HomeMy Public PortalAbout5813 - 5815 ENCINITA AVE_Building__ 76A63eA DBS.9 6-e5
APPLICATION FOR BUILDING PERMIT
'DIVISiON OF BUILDING AND SAFETY BUILDING ^ 5
Deportment of County Engineer ADDRESS /y
County Of LOS Angeles LOCALITY .� V�•C
WM.J. FOX. COUNTY ENGINEER NEAREST �•� / N��
CASSATT D. GRIFFIN, SUP-TOP BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE SEWER MAP
FOR APPLICANT TO FILL IN I co"sT. BK Pa
BUILDING`'NI,3 yI� T / } MAP n STATE
ADDRESS-(q%���•��%/�jA Lia rf'jN k' LI l�' NUMBER /�0� HWV �B D
LOT NO.� [Vjp] L �e� g�j9CrK ' �I USEZONE SPECIAL
CONDITIONS
TRACTOF OL
S
SIZE OF LOT �i/' 11 C I NO'NOW ON LOTS O BUILDING EXIST.
SETBACK YARD HWV STREET NAME WIDTH
USE OF FRONTO/
EXISTING BLDG. . P L
OWNER/�)j/ h A&7/{-, BIDE �
P. L.
MAIL /� �
ADDRESS 7 S"A (Lj' ��/LIL(.1 /LO O TRACT DWELL. 1 UNIT 5 INDUSTRIAL
•-TELLL. 1 DWELL. 1 UNIT
CITY NO. ' J ' 6 PUBLIC BLDG.
ARCHITECT OR TEL. 2 DUPLE% 1 UNIT
7 ADDN., ALT.. ETC.
ENGINEER NO. 3 APT. _UNITS
H M19CEL.
ADDRESS 4 COMMERCIAL
M/J ' A ( rELs£�33E:1 i INSPECTION RECORD
CONTRACTO�RJ{{ / �, EI'� ifjl5r NO: /' J N
ADDRE59'611' T /7/Jt•�'#1P /SI✓rj R-CU121"Eo1
DESCRIPTION OF WORN
NEW ADD ALTER REPAIR DEMOLISH �- {
,0 MLmA
SO. FT. NO. OF NO, OF -
812E / / 5TOR1 E9 FAM ILIE9
USE OF STRUCTURE . LC . eG kw 1-O aA.T- hAI
81G NATURE OF
APPLICANT �� q ��� APPROVALS
L
ADDRESS
S DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION 1
$ P. C. S 51 FORMS. MATERIALS 1{ l {�
FEE FRAME: FIRE STOPS,
eC BRACING, BOLTS 1 •.56- L..
$
VALUATION �j Qp I FEE 366 o FURNACE: LOCATION,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GA5 VENT. DUCTS U 4
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT.
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. A LAT". EXT.
SIGNATURE OF HOUSE
AND POSTEDR l� STm 111 X.�
PERMITTEE �/J(/H�p
ADDRESS -• FINAL 4
WM. J. FOX.COUNTY ENGINEER VALIDATION C. N. DIRLAM. CHIEF BLDG. INSPECTOR
. :G00 0 0 71=2 Ov 15 1 6 1 7.5 0
p2.24S WV2__2 1 . 35.00
WORKERS'COMPENSATION DECLARATION
ent to sf
insure,boraafcertifcatte of Workers' Comtpensaton Insurane, - APPLICATION FOR BUILDING PERMIT *
or a certified copy thereof (Sec. 3800, Lob. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. PC 975 58 mpony Republic Indemnity BUILDING
�- Certified copy,is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with the county building inspec- - BUILDING
`tion department. ADDRESS 5813-5817A Encinita ,
Dale 11-1-86 Applicant Randolt Roof Ino CITY Tpmplp City ZIP 91720 LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. - NEAREST
COMPENSATION INSURANCE . SIZE OF LOT NOW ON LOT CRO55 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 I PAGE PARCEL
TEL. 4 USE NE Mt
AP
I certify that in'the performance of the work for which this OWNER - _ NO. — NO.
permit is issued, I shall not employ any person in any manner (�J/fQ SPECIAL t1
so as to become subject to the Workers'Compensation Laws. - ADDRESS 750 W. Baylor (y CONDITIONS O
V
' - 6-12-86 Randol Roofing CITY ZIP In
Date Applicant ARCHITECT OR TEL. O
DISTRICT GggqOUP TYPE FIRE PRO SSED BY
NOTICE n, APPLICANT: If, after making this'CerliWore of ENGINEER NO. /J CONST. -ZONE •V
Exemption,ibnyou 2
pr should become subject to the Workers-
Compensation provisions of the.Labor Code, you-must forth- ADDRESS
with comply with such,provisions or this permit shall be - - TEL - STATISTICAL CLASSIFICATION APT. C W. Z
deemed revoked. , CONTRACTOR NO. —
LICENSED CONTRACTORS DECLARATION - t . - CLASS NO. -� DWELL. UNdS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 529 E. Valle. NO.451()17
(commencirig with Section 7000)of Division 3 of the Business and LIC SEWER MAP
Professions Code, and my license is in full force and effect. CITV CLASS BK PG '- VALIDATION
' SO. FT. NO.OF NO. OF HECK
License Number 451937 Lic.Class C-39 SIZE STORIES FAMILIES ONE -
VALUATION _
Contractor Randol' Roofing Dote 6-12-86 - DESCRIPTION OF WORKRe—roof two duplex nD ❑❑ s 31922.00
Fit am exempt under Sec. '- ❑ ,
ALTER
-B.BP.C. for this reason REPAIR $
Date:. USE OF DEMOL ❑
EXISTING BLDG. Duplex
APPLICANT - TEL. FINAL,-/ 2 J
Signature PRINT) Randol Roofin NO. _
OWNER-BUILDER DECLARATION _ DATE - -
..I hereby affirm that I.amexempt from,the Contractor's License
Law for the following•reason (Section 7031.5, Business and ADDRESS 529 E. VAIIPv R1 CZ FI L ;2 4 9 37 A'
Professions Code): -- - PRESENT B/
BUILDING '# s e e e e
1, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and ' I e e 6 8 6 3
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING - TEL e a ,
1, as owner of theproperty, am exclusive) contracting CONTRACTOR NO.
Y s 0'Q —8 6'
with licensed contractors to construct the project (Seo- ADDRESS
tion 7044, Business and Professions Code). ,
CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTA PROP ETBLINEF WIDTH
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.
Sm Lender's Name
LDMA Ref. #
Lender's Address P.C. Fee S- Permit Fee 58. 1'3 '
i
I certify that I have read this application and state that the Issuance Fee LDMA P/C#
a above information is correct. I agree to comply with all County Investigation Fee
ordinances and State lows relating to building construction,
u and hereby authorize representatives of this County fo enter Total Fee LDMA Perm. #
� upn t e bov -menti ne roperty for inspection purposes.
a — f 6-12-86 SEE REVERSE FOR EXPLANATORY LANGUAGE .
II, Signature of Applicant r Agent Date t