The URL can be used to link to this page

Home My Public Portal About5803 ENCINITA AVE_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN gp� ss I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESSl or a certificate of Workers'Compensation ns r ce,or a c tified 5803 Enc ini to Avenue copy thereof (Sec. 3800,Lab.C.) GY�'en Eagle � P le City ZIP 91780 LOCAU Insurance Co. � Policy No. Company. _ SIZE OF LOT - - NO.OF SLOGS.NOW ON LOT Certified copy is hereby furnished. ' I ^ ^ NEAREST CRO ST. El Certified copy is filed with the c n buildiampn , TRACT BLOCK LOT NO, 01 5387- 17-039 USE ZONE MAP NO. Date ' INY /93 Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKER OWNER TEL No. YES NO COMPENSATION INSURANCE Hung Chow 81 —574-0050 WITHIN 1000 FT.OF SCHOOL' ADDRESS (This section need not be completed if the permit is for one hundred 2894 Larkfield DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) CITY ZIP �o� 3 I certify that in the performance of the Work for Which this permit Arcadia 91006 is issued, I Shall not employ any person in any manner so as to ggCHITECT OR ENGINEER - TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLLAA.SSIIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS ' NOTICE TO APPLICANT. 11, after making this Certificate of REQUIRED TOTAL SETBACKFROM EXIST Exemption, you should become Subject t0 the Workers CONTRACTOR . TE NO _ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Holland Awning & Shade CO81b-284-2074 FRONT comply with such provisions or this permit shall be deemed revoked. AD RESS LIC P L \ 285 So. Mission`Dr. 495869 SIDE LICENSED CONTRACTORS DECLARATION CIv LIC oL P L I hereby affirm that I am licensed underprovisions of Chapter 9 §an.,Gabriel C- SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Coca,p d license is in full force and effect. Z; ., NEW rA BK PG \ D d License Num er 4 5 69 Lic.Class C-61 DESCRIPTION OF WORK ADD ❑ VALUATION 0 io algid—Awnin E 7 Canvas Awning Contractor gate 94 ALTER ❑ $ -0' U anucle—I.,o. [C ❑ I am exempt under Sec. REPAIR ❑ $ 0 BAP.C. for this reason x I, DEMOL ❑ LDMA P/C - Date: Ueslalent810G URM ❑ 1 CO Signature REFILL T(PRINT( TEL NO. LDMA.Pemn a - i'('- e' ? 1 a /� �H_.:d .r ❑ I, as owner of the property, or my employees with wages as HO 18n wning .. .... Z t.71t their Sole compensation, will d0 the work and the structure is ADDRESS '36 not intended Or offered for sale (Section 7044, Business and ^ FINAL DA a Q 4 Professions Code.) —�_ "{ __ i ITEMS . WILL THE APPLICANT OR FUTURE BUIIfNNG O(:(.UPAM HANDtf A HAZAflWl15 MATERWL OR A MIXTURE OONTNNING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q OL a '�� ❑ 1, as owner of the property, am exclusively Contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY ..a� Y I�d NL V O licensed contractors to construct the project (Section 7044, YES❑ No IX r :HEi:�t 86.70 Business and Professions Code.) WILL THE INTENDED USE MI THE BUIDLITR BY THE APPLICANT OR FROM T BUILDING SOUTH 'f OCCUPANT REQUIRE A PERMIT FOR LQRICT CTION OR EE PERMITTING G CH THE SOUTH -HANvE I 0 CONSTRUCTION LENDING AGENCY COAST PIP OUALRV MANAGEMENT DISTRICT ISCAOM0)SEE PEPMRTING CHECKLIST FOR -...- fTl'1�1 Gwoaurves. - I hereby affirm that there is a construction lending agency for YES E] 'Off ( �y the performance Of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING dll l[CII—�1[IU1 5/13/(^10 m 3097,Civ.C.) Sell I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. - TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 220.140 CONCERNING HAZARDOUS - / aH l I 3:16 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. (bYY p Lender's Address o wmcR oR Aceur o I certify that I have read this application and state under penalty 4 of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE $ wVaIlty ordinances and tate laws relating to building and hereby author a representatives ( this Count ISSUANCE FEEh i e property for ins ction p pos �J � INVESTIGATION FEE TOTAL FEE O vaa - Darrell L. Howard, J . 5/11/93 SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent'to self O O �/(� M FOR O fp� Fl�@lp��(/�� D �p}l��y��pL�//p�� idsure, or a certificate of Workers' Compensation Insurance, aPP�U�7�1rM V Il -OR BU�LSDD �II V G PISUOMT or a certified �d copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES - - '" `BUILDING'AND SAFETY Policy Noll Componytoed t�dLJL -- BUILDING' El Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN ADDRESS Q 91J C)iJ I T-A Certified copy is filed wit4'h nty build ins ec- B DINS 8 O3 .� t N LTJ t' P tion department. CITY rEHPLEE/T ZIP LOCALITY +. . Date .Applicant - NO. OF BLDGS. NEARESTCERTIFICATE OF EXEMPTM WORK RS' SIZE OFLOT NOW ON LOT CRO55 Si. COMPENSATIONNCE _ ASSESSOR(This sectionneed not be comphe permi is or one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) NO USE ZONE• MAP OWNER NO. 1 certify that in the performance of the work for'which this - permit is issued, I shall not employ any person in any manner• ADDRESS - ' �• SPECIAL > CONDITIONS d so as to become subject to the Workers' Compensation Laws, O CITY c-,4b . ZIP Dote—Applicant ' ARCHITECT OR TEL. NOTICE TO APPLICANT: If,.after makingthis Certificate of- ENGINEER • - NO. DISTRICT '•GROUP TYPE FIRE PROCESSED BY O CONST. ZONE V Exemption,; you- should become subject to the Workers' / / u Compensation provisions of the Labor Code, you must forth- ADDRESS. - cT Gd J 3LC14cL� n. with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFIC�AT¢I �I APTy CONDO. Z deemed'revoked. CONTRACTOR '/ LRE NO. L1.LGl�c� ti LICENSED CONTRACTORS DECLARATION UC. CLASS NO. DWELL. UNITS I hereby off irm that)am licensed under provisions of Chapter 9 - ADDRESS J 6n NO' " SEWER MAP - (commencing with Section 7000)of Division 3 of the Businessv LIC.CLA .-.7/� and Professions Code,and my license is in full force and CITY effect. _ _ BK pG VALIDATION /nG SO. FT. NO. OF NO. OF CHECK - License NumberQ`'1V/O Lic. CIasS ! SIZE I STORIES. FAMILIES ONE ADD VALUATION Contractor �•\ 1 Dote '��— S'Z DESCRIPTION OF WORK NEW ❑ V r� �� , _ . . - 11 �l D ❑I am exempt under Sec. - - ALTER _❑ B.BP.C. for this reason 1..I$ L i'4 L L_ - _ �G E REPAIR ❑ t _ Date: USE OF N EXISTING BLDG (DEMOL ❑ Signature APP(ICAN) E >)L TEL ��" -/If4 FINAL ' OWNER-BUILDER DECLARATION _ PRINT I hereby affirm that I am exempt from the Contractor's License GATE Law for the following reason (Section 7031.5, Business and ADDRESS AO i FINAL4 Professions Code): - PRESENT By "- ❑ I, as owner of the property, or my employees with BUILDING wages their sole compensation,willdotheworkand ADDRESS. T+r7Ql39 ® 38 the structure is not intended or offered for sale(Section LOCALITY D - 7044, Business and Professions Code.) MOVING 'TEL CHECK. �'�•�T' ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. �. with licensed contractors to construct the project (Sec- ADDRESS - CHANGE •100 tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. - ' CONSTRUCTION LENDING AGENCY• SET BACK YARD Hwy PROP. UNE WIDTH hereby affirm that there.is o construction lending agency for FRONT elbooh lorl1 iU/_1/Y2. the performance of the work for which this permit is issued P.L. 9:7- SIDE 3097, Civ. C.). - - SIDE 0219 . 1 fi� :7- P.L- Lender's Name ' LDMA Rel. p P.C. Fee$ Permil Fee / �O Lender's Address - + a I certify that I hove r d this application and state that the. Issuance Fee LDMA P/C p ' 8 above information is rect. I agree to comply with all County Investigation. ee - R ardinanc and $tat ws relating to building construction, Total Fee LDMA Perm. p . a a her y authoriz epre ntatives of this County to enter _ - u n e obov�e ones roperty for inspection purposes. ' _ SEE REVERSE FOR EXPLANATORY LANGUAGE naNra of ¢o t or Agent Data S WORKERS'COMPENSATION DECLARATION •. /� I�Ir�� /� I'� p FOR I�p/�� I�I�I�'/� /� G� I hereby otfirm that I have a certificate of consent to self - /pL L;�Icy p(( LAI pOIIk�IL ISOR D�U��D�IL��IMG I�EL_yrIpVAI II .'insure, or a certificate of Workers' Compensation Insurance, /rk18 ll `V- !/—kl U V Il .110 LJ II V Il IS lIY111 C/ll 11 or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. -Company - ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING f PY• Y ADDRESS 0o3 bie-in ❑ Certified copy is filed with the county.building inspec- BUDDwG •f�y1 ',t _ t tion department.. ADDRESS L//t kL t pl Ci f / L Dote Applicant CITY I 1`11C.1 !` ZIP - LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT d Q , NOW ON LOT - CROSS ST. 11�Jpr�rnQ✓( COMPENSATION INSURANCE - ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCKLOT NO. "' ' MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) {. ,p TEL_ / - - OWNER, V C t11 J`. NO. > Z- USE ZONE MAP u I certify that in the performance of the work for which thisL NO. /, permit is issued, I shall not employ any person in any manner ADDRESS ✓r , ,) �_� SPECIAL d ///CCC CONDITIONS so as to become subject to the Workers' Compensation laws. - / O ' i CITY �C ZIP 0(7 LJ U 'Dote Applicant - ARCHITECT OR TEL. /' (7� NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER Vrl Q k NO. > U'U V DISTRICT GROUP NST FIRE P OCESSED BY O Exemption, you should become subject to the Workers' ,fp' '/ ,j(O U Compensation provisions of the Labor Code, you must forth- ADDRESS -OV � ✓ ✓ ACL a with comply with,such,provisions or thispermit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. d deemerevoked. CONTRACTOR NO. - z LICENSED CONTRACTORSDECLARATION jADDRESS �liG(lR[ CLASS NO.�MAIF Ur IS I hereby affirm that I am licensed under provisions of Chapter 9 S SC� 1-c�t�O�/ (commencing with Section 7000)of Division 3 of the Business \ LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITU CLASS BK VALIDATION SQ. FT. NO. OF ,�J - FA OF i CHECK License Number. Lic. Class SIZE STORIES v FAMILIES ONE /� VALUATION-7,10 Contractor Date �N�rs DESCRIPTION OF WORK ) SI✓I NEW $ ' I ' / D ' "\ Condurn OL'Vl ADD ❑ ` D ❑ am exempt under Sec, _ ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF -- EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL r'/ - g OWNER-BUILDER DECLARATION (PRINT) C d u NO. '7. I D `,) FINAL —� I hereby affirm that I am exempt from the Contractor's License p DATE — Low for the following reason (Section 7031.5, Business and ADDRESS AY ve FINAL Professions Code): PRESENT B 1 f' It.' ❑ - BUILDING T 9oIJ7 J I, as owner of.the property, or my employees with ADDRESS r t 11 'Kf,, r t wages as their sole compensation,will do the work and - `, """' '.raJ� - 7\\ ITE 1I he structure is not intended or offered for sale Section LOCALITY n 11 �) -10 7044, Business and Professions Code: (. MOVING TEL ��y.—��/ i�oi`� V If�I>at A_t_.1at., CONTRACTOR NO. as owner of the property, am exclusively contracting ��`�aO„�,/ 'l _�Ir't'}'•( �v; l],1) with licensed contractors.to,construct the project (Sec- - ADDRESS T tion 7044, Business and Professions Code.) �'�, t r (' (fhz17F f Ifl. REQUIRED TOTAL SETBACK FROM EXIST. ' CONSTRUCTION LENDING AGENCY SET BACK YARD HWv PROP. uNE WIDTH I hereby off irm that there is a construction lending agency for FRONT the performance of theworkfor which this permit is issued P.L. (Sec. 3097, Civ. C.).a ' ' SIDE Lender's Name �).�i1 CI livl•/ P.L. _ - - t� tl !y/t�i :I.J i H 11 $ ,�/ [QST I _ 2 ,( LDMA Ref. It .. I � � I r�)YT S '(/�.1 Py I CI P.C. Fee$ Permit Fee /J e1 �.�4 Lender's Address t ' a I certify that.1 have read this application and state that heF / Issuance Fee T 7 LDMA P/C It D 8 above information is correct. I agree to comply with all County Inve_sligation Fee ordinances and State laws relating to building construction, Total Fee I/� r/d• D 1 J LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-me toned prop ty for inspection purposes. - - --L/ 2 L SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Mpiplicao or A ent Date y