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HomeMy Public PortalAbout5746 ENCINITA AVE_Building__ 76AG38A13139-3 APPLICATION FOR BUILDING PERMIT 11-ee DMSION OF BUIIDING AND SAFETY BUILDING Deportment of County Engineer t County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN. SUPT OF BUILDING CROSS ST. �YIPJ FOR APPLICANT TO FILL IN TYPE BK PG DISTRICT No. GROUP EWER MAP CONS BUIR"S 6 �/U/ ,41C�N�Z MAP STATE YES NO. ADDRESS 7,/ L `tt // NUMBER HWY ' LOT NO. / / Sp SQ I W B CK USE ONE SPECCONDITINL ONS ONS TRACT /yf 5© ' ` / / NOW ON OFN LOTSLOGS I BUILDING EXIST. SIZE OF LOT YARD HWY STREET NAME USE OF / ,,////ff SETBACK , WIDTH EXISTING BLDG. HDMG 4/WG //�/✓L�• FRONT P.L. OWNER Ml� d-Mt-S GL7'U-Iy�.,oT� SIDE P MAIL / P. L. ADDRESS O TRACT DWELL.. I UNIT .fesrJ �/e C.. l T /EL. 0 "`J y J6 t DWELL 1UNIT 6 INDUSTRIAL , CITY /� � NO.�ELI+ / 2 DUPLEX 2 UNITS 6 PUBLIC BLDG. ARCHITECT OR T . ^^ 7 ADDN.,ALT.. ETC. - ENGINEER NO. 3 APT. 0—UNITS 8 MISCEL. ADDRESS 4 COMMERCIAL TEL INSPECTION RECORD CONTRACTO NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH I SQ. FT SIZE . O NO. OF NO. OF / y STORIES FAMILIES USE OF STRUCTURE oma!e we / i�✓b SIGNATURE OF APPLICAN APPROVALS am ADDRESS:/,�yyDATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION C/ -Y �n S + P. C. S �„ FORMS.MATERIALS / �7 ..7 /•JO-`%] FEE FRAME: FIRESTOPS. / VALUATION 5 ® BRACING. BOLTS M�_ ,[ FEEfx FURNACE: LOCATION, I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT. DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT e AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATINGIaDING CONSTRUC- TION. L LATH. EXT. SIGNATURE OF �(-. �f� HOUSE NUMBER COR- PERMITTEE RECT AND POSTED 2 7 ADDRESS FINAL ✓ I. JOHN A. LAMBIE. COUNTY ENGINEER VAMDATI H CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR jj&9 8 9 2`ISD, SEP 5 1 4.00 in IV s wfiticER3"_ o ,..i ON nt to se insurTiee, ora cerfifi�ateo WorkeK Cicae of coomtpensation elnsuran elf QO'pUC/, T0ON...FORBUOd©ONIG_ P[ I_ G 1O7 ora certified copy'thereof (Sec. 3800, Lab. C.) '" ' -- ' - - �4, a.,.,•,,. . I. r` . ct . // // COUNTY OF LOS ANGELES BUILDING,AND SAFETY- , Policy No.. Company �.J_) su 'L .. .. '-- - • Certified;copy.Whereby furnished. FOR APPLICANT TO FILL IN BUILDING -y�-/6 � _ ADDRESS / /C ' Certified copy is filed'with the county bbilding inspec- " - BUILDING S,7 I tion.department •' - % _ ADDRESS 'Applicant �il!/ � �"!' CITY ZIP LOCALITY ' CERTIFICATE OF EXEMPTION FROM WORKER NO.OF BLDGS. + - NEAREST k9• t "'COMPENSATION'..INSURANCE - A.1c ". SIZE OF LOT ,jO '�.�.-U' NOW ON LOT CROSS ST. _ (Th'is!tsection'need.ndt.be'corripleted if•the permit,is'for.one' - • /rr - "✓ ASSESSOR �•�� hu ndred,dollars ($100)or less.) U.. TRACT f4/ BLOCK LO NO. 7] MAP BOOK ' ' PAGE' PARCEL . i •... OWNER / -ISL•9.TJ NO. _ USE ZONE MOO. • . C�---�_ � r. J I certify that.in'the performance of the"workfor which-this > permit is issued,'I shall not employ'any person in any•monner _ - SPECIAL- so°as to become sublect to the Worker Com pe nsati Laws ADDRESS - - -' CONDITIONS V t� / :. CITY _ ZIP _ -- - + O Dote—'Applicant ''" ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE ESSED BY E.enNOTO'you SANT If,'become making this'the mate of ENGINEER NO. . '- CONST ZONE V Exemption;ion p should become subject to the Workers- ��J's�S//77C7 / ✓ n ly Compensation provisions`of the LaboE:Code you,must.forth- ADDRESS ✓!V t`�•(\ - - y %. with,comply.with such rprovisions or this permit shall be - _ _ - TEL (�// STATISTICAL CLASSIFICATION APT. CONDO,- _ deemed,revoked i. � . }��j 1 _ ' F .++: � CONTRACTOR NO. G .7 � _ - LICENSED CONTRACTORS DECLARATION - _ p - -.LIC. CLASS NO. DWELL'UNITS— I'hereby affirm that I am licensed under,provisions of Chapter 9 ADDRESS ���l -o, "c` NO. Zv commencing witF Section'7000)of Dr'vision 3 of the Business and LIC p SEWER MAP. =. ' Professions'Code, and my license is in full force and effec/t. CITY -�� r CLASS t: G, LBK - - - - -VALIDATION SO. FT. �- NO: OF NO. OF CHECK , �- t f� 1' SIZE S� STORIES-• FAMILIES ONE r LicenseNumber� tLic Class - ' VALUATION_ _ G � D PTION OF WORK... _ _ .CC.NEW•- .Q r _ _ Contractor 'Date G ADD $ I am exempt under Sec. i ALTER ❑ D 6,8 P.C. for this reason - REPAIR. ❑ $"` -- _ - ""'" .;Y-. USE OF -.Da/tie{.��' EXISTING BLDG. ` DEMOL ❑ ._. - - _! 'Signature Q-•��'� ��"r.•r"`�� ei. - APPLICANT.- _. _. ,.___ _ - - TEL. FINAL WN� ER-BUILER DECLARATI� PRINTF - NO.- .DAT -I.hereby affirm.that I am exempt from the Contractors License > _ ._ .- - Law for the following reason (Section 7031.5, Business and, ADDRESS - FI Y'Y'- 'Professions Code):' _ ^' " ' '—""'- '" PRESENT - - - -- - 4.�9' 'A�-.'., - BUILDING I, as owner of the-property, or my employees with :. ADDRESS _ _ .- _ _ _ _#'! • e e�e 1, wages us their sole compenscition,will do the work and 1 99,88 the structure is at intended or offered for sale(Section LOCALITY ( ' '' • •---7044,-Business and Professions Code) - -"- - MOVING -' --- TEL - '- - - I, as owner of the property, am exclusively contracting CONTRACTOR NO. _ _ _ 9 8,= - with licensed—contractors to construct the project-(Sec- -" - pDDRE55 ,r � - 9 8 U' tion 7044, Business and Professions Code). - _ Y 0 2 2 4 _ ,REQUIRED TOTAL SETBACK FROMT. 8 6.. -- ' - CONSTRUCTION LENDING AGENCY SET BACK 'YA D"' HWY. PROP. LINE WIDTH y .� I hereby affirm that there is a construction lending agency for y FRONT -- - I r ' the performance of the work for which this permit-is�issued - - P.L- -- - • - - - •�- '- '- ``-:' ' ' -'--- (Sec. 3097, Civ. C.). SIDE s .) P.L Lender's Name LDMA Ref. # _ P.C. Fee$ - -. - Permit Fee39 Lender's Address w I-certify that-I have read this.opplication.and state that the . Issuance Fee - 4J� r -.LDMA.P/C.#-- - - �; - Q above information incorrect. I agree to comply with all County Investigation Fee - / Q , • • ' _ - _ g ordinances ond,State laws relating to building construction, Total Fee.- ! - U' LDMA Perm # - -- - - - -- -and hereby authorize representatives of this County to enter m upon the ab ue-m noon prop ty or inspection purposes. Z7+ L SEE'REVERSE FOR EXPLANATORY LANGUAGE Mt 1 - r_Signature of Applicantor Agelg -- Date - - -- - '- - -� -- - - - -- _ - -- -- ---- I