HomeMy Public PortalAbout5837 - 5839 ENCINITA AVE_Building__ , DEPRBTMENT OF BUILDING AND SAFETY FB 8ED @ 9_0,(J_,D 0 H Q
COUNTY OF LOS ANGELES !T' ' tvJ 1� ®�J
WM. J. FOX, CHIEF ENGINEER �� A � APPLICATION -FOR APPLICANT TO FILL IN g FOR OFFICE USE ONLY
& - 3DISTNO. PLLn NNCK. .RREC.NO. PERMIT NO.,
.BUILDING ���� �
-2-
ADDRESS ,( Y-101 T
3 4
d' /r C- � 09 7-OC7 �R IAEIVED BV DATE OF A,PPPL. DATE IISSUED
LOCALITY T r T L 'J�IF/Y _� _u •y �-,�O
` NEAREST
CROSS ST. L ABUILDING
661 S63%/
rd 71� _3 L n� � -4e,39
OWNER 95j9 e- �-< C/ N'9
lMAILj�f/� ` LOCALITY ..r . I
ADDRESS ~ P_ YI'��
NEAREST; 1 �f T✓�/pr
Lj p//��/ CROSS ST.
' CITY A.r�9 NOLST J • /V O ' FIRENIGOF GROUP
ONE, 1 I PLANE L TYPE GJ
ARCHITECT OR TEL _ J7
ENGINEER NO. BLDG. / r
SETBACK,LINE A /�• 4G
ADDRESS USE � APPROVED
' TEL ZONE BY DATE
_ CONTRACTOR NO. HOUSE NUMBERING
ADDRESS
MAP NUMBERYd dD 6 �NO. ASSIGNED By_ Y
LEGAL _ CORRECTIONS
DESCRIPTION LOT NO. i7 7 BLOCK _
TRACT / vy D 7
OF SIZE OF LOTlf O/�%+� I NOW ON LOSLOGS.
USE OF ` NO. OF 4 �• ,E G:7+ p/G n.a.d - tJ.9F66
EXISTIN BLDG. I FAMILIES
DESCRIPTION.OF WORK
0
NEW ALTERATION ADDITION �-�- D
REPAIR DEMOLITION F
SD• FT. 7 y NO.OF
612E ROOMS STORIES
EXT.WALLRoof
7'(1! cQ I COVERING wMp
COVERING
USE OF STRUCTURE
/� T?. S
INSPECTION FOR APPROVALS
OCCUPANCYAS INSPECTOR SIGNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS �� Z
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN IB FRAME: FIRE BTOPS, //'
CORRECT. BRACING, BOLTS /
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES I / (Arr "y
FURNACE: LOCATION,
AND STATE LAWS REGULAT)N uUl INS CONSTRUCTION.
- -S GAS VENT, DUCTS
J
BIONATURE O LATH. INT.
PERMITTE
LATH. EXT.
ADORE59 2�7-SZataL/
PLASTER. INT.
AUTHORIZED ADT.
PLASTER, EXT.
$ / P C 8 �JQO(, HOUSE NUMBER COR-
9D0
O
V FEE eS' I RECT AND POSTED �w+'
VALUATION FEE ® �O'�V FINAL �� �a
76 SA OBS 3 7-51
APPL0CAMN FOR BWLMNG PERINT
COUNTY, OF LOS ANGELES BUILDING AND SAFETY
• WORKER'SCOMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR �•
BUILDING ADDR Bs - - .3 - i N C f
Ihereby affirm that'I*'have a certificate of consent to self insure,-
or a certificate or Workers•Compensation Insurance,or a certified
6AI /1 1,11112-
cPoOPL Y theore.9Sec.380 alb.C.)G) CI ZIP .NOW
- LOCALITY"
✓�/
NO OF BLDGSSI E OF LOT N� / 1 /
ComPan � � NO
LOT
Certified copy i5 hereby furnished. NEAREST CROSS ST.
❑ Certified copy is filed with the unty building n pact on TRACT - BLOCK LOT NO
'.
department.
USE ZONE MAP NO. . ....c-
D' Applican ASSESSOR MAP BOOK PAGE PARCEL '
SPECIAL CONDITIONS
CERTIFICATE OF EXEMP FROM WORKERS' OWNER TEL No:
COMPENSATIO INSURANCE 1J / WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not tie completed if the permit is for one hundred
ADDRESS -
J d IVDISTRICT GROUP TVP CONST. FIRE ZONE PROCESSED BY
dollars(ST 00) or less.) '.. - Al
CI ZIP O� Y _ I
I certify that in the performance of the work for which this permit •"� -,� �— �Cf_./�
_
is issued, I shall not employ any person in any'rnanner so as t0 ARCHITECT OR ENGINEER TEL NO. -
become subject t0 the Workers'Compensation Laws.. - STATISTICAL CLASSIFICATION APT CONDO
Date Applicant' ADDRESS' 'CLASS NO 1-52 DWELL UNI
NOTICE TO APPLICANT.' If, after making this Certificate r,Of ' REQUIRED TOTAL SETBACK FRO
NT. M' EXIST
Exemption, you should become subject to the Workers' CONTRACTOR TEL O. ySET BACK YARD . HWY PROP LINE WIDTH -
Compensation provisions of the Labor Code, you must forthwith ,
FRONT
comply'with'such provisionsor this permit shall be deemed revoked. ADDRESS ,' LIC.NO. 'PL }
LICENSED CONTRACTORS DECLARATION LIC.CLAS��
SIDE O
I hereby affirm that I am licensed underprovisions of Chapter 9 �'i3 SEWER MAP - ,
(commencing with Section 7000)of Division 3 of the Business and T.SIZE NO,OF STORIES N0.'OF FAMILIES 1 Cr
Professions Code,�and my license is in Full force and effect. NEW ❑ -BK "PG
3/T7 qq DES ON OF WORK ADD ❑ , VALUAT DN O� D (�
License Number Lia Classier.. /
ContractorCl//1 /IA�i�i Dale ��-r _ Z ALTER .'.❑- $'� - W
D_
$. Z
❑ 1 am exempt under Sec. - _
BBP.C. for,this reasont' f fR DEMOL .C1CDMA P/C n
Dat : USE OF.EXISTING B 3 7 URM' ❑ 1
Signature APPLICANT(PRI . TEL NO. - LDMA Perm ar %
-
❑ I,.as owner of. the rty, or my employees with wages as Z -1r c
their sole comp sa n, will do the work and the structure is ADDRESS 0 -03 � 11 5.65
not intended`or red for,sale (Section 7044, Business and J FINAL DATE O_ 1 !TENS
Professions COde.l WILL THE APPLICANT OR FUTURE.BUILDING OCCUPANT HANDLE A,HAZARDOUS MATERIAL 'f(_.Z
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J
❑ 1, en owner of the property,.am the project
contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? r a 1-75 v 6k5
FINAL BY 7 TOTAL
licensed contractors to construct the project !Section 7044, - -
Business and Professions Code.) YES 0 No CHECK
OCCUPANT
WILLCC THE INTENDED USE MI THE SUIDUNO BY THE MODIFICATION
OR FUTURE BUILDING �+1'�
COASTA IR REQUIRE A PERMIT FOR CONSTRUCTION(aCION OR EE PERMITTING
FROM THE SOUTH - CHANGE a I)IJ
CONSTRUCTION LENDING AGENCY COAST AIR'QUAUTY MANAGEMENT DISTRICT ISCpOMD)SEE PERMITTING CHECftUST FOR Ill'IYV
cwoauNEs ,
1 hereby affirm that there'is a construction lending agency for YES El No 13
the performance of the work for which this permit is issued(Sea r
z r
IH EC READ I HE UNDERSTAND MY REQUIREMELS NTS
TS ATION UNDERTHGUIDE OS THE ANGELS COUNTMC Y ITTING
ppnn-0p�1'- 411 1.1r =•
,3097, CIV.C.) /y�� CHECKLIST, UNDERSTAND TI REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. •C!
I V TITLE 2,CHAPTER 2,20 MATERIALS REPORTING ANDTFORS2 20 100 OBTAININGTHROUGH 220 140 A PERMIT FROM THE CONCERNING HAZARDOUS CG 9 { Ari 9:54 p_4
_m Lender's Name JL16 1 H
Lender's Address w+xER OR.ceu. ,
3 1 certify that I have read this application and state under penalty "
p of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE' • rJg�
with all county ordinances and State laws relating to building UX '
m cons 'on, and here b uthorize representatives of this County ISSUANCE FEE
O to qrnter Vpon the abov - ntioned pr:7�q for inspection purposes.
INVESTIGATION FEE TOTAL FEE '
a � a roams•,a x T
SEE REVERSE FOR EXPLANATORY LANGUAGE