HomeMy Public PortalAbout6023 ENCINITA AVE_Building__ CHTY
sA6]BACEn90J3-,,APPLICATI-ON FOR BUILDING PERMIT
COUNTY OF LOS ANGELESnoILDIN ENr/M/T // C.
DEPARTMENT OF COUNTY ENGINEER DRESS
BUILDING AND SAFETY DIVISION LOCALITY E Cl
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SUP'i OF BUILDING CROSS ST.
DIS TR CT NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING A'/ w`�7A A, STATISTICAL CLASSIFICATION SEW
ADDRESS 602 e/Y {may A CLASS. NO.p_ _DWELL UNITS — BK PG
Vf 7 Y v(N- /- ' BLOCK WATER
CERTIFICATE: NOT REQUIREDTz RECEIVED ❑
rr
TRACT MAP GG HIGHwgv STATE MAJOR SECOND. OCM.
NO.OF BLOGS. NO. Ci�} i ICIRCLE)
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
.EXISTING BLDG. ,� I—
EL L I
OWNER '�I • W NO. BUILDING YARD HWY TREE NAME EXIST.
/( SETBACK - WIDTH
ADDRF_SS 6 / .. FRONT /G/'
ARCHITECT OR TEL P. L. L G/ -
ENGINEERNO. 51 E
P L. 6
-
ADDRESS .O
TEL. �� 2 V
FLf f/
CONTRACTOR _ NO.
ADDRESS p/ ' v A O
.y-r.
DESCRIPTION OF WORK l p yuvrIi
NEWX ADD ALTER REPAIR DEMOLISH
SQ. FT. NO. OF NO. OF
SIZE . STORIES , FAMILIES /•
USE OF
STRUCTURE ,
SIGNATURE OF
APPLICANT -
VALUATION S OO Q 0
APPROVALS IDATE INSPECTOR s SIGNATURE
P.C. PMT. FOUNDATION: LOCATION }� l�, /� /X ✓f
FEES FEES FORMS. MATERIALS
—' FRAME: FIRE STOPS. �� ? 1
I HEREBY ACKNOWLEDGE THAT I HAVE REAOTHIS APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS'CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. /
WITH ALL COUNTY OROIH4NCE5 AND STATE LAWS REGULATING GAS VENT.-DUCTS
BUILDING CONSTRUCTION. I'CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANV PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR WILL
OF THE STATE OF CALIFORNIA RELAT�
ING TO WORKMEN'S COMPENSATION SU RA NCE. EXT.
SIGN ERE
ITE O OUSE NUMBER-COR- '
PERMTEE RECT AND POSTED _
ADDRESS FINAL $ Gr
JOHN F. LEWIS. PRINCIPAL STRUCTURAL E
PLAN CHECK VALIDATION -'CK. M.D. CASH _ PERMIT VALIDATION cK: M.o. case
LAC,o.8;8.577G 'AUG-14 . :1 D 1150 Q
APPL OC/aT500 FOO R o M LOM PEM
T �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, n
or a certificate of Workers'Compensation Insurance,or a certified 0.0 t.3 �'�`
Copy thereof(Sec.3800,Lab.C.) CITY /1F` zl�./ LOCAU
Policy No. Company CRE OF OT ( NO.OF BLDGS.NOW ON LOT
❑ Certified Copy is hereby furnished. NEAREST CROSS ST.
❑ Certified copy is filed with the County building Inspection TRACT BLOCK LOT NO. USEZONE MAP NO.
department.
