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HomeMy Public PortalAbout5470 ENCINITA AVE_Building__ Q5 76A638A w 'CE#803jAdV.6/781 'A - d APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING g'� �) may-- ADDRESS (� BUILDING ADDRESS '/�o E,v G /l/ / LOCALITY // NEAREST CITY i�hF_ �� ZIP CROSS ST. Cc L L NO.OF BLDGS. AS SIZE OF LOT / X ��S NOW ON LOT MAP BOOK PAGE- PARCEL E W.11 13-FF-5 DISTRICT GROUP TYPE FIRE CE SE BY TRACT/3c.914 / -JVD BLOCK LOT NO.33 yS CONN./ TEL. ZS E t., tet, �X V OWNER OP-4- S. KE SCS/ O. 6V's' Q _ STATISTICAL CLASSIFICATION WEER MAP`_ ADDRESS y �Nc N / CLASS NO _DWELL.UNITS CITY M M, 1+F— C J ZIP ARCHITECT OR _ TEL. VALUATION $ J U ENGINEER F_ �M)9 7�,0J�/, NO. �3:2 Z� ADDRESS L /d r G D1 . BLDG.SETBACK FROM '11 TEL FRONT PROP.LINE OF (STREET) CONTRACTOR ) /V C��a✓T- NO.�sZ. 3�$ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS L, G Np 7+3$"5 2 FRONT PROP.LINE HIGHWAY WIDTH LIC. + CITY ( r 12RRK _ CLASS I — BLDG:SETBACK FROM CONSTRUCTION LENDER SIDE PROP.LINE OF (STREET) NAME AND BRANCH HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING � = 6 ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH � SO.FT., NO.OF NO.OF r^ CHECK + _ SIZE ©� STORIES OILS FAMILIES VA)1=. ONE /ys °G' DESCRIPTION OF WORK / 00NEW ❑ P.C. Fee$ Permit Fee / r � M� ADD ❑ Issuance Fee g A(907-10A) ALTER O REPAIR ❑ Total Fee USE OF �\ DEMOL ❑ EXISTING BLDG. WSJ /(ICG ZO APPLICANT /Yc,' ` TEL pyo✓vy��Y7>�1 �w/✓—� (PRINT) DrI� G/v/V NO. ,Q :23;2 - /rT Y4 P O��2 S BY(SIGNATURE) Q IHEREBY ACKNOWLEDGE THAT I E READ THIS APPLICATI AND STATE Y THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF �2 n L n THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z G G 6 U 2 A PENSATION INSURANCE. g d # 0 0 0 0 0SIGNATUR1 PERMITTEEEO 2'0 1 0&0 0 ADDRESS d CITY s?`10kJ7= J�iK NO. 523 X32 _0 0208-79 F P .O O 'CIALNDITIONS��� BY C�= �' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ..,J. .- BUILDING AND SAFETY, BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS " Y '1 or a certificate of Workers' Compensation Insurance,or a certified ,6 0 I .C. u copy thereof(Sec.3800,Lab.C.) QIP ZIP 1 �6 17 S-�,Ap -)-LAUD l • LOCALITY Policy No. Company SIZE OF LOT C�t NO.OF BLDGS.NOW ON LOT R❑II,�Certified copy is hereby furnished. tj J�l.�T, z— NEAREST CROSS T. - z, ertified copy is filed With the county b ing i spection TRAC BLOCK LOT NO. depart en , USE ZONE MAP NO. �fy«� ASSESSORP BOfJks- PAGE„O PARCEL, ­ Date Applicant O� OC/GV �. ✓.�! �� _.r SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WO KERS' OWNERy TEL NO � COMPENSATION INSURANCE 9 JC" _ Z P6 /Y 31 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS S-9 :20 W, I k)r� Ao, ._ DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($700)or less.) �J I certify that in the performance of the work for which this permit CIT 1-7fi13 ��� r T/ is issued, I shall not employ any person in any manner so as to V become subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. -IG11 STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.-1-4 DWELL UNITS NOTICE TO APPLICANT.- If, after making this Certificate of* REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' ' CONT ACTOR /� TEL NO. / SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith � v4F �T CooSi LTO d S CPS-q 6/ FRONT comply with such provisions or this permit shall be deemed revoked. I ADDRESS LIC.NO. —PL LICENSED CONTRACTORS DECLARATION Z I C i (7 S SIDE C LIC.�SS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO. F FAMILIES a Professions Code,and my license is in full force and effect. NEW K PG v El B License Number / Lic.Class DESCRIPTION OF WORKADD ❑ VALUATION , Contractor A. agZt, Date 9 409 ek4_ ALTER El $ Id,zo� v W REPAIR [I C17 ❑ N I am exempt under Sec. $ Z B.BP.C. for this re a n DEMO ❑ LDMA P/C# _ te: \ USE OF EXISTIt� 'T?, LD . URM ❑ Signature _ s _ APPLICANT(PRINT TEL NO. LDMA Perm# ❑ I,as owner of the property, or my em oyees with wages as \ z their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and 11-2T✓e FINAL DATE Q L Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, Business and Professions Code. YES❑ NO[ '/ - WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ii)` _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR i A I I 2S-4 s 4�5 GUIDEhereby affirm that there is a construction lending agency for YES❑ No 'f:` C4 the performance of the work for which this permit is issued(Sec. 