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Home My Public Portal About5521 ENCINITA AVE_Building__ 76A636A CE#803 2-63 APPLICATION FOR BUILDING PERMIT , +, COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTR CT NO GROUP TYPE P C SSED BY FOR APPLICANT TO FILL IN coNsr " BUILDING STATISTICAL CLASSIFIFTION SEWER MAP ADDRESSG' .�f� CLASS NO _��DWELL UNITS BK ' PIr LOT NO �1" - ,E? (/ (ih BLOCK WATER NOT REQUIREDRECEIVED El 11 vNjTRACT _ MAP HIGHWAY NO OF LOGS NO (CIRCL STATE MAJO SECOND CA SIZE OF LOT,jdX NOW ON�LOT USE ZONE SPECIAL USE OF ,CONDIT S EXISTING BLDG • '� � OWNER G NE) BUILDING1ST SETBACK ARD WY STREET NAM WIDTH ADDRESS FRONT , / ARCHITECT OR TEL P L L ENGINEER NO SIDE P L CL ADDRESS O TEL V CONTRACTO ! VI ADDRESS_5__ DESCRIPTION OF WORK 0- NEW ADD ALTER REPAIR DEMOLISH SQ FT NO OF _ NO OF -- - SIZE 8 STORIES FAMILIES USE OF . STRUCTURE SIGNATURE OF APPLICANT VALUATION $ APPROVALS DATE ( SPECTORGNATURE P CPMT a.E'J FOUNDATION LOCATION FEE S FEE 5 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT ° -TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN 5 COMPE SATION SURANCE LATH EXT SIGNATURE OF HOUSE NUMBER COR PERMITTEE RECT AND POSTED ADDRESS e IJ FINAL JOH PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION TRCK T RM O ENGINEER V.{moo 7 3 7 9 Aft 7 1 n 1 5.0 0— r Y-' APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRE�S I hereby affirm that I have a certificate of consent to self Insure BUILDING ADDRESS or a certificate of Workers Compensation Insurance or a certified 5521 ENCINITA ST. copy thereof (Sec 3800,Lab C) CITY TEMPLE CITY ZIP 91780 Loc ITY Policy No 1046140 Company STATE FUND SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy Is hereby furnished I NEAREST CROSS ST Certified copy is filed with the county building Inspection TRACT BLOCK LOT NO department USE ZONE MAP NO Date 11-1-94 Applicant RANDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER GARCIA 2J3N 726-1597 YES NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS 360 BLUFFDALE DR. DISTRICT GROUP CONST RE ZONE PROCESSED BY dollars ($100) or less) I certify that In the performance of the work for which this permit CIMONTEREY PARK ZIP 91754 Is Issued I Shall not employ any person In any manner SO as to ARCHITECT OR ENGINEER 'TEL NO •J become subject to the Workers Compensation Laws STATISTICAL CLA SIFI�ATION APT CONDO Date Applicant ADDRESS CLASS NO / DWELL UNITS NOTICE TO APPLICANT if, after making this Certificate lot REQUIRED TOTAL SETBACK FROM EXIST Exemption you Should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L 529 E. VALLEY BLVD. 451937 SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 C-3 SEWER MAP d (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES BK Professions Code,and my license Is In full force and effect NEW ❑ VA PG , Q E] VA License Number 451937 Llc Class C-39• DESCRIPTION OF WORK ADD VALUATION V Contractor RANDOL ROOFINgate, , 1-31-96 REROOF HOUSE & GARAGE WITH ALTER ❑ $ 4,000-00 20—YEAR CLASS "A" FIBERGLAS REPAIR jj�C El $ I am exempt under Sec V B&PC for this reason SHINGLES. DEMOL ❑ LDMA P/C# W CL Date USE OF EXISTING BLDG URM ❑ N Ryn Signature APPLICANT(PRINT) TL N LDMA Perm# ? ❑ I, as owner of the property, or my employees with wages as RANDOL ROOFING Y8'9-4040 z r,. T aF their sole compensation, will do the work and the structure Is ADDRESS O a not Intended or offered for sale (Section 7044, Business and VALLEY BLVD. SAN GABRIEL FINAL DATE Q _ o Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J I ITE7?: ❑ I, as owner Of the property, am exclusive) contractor with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL B J —a a' licensed contractors to construct the project (Section 7044, I I_I 1 A g3 m 40 Business and Professions Code) VES E3 No 1:1 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING C l L 07.4-0 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDEUNES - yi1 1 { t�t N G - I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING _ 3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS 2 Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD o Lenders AddressONr 4 Yc NER OR AGENT O oI certify that I have read this application and state under penalty O of perjury that the above Information is correct I agree to comply PC FEE PERMIT FEE N with all count ordin nces and State laws relating to building 111'OO < coBn structio autho a representatives of t is C unty ISSUANCE FEE co to u n endo perty for In I r 26.40 m < INVESTIGATION FEE TOTAL FEE co r ,gnnmra Aa �« i ate SEE REVERSE FOR EXPLANATORY LANGUAGE