HomeMy Public PortalAbout6139 ENCINITA AVE_Building__ 76AG38A CE#803 3-68
APPLICATION FOR BUILDING PERM,
COUNTY OF LOS, ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDa Ess 3
BUILDING AND SAFETY DIVISION LOCALITY
A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST
CROSS ST. JI _
FOR APPLICANT-TO FILL IN DISTRICT NO. GROUP TYPE _ .-P SSED BY
/^ CONST
Print ort pe only) - �"rd • / 1
BUILDING STATISTICAL CLASSIFICATION SEWEFI,MAP,
ADDRESS 6139 N. Ellcinita$ Temple.Ci CLASS NO.<—DWELL',UNITS BK PG
LOT NO. �Q BLOCK Up ZONE MAP ',- - - - -- -
��yy NO.
TRACT 04 SPECIAL
NO.OF SLOGS. 2GU CONDITIONS
SIZE OF LOT 1?19 -le 6cwD NOW ON LOT
USE OF Dwelling
EXISTING'BLDG:eBLDG.SETBACK FROM.TEL FRONT PROP.LINE OF (STREET)
OWNE urtta Hills NO. 286-3417 _
tTYPE OF EXISTING 3ETBACK HIGHWAVr- -} ,YARD - --TOTAL
ADDRESS 39 - 'HIGHWAY WIDTH FROM{.L.
6160
CITY Tem le Cit BLDG.SETBACK FROM - -ARCHITECT OR TEL. SIDE PROP.LINE OF ET)
ENGINEER NO.
TYPE-OFEXISTING SETBACK H + YARD = ' TOTAL
ADDRESS HIGHWAY WIDTH FROM
t� TEL,np _
CONTRACTOR y NO. 28 ^LIU -LO O + DD_
ADDRESS 1 NO. 606 0 - CORNER CUTOFF YES ❑ NO ❑ U
LIC.
CITY San Gabriel CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS
U
DESCRIPTION OF WORK W
I y
z
NEW ADD ALTER REPAIR DEMOLISH - -
SO. FT. _ -NO. OF NO, OF _
SIZE .STORIES -FAMILIES '
USE OF
STRUCTUREReroof House &Attached. Garag
with 235# Comp. Shingles*
SIGNATURE OF
APPLICANT ,
VALUATION $
G GD APPROVALS DATE INSPECTOR'S slpnA TU RE
P.C. _ PMT. FOUNDATION: LOCATION
FEE S FEES 9.00 FORMS, MATERIALS
FRAME: FIRE STOPS,
HEREBY ACKNOWLEDGE THAT I"HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING. CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY.ANY PERSON IN VIOLA-
TION OF THE LABOR CODE OF THE STATE yO(C�F,[.CALIFORNIA RELAT- LATH, INT.
ING TO WORKME N'5 C�OlaldffAtb '
ILU{p �I{/• LATH, EXT.
SIGNATURE OF - --'- HOUSE NUMBER COR-
PERMITTEE' RECT AND POSTED
ADDRESS 600 S.San Gabriel.San Gabriel FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O. CASH
1Jlc.[� a�
LHCo� 94 8�3 OCT21 1 D 0
_850334 SB::-..-
WO
RKERS COMPENSATION'DECLARATION
I " " FF��. /� I�r�l�'. �L. G� -
I heyeby affirm,that have a certificate of consenL,to self ��li O��l��®I�11 F®R Aii � RDONff PERM lnl/AL� II �,
insure, or certificate of Workers' Compensation Insurance, - (/=J LL _ _u u�r_ __ vel II LS II SIO Y/❑ ll C�
or'acertified'copy thereof (Sec 3800, Lab' C.)
1V85-2251 { ,�yremont. indemnity COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. mpa - - 1 - • .
a Certified,copy is hereby furnished. . .'r r ,- POR APPLICANT TO FILL N BuuliwG .6 ����, -
AG: ss
®. Certified copy is,filed with the county b'uildirig mspec- - BUILDING - - -
'tion'department. t' "�' t` 61 ADDRESS Encinitas
Dote' 7 i ApplicantV i rn f n Rnnf '-rn CITY Temple City ZIP b LOCALITY - - -
'CERTIFICATE OF EXEMPTION FROM'WORKERS' •' ' ' -- , _- NO. OF BLDGS. - - NEAREST -
_• •
COMPENSATION INSURANCE'- •' SIZE OF LOT NOW ON LOT CROSS ST.
Jliis'seci'oin need not be!completed'if the:permitris for'one -- - - -- ASSESSOR
hundred dollars ($100)or less ) 1 TRACT - BLOCK - LOT NO. MAP BOOK PAGE 1 PARCEL
"' TEL. U ZONE MAP
OWNER _ Mrs'i.H I 1 IS— .- \ NO. 2✓ }
1 certify that in ihe,performance of the work for which this - NO.
permit is issued, I shall not smploy any person i. 11n any manner. _ / SPECIAL •• 6
so as to become subject to the Workers"Compensotion-Laws. ADDRESS as above ° CONDITIONS _ V
., . ..rt. .. CITY..._ ZIP ._"' '�- K
Date t A Leant , ARCHITECT
OR TELNO DISTRICT. ._GROUP TY NST 1 f O
NOTICE TO'APPLICANT'�f,`after making' this Certificate of _ _FIRE_.. _ _ PRO ESSED BY
`Exemption''tyou' should become subject"to lthe Workers' ENGCO ZONE V
W
Compensationjprovisions.of the Labor.Code, you must:forth- ADDRESS - -yf - + _3 - y
with comply with such-provisions or: this,,permit sh8llk be '- TEL - - STATISTICAL CLASSIFICATION r APT. ONDO. Z
deemed revoked ty ,;, a' + .i= .�• ,+. CONTRACTOR V i r i'n Roof Co. No28 -0 0 _
LICENSED CONTRACTORS DECLARATION - , - - - -- - - - --- UC CLASS NO.�DWELLUNITS
I hereby,affirm that,I am licensed under provisions of Chapter 9 ADDRESS P:0• Box�J� NO. 160650. ,
(cdmmenang with Section 7000)of Division 3 of the Business and _ LIC - ,�_ - -_, EWE P
SEWER
Professions Code and'my license'is ,'full force and effect. CITY San �GeI)riel -91778 CLASS C39 BK. PG'. -VALIDATION
` ' ' ` ` _ NO OF NO OF HEC
License Number 1650, Uc Class C39 SIZE ' STORIES FAMILIES ONE
. .�,• ,<_.. ., , •, _ ,VALUATION
" V'ITOIfI ftoof�_Date7�17785 DESCRIPTION'OF-WORKRe-roof house- & - NEW- $
.1568.00 '
Contractor Li ADD
1 am exempt under'Sec '-' - ALTER r >
BBP.0 for this reason - ... 'composition shingles. 24 SCIS! ❑ ,S- -- - - -- --
REPAIR -
- - "- - Date: USEOFEXISTINBLDG: dwelling DEMOL ❑
APPLICANT -- - _ - TEL. FINAL- - 2 4 9 7_A
PRwn V i r rn Roof Co No. 2.8 -0 0 '.i
" OWNER-BUILDER DECLARATION _ _ __ _ -DATE -
.•Lhereb offirm that I am exem (from-the Contractors License _ - _
y. P ADDRESS P•0: Box J San Gabriel .91778 FTN L ' i' # ,1
Law'for the following'reasom(Section 7031 S, Business and i
'Prbfe55ibns'Code). PRESENT' - a 9. $8 '
❑. __. _ BUILDING
as owner of the property, or my employees with ADDRESS
_ wages as their sole compensation;willdo the work and 4.9•,8 8 v
the structure is riot intended or offered for sale(Section LOCALITY a- -
'— -'-7044, Business and Professions Code).' ' ' MOVING"' '"-" - - TEL '^ ( Y,�s'Q� df - i-011 9-85
as owner of the property, am exclusively contracting CONTRACTOR. NO.
"'—with'.licensed-controctors to construct the project (Sec- ADDRESS !!! U
- " '�f ( /
tion 7044, Business and Professions Code). 7
_. .._.. . .REQUIRED .. .. .TOTAL SETBACK.F '-" "yvIDTH -- - '�
'CONSTRUCTION`LENDING AGENCY _ SET BACK YARD- HWY PROP. LINE
hereby affirm that there is a construction lending agency for FRONT •? �. - ` t
--.the performance-of the which this permit is-issued -- - P:C--- -
,(Sec. 3097, Civ. C.). SIDE
Lender's Name LDMA Ref. a
0
-. P.C. Fee$' _ __ _ Permit Fee ' - -39,38-
- . -. • - '- .
l 50 DMA PTC a
lenders Address
-(.certify that I have read this-application.and state_that they _ - - - Issuance Fee - 0• -^' -
a above information is correct.i agree to comply with all County V Investigation Fee
-,ordinances and State-laws relating to building construction, ,__. 119.88- i
u and reby authorize representatives of this County to enter -- "- - - Toml•Fee - - —' LDMA Perm.'a - --
m upo the above:mentioned pr perty or ' spectio purp/q ses. -
/// 1..' I` SEE REVERSE FOR EXPLANATORY LANGUAGE r
-- - 'Si Lure of Applicant or Agenr - - Date _ '