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HomeMy Public PortalAbout6149 ENCINITA AVE_Building__ rs�===•CES=o == APPLICATION FOR BUILDING PERMIT — BUILDING AND SAFETY DIVISION BII I LDINGESS C ADDR - Department o1 County Eagtneex i County of Loa Angeles LOCALITY , I .JOHN A. LAMBIE, COUNTYENGINEER NEAREST C CA68ATT D. GRIFFIN.. SwTOF BOILeING CROSS ST. FOR APPLICANT TO FILL IN °I6TR!�rO. GROUP - TYPE - SEWER MAP PG " CONST. �� ��{{�/� ADDRE ([J �TM /V �M/�.1/ a+ STATISTICAL CLASSIFICATION 7 CLASS. NO. DWELL. UNITS LOT NOII 2D p BLOCK �) NUMB ER OO STATE 'YES NO TRACT .! D L/ USE ZON SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT ��'L K J g3, '3 5 NOW ON LOT USE OF I / EXISTING BLDG.�gLt,-Mi1,bC✓LerC-L BUI EXIST. ^� YARD HWY ,STREET NAME ft�b ��•- SE-i BACK WIDTH OWNER .�,f FRONT �J 7J - /_.�., 1 MAIL //� Fna/' F. E OCCJ ADDRESS ('� � V / �--� SIDE TEL. F. L. 4 CITY r= P e NG-G _ CjCE7 • INSPECTION RECORD 4 ARCHITECT Oip r ENGINEER /Ci ek Hz'�t�(r•x'N6. � '/y9dl _ 9-z7-sem./,�YIk1 f',�se/7 &=.9G ADDRESS C' iTEL.C�L�G�/LK�LI •'�-' `` YF/C�- -ia1i.uARV iJr�J.PA— tiil,:rr .CONTRACTOR 0.zz' W'�� 1 NO. 71�. DESCRIPTION OF WORK OO NEW S ADD ALTER REPAIR DEMOLISH SO. FT. NO. OF SIZE ORIES // l ,a TFAMILIES ND PMS• LADDAS A STRUCTUREh _.b--t_G -/(SLP:-t3iLL r /-U-S7P�J7r•t 2NA CAL L— /T.rn -- APPROVALS LE'FTPF✓''Ji''D 'Gve�7�•SI TURE OF v"L �. IICANT -s DATE INSPECTOR'S SIGNATURE / i 1 -iY�/l Vw(�LL.w{'!"L F UNDACRMSTION: LOCATION -97 �����r -QQ�p. C. S / "�l 1�� lL�[ RNAC : LOCN.TION , �` FEE 6 n -GAS VENT. DUCTSN 1 'L � FEE . . . ray ( I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATA. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CONIPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. 4-1,01 "J l �4A '��by�� k STATE LAWS REGULATING BUILDING C NSTRU ION. _ - 6SIGNATURE OF C C-_}J-"L.�[/ HOUSE NUMBER COR- PERMITTEFr� RECT AND POSTED ADDRESS I AM! FINAL ItI JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE N. DI:LAM. PRN"PAI STRUCTURAL ENGINEER PLAN CREC6 VALIDATION CK. M.O. wery - PERMIT VALDATION K M.O. CA=M _ 012'70 AUGT916 1 14251 c. t I�2'3_4 3 SEP 16 1 2 8.5 0 2 6A698A CE#903.10.56APPLICATION FOR BUILDING PERMIT *.. BUILDING AND SAFETY DIVISION BUILDING Department of County Engineer ADDRESS ` County of LOB Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST. /L 1 DISTRICT NO, GROUP' TYPE SEWER MAP' FOR APPLICANT TO FILL IN I co sr. -iqK c BUILDING / - ADOREBB ID�7�j/ �1 (. �.wL I STATISTICAL CLASSIFICATION LOT NO: 4 CLASS. NO DWELL. UNITS BLOCK MAP +y STATE \ [,J NUMBER ) HWY YES NO TRACT 3 _ USEZ NE SPECIAL _ ��jj y NO. OF BLDGS. CONDITIONS SIZE OF LOT UO X IR'S, 3, 37ri NOW ON LOT � USE OF EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST. _ SETBACK WIDTH OWNER ]/J]L. FRONT AMAIL DDRESS 6!Y? /( � P. SIDE ' TEL 6 fir©! P. ary 17 o. / fJ INSPECTION RECORD. ' ARCTEL.O e ��� ENGNO. yip( I E - 3 c� ADDRESS TEL. .- CONTRACTOR ®�Lil "`-"' NO.. �gR p� FT ADDRESS DESCRIPTION OF WORK /!/ ^� /397�lrFtC n T/1 NEW X ADD ALTER REPAIR DEMOLISH SO. FT, yy //6 . NO. OF NO. OF SIZE ac/ STORIES FAM ILIES USE OF STRUCTURE APPROVALS SIGNATURE OF APPLICANT PATE I/NG/SP1�EC{lTnYOHIA'SISIGNATURE IGNATURE ADDRESS FPION ORMSt MATERIALS 71 P. CS FRAME: FIRE STOPS. E NG, BOLTS VALUATION FURNACE: LOCATION. FEE -GAS VENT. DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES A LATH. EXT. STATE LAWS REGU TING BUILDINq� Cr — SIGNATURE OF qq (/� I/A/// HOUSE NUMBER COR- or - RECT AND POSTED ' ADDRESS FINAL JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL.ENGINEER PLAN CHECK VALIDATION cK. m,0. cASH PERMIT VALIDATION K; ni,o. -ASH `,,,T4 2:3 4.4 SEP 16 .. 1 4.00 8 .® VFORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPUCQ.Tp�.N •FOR_ o M�d��NO PERMT. insure,'or a certificate of Workers' Compensation Insurance, , or o certified copy thereof (Sec. 3800, Lab. C.) COUNTY,OF LOS ANGELES - . BUILDING AND SAFETY Pofi� No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS El Certified copy is filed with the county building inspec- _ BURRING / /J �A 'C t N/7+A iJv� tion department. ADDRESS l 'V /7 CITYEYL1 FL�Glr9'ZIP / 7 7S LOCALITY Date Applicant CROSS O. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT JCC �NOW ON LOT NEAREST T.S COMPENSATION INSURANCE 6 / ASSESSOR (This section need not be completed'if the permit is for one TRACT 0 BLOCK Igtoo LOT NO. SK MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) ' - OWNER Q e C" 7ELNO.fr/r3O9'— USE ZONE MAP I NO. ,/O SPE 1 certify that in the performance of the work for which this /L� (a0 SPECIAL - Y permit is issued, shall not employ any person in any manner ADDRESS �- 5(/[ T(j Q' CONDITIONS a so as to�b-eco"'m�e�s.,u�b�ject to the Workers'Compe sotion Laws. " ,• !EL ZIP- p _ r U CITY Date ri tl jApplicant ARCHITECT OR _ TEL. DI TRIG' GR UP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after makm this'.Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' - ry Compensation provisions of the Labor Code, you must forth- ADDRESS - - - , ! 3 a withcomply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. N deemed,revoked. CONTRACTOR NO. z LICENSED CONTRACTORS DECLARATION CIA No.�Dweu. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO' SEWER P (commencing with Section 7000)of Division 3 of the Business _ LIC. and Professions Code,and my license is in full force and effect. CITY. CLAS$ BK . � ' VALIDATION SO. FT:- NO. OF NO. OF CHECK License Number Lic. Class SIZE ( STORIES FAMILIES ONE -- VALUATION , ContractorDate DESCRIPTION OF WORK NEW $ / ❑I am exempt under Sec. 00 j �1� ADD D ' .ALTER ❑ •, BAP.C. for this reasonREPAIR F-1S _ Date: - US OF . . -. EXISTING BLDG. DEMOL ❑ Signature - APPLICANT TEL. FINAL •y�� A.0 OWNER-BUILDER DECLARATION (PRINT) G C O. �N"' .. DATE Lt, (d 2!1/ I hereby affirm that I am exempt from the Contractor's License - ���s / Pow for the following reason (Section 7031.5, Business and ADDRESS c><./ 5L`� , FIN Professions Code): PRESENT ❑ -I, as owner of the property, or my employees with BUILDIN i A ADDRESS - ANT.T .. _.. wages ct their sole compensation,will f o the work and D ` _ the structure is not intended or offered for sole(Section LOCALITY 3307 J - 7044, Business and Professions Code.) MOVING TEL N�• 14`•'6 I, as owner of the property, am exclusively contracting CONTRACTOR NO. /y 1 ITEMS - Lionwit7044, Business ands to ProfessionscCode project (Sec- ADDRESS n�, �.- 'j- \s'�+\'`ryTO��TA.IL� 143 - 6(3 REQUIRED TOTAL SETBACK FROM EXIST. -' 4fiG�R 14.:r.9. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ' 1 1 hereby affirm that there is a construction lending agency for FRONT _ ����T• the performance of the work for which this permit is issued - -P.L. (Sec. 3097, Civ. C.). .SIDE _ P.L. V Lender's Nome. IOMA Ref. N • Dd00-0001 b/la1°5' $ Lender's Address P.C. Fee S Permit Fee • 1 AM 9;14 / Jam.9 a I certify that I have read this application and state that the Issuance Fee 0 .� O LDMA P/C N D 0 8 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # a and hereby authorize representatives of this County to enter up o a above-m toned p'/eV for inspe tion purposes. S _ EE - c ':•\. a purposes. lj SEE REVERSE FOR EXPLANATORY LANGUAGE ��• _\ .{, .t . '*�' �- s � 1 i � •1 n Sign re of Applicant or Agent Data - v - J• - 1, _ 1 •.� WORKERS' COMPENSATION DECLARATION FOR I� I� /� r�p rr�/� /� hereby affirm that I. have a certificate of consent to self r- ����I( /(y���OIIOII I}�ISy; hLn n��D�II@dl([ rA, PERMT insure,or a certificate of Workers Compensation Insurance, !