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HomeMy Public PortalAbout5420 ENCINITA AVE_Building__ aAPPLICATION FOR Il '`eta ;rUILDING PERMIT FOR APPLICANT TO FILL IN - AooRRESS BUILDING ^ ADDRESS 5 /�0 V LOCALITY e J CITYL ZIP �j TT NEAREST j 17q V CROSS ST. �� L O.OF BLDGS. ASSESSOR SIZE OF LOT ©' U NOW ON LOT MAP BOOK C11 PAGE PARCEL d� DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT J 97 1 BLOCK rLOT NO. .S Q� j� CONST ZZLLE- TELOWNER I L— � V7 L NO. - ®O STATISTICAL CLASSIFICATION SEWER MAP ADDRESS (} /'EC CLASS NO. DWELL.UNITS BK PG CITY L V L,` C ZIP D USE ZONE MAP ARCH( ECT OR TEL. NO. ENGINEER NO. ii SPECIAL 1 CONDITIONS ADDRESS RO D DEPARTMENT APPROVAL REQUIRED,.-'. YES ❑ NO ❑ TEL. CONTRACTOR NO. BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO. TOTAL SETBACK FROM TYPE OF I EXISTING LIC. HIGHWAY + YARD - FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS CONSTRUCTION LENDER NAME AND BRANCH W , BLDG.SETBACK FROM 0V ADDRES ® � TY C SIDE PROP.LINE OF (STREET) O SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING U SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH +. = DESCRIPTION OF WORK' NEW ElZ - ADD CORNERCUTOFF YES ❑ NO ❑ ALTER ® IN OPEN SPACE YES. ❑ NO ❑ USE REPAIR r_1EX STOING BLDG. �(.�` h �-- DEMOL ElIN COASTAL PERMIT ZONE YES ❑ NO ❑ APPLICANT TEL p PRINT) tfA R g i L NO. 0 �d BY(SIGNATURE) HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STJE „•../ � THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINAN AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S C ` PENSATION INSURANCE. �+� .V P• SIGNATURE OF FINAL BY PERMITTEE DATE ADDRESS 1 CITY —"— N�2� -mayP C.Fee$ Permit FeeIssuance FeeVALUATION � � Total Fee PLAN CHECK VAL16ATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH 8 8.3 r:APR 13' 1 U 4 3.0 0 Aid ©S 76A638B CE#803B 8/77 Vth ' COMPENSATION DECLARATION affirm ure!y off'or a certificate of Workers, Comtpensation e of eInsuran nt to se, APPLICATION FOR BUILDING PERMIT or a KPrtified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nb. Company BUILDING ❑ Certified copy is hereby furnished. "FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING Y m tion department. ADDRESS sv CITY ..� L ZIP LOCALITY Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT o NOW F LOT CROSS ST. Q /vv�✓ COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) �r� TEL. USE ZONE MAP 7 ' OWNER ©f(/�11%t (3ipf NO. NO. I certify that in the.performance.of the work for which this P 1 pSPECIAL >_ ermit is issued, I shall not employ any person in any manner ADDRESS G yV/ ✓G p\�l CONDITIONS a- so as to become subject,to the Workers Compensation Laws. O '�'% CITY ZIP / U X Date zd Applicant ARCHITECTOR TEL. TYPE 0 /• NOTICE TO APPLICANT: If, afte making this Certificate .of ENGINEER "-Jr NO DISTRICT GROUP CONS ZONE PROCESSED BY O Exemption, you should become subject to the Workers' / y �\ w Compensation provisions of the Labor Code, you must forth- ADDRESS /•0 (/v / v O� a with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. �`'� � Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.L- / DWELL. UNITS 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS (commencing with'Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG J VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE.4:1_31? STORIES FAMILIES ONE . 23 VALUATION DESCRIPTION OF WORK NEW ❑ ACCT. Contractor Date S f' ADD ® '- 3307 443.70 ❑1 am exempt under Sec. T I ALTER ❑ :1 y��i1,7 B.&P.C. for this reason G r REPAIR © S r - OlY yTI��' Date: - USE OF /��,,,� -• ,, � . ; L. t O I AL 443 - 70 EXISTING BLDG.(rl�r6l EMOL ❑ b: F APPLICANT �— TEL FINAL' ; ;` �' r i 443.70 Signature ��jj_` p� /) OWNER-BUILDER DECLARATION (PRINT) /Go NO."�V"--75� DATE 1/ Gt-!tR't [I[I I hereby affirm that I am exempt from the Contractor's License f� ° Law for the following reason(Section 7031.5, Business and ADDRESSFIN I' Professions Code): PRESENT 6/15. /089{ BUILDING 0000-MOI 4�2 I V I, as owner of the property, or my employees with ADDRESS _, wages as their sole compensation,will do the work and 3996- 1 AM 9:46 the structure is not intended or offered for sale(Section LOCALITY' ' 7044, Business and Professions Code.) MOVING TEL. ❑ CONTRACTOR NO. 1, as owner of the-property, am exclusively contracting with licensed contractors to.construct.the project (Sec- ADDRESS tion 7044, Business and Professions Code.) I, 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 .. '^I W P.L. Lender's Name. P.C..Fee LDMA Lender's Address o I certify that I have read this application and state that the 33 Issuance Fee Q.–� LD/L4 P%t#) V above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee 7.06) LDJJ Perm a and hereby authorize representatives of this County to enter upon ;Wthe -mentio ed propert for inspection purposes. p QOt� �/rs� SEE REVERSE FOR EXPLANATORY LANGUAGE '�� (~�J • ��r Signature at Applicant or Agent Date M ( •;. ;.. _ ;