Loading...
HomeMy Public PortalAbout5805 ENCINITA AVE_Building__ I M. COUNTY OF LOS ANGELES BUILDING AND SAFETY. WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL GSD R s BUILDING ADDRESS O ¢P C� hereby affirm Shat have a certificate of consent to self insure, rj80,5 Eneinita Avenue or a certificate of Workers' Compensation Insurance,or-a certified copy thereof(Sec. 3800,Lao.c.) GoiInsura�a Co. Temple City ZIP 91780 LOCALITY Ppycy NO. _ COLD SIZE OF LOT N0.OF BLDGS.NOW ON LOT 11 n Certified copy is hereby furnishetl. NEAREST CROSS o-Certified copy is filed with the c ty buildin in a on TRACT BLOCK LOT No. dep r e t. 5387- 17-039 USE ZONE. MAP NO. Date � f/93 Applicant ASSESSOR MAP BOOK ' PAGE PARCEL SPECIAL CONDITIONS ', OWNER TEL NO CERTIFICATE OF EXEMPTION FROM WORKERSYES NO COMPENSATION INSURANCE HUng Chow 81 - 574-0050 WITHIN moo FT of scrlooL? (This section need not be completed if the permit is for one hundredAD gR�E,$$$$ �({yµ Larkfield DISTRICT GROUP TYPE CONST. FIRE ZONE AESSED Ry dollars (S 100)or less.) - GITY ZIP . ' 3 I certify that h the performance opens n in any which this permit Arcadia 91006 is issued, Shall not employ any person at any manner so as t0 ARCHITECT OR ENGINEER TEL NO. become SUbl¢Ch to the Workers'Compensation Laws. ., STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS - CLASS NO, DWELL UNITS • NOTICE TO APPLICANT. If, after making this Certificate ofREQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' "CONTRACTOR TEC—NO. SETBACK YARD HWY PROP LINE WIDTH t Compensation provisions of the Labor Code, youmustforthwith Holland Awning & Shade C0818-284-4074 FRONT comply with such provisions or this permit shall be deemed revoked. AD SUC,N P L So. Mission Dr. 895869 SIDE LICENSED CONTRACTORS DECLARATION CITv LIC.CL 95�61 P L I•hereby affirm that I'am licensed underprovisions of Chapter 9 SanyGabTi el c. 50.FT SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP (commencing with Section 7000)Of Division 3Df the Business and - • Professions Code,and my license is in full force,and effect. . NEW W BK PG D d License Number' 495869 Lia E]Class C-61 DESCRIPTION OF WORK ADD VALUATION O Contractor Holland Awnin�at¢ 5/1193 Canvas Awning ALTER ❑ $ �� U Shade Co. Cc ❑ 1 am exempt under Sec.' REPAIR ❑ $ .- v 0 1 B.&P.C.G this reason - - - DEMOL ❑ .LDMA P/C W USE OF F��xISTIyyGG,,DLD - - d Date: � KeS10eA`�aL URM ❑ ....._. -......_- _ (n 'Signature APPLIC(�yT(PRI(JTping TEL NO. LDMA Perm# ' _ j - Z ❑ I, as owner of. the property, or my employees with wages as HO _an - - - -o .. Af-h1'.7 their sole compensation, WJI do the work and the structure is ADDRESS _ i7 _ FINAL DATE - ~ �'t - 4 >' riot intended ode.)offered for sale (Section 7044, Business and .x1 _ 86,jl,l Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �/�//�jENS I OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE • a 1 ' C"'"' ❑ a5 OWn¢f Of t110 property, am a%CIIeIVey contracting Wltll AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY `'A � "' licensed contractors to construct the project (Section 7044, Es❑ No l$ ___ �•'TOTAL u6 -.-7p . Business and Professions Code.) +_.HEt.l:. ON THE INTENDED USE MI THE BBY THE APPLIOICT OR FUTURE BUILDING OCCUPANT QREQUIREUALITY q PERMIT FOR CONSTRUCTION TRICT( D) ZE PERMITTING FROM THE T FOR 'JL' ''' CONSTRUCTION LENDING AGENCY COAST AIR ouqury MANAGEMENT o1sTRlcT IscgoMDl SEE PERMlrnrvc cHEcicusr FOR _ CHANGE I hereby affirm that there is a construction lending agency for YES El No E$ ry the performance ofthe Work for Which this permit is issued(See I HAVE READTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING }�(� m 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE - TITLE 2,CHAPTER 2.20 SECTIONS 220.100 THROUGH 220.140 CONCERNING HAZARDOUS '- 'J• 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMO. ... - y6�7 o Lender's Address 0 - _ avneR aR ANT o ofcerfify perjury that have above this application and state under penalty 4 Of perjury that the above infOrmafion is Correct.I agree f0 Comply P.C.FEE PERMIT FEE