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HomeMy Public PortalAbout6204 ENCINITA AVE_Building__ -APPLICATION FOR Il BUILDING PERMIT . 'FOR APPLICANT TO FILL IN ADDRESS a BUILDING - - ADDRESS LOCALITY NEAREST CIT ZIP CROSS SU NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP.BOOK PAGE PAR UjlJ ^^ DISTRICT I. GROUP ITYPE FIRE PRO ES ED BY TRACT LBLOCK LOT O. �.V CONST ` / ZONE TEL. 5 i 45 __Z7y OWNERfekG NO. JJ � STATISTICAL QASBIf ICq/TION - SEWER MAP ADDRESS (p CLASS NO.=DWELL UNITS QB CITY ZIP 5 Z E MAP / NO' O ARCHITECT OR TEL. SPECIAL ENGINEER NO. CONDITIONS ADDRESS EL, J y� ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO CONTRACTOR �O NO. B 13J/ BLDG SETBACK FROM LIC p, FRONT PROP.LINE OF �- �JN /n�- STREET)'ADDRESS oZ NO. 0 x- TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAV + YARD = FRONT PROP.LINE HIGHWAY WIDTH - CITV CLASS CONSTRUCTION LENDER a NAME ANDBRANCH d' J BLDG.SETBACK FROM - ADDRESS PROP.LINE OF —STREET)ADDRESS CITY O SQ,FT. NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SET FROM EXISTING w SIZE STORIES FAMILIES ONE SIDEP T) HIGHWAV WIDTH N N + - Z DESCRIPTION OF WORK NEW � ADD �ORNEKCUTOFF YES ❑ NO 201-h 4L ffg� A- ALTER id 9IN OPEN SPACEYES ❑ NO REPAIR ❑" USE OF. ❑; IN COASTAL PERMIT ZONE YES ❑ NO EXISTING BLDG. DEMOL APPLICANT _ TEL C/ LG.f, /NS.d G-•9-T� Gact IPRINTI NO, If BY ISIGNATUREI, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING 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 RELATING TO WORKMEN'S COM- PENSATION INSURANCE. - E Q SIGNATURE OF .1 FINAL 3 '� /7= �V BY. 'PERMI77EE ..DATE ,. ADDRESS• • � ° TEL. _ •� P.C. Fee$ 7 Permit Fee CI7 NO Issuance Fee —� VALUATION cr� •� ,I; ' ' Total Fee PLAN CHECK V LIDATIOa - .a. -CA6N P RMIT VALIDATION CK. M.O. CASH 369�JUL 52' 0O 5 1 