'L='K 5 - I HAVE RE D THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ - 3097,CIV.C.) CHECKLI .I UNDERSTA MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, ti(`� j TITLE 2, APTER 2 S C ONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS -• •' Lender's Na a MATE REP NG A FOS OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Ad ess OWNER OR AGENT • I certify tha I have read this application and state under penaltyt=('I-f0 )=E 11=•� of perjury t at the above inform on is correct.I agree to comply PC.FEE PERMIT PERMIT FEE �! 4 5 5 a with all c unty ordi ces State laws relating to building i.: _ AM '-• < construc n, and re y rize Ppresentatives of this County ISSUANCE FEE ` Q co toe r pont ab e- tinned property for inspection purpose m INVESTIGATION FEE TOTAL FEE tum,ol Applicant m Age SEE REVERSE FOR EXPLANATORY LANGUAGE '.ti• .WORKERS', COMPENSATION DECLARATION I heretJls that I have certificate of consent to self in as.a certificate of Workers' Compensation Insurance, . APPLICATION F R„�S._ , U I L D I N G PERMIT ortified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Ncr, Company' Z'o.�� BUILDING 21 Certified copy is hereby furnished. 59 C FOR APPLICANT TO FILL IN ADDRESS El Certified copy is filed with the ounty building inspec- ADDRESS J ( v tF/VG/N7 tion department. , /�!, /7/v CITY' �� �' ` r� ZIP LOCALITY Date Applicant4 NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKER SIZE OF LOT Z Z S ,2 NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCE y ASSESSOR { (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK.' )SAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER �r��G�-1{�r! S W���'C'L(Z�, NO. USE ZONE � MAP NO. rl IO I certify that in the performance.of the work for which this A�t SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS '3Y 70 4FNCINJ-rA axil �”' CONDITIONS 0 so as fo become subject to the Workers' Compensation Laws. �+ p, �( U CITY lZ C.j ZIP // 7G(J Date Applicant ARCHITECT OR TEL. Ix DISTRICT GROUP TYPE FIRE PROCESSED BY Q NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE U Exemption, ou should become subject to the Workers' �• Compensatio provisions of the Labor Code, you must forth- ADDRESS d" 1 N with comply with such provisions or this permit shall be Yj/ a .TEL. STATISTICAL CLASSIFICATION APT. CONDO. Z "deemed revoked. CONTRACTOR /1©E/tll �,) NO.S7`7•VS-9 — LICENSED CONTRACTORS DECLARATION �.s LIC. CLASS N DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 0/ ��• `>/ +/ NO.S7/�leq SEWER MAP (commencingwith Section 7000 of Division 3 of the Business LIC. ) CITY T`1+ C7� �� CLASS VALIDATION and Professions Code,and my license is in full force and effect. BK.J PG/P4.,5_ y I G� SQ. FT. i 6 NO. OF NO. OF CHECK License Number S/f' / /O Lic. Class SIZE STORIES FAMILIES. ONE VALUATION ^�' /✓/� l LN i DESCRIPTION OF WORK t�132A NEW ❑ Contractor Date $/D ADD \❑ pop. I am exempt under Sec. ALTER E! B.&P.C. for this re a on REPAIR ❑ $ USE OF DEMOL ❑ ate: EXISTING BLDG. /Q APPLICANT t/ �- TEL. �/r Signature FINA (PRINT) TjQU/Tj �(J�ij// NO. X5717 DATEL 2. OWNER-BUILDER DEC ATION ) I hereby affirm that I am exempt from he Contractor's License ADDRESS /�� ��ZN �r G E FINAL Law for the following reason (Section 7031.5, Business and a Professions Code): PRESENT BY BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and __`•._i F ' 'Q s`i LOCALITY the structure is not intended or offered for sale(Section Poo. MOVING TEL. 7044, Business and Professions Code.) .