j tJ � �../ With all Arty ordinances nd .State laws relating to building am constY t' n, and reby rile representatives of this County ISSUANCE FEE ^ to r pant IDned propert r inspection opsIs. ' a Ra g INVESTIGATION FEE TOTAL FEE m a Co J V m��m Wpam a Msm ' -Darrell L. Howard. r. 5/11/93 SEE REVERSE FOR EXPLANATORY LANGUAGE Cp' WORKERS' COMPENSATION DECLARATION Al /,i �EI��lI1� R• M'[/��.r I��} �/�LL///1L� IAfiereby affirm that have a certificate of consent to self /U\ pp��ll Q��OII V. �Ol1U ����D�U V V PISR LL�r 'insure, or a certificate of Workers Compensation Insurance, !r\l �7 qr a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES - BUILDING AND SAFETY - Policy No. • Company BUILDING ` ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN - ADDRESS 903; G%�/ f ❑ 'Certified copy is filed with the county building inspec- BUILDING tion department. . ADDRESS 0CI�y1 `C fr{d Cf f Date Applicant - CITU wry, 'f I ZIP - LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT CNOW ONLLOTS NEAREST / COMPENSATION,INSURANCE - CROSS ST. Ur YI?A' (This section need not be completed if the permit is for one TRACT - BLOCK 'f LOT NO. ASSESSOR I MAP BOOK - PAGE PARCEL .hundred dollars ($100) or less.) + OWNER /1 '� V ILL. 7 DdS(�. USE ZONE NOP - NO. 3bS certify that in the.performance of the work for which this 7 SPECIAL a permit is issued, I shall not employ any person in any manner ADDRESS L CA Y I �4 r\"� CONDITIONS so as to become subject to the Workers' Compensation Laws. ./ - 0 CITY T C C44 C ZIP Cl N - - Dote Applicant - ARCHITECT OR TEL. [[ M NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER of C' OL{•. NO, 72 -.DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. Z NE U Exemption, you should become subject to the Workers' ��(( �yj fC•y� Compensation provisions of.the Labor Code, you must forth-. ADDRESS 2: O r d ( '�(/ - -3 ✓ `� Garli'�L�L' a with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFJICATION APT. CONDO. h deemed revoked. CONTRACTOR NO. - Z LICENSED CONTRACTORS DECLARATION UC. CLASS NO. O D - DWELL, UNITS_ ADDRESS G`"'lL`71-w '-'-L�.[�G/CyKLj I hereby ting that I am licensed under provisions of Chapter 9 _ - SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. . and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SO. FT. NO. OF /t - NO. OF i CHECK ' License Number - Lic. Class SIZE STORIES "!/ FAMILIES I ONE VALUATION y.. Contractor Date— DESCRIPTION OF WORK I NEW f• t>Zl •�'` D P "I n-j ADO ❑ J ❑ O ctam exempt under Sec. ` ALTER ❑ B.BP.C. for this reason t REPAIR ❑ S El Date: USE OF 1 • +.^. pi'-� .. �! . r", - .. EXISTING 81_1581 - �J DEMOL APPLICANT /� '` TEL. r`f �•�/ Signature - (PRINT) ' V✓1 C JL( NO. `(4 47 FINAL OWNER-BUILDER DECLARATION > ,/ DATE b I hereby affirm that I am exempt from the Contractor's License ADDRESS L I� `f 1 Law for the following reason (Section 7031.5, Business and FINAL; Professions Code): . PRESENT -. By G ,t ❑ BUILDING g "1 ht.1-+ •T 1, as owner of the property, or my employees with ADDRESS a3 , � / wages as their sole compensation,will do the work and LOCALITY - - // - / II.D I+'�:D 'tl�' i`•.LJ-�Id It structure is not intended or offered for sole(Section /�-7-9 \V/,,f 'V -C-1 - 7044, Business and Professions Code.) - MOVING TEL, I� CONTRACTOR NO. O"Ss _ 1, as owner of the property, am exclusively contracting / r t i:l with licensed contractors to construct the project (Sec- /JJ. - ) -7 ri"' ADDRESS __..- tion 7044, Business and Professions Code. - t HEC .. REQUIRED- TOTAL SETBACK FROM -EXIST.. .L�'f LZ%� +/�'1 - K. CONSTRUCTION LENDING-AGENCY SETTBACK � YARD HwY PROP. LINE I WIDTH I I hereby affirm that there is a construction lending agency for 'r-FRONT the performance of'the work for which this permit is issued P 1_: ' - - _/•�� ')�( (Sec. 3097, Civ. C.). SIDE =I-1- �nn) P L Lender's Name. Gney'aY RnT�{r-) k � Q `� /' q 1 ( r w. 4'1v,,(1"1 L\nl U r.q rcd d( P.C. Fee$ (/�' / I Permit Fee ✓T �C-� LDMA Ref. r �) r DUO ij_I�': - J,l 1!l'-. Lender's Address A 4 a I certify that I have read this application