILDING ' tion department ADDRESS11� �,• �l� ° � - 1 CITY err _ el ZX ZIP �� ; LOCALITY Date Applicant _ NO OF BLD05 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ", SIZE OF'L& NOW ON LOT ' COMPENSATION INSURANCE _ S_SESSORS I (This'section need not be completed if the permit is for one TRACT BLOCK LOT NO P BOO P PAGE r PARCEL hundred,dollars ($100) or less ) TEL �y S , - ' OWNER NO _w _ US OP `•oG� . I certify that in the•performance of.The work for y, - - SPECIAL 141 permit is issued, I shall not employany person in any manner w " ADDRESS gj� �i f Q CONDITIONS Y d so as to become sublect to the Workers' Compensation Laws _ Sr O CITY ° ZIP ©� 3 s U Date - Applicant ARCHI CT+OR. EL ,t ENGINEER s �, 'DISTRICT- GROUP TYPE � FIREza t NOTICEJO APPLICANT If, after making this Certificate of -- • NO CONST ZONE Exemption,,you♦should become subject to the Workers' s r U Compensation provisions of the,Labor Code, you must forth- ADDRESS _ r `J, ✓ 3 d with comply with such provisions or this,permit shall be r TEL STATISTICAL CLASSIFICATION APT CONDO _ N deemed revoked CONTRACTOR r, = Z LIC CLASS NO DWELL UNITS " LICENSED CONTRACTORS DECLARATION � - 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 PrqfessionsCocle,and my license is in full force and effect CITY CLASSBK VALIDATION SQ FT NO OF NO OF CHECK License Number Lic Class FIG SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ Contractor -` Date a ADD ❑ ❑I am exempt under Sec VV 4 ❑ ALTER B&P C for-this reason REPAIR $ Date USE OF EXISTING BLDG IDEMOL ❑ i ' Signature APPLICANT TEL FINAL - - OWNER'BUILDER DECLARATION (PRINT) NO ` DATE, I hereby affirm than am exempt from the Contractor's License - -Law for the following reason (Section 7031 5; Busme`ss and ADDRESS FINAL 1 Professions Code) PRESENT B " Y"^,� _` c a ❑ I, as owner of the `property, or my employees°wrfh ADDRESS wages as their sole compensation,will do the work and ~ ' `', 4 n- the structure is not intended or offered for sale(Section LOCALITY , / 3M7 7044, Business and Professions Code ) MOVING TEL- - - / � �Mt: 4 c 3 CONTRACTOR NO 1 ���-1t- ❑ 1, as owner of the property, am exclusively contracting - /� t with licensed contractors to construct the project (Sec- ADDRESS r TOTAL 98� 6 tion 7044, Business and Professions Code ) REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD 'HWl PROP LINE WIDTHt I hereby affirm that there'is a construction lending agency for FRONT ' �`HtaE Ii! the performance of the'work for which this permit is issued P L (Sec 3097, Civ C ) SIDE PL Lender's Name r I� 11-001 g! 1;`a,: - - +- LDMA Ref #-. ' p P C Fee$ Permit Fee �?i�v 1 IM 8:1-, Lender's Address i I certify that I have-read this application and state v that the Issuance Fee 6` LDMA P/C#, ► 8 above information is correct I agree to comply with all County Investigation Fee yy �' R ordinances and State los relating to building construction, Total Fee j LDMA Perm i < and hereby authorize representatives of this County to enter upon the above-mentioned property, 'inspection'purposes / SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturepplicant or Agent Date