�'s(:.'s,�_• rRE NO. I, as owner of the property, am exclusive) contracting — J •-1--lE• with licensed contractors T construct the project (Se - Ti�t 1-'�, - tion 7044, Business and Professions Code.) . TOTAL SETBACK FROM EXIST. ='t`fit CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH CHANGE 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 LDMA Ref. # r;e rr Permit Feeff'r _ 3 Lender's Address 2 0 I certify'hat I have read this application and state that the Issuance Fee J ' a� LDMA P/C# , S above in ormation is correct. I agree to comply all County. Investigation Fee 0 ordinanc s and State laws relating to building construction, TotalFee U • v LDMA.P.erm.r#.. '��; ,{.�•," _. _ a and her y outhor'2e representatives of this County to enter upon th above- ent' ned property for inspection purposes. "�Z—q SEE REVERSE FOR EXPLANATORY LANGUAGE ignaturepplicant or Agent • Date WORKER,,,' COMPENSATION DECLARATION 'insure,ora certif caathat te of Worke s' CompensaT on Insurancself , APPLICATION FOR BUILDING PERMIT o:+a certified copy thereof (Sec. 3800, b. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.� t�ompany ❑ Certified copy is hereby,furnished. �D— /� FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the ounty building inspec- FADDRE NG `/7 SS tiondepartment. �jjDate / A licant �� JY► /� ZIP IW LOCALITY PP NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION TROM WORKERS' SIZE OF LOT �!/3 NOW ON LOT CROSS ST. 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.) 7 L. OWNER k) AE' USE ZONE MAP I certify that in the performance of the work for which this SPE permit is issued,'[shall not employ an person in an manner ADDRESS. / SPECIAL P P Y Y P Y ✓ Z U � � ��( CONDITIONS � so as to become subject to the Workers' Compensation Laws. l". �.� �} O CITY ZIP /1 7 Date Applicant ARCHITECT OR TEL. PP DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after makingthis,Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' �0� ��� L/ Compensation provisions of the Labor Code, you must forth- ADDRESS v a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR �_-� NO.�'7�-j3 Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — SEWER hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS � �� 1W N NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business ` L LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK. b PG. 1 VALIDATION SQ. FT. NO. OF NO. OF 2 S CHECK License Number -1��� Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor ,C��.v�& 8"rte ��3U. `/ DESCRIPTION OF WORK��� � NEW 1:13 Cd D �-0 f ADD Elo ❑I am exempt under Sec. ► ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. � � DEMOL ❑ Signature APPLICANTTEL. FINAL OWNER-BUILDER.DECLARATION (PRINT), �i4U/ O. jV/ N9�S DATE 1 hereby affirm that I am exempt from the Contractor's License ADDRESS s�s '7.';--- Law ' FINAL for the following reason (Section 7031.5, Business and Professions Code): PRESENT BY x BUILDING ❑ 1, as owner of the property, or my employees withADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for'sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with.licensed contractors to construct the project (Sec- ADDRESS ;hltz z tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. YARD HWY CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT ,; I'� the performance of the work for which this permit is issued P.L. �tf NILS= (Sec. 3097, Civ. C.). SIDE > P.L. Lender's Name. _ 4-: LDMA Ref. # Vit ,'1 P.C. Fee$ Permit Fee .,.., „ Lender's Address 193 a , - AI (= o I certify that I have read this application and state that the Issuance Fee 1 J LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee r ordinanc s and State laws relating to building construction, Totol Fee �` � LDMA Perm. # a and here y authorize representatives of this County to enter upon the above- t' ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signetfure of Appl' ant or Agent Date