/'illi II VU'll, ll V 11 111100 I�JUJ Il V G/ Il Ilgl11711 II or a certifiedcopy thereof (Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDING AND SAFETY PoGq No. - - Company - BUILDING Eln - - -- ❑ Certified copy is'hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 7 Certified copy is filed with the county building inspec- BUILDING 91 i _�1 12_1 q J y� W it tion deportment. � � � ....,�L ' ADDRESS /� �V/'� /7Y—(/�// 170 .ry!/ Date / 'Applicant V'w++�'^�V CITY e p C��/ ! ZIP //�/ LOCALITY F7 M NO. OF BLDGS. NEAREST - 'CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE of LOT I •NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need'not be completed-if the permit is for one TRACY`-' r E/ - BLOCK alere LOT NO. Zv v MAP BOOK P GE PARCEL hundred dollars ($100)or less.)' TEL pp OWNER Gd5OIP6,E (!/I�c,c NO. GOp7 US ZONE MAP. „ certify that in the performance of the work for which this �L r I NO. permit is issued, fshp not employ any person in any manner ADDRESS (p�(®C/ S U�-,I A�✓/Q SPECIAL Y_ CONDITIONS d sous to become subject to the Workers' Compensation Laws. . ., /�nA' p r/ J /'��/ 0 CITY J/l!�.�A�/�. I�-L ZIP / / /� Date Applicant ARCHITECT OR TEL. - Gc NOTICE TO APPLICANT: If, after makin this Certificate of ENGINEER NO. '. 'DI RICT GROUP' TYPE FIRE PROCESSED BY O 9 _ CONST. ZONE ^ n U Exemption, you should become subject to the Workers' ` / w Compensation provisions:af the.Labor Code;.you must forth- ADDRESS t V w with comply with such provisions or this permitshall be TEL. 5 ISTICAI CLASSIF DATION - _ APT. CONDO. N deemed.revoked., CONTRACTOR NO. // LICENSED CONTRACTORS DECLARATION a CLASS NO. DWELL. Z UNITS— - I.Fete by affirm that I am licensed under provisions of Chapter 9 ADDRESS O' SEWER P (commencing with Section 7000)of Division3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY.: CLASS BK S VALIDATION SO. FT. NO. OF NO. OF CHECK - License Number Lic. Class SIZE O STORIES FAMILIES ONE • • -- - - ❑ VALUATION Contractor Date DESCRIPTION OF WORK y NEW ,. $ - *ADD - D ❑I am exempt under Sec. .ALTER. , B.BP.C. for this reason _ REPAIR ❑ $, Dote: USE OE _ EXISTING BLDG. DEMOL ❑ Signature APPLICANT - ,TEL. .- FINAL OWNER-BUILDER DECLARATION (PRINT) -NO. f �p DATE I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS FINAL. - 1 Professions Code): - • ' PRESENT' - - - -' C�l - '•' - BUILDING ❑ Cas owner of the property, or 'my.employees with ADDRESS ACCT s .T ' wages asiheir sole compensation,wilfdo the workand - ' the structure is not intended or'offered for sole(Section OCALIry � 3307 265.50.� 7044, Business and Professions Code.) • - MOVING - TEL. - �L.L I, as owner of CONTRACTOR NO. 1 ITEMS the property,am exclusively contracting t with licensed contractors to construct the Project (Sec- ADDRESS . '• s ` L TOTAL �pno� tion 7044,•.Business and Professions Code.) ' s -Z`, 1 -\TOTAL F REQUIRED TOTAL SETBACK-FROM EXIST. _ > 2 C _ CONSTRUCTION LENDING AGENCY' SET.BACK YARD HwY PROP. LINE WIDTH ; -�1 CHECK � 28_x._0 I hereby affirm thot there-is a construction lending agency for FRONT -the performance of the work for which this'permih is issued P.L. - CHAHC7E'Y .00 (Sec 3097, Civ. C.). SIDE - - Lender's Name Cp ' P.C. Fee.$ Permit Fe S > (� �,; LDMA Ref. N 0000-OCtl�1 6/14/2] 3 Lender's Address - _ S'T JO 1 AM 9,1 o I certify that I hove read this oppllcation and state that the Issuance Fee C] .� CDMA P/C# - 8 - above information is correct. I agree to comply with all County Investigation.Fee _ / t• , t - R ordinances and-State laws relating to bbilding construction, Total Fee ffJ CDMA:Perm p . >I `Y i �•Y 'l , ,, < and hereby authorize representatives of this County to enter upon a above-menti* ed property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Applicant or Agent Date