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Home My Public Portal About5710 ENCINITA AVE_Building__ 94; 76636A CEAA3033-e6 APPLICATION FOR UILDINePERNI IT]- LJ COUNTY OF LOS ANGELES BWLOING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JE NKINS.SUP'T OF EI CROSS ST. DIST RIfLJ G UP. YPE P CE 7 N70,13YFOR APPLICANT TO FILL IN CONST. STATISTICAL CLASSIFICATION SEWER MAP BUILDING /0 C ' T ' �1 Apo RE'S CLASS NO.��DWELL UNITS /J LOT NO. BLOCK USE ZONE MAP NO TRACTy SPECIAL - N0. OF BLDG S. CONDITIONS SIZE OF LOT NOW ON LOT USE OFF -;-.//` ` AiDa �!/ Sa OL p O. SETS CK FROM \ G TEL. iRONT.PROP. LINEE OF � � � (9T RE Ei) OWNER .J •GL NO. TYPE OF EXISTING SETBACK HIGHWAY. +" YARD TOTAL ADDRESS QTA HIGHWAY WIDTH RROM C.L. (o - + CITY _rplo� BLDG. SETBACK FROM, _ ARCHITECT OR TEL '-TG SIDE PROP. LINE OF (STREET) ENGINEER N,/OJ, pp TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL gc ADDRESS O p 47o; /(i HIGHWAY WIDTH FROM C.I. TEL. + CONTRACTOR. ADDRESS {/ ('f NO E,� - CORNER CUTOFF YES ❑ NO y C CITr cLcAis 2161z99 SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK NEW X ADD ALTER REPAIR DEMOLISH SOZ .FT. Q NO. OF NO. OF SIZE 3 STORIES FAMILIES USE OF STRUCTURE 5 L Z SIGNATURE OF APPLICANT L•"-1 - VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE UNDATION, LOCATION FEE$ FEE$ 1� o FOFORMS, MATERIALS FRAME, FIRE STOPS,' 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT, AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILOING CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT, TION OF THE LABOR CODE F THE STATE OF CAL( RNIA RELAT. ING TO WORK M EHSCOMPE ATIO IN URANCE. - LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RE CT AND POSTED ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL ST URAL ENGINEER ' PLAN CHECK VALIDATION K.: N.D. CASH _ , PERMIT VALIDATION DH. M.D D.sH LAC0 8 1 6.2- APR 21 2 1 � 4.6 3- LL�8 1 6 3G hrR21 1 D 1 8.50- 1910258 SB All✓If' IL- 0C/i TON Ir OR BUOL MNO PEWIN r u COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION - FOR APPLICANT TO FILL IN BUILDIN DRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure, 5710 Encinita or a certificate of Workers'Compensation Insurance,or a conified CITY ZIP copy thereof(Sm.3800,Lab.C.) Republic LOCALITY Poli No. PC997500 Company Indemnity Temple Cit 91780 Policy SIZE OF LOT NO.OF BLDGS.NOW ON LOT c� ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ® Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. ' USE ZONE MAP NO. Data 7-1-92 ApplicanlVirgin Roof CO. ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS OWNER TEL.NO. CERTIFICATE OF EXEMPTION FROM WORKERS' John Seixas WITHIN 1000 FT.OF SCHOOL? YES NO COMPENSATION INSURANCE ADDRESS (Thisseclion need not becompleted fthe permit isforone hundred 5710 Encinita DISTRICT 'GROUP TYPECONST.' FIREZONE PROCESSEDBY dollars($100)or less.) CITY .ZIP I certify that in the performance of the work for which this permit Temple City 91780 ;s Issued, I shall not employ any person in any manner Be,Be to ARCHITECT OR ENGINEER TEL NO. o` become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Dale Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST CONTRACTOR TEL NO. Exemption, you should become subject you the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Virgin Roof Co. 287-0507 LP ONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. L P.O. Box J 160650 DE LICENSED CONTRACTORS DECLARATION Cm LIC.CLASS L I hereby affirm that I am licensed under provisions of Chapter 9 Temple City C39 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO.OF STORES NO.OF FAMILIES C Professions Code,and my license i9 in full/OrCO and affect. 6 NEW O BK PG D U License Number Lie.Class 160650 C39 DESCRIPTION OF WORK ADD ❑ VALUATION W IS Virgin Roof gets 6-30-93 Tear off existingthen apply ALTER ❑ $ 2441.00 z Contractor _ 1128, 1111 and ca sheet. REPAIR El❑ I am exempt under Sec. $ EAR.C.for this reason 6 S S. DEMOL ❑ LDMA P/CM Date: USE OF EXISTING BLDG. .URM ❑ Patio 1 Signature APPLICANT(PRINT) TEL NO. LDMA Perm M ❑ I, as owner of the property. or my employees with wages as Virgin Roof Co. 287-0507 O Acci.s their sole compensationwill do the work and the structure is ADDRESS - f _ - ,not intended or offered for sale (Section 7044, Business and P.O. Box J San Gabriel CA 91778 FINAL DATE Q 73117 ,�1_,!Il APPL Professions Code. o MLLTHENTORFUTUREBUILDINGO URWTHANDLEAH RDOUS"TERIAl. OA A MIXTURE CONTAINING A HAZARDOUS WI EQUAL TO OR GREATER THAN Q 1 1�Ce iJ ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS1MTEAlAl51NFORAUTION GUIDE? FINAL y t licensed contrectors to construct the project.