ASSESSOR MAP BOOK PAGE PARCEL
Date Applicant SPECIAL CONDITIONS -
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER V / TEL NO. G,^ VES NO
COMPENSATION INSURANCE `�°�^"���'"" tt k'l`Ac (.�r�7"y WITHIN 1000 FT.OFSCHOOL4
AD HESS
(Trig Section DBBd not be Completed if the permit Is for one hundred � ('J� I��(•n� DISTRICT /J 'GROU^P TYPE�?�ST.' FIRE ZONENSEDBY
dollars(Etat)or less.) CITY .ZIP �,O (� . /� TYPE
/ '�7
I certify that in the performance of the work for which this permit cp 1 C. G C-/ J i7� a K J `-•IMI�� ✓/rl
Is Issued, I shall not employ any person in any manner so as to .Z Aqp(¢�JHITECT O INEER TEL.NO.
become subject to the Workers Compensation Laws. R4 �.. L /-`p +�( ] "/ �.sd r,0.�1 STATISTICALC FICATIONAPT CONeub
Dale Applicant ADDRESS CLASS NO. DWELL UNITS
J
NOTICE TO APPLICANT: if, after making this Certliicate Of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, CO TRACTOR EL.NO.
Compensation
you Should become subject you
u Workers'with bl1 1 f I A� `^F �QO SETBACK YARD HWV POOP LINE WIDTH
Compensation provisions of the Labor Cotle,you must forthwith W �J / / FgDgr
comply with such provisions or this permit shall be deemed revoked. ADD oZ,3 �.. ^1 LIL///i G•5� PL
SIDE >'
LICENSED CONTRACTORS DECLARATION clTy LICC�� PL
I hereby affirm that I am licensed CO.FT SIZE NO.OF STORES NO.OF under provisions of Chapter 9 Rj SEWER MAP
FAMILIES 5
(commencing with Section 7000)Of Division 3 of the Business and nc� NEW '� BK PG
Professions Code,and my license is in full force and effect. �� o-4'73 3 .. �
` DESC//GOiNlOF RKr0.
ADD ❑ VALU0 �
D ACCT
License Number Lia Class ALTER ❑ 8�
Contractor Date o A
W
�I p 3,4137 91 2.0
❑ l am exempt under Sec. � 1 ^ REPAIR ❑ $ r 3 �S�-a� d 1 ITEMS
EMS
B.BP.C.for this reason DEMOL ❑ TOTAL 902. 06 CDMA P/C e
Date: USE OF EXISTING BLDG. LIRM ❑ CHECK 902.06
Signature APPLICANT(PRINT) TEL.NO. LDMA Perna _
❑ ro CHANGE ,lry`i
1, as owner of the
property, or my employees with wages as O
their Sole compensation,will do the work and the structure is ADDRESS
not intended Or offered for sale (Section 7044, Business and FINAL DATE C 0000-0001 4/19/}(i
Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDINGOCCUPANT HANDLE AHAZAROOUSMATERIAL J
property, am exclusively g OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN < 0194 1 AM10.1)`
❑ 1, as owner of the r0 y contractin With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATON GUIDE? RN/1L BY
licensed contractors to construct the project.(Section 7044, YES❑ NO❑
Business and Profession$Code.)
WILL THE INTENDEDDIRE USE MI THE BUILDING BY THE AP MODIFICATION
IO FUTURE BUILDING
OCCUPANT REQUIREA PERMITFORT DISTRICT
(S N OR O)SEE
F ING THESOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SGOMO)SEE PERMITTING CHECKLIST
FOR GUIOEUNES.
I hereby affirm that there is a construction lending agency for YES
❑ No❑
the performance Of the WOfk for which this Permit is issued(SBC. NAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE
AND THE SCAOMD
3097,(i1V.C.). PERMITTING CHECKLIST UNDERSTAND MV REWIREMEHI$UNDER THE LO$ANGELES
COUNTY CODE,TITLE2,CHAPTER ZMSECTIONS zMAW HROUGH 2.3112000NOERNING
Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
Lender's Address ,�re,
o' I Certify that I have read this application and state that the above
$t Information is correct. I agree to comply with all county P.C.FEE O O PERMIT FEE
iZ4 ordinances and State laws relating to building construction,and
hereby authorize representatives of this County to enter upon ISSUANCE FEE
the above-mentioned property for inspection purposes. J
< INVESTIGATION FEE TOTAL FEE I
" BYnWnv1AM MUI.Pw� CY
SEE REVERSE FOR EXPLANATORY LANGUAGE• '