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Home My Public Portal About5949 ENCINITA AVE_Building__ ACV- v APPLICATION FOR COUNTY OF LOS ANGELES TMENT OF COUNTY ,4 BUILDING PERMITDEPA BUILDNGAND SAFETY DIVSIONR BUILDING O FOR APPLICANT TO FILLIN ADDRESS ,;.$- / BUILDING f• `�� - L ADDRESS )Z7Al411,,0Y 1511 Yt LOCALITY ,y <iL✓ y/' NEAREST - CITY K*1,14 %Z, ZIP / 6 G/ CROSSST. ,/jiM•�° / ti ' NO.OF BLDGS. �) A55ESSOR ' SIZE OF LOT NOW ON LOT CX-- MAPBOOK PAGE PARCEL TRACT s`J (•J BLOCK LOT NO. �J O�f �SOCry CONS TELFIRE PROCESSED By . Jjgw OWNER_07o),71-15 %41- r NO.p7 S STATI5TICALCLASSIFICATI N J SEWER MAP ADDRESS "�J �h�G%d/J i/f' CLASS NO. �' DWELL.UNITS -iG BK 90PG CITY ZIP USE ZONE NOP ' o7OO7 ARCHITECT OR T L. ENGINEER NO. SPECIAL a9•SS !) Z CONDITIONS .3�-7D•S ADDRESS -EL. ROAD DEPARTMENTAPPROVAL REQUIRED YES❑ •NO ❑ CONTRACTOR NO. BLDG.SETBACK FROM LIC. FROM PROP.UNE OF (STREET( ADDRESS N0. TOTAL SETBACK FROM TYPE Of EXISTING LIC.. HIGHWAY +, YARD = FRONT PROP.LINE HIGHWAY WIDTH CITY CLASS _ CONSTRUCTION LENDER + O NAME AND BRANCH BLDG.SETBACK FROM V ADDRESS CITY SIDE PROP.LINE OF (STREET) SO.FT. NO.OF NO.OF CHECK HIGHWAY + . YARD TOTAL SET BACK FROM TYPE OF EXISTING w SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH . ❑ + = Z DESCRIPTION OF WORK NEW xfi�ftl 2 �T�•>✓�.. ADD ❑ CORNER CUTOFF VES' ❑ NO ❑ ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ f• G 7� REPAIR ❑ USE OF DEMOL IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG, TEL Z T �/ APPLICANT �dT�e (PRINT) Y TEL &. 3 E BY(SIGNATUR /e I HEREB A OWLEDGE THAT I HAVE EAD.THIS APPLICATION AND STATE iHAi THE B E IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAW$ GULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELArING TO WORKMEN'S COMA PENSATION INSURANCE Q 'SIGNATUR - FINAL / 79 BY PERMITTEE F DATE ' ADDRE CITY 4 TEL P.C.Fee$ Permit FeeNo �7y• �� Issuance Fee /• Q� VALUATION TataIF ' PLAN CHECK VALIDATION CK. M.O. cnsH PERMIT VALIDATION M.O. CASH 3 3 2Ju'L 3 1 U i_v U Os 78A83BA CE/803A 8/77 D WORKERS' COMPENSATION•DECLARATION�t_• ( ' J • • r �I hereby affirm that I have a certificate of'conseni to self OO OR M O RO �//A�� insure, or ci tertificate'.of Workers' Compensation Insurance, ' ' 1 LL O��\�j!/"Ll��O L1 �1 FOR R ✓U O L D�LI V O P iEII�111 V U� i M or a certified copy thereof (Sec. 3800,-Lob. C.) t COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING 5949 Ene insta Ave . , tion department. ADDRESS LOCALITY Date ApplicantCITY Temple Cit , - CA zip 91780 ceosssT. CERTIFICATE OF EXEMPTION FROM WORKERS' 1 80 x 180 . NO. OF BLDGS. 1 ASSESSOR COMPENSATION INSURANCE SIZE OF LOTNOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one 59 4 38 USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO: 4, NO. 007 TEL. _ SPECIAL Y I certify that in the performance of the work for which this OWNER Mr & Mrs J. MartinNO. 28 I —/RICT GROUP lTlO TYPE FIRE ED BY O permit is issued, 1 shall not employ any person in any manner ADDRESS 5 / E ^, CONST. ZONE V so as to become subject to the Workers'Compensation S. p /' -T pd CITY Temple City, CA. 91780 S�Q �t ) �s ' O /Dote 3 Applicam •'+%=� _ STATISTICAL CLASSIFICATION APT. CONDO, V NOTIC T APPLICANT: If, a er in f Certificate of ARCHITECT OR TEL. ''�� JJ g ENGINEER NO. CLASS NO.�DWELL. UNIT$_ W Exemption, you should be a subject to the Workers' N Compensation provisions of t e Labor Code, you must forth- ADDRESS SEWER-MAP—___, Z with comply with such provisions or this permit shall be TEL / t deemed revoked. CONTRACT BK. L—PG �I VA (DATION LICENSED CONTRACTORS DECLARATION uC. _ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS VALUATION ;- (commencing with Section 7000)of Division 3 of the Business and - LIC, i• ��O Professions Code, and my license is in full force and effect. CITY $ (s D SQ. FT. NO.OF NO. OF CHECK License Number - Lic.Closs SIZE STORIES 1 FAMILIES ONE Contractor Dote DESCRIPTION OF WORK 1303 SF additi O $ and remodel of existin ADD I am exempt under Sec. _ ALTER ""A975 SF house . DATE — B.BP.C. for this reason REPAIR Date: EXISTINGBLDG. Single fam. reside ID.&L Q FI Signature - APPLICANT TEL, OWNER-BUILDER DECLARATION PRINT Bruce Benson NO. 2861293n C�/ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 9544 Kennerly, Tem le Q1t Professions Code): PRE EN � 3 BUILDING I, as owner of the property, or my employees with ADDRESS _ wages as their sole compensation,will do the work and N ya 0 the structure is not intended ar offered for sale(Section LOCALITY p 7044, Business and Professions Code). MOVING TEL. a - �`� ��` is o e o e CONTRACTOR NO. \ _z_•1K3' 1, as owner of the property, am exclusively contracting ,L with licensed contractors to construct the project (Sec- gDDRE55 ..r 't` '~;f , A J tion 7044, Business and Professions Code). �� c r • .r. REQUIRED TOTAL SETBACK FROM EXIST .. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH c i - .Z I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. 1..)o 1 Q ZSec. 3097, Civ. C.). SIDE Cl t P.L. Lender's Name �t Lender's Address P.C. Fee b : Permit Fee '?//C(Jg � I certify that I have read this application and state that the Issuance Fee J V , above information is correct. I agree to comply with all County Investigation Fee 1 ' S ordinances and State laws relating to building construction, Tolol Fee --5786 d and hereby authorize representatives of this County to enter r "t A upon a above-mentioned prope for inspection purposes. ♦ _ < — J4 I SEE REVERSE FOR EXPLANATORY LANGUAGE Signa are of Appli t or Agent i KERS' COMPENSATION DECLARATION p r� p FOR .toss p p It I� p/� Ids p�s �s Il G.� L/,I'TfI wn, m that I have.a-ce'lCome of consent to ce, ��n �� /pV ��IIKVI Ip�gy I;`II ILII D� IIY�II(L c-. 1�1}I�(In\Y lj � 'Irtificate of Workers' Compensation Insurance, LL (/"ll Ll V 0 Uhl B V LS U V G 11_E 01110911 Il LLJJ or o certified copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ILD ESS ADDRU �� Certified copy is filed with the county building inspec- BUIADDRESS LDING L tion department. Dote Applicant CITY / ZIP . LOCALITY r CERTIFICATE OF EXEMPTION FROM WORKERSNO. OF BLDGS. NEAREST COMPENSATION INSURANCE ' SIZE OF LOT .0/' a NOW ON LOT CROSS ST. 17 (This section need not be completed if the permit is for one ASSESSOR ' hundred dollars ($)00)or less.) TRACT BLOCK LOT NO, MAP BOOK PAGE PARCEL TEL USE ZONE I MAP I certify that in the performance of the work for which this OWNER Iqow / NG d NO. permit is issued, I shall not employ any person in any manner -LL �pn¢L.�S K _/ SPECIAL so as to become subject to the Workers'Compensation Laws ADDRESS CONDITIONS O CITY ZIP V Dat ✓ Appican 7 ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR SSED BY O NOTICE TO APPLICANT: If, after making this ificate of ENGINEER NO. Exemption, you should become subject to the Workers to -2. CONST.--fir ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS t � — ✓ �F with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTORa r_ NO. Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS A NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BI( PG VALIDATION SO. F NO.OF NO. OF CHECK License Number tic.Class SIZE BTORIES FAMILIES ONE VALUATION DESCRI 10 OF WORK NEW ❑ dQ Contractor Date ADD s3 •' " ' - - `•❑ I am exempt under Sec. AS_�&VrICI_A OF �—G ALTER D $ 1 25.8A r' r B.BP.C. for this reason U u REPAIR ❑ s #'° ° °`° 23 Date: USE_ EX*TOING BLDG. DEMOL ❑• ) ° 3 7 Q S O Signature APPLICANT TEL. FINAL J� ° ° 3 7 0.5 0 5 _ OWNER-BUILDER DECLARATION PRINT NO. DATE -20 I hereby affirm that I am exempt from the Contractor's License gDDRE55 FINA ( 2 06-88 Law for the following.reason (Section 7031.5, Business and Professions Code): PRESENY By BUILDING / IJII 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ✓99 j the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. I �. r., ❑ CONTRACTOR NO. �,all EM] I, as owner of the property, am exclusively contracting ( f�T _ f at:- with licensed contractors to construct the project (Sec- 'r3"'Ct cult tion 7044, Business and Professions Code). ADDRESS - �4 + 4-+��%ff t - REQUIRED TOTAL SETBA hYll CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHECY, I hereby affirm that there is a construction lending agency for FRONT ,111) the performance of the work for which this permit is issued P,I, - CHANGE (Sec. 3097, Civ. C.). SIDE s P.L. _ Lender's Nome - �O L- C)11-00101 1�iJ/55 (� LDMA Ref. R `��' F,� �T m P.C. Fee$ C •J O Per Fee L/t (� 1 al110.26 Lender's Address - I certify that I have read this application and slate that the Issuance Fee / �(/ ?DMA P/C If ' a above information is correct. I agree to comply with all County Investigation Fee o- 1 SD q ordinances and State laws relating to building construction, Total Fee O LDMA Perm. M and hereby authorize representative of this County to enter upon the bove-mentioned pr r y r inspection purposes. m I SEE REVERSE FOR EXPLANATORY LANGUAGE - T/ SignatvreofA,Wgcort or gem '/ Date VVV