and state that the Issuance Fee O+ -74- LDMA P/C It - above information is correct. I agree to comply with all County Investigation Fee _ /�/S D / ordinances and State laws relating to building construction, Tor.] Fee l LDMA Perm. # and hereby authorize representatives of this County to enter upon the above- entione property forinspection purpos s. t r -6 I - 2SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of-ApiRlicarill ar AgentDale WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self A PPS p CAT HU N..; FOR 'M M D d M N 0 P E 6°3FAU insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sea 3800,• Lab. C.) ` p COUNTY OF LOS ANGELES' .BUILDING AND SAFETY ' Policy No1�`r 77� bCoampony[A,r_- C" CV4El\ ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDINGADDRESS �O Jr— Certified J C BUILD - ❑ Certified copy is filed with the county but i q inspec- ADDRESSING Q C IJ 7 6J pion department. ' CITU 6l C IF LOCALITY Date pplica ni NO. OF BLUGS. . CERTIFICATE OF EXEMPTION F OM WORK RS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST, COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permi is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARC hundred dollars ($100) or less.).; 7 TEL. ' OWNER' Com- J NO. - USE ZONEMAP I certify that in the performance of the work for which this NO. �S6� .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 QC, ZIP Date - Applicant ARCHITECT OR TEL. DISTRICT -GROUP TYPE - FIRE PROCESSED BY Q ' NOTICE TO APPLICANL;If, after making this.Certificate of - ENGINEER - NO. - - - CONST. ZONE V Exemption, ryou should become subject to the Workers' /� L. . 7 . •/ , LJ Compensation provisions of the Labor Code,you'must.forth- ADDRESS - J' O J with comply with such provisions or.this permit shall be TEL STATISTICAL CL4551� ATION APT. CONDO. Z deemed revoked. - CONTRACTOR S/Ocu—z vN� CC�• NO.y`16-1 y/ 2a.,. LICENSED CONTRACTORS DECLARATION LIC. �^L c CLASS NO. ELL ITS_ I hereby off irm that I am licensed under provisions of Chapter 9 - ADDRESS I -47 NO. rx yI V1 p '(commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP CITY C 10 1 CLASS G— �(,t, BKand Professions Code,and mylicense is in full force and effect. BK. PG. ^L/ 'l�dc 50. FT: NO. OF NO, OF CHECK - License Number d 7 W`I Lic. Class �� S I STORIES FAMILIES ONE VALUATION Contractor "C A '- G " Date/ �t�� DESCRIPTION OF WORK NEW ❑ .s ��©• _. _ ADD ❑ D. .• ❑I am exempt under Sea _ � �r J � ALTER ❑ _ _ , ,B.BP.C. for this reason• O ♦L REPAIR ❑ $ — ate: Z USE OF. I EXISTING BLDG. DEMOL ❑ Signature APPLICANT \\ '' 11 iTEL �y FINAL ER-BUILD DE LARATION - (PRINT) L..I 'NO. Y• yE+ DATE /I //�� I hereby affirm that I om ex im f fr the Contractor's License gDDRE55 �,� /v/}'Yp4-T �G 7 — '- Law for the following reason Section 7031.5, Business and FINAL 'r: - G� Professions Code): PRESENT - BY ❑ I, as owner of the property, or my employees with BU — ILDING ADDRESS . • - wages as their sole compensation;will do the work and the structure is not intended or offered for sale(Section LOCALITY - I 7044, Business and Professions Code.) MOVING TEL. - - -' E] 1, as owner of the property, am exclusively contracting CONTRACTOR NO. _ C with licensed contractors to construct the project (Sec- ADDRESS '-L ' ' "' tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT REQBACK YARD - HWY TOTAL SETCK EEX, FROM - IDS H IN I hereby off irm that there is a construction lending agency for FRONT the performance of the work for:which this permit is issued P.I'. - (Sec. 3097, Civ. C.). SIDE _ P.L. Lender's Name .CDMA Ref. # - P.C. Fee$ LZ Permit Fee Lender's Address a I certify'that I have r -d this application and state that the Issuance Fee LDMA P/C# 0 O above information i c rrect. I agree to comply with all County Investigation Fee ordinanc and St to flows relating to building construction, Total Fee LDMA Perm. # a and h y autho z repr entatives of this County to enter •up theab ve-m ion property for inspection purposes.1 a c.� SEE REVERSE FOR EXPLANATORY LANGUAGE 'gnmure of plic nt or Agent Dote r