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HomeMy Public PortalAbout6054 ENCINITA AVE_Building__ 76A638A CEP8031-67AP; LICATION FOR BUILD NG PER LJ COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS J BUILDING AND SAFETY DIVISION LOCALITY ( C L7 JOHN A. LAMBIE. COUNTY ENGIN<EK NEARESTn/y� COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST. g FOR APPLICANT TO FILL IN DISTRICT :;l f/ _PjJ IGNST. ADDRESS O S{L _CW ,//V) TAS STATISTICAL I E Cc TION $B ER�MPAOP- CLASS NO. DWELL UNITS LOT NO, BLOCK USE ZONE MAP 0 G /n NO. l/ ETRACT /" SPECIAL NO. OF GLDGS. CONDI IONS 512E OF LOT NOW ON LOT USE OF EXISTING RI DO BLDG. SETBACK FROM TEL. FAONT PROP. LINE OF (STREET) OWNER ,.... ^, NO. TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL ADDRESS OS /E Li /,Ct/ � HIGHWAY FROM LL. CITY C.'! �L.�' /T/ + _ ARCH TECT OR TEL. BLDG. 9l TBACK FROM ENGINEER NO. 91DE PROP. LINE OF /STREET) TYPE OFEXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS �I. NIGNWAY WIDTH FROM C.L. CONTRACTOR {�IISS rON fj4_p/2,S NOTEL��Lf3r7330 + ADDRESS �ZS2 VON /T LIC NO �'ZJ ��I. CORNER CUTOFF YES NO c CITYS - ?/ C LID "/`' SEE REVERSE SIDE FOR SPECIAL APPROVALS a DESCRIPTION OF WORK SO:FT. ADD ALTERNO. OF REPAIR `HOE OPLISM ' ter- �/-1, 7 �//j X� , - Z SIZE STORIES 'FAMILIES (//w��O V]'� � /✓S� LA/./is .e✓'� USE OF / /11341YIA /ZiC/J(I �il�LLrp,,. STRUCTURE of 61 cerVC WAFL P/t�"f/lam®�y�� `f/f ��F))) SIGNATURE OF �sF,�j (./^KL • -. �/ APPLICANT M,(,/ / v A.� VALUATION$ "SI© •00 APPROVALS DATE INSPECT pSSIGNATURE P.C. PMT, FOUNDATION, LOCATION FEE$ FEE$ V FORMS, MATERIALS FRAME, FIRE STOPS, / HEREBY ACKNOWLEDGE THAT HAVE AND THIS APPLICATION BRACING BOLTI AND STATE THAT THE ABOVE IE CORRECT AND AGREE E COMPLY FURNACE: LOCATION WITH ALL COUNTY TIORDINANCES, I AND ETRE LAWS REGULATING GAS VENT. DUCTS AUTHORIZED CONSTRUCTION. CERTIFY THAT JN DOING THE WORN TION THE HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH. INT. TION OF TME LABOR COO[ OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. /� LATH. EXT. SIGNATURE OY /� Ai ,rM� rn/(7 / HOUSE NUMBER COR_ PERMITTE �,-ACL/ .FY✓N ///LL��VV!! ffflll 111 LLL RET AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O CABH JLACo1 0 3 91� OCT 4 1 D 4.50- . APPUCAMON- OR, BULL IG PERNT ] COUNTY OF LOS ANGELES -BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI ADDR,Fs�s ��, . I hereby affirm that I have a certificate of consent to self insure- BUIL NG ADDRESS I or a certificate of Workers' Compensation Insurance, or a certified CTV� G/ ZIP - G copy thereof (Sec.3800,Lab.C.) /+ '' -• ' L� r LOCALITY _ Policy No. �o COmpan z SIZE OF LOT NO.OF BLDGSf NOW ON LOT ❑ Certified copy is hereby furnished. - NEAREST CROSS SL - aI Certified copy is filed with the co Ply building inspe i TRACT BLOCK LOT N0. department. . USE ZONE MAP NO. Date } Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS} OWNER - y / TEL o. 1� WITHIN moo FT of SCHOOL? No COMPENSATION INSURANCE C (This section need not be completed if the permit is for one hundred ADZ ESS' - r4 DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or,less.) (, CITY . C , ZIP ('certify that in the performance of the work for which this permit — / 6 py� f�iO/ is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER - -. �✓ -J Q /'- Gf�' =fes became SubIBCt to the Workers'Compensation Laws. TEL NO. STATISTICAL CLASnSIFIC'ATION APT CONDO Dale Applicant .ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject t0 the Workers CONTRACTOReq �T�L NO. SET BACK YARD HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith C� 9 FRONT comply with such provisions n..this permit shall be deemed revoked. AD ESS LIC,NOT PL LICENSED CONTRACTORS DECLARATION 3Z SIDE -H CITY /4 V � pT � LIC. A55 P L Ae I hereby affirm that I am licensed underprovisions of Chapter 9 !"� v " SEWER MAP (Commencing with Section 7000)Of Division 3 of the Business and 5 T.SIZE NO.OF IE STORS N0.OF F. MILIES _ Professions Code,and my license is in full force andel effect. -Qf / NEW El PG d License Number /"0 p_ Lia Class >T.�� �J' DE RIPTION OF WORK ADD ❑ VALUATION /��->,n p 0 Contractor Y1,�-Q,k / Date ALTEReop REPAIR ❑ $ 0 ❑ lam exempt under Sec. B.&PC.for this reason DEMOL ❑ 0 LDMA P/C# W Date: USE of EXISTING BLDG. �S URM -❑ Signature APPLICANT(PRINT) l TEL NO. LDMA Perm# - 3307. . .. 130.6[i z El 1. as owner of the property, or my employees with wages as / 0 EMS .their sole compensation, will do the work and the structure is AD RESS 1 LT_ not intended or Offered for Sale (Section 7044, Business and FINAL DATE o TOTAL 180 ® 60 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL t�('/ - 1 ❑ as owner Of (tie r0 art am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE /� �, Q CHECK yC,l 60 P P y. Y g AMOUNTS SPEC( ON THE HAZARDOUS MATERIAL INFORMATION GUIDED FINAL BY _ licensed contractors to construct the project (Section 7044, yEs❑ no - CHARGE Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST FOR fdF� UE Gtr GUIDELINES. W VL 0000'0001 a/iir.� I hereby affirm that there is a construction lending agency for YES El No - theperformanceof the Work for Which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALSINFORMADON GUIDE AND THE SOAOMD PERMITTING 8153 1 AM10:ill m 3097,CIV.C.) CHECKLIST.(UNDERSTAND MT REOWREMEare ON LOS ANGELES COUNTY CODE ^' TITLE 2,CHAPT .20 SECTIONS 2 20 100 TH GH 2 CONCERNING HAZARDOUS Lenders Name MATERIAUS E 0 IINNGAND F OOZAIM);G MIT pry.THE SCAQMP o Lender's Address --l�lrIS�U� ,L` as71/� o cn nnX nnpcEUT o I certify that I have lead this application and state under penalty 0 of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE $ with all county ordinances and State laws relating to'building mthis County 1` wwI rodm..o.Aaml Lives of ISSUANCE FEE I inspection purposes. a INVESTIGATION FEE TOTAL FEE [ a - SEE REVERSE FOR EXPLANATORY LANGUAGE w