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HomeMy Public PortalAbout5526 ENCINITA AVE_Building__ ©S 76A838A , CE#8031w F�/ /78) " APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN ADIDRESS SS 2 6 eAO 4161 A14P- LDING ADDRESS 5526 ENCINITA AVE. LOCALITY 1✓i't4/Jl NEAREST CIT ZIP CROSS ST . fJ NO OF BLDGS ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT G OUP T E FIRE PROCESSED BY TRACT BLOCK LOT NO NST ZO L OWNERNp 285-188 ` :-1-LERAN, ) STATISTICAL CLAS FICATION TtZ EWER AP ADDRES55526 'ENCINITA RVE. CLASS NO 3/ DWELL UNITS A BK2PG CITY TEMPLE CITY ZIP /`� ARCHITECT Of -ARREL MILES TEL VALUATION ENGINEER r� ADDRESS ioiO. ROBERTSON 1Z LA BLDG SETBACK FROM TEL FRONT PROP LINE OF (STREET) CONTRACTOR WALNUT -POOLS NO 912-154HIGHWAY + YARD = TOTALSETBACKFROM TYPEOF EXISTING ' ADDRE2d 4 5 0 GOLDEN SPRINd� 319018- FRONT PROP LINE HIGHWAY WIDTH_ LIC + CITY WALNUT CLASS BLDG SETBACK FROM CONSTRUCTION LENDER SIDE PROP LINE OF (STREET) NAME AND BRANCH- t • HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP LINE 1HIGHWAY1 WIDTH 0 SO FT NO OF NO OF CHECK + = V SIZE 386 STORIES FAMILIES ONE 0 ® 3-ZO_ Permit Fee DESCRIPTION OF WORK O NEW P C Fee$ _ _ ` ADD ❑❑ Issuance Fee { a ALTER REPAIR ❑ I Total Fee ° 2 USE OF DEMOL ❑ Z EXISTING BLDG ZO 2 ° ° 4 z 2 Q APPLICANT TEL ` (PRINT) WALUUT POOL NO 9121541 t , c 0004320= J BY ISIGNATUR ) / '`� Y tr 1 ,1 1.07-78 ('HEREBY AC NOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE uu 1 2 Q 4 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE _ WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF - V # O O O O O 1 THE LABOR CODE OF THE STA9E OF CALIFORNIA IN R ATING TO WORKMEN S COM 2 PENSATION INSURANCE 2 0-0 6 1, 00 SIGNATURE OF ° ° ° 6 l,�p� PERMITTEE ADDRESS 4 LDEN SPRINGS DR. C� ;Q 7-7 8 CITY WALNUT No 91-2-154 a 0 UJONE NOP D 8 ; _ �7 SPECIAL t' ' /26 CONDITIONS :ELU - FINAL / BY DATE ' r ORv ERS'COMPENSATION DECLARATION _ tie y.affirm ta Ir have a certificate of consent to self A P P L I CA_ TION FOR B U I LD I N'G PERMIT � tnsJb re, r a certificate of Workers' Compensation Insurance, 4 or a certified copy thereof (Sec 3800; lab C ) - - t.]t,COUNTY OF LOS ANGELES BUILDING;AND SAFETY - Policy No Company _ - . - ---' - -, 0' copy v FOR APPLICANT TO FILL IN y BUILDING+ ��� Certified co s hereby furnished ADDRESS Certified copy is filed with the county building mspec- BOIL-DING Ave i,tion,department+ ADDRESS�I• r/yc�1+4� �Cf,T/Y1r �j N p Date '7. y Applicant �' i CITY , L e-TTY ZIP // ,80 LOCALITY J CERTIFICATE OF EXEMPTION'FROM WORKERS' * SIZE OF LOT �5�'x GSA NOW NO F BLDGSR _ Mt CROSS'COMPENSATION INSURANCE a (This section need not be completed if'the permit is for one TRACT BLOCK��� - 10T-NO ASSESSOR - - -- 6 •,'< hundred dollars ($100)or-less TEL MAP BOOK PAGE PARCEL I rt, , _. OWNER 7AYANt- A. PA-r L -NO 2gq 01,go USE ZINE MAP !j- - I certify that in thetperforrtianrce of,the work for which this / l! O 2/V ). permit is issued, I shall not employ any person in any manner j SPECIAL t� d ADDRESS- C"Z-s C'v OU-C- - CONDITIONS O so as to become subject to the Workers'Compensation Laws . T j • ,.. ' •\ ,. _ CITY _ZIP Date ''t ` `ApphcanT ARCHITECT OR TEL O NOTICE`TO APPLICANT `If, after making this Certific5te of jE�/ �G A, j Z_ cid 3 DISTRICT _ _GROUP TYPE - _ Y FIRE PROCE ED BY__ Exemption',you should become subject to the 'Workers' ENGINEER NO CONST,/ ZONE ri Compensation provisions of The Labor,Code, you must forth- ADDRESS t(3�`Nk } `!' e'3 - . . � - IL with comply with such provisions or thishpermit shall be c ' TEL N deemed,revoked .., t, �_ CONTRACTOR J NO - STATISTICAL CLASSIFICATION APT CON _z LICENSED CONTRACTORS DECLARATION r _ _ LIC-_- _ CLASS NO bWELLUNITS A I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS C" NO r (commencing with Section 7000)of Division 3 of the Business and _ _ _ LIC SEWER MAP Professions Code, and my license isinfull force and eff;t CITY — CLASS T - BK' - VALIDATION' ' ' SQ I A/� NO OF �A p NO OF _� CHECK l License Number 1 ' 'Lic Class 3 SIZE �Ta TORIES PG 9 FAMILIES ONE L a n �.� VALUATION _ ,1 ..! s 6.t,- DESCRIPTION OF WORK F��A �/ ,C'�11vt - - NEW-- E] Y' CoMiactor ® r , I am exempt under Sec FYA1�i�) 08 ADDALTER B&P Cvfor this reason C2 >n G to REPAIR \ $ USE OF ❑ QC/ 1 6 3 3 A ' Date EXISTING BLDG DEMO' - __ _ APPLICANT - TEL ` C7 FINAL # a e o 0 2 3 Signature ry'r' a PRINT A►Yr A. PA Te NO OWNER-BUILDER DECLARATION _DATE s I hereby affirm that I am exempt from,the Contractor's License - 2 3'67 8 y�` Law for the following reason (Section 7031 5, Business and ADDRESS e7-5 G2 d V--`ff FIN " 'Professions Code) '^ ' ' _- PRESENT '` - - BY �/ fL BUILDING 5 2 C En C i'�1,•�G �1 ti��- ° 0 0 2 3 x 7 8 c� j, as owner of the property, or my employees with ADDRESS _ wage's`ds-their'sole compensatron,will do the work and LOCALITY I Q e C GA ' �f tr y�j r'� - 0 3 0 5—8 5 ' the structure is not intended or offered for sale(Section ' �j���� ` -7044;Business and'Professions Code)- "' -- MOVING - �_ - - - TEL - �-� -^�- t /f-'/ � - - - I ICONTRACTOR - NO , as owner of the property, am exclusively contracting � with licensed contractors To-construct the project-(Sec- rADDRE tion 7044, Business and Professions Code) � � # , b. TOTAL SETBACK _ - CONSTRUCTION LENDING AGENCY - _ YARD HWY PROP LINE WIDTH v" I hereby affirm that there is a construction lending agency for i the-performance of-the work-for which This"permit is issued(Sec 3097, Gv C )Lender's Name ��11 U/1 I IDMA.Ref # r,der's AddressZ-V Permit Fee-I certify that I have read this application and state that the t J � Issuance Fee -- f SCSLDMA P/C#a above information is correct I agree to comply with all County n Feeordinances and State laws relatingto building construction, ._, Total fee - { -LDMA Perm # ;- -� and hereby authorizerepresentatives of this County to enter upon the above-mentioned property for inspection purposes 9 S" L - SEE REVERSE FOR EXPLANATORY LANGUAGE °Signature of Applicant or Agent -- -- -Date