(Section 7044, EB❑ NO `-" T1t3 iL 32 - 00 Business and Professions Code.) THE HECK - WILL THE INTENDED USE MI THE BUILDING BY THE RMODIAPPLICANTMODIFICATION FUTURE BUILDING `-•ITEI��'. _i,I(� OCCUPANT QUALITYREQUIREMANAGEMENTFOR T D STRICT SC OMD)SEED OWMIOM THESOUTH r JJ _ CONSTRUCTION LENDING AGENCY FOR AIR QUALITY MAIUGEMEM OIST111CT(BOAOMO)BEE PERMITTING CMECNLIBT �A� ,I ,(( I �{j}(.�1]j: ,IJI] FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No I I theperformance Of the Wolk for Which this permit IS Issued(Sec. I HAVE READ THE HAZARDOU0VA 'A.-Y.EN.FU1RR-.A.'-- TGUIDE AND THE SGAOMD q 3097,CIV.C.). PERMITTING CHECKLIST..UNDUNDER THE LOS ANGELES OUQfI—Q�IIJ1 �j1/ �I(iCOUMTYCOOF,TITLEP,CHAPTEa1IMTHR000NZ 11�eCONCERNINGLender's Name HAZARDO SMATERIA T NI`il M O THEBCAOMD. Lendefs Address I aAmw o' I certify that I have read this application and state that the above R information is correct. I agree t0 comply with Bill county P.C.FEE PERMIT FEE FZ ordinances and State laws relating to building construction,and $69.00 hereby authorize representatives of this County to enter upon ISSUANCE FEE t a above-men ed property f ins pectlon purposes. 13.00 m 9-4-91 INVESTIGATION FEE TOTAL FEE a. 82.00 SEE REVERSE FOR EXPLANATORY LANGUAGE• - Job 4880271 SB WORKERS'COMPENSATION DECLARATION I hereby affirm tcertificate consent to self insure, ora certificate of Workers' Compensation Insurance, (/rpkq P P L�C.0.8-01" .0.p- "�ON p O? R [BUOLDO G PERMT , or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY 'Policy No. W0007146 Company Beaver Insurance . Certified copy is hereby furnished. FOR APPLICANT TO FILL IN gDIDRE55 v Certified copy is filed with the county building inspec- BUILDING L tion department. ADDRESS 5710 Encinitas Date 7-1-88 Applicant Virgin Roof Co. CITY Temple City ZIP 91780 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This'section need not be completed if the permit is for one ASSESSOR hundred dollars (§100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZO MAP I certify that in the performance of the work for which this OWNER Mr. John Seixas NO. NO. permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL I CONDITIONS so as to become subject to the Workers'Compensation Lows. U Data Applicant CITY ZIP 91780 NOTICE TO APPLICANT: If, offer makingthis Certificate of ARCHITECT OR TEL, DISTRICT OUP TYPE FIRE PROCESSED BY O . / U Exemption, you should become subject to� the Workers ENGINEER NO. CONSTZS9NE Compensation e- provisions of the Labor Code, you must forth- ADDRESS O LLI a, with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT: CONDY. deemed revoked. CONTRACTOR Vir in' Roof CO. NO, 287-0507 Z LICENSED CONTRACTORS DECLARATION LIC. - CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Box J NO. 160650 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY San Gabriel CLASS C39 BK PG VALIDATION SO. FT. NO.OF • NO. OF CHECK License Number 160650 Lic.Class C39 SIZE STORIES Qne FAMILIES ONE 15VALUATION Contractor UlYgln ROOF GO. pate 6-30-$9 - DESCRIPTION OF WORK ,NEW ❑ ADD 0 $ 694.00 D I am exempt under Sec. nnn1v r.Inqq "A" Fjhprglaqq ALTER B.BP.C. for this reason REPAIR $ e: -Dat - USE OF DEMOL EXISTING BLDG. Garage El Signature APPLIPCANT TEL. FINAL OWNER-BUILDER DECLARATION RINT NO. 287-0507 DATE//—/ �- I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS P.O. Box J, Sen Gabriel . 91778 FINA 61 Professions Code): PRESENT 0.1 .7 3 A BUILDING I, as owner of the property, or my employees with ADDRESS # e • e e e�1 wages as their sole compensation,will do the work and D 3 the structure is not intended or offered for sale(Section LOCALITY 0 0 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 - e o • 3 3 0 0 U tion 7044, Business and Professions Cade). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPB LINE WIDTH 0 Z.1 3'-88 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 P.L. Lender's Name LDMA Ref. R m Lender's Address P.C. Fee E Permit tea D certify that have read.this application and state that the Issuance Fee LDMA P/C If above information is correct. I agree to comply with all County Investigation Fee _ ordinances and State laws relating to building construction, Total Fee 33.00 LDMA Perm. R and hereby authorize representatives of this County to enter upon the abovve-mentioned property for inspection purposes. t Yj t by J flM( A 1 5-24-88 SEE REVERSE FOR EXPLANATORY LANGUAGE noture of Applicant or Agent Dote -