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Home My Public Portal About5803 1/2 ENCINITA AVE_Building__ qW APPUCATIONF' OR BUILUNG PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDInIO�ppq 2 I hereby affirm that I have certificate of consent to self insure, BUIL�pLG,gpp.RE�S cinita Avenue Or a certificate of Workers'Compensation 1n uranee or a Certified copy thereof (Sec.3800.Lab. C.) Gol en $ogle CITYTemple-CityZIP 917$0 Locnur Policy No. - CInsurance CO. yyyy ompany SIZE OF LOT NO,OF BLDGS.NOW ON LOT -- L'JCertified Copy is hereby furnished. NEAREST CROSS ST. \ ❑ Certified copy is filed with the c n bull din ins TRACT BLACK LOT NO. department. 5387 01/-039 USE ZONE MAP ND Date 5/11/S Applicant ASSESSOR MAP BOOK - PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKER OWNE Hung Chow 1g_—ryp 74-0050WITHIN 1000 FT.OF SCHOOL? YES NO COMPENSATION INSURANCE . (This section need not be completed if the permit is for one hundred ADCR 94 Larkfield DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars 1$100)or less.) CITY ZIP I certify that h the performance of the work for which this permit Arcadia 91006 p bissued, I shall not employ any person at any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date ApplicantADDRESS CLASS NO, Z� DWELL UNITS NOTICE TO APPLII If, after making this Certificate of REOUI REDTOTAL SETBACK FROM E%IST Exemption, you should become Subject to the Workers Q9NIRgCTO TEL NO SET BACK YARD HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith K011an`� Awning & Sande CO 818-284-2074 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIG NO. PL 205 So. Mission-Dr. 495869 SIDE LICENSED CONTRACTORS DECLARATION hereby affirm that I am licensed underprovisions of Chapter 9 c an-Gabriel LTC6lvi P L 11.. 00SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code, and m license is in full force and effect NEW ❑ BK PG d 49569 C-61 OES IPTIONOFWORK VALUATION License Number Lic.Class `�'anvas Awning ADD ❑ 0 Contractor Hol an��ate Exp. 7 94 g ALTER ❑ $ D V ❑ am exempt under Seca REPAIR ❑ $ 0 BARD.for this reason F�c yyG G DEMOL ❑ CDMA we x' - W Date: USE OF Kest b"ala1 URM ❑ CL Signature APPUCQIN(T(Pj 1% TEL NO LDMA Perm ❑ I, as owner of the HO an Wnin & Sande CO I' i property, or my employees with wages as g Z H:GT.. their sole compensation, will do the work and the structure is ADDRESS O �3 7 ^66.711 not intended Or offered for sale (Section 7044, Business and FINAL DATE 1 .6 Professions Code.) - — �� (� ° 1 ITEMS WILL THE MRICONT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ORA MIXTURE CONTAINING A HAZABOUS MATERIAL EQUAL TI OR GREATER THAN THE _ _ ❑ I, as owner of the property, am exclusively contracting with - Q . AMOUNTS BPECI,F�IFLn ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYE J I t - 0 licensed.contractors to construct the protect (Section 7044, YES❑ NO Ll" _ ' -_ � 1 ,I�L Business and Professions Code.) _ I-'G CHECK V 70 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING \ •f OCCUPANT REOUIRf A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION'LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT tSGAOMDI SEE PERMIFTING CHECKUST FOR CHANGE .011 GUIDELINES. I hereby affirm that there is a construction lending agency for YES C1 NO m the performance Of 1r1e WOfk f0(WI11C11 this permit IS ISBOBd(SBC: (HAVE READ THE HAZARDOUS MATE RIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING - (� 'j 5/13/9J N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. I�I II�IJ-1JL)�11 �1/ 13/9J TITLE 2.CHAPTER 2.20 SECTORS 2.20.100 THROUGH 220.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Genf r 1 AM 17 o Lender's Address ti'I 0 QVnr.W IGEN _ b 1 certify that I have read this application and state under penalty PC,FEE PERMIT FEE of perjury That the above information is correct.I agree to comply N with all unty ordinances and State laws relating to building mconstr on. and hereby a prize representatives of this County ISSUANCE FEE �� < to on t o oned prop y for inspection rpo s. INVESTIGATION FEE TOTAL FEE / 70 L r'e '1.. Howard .)I. S 1/93 SEE REVERSE FOR EXPLANATORY LANGUAGE/O WORKERS' COMPENSATIONDECLARATION III�� a /� y� r�p FOR: I hereby affirm that I have ra certificate of consent to self n P ter U �` p �O N I}®.I_p- B U R M N� PER � lT insure; or a certificate,of Workers"Compensation Insurance, 9'G tl SM/rY 0 Il V 0 UO �f�u (f ' . or a certified copy thereof (Sec. 3800, Lab. C.�)\l y- _ - . COUNTY OF LOS ANGELES,• - BUILDING AND SAFETY ' Policy No. '77 -I!�pony/f>'G�/SG✓ '6rA L y - + - •BUILDING Q /' ! ❑ ' Certified copy is hereby furnished. ' - , FOR APPLICANT TO FILL IN ADDRESS ,� /�/.�,./ N i— t�l ❑ Certified copy:is'filed'with the coun4-is - BUILDING �•^� tion department. . ADDRE55 CITY P Ca ZIP' LOCALITY' ,Date 9 /g sZ,Appicanf _ NO_OF BLDGS. -CERTIFICATE OF'EXEMPTION fR M SIZE OF'LOT - NOW ON LoiNEgRESTCROSS ST. COMPENSATION INSURAN _ g5SE550R (This.section need not be completed-if thTRACT BLOCK - LOT NO. MAP BOOK- - PAGE PARCEL hundred dollars ($100) or less.)' TEL. • OWNER p NO. ' USE ZONE MAP NO I certify that in the performance.of the work for which this yA / SPECIAL permit is issued, Ishall not employ any person in any manner ADDRESS 4A:9-,e ,O -AjC /\ `P CONDITIONS d so as to become subject to the Workers' Compensation 0 CITY DI •• _ 'SIP �O Date Applicant ARCHITEC OR - 14. '" TEL. ..DISTRICT GROUP 1TVPE - Oe FIRE PROCESSED BY NOTICE TO APPLICANT: If,, after making this Certificate of - PNGINEER. _. `. ` NO; t CONST. ZONE P- Exemption, you should become subject to the ,Workers' _ - - y fJ tV Compensation.provisions of the Labor Code, you must forth- '. ADDRESS 00 ti -J vim' G. with comply with such provisions.,${ this permit shall be KiPS lciqt Fo-r., TEL - STATISTICAL CIASS!12�ATION _ - - APT., CONDO. � ;Z deemed revoked. - _. CONTRACTOR .NO. —/,o 6G�' - _ LICENSED CONTRACTORS DECLARATION - ) On LC ^ CLASS NO. `c�� 1•'�EitlGELI. hereby affirm that lam licensed under provisions of Chapter9 ADDRESS)S3.2 fit `YO ET NO.,�( ,1��O - LIC. SEWER MAP- ,(cammencing with Section 7000)of Divisiom3 of the Business CIN 1 a 1 GLA$$ Gt_/ C and Professions Code,and my license is.in full force and effect. - , BK PG VALIDATION , 'e SO'FT: NO. OF .- NO OF CHECK License Number T� `i J Llc, Class(. SIZE STORIES FAMILIES. .. ONE,v st h VALUATION DESCRIPTION Contractor �Cr 'Dae �a-ZL DESCRIPTION OF WORK (. NEW Date ADD' $ ... .. O D Elam exempt under Sec. ' _,D ALTER ❑ B.BP.C. for this reason - F..'. .. . /•..1 S._ 1. •A�c3` REPAIR ❑ Date: , USE OF - EXISTING BLDG 1 DEMOL ❑ ' _ Si naNre APPLICANT - TE . / - Signature—OWNER-BUILDER DECLARATION - (PRINT) � L.L`'X1 a6)rJ , VY6-./y/y FINAL _ `� - I hereby affirm that I-am exempt from the Contractor'sLicense - - -. T _. .t DATE. r, y_7 ,s -Law for the following reason (Section,7031 5, Business and 'ADDRESS 2"r R<14.�>q 'FINAL Professions Code): PRESENT - _ _ B ❑ I, as owner of the property, or m em to ees with BUILDING i_r ;r T P P Y+ Y' P Y ADDRESS _ wages as their sole coni ensat ion,.will do the work and thstructure is not intended or offered for'sole(Section LOCALITY 7044, Business and Professions'Code.) •. MOVING ,. TEL. .- -- - f,rf_4_, ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project-(Sec- ADDRESS - -- . l.!".{ii`(U� °1-I 1 ' tion 7044, Business and Professions Code.) - ' REQUIRED .. TOTAL SETBACK FROM EXIST.'CONSTRUCTION LENDING AGENCY .SET BACK YARD' HWV PROP LINEWIDTH ' hereby affirm that there is a construction lending agency.for FRONT _ t!t� :! l� -I�1_1J1 11Y .? = i the performance of the work.for which.this permit is-issued P.L. - "'-" __ _ (Sec. 3097, Civ. C.). 'SIDE_ r- ^ "f?I; - PL. - 4 - S .f - Lender's Name LDMA Ref..X. . .. : $ Permit Fee `vJ t � Lender'sP C Fee _Address � .. v a certify that I have rea this application grid state that the - /� Issuance Fee �S 7. d LDMA PI D1 - 8 above information is car, ct. I agree to comply with all County ; investigation Fee. . ` '`/ R ordinance -nd Hs relating to building construction, - Total Fee CO 7 LDMA Perm. H a and here autresen lives of this County to-enterup n abovd pr erty for inspection purposes. Z SEE REVERSE FOR EXPLANATORY LANGUAGEP 6e r nature of.A ant Agent Date - - - fa 1 1 ' ,WORKERS' COMPENSATION DECLARATION dl`hereby affirm that I have a certificate of consent to self //u�\ O D (/,a//O�� M FOR D � 1p' p�1 M1/`�m p insure, or a certificate of Workers' Compensation Insurance, '•. /�PP,UC�/a��O.N�I. FOR BV�LSDD NG PEUUOC/ T `4r a certified copy thereof (Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ FOR APPLICANT TO FILL IN BUILDING Certified copy is hereby Furnished. ADDRESS ❑ Certified copy is filed with the county building inspec- ADDRESS V IL I I fi I �f UILDING tion department. .fes CITY' _r{'}') _i I ••ZIP - LOCALITY ' Date Applicant _ NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 17 0 } S, NOW ON LOT NEAREST 2' CROSS ST. IAJ2� yl COMPENSATION INSURANCE ASSESSOR _ (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or,less.) OWNER Cr1Ci 1 tae NL. / C) USE ZONE MAP 1 certify that in the performance of the work for which this �/� / 1 NO permit is issued;I shall not employ any person in any manner ADDRESSSPECIAL ZA v f I - -` CONDITIONS so as to become subject to the Workers' Compensation Laws. 0 CITY Aviradta ZIP00'6 Dote Applicant - : ARCHITECT OR . 1 TEL Of NOTICE TO APPLICANT: If, after makingthis Certificate of •- ENGINEER V N D NO 7 Z -DISTRICT GROUP TVPE FIRE P OCESSED BY CONST. ZONE O Exemption, you should become .subject to the Workers' ,./ r Compensation provisions of the Labor Code, you must forth- ADDRESS 7-Aq Cf- L4Y rC (.1r �'• !i� - ,� v 3 �La'-/��L/G a with comply with such provisions or this permit shall be TEL. STATISTICAL.CLASSIFICATION APT. CONDO. to deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS,DECLARATION C/ �`LI CLASS NO.�DwELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS '/ GGv L� (commencing with Section 7000)of Division 3 of the Business �e t LIC. SEWER MAP - . and Professions Code,and my license,is in full force and effect. V t CITU CLASS BK PG VALIDATION $Q. FT. . NO. OF —/ NO. OF CHECK - License Number Lic. Class SIZE STORIES `• FAMILIES ONE - !'^ - q - VALUATION Contractor - Dofe ��L DESCRIPTION OF WORK C NEW �J //`` /' J(1 ADDS El $ O D Elam exempt under Sec '7f N L-.0r1Q - ._ ALTER 0 B.BP.C.,for this reason _ REPAIR ❑ $ - USE OF Date: EXISTING BLDG x `' _ `DEMOL ❑ Signature APPLICANT 'rte ` TEL'- _ FINAL OWNER-BUILDER DECLARATION (PRINT) HD{!�� • C A � JNO. J�ZV FINALDATE, - I hereby affirm that g r exempt from the Contractor's License ADDRESS Z CLT✓ � f` d re- L'( FINAL - f Law for he rollowing reason (Section 7031.5, Business and Profe ons Code): 1 - PRESENT - - - -' - 8y r•rr s BUILDING - Ii'_•+t ' as owner of the property, or my employees with ADDRESS 1L «r ' wages astheir sole compensation,will do the work and LOCALITY 1��''p�,/ 9 r�,t }k€ , Business is not intended or offered)for sale(Section D /� ,�1 } i t��_ 04 structure Business and Professions Code. n MOVING- TEL. VV^r y I' ICONTRACTOR NO. , as owner of the property, am exclusively contracting qI with licensed contractors to construct the project (Sec- ADDRESS -TOTAL tion 7044, Business and Professions Code.) •• ;` •�;j`�i;`'s sE• '! REQUIRED TOTAL SET LACK FROM' EXIST. DOQCONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINEI WIDTH I \ •� = it tC�Ui?r� :•IjI} I hereby affirm that there is o construction lending agency for FRONT Ur- the _ ' _ ..i� the performance of the work.for which this permit is issued P.L_ (Sec. 3097, Civ. C . SIDE- Lender's Name 'Ill P.L - - \ �� r'��07i1(!f!•-iii hj;, - F./5 j/ fug 9 GII.NJynDr, dill Ccs ,` fill .I l'- n-, v P.C. Fee$ a/ // Permit Fee N S .�� LDMA Ref. N ._',1Jt. t f1f l.0 Lender's Address p ! - I certify that I have read this application and state that the 1 lbo Issuance Fee LDMA P/C N D 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State lows relating to building construction, Total Fee mal rf 3 LDMA Perm. N a and hereby authorize representatives of this County to enter . - m upon a abov - entione pre erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of p' licant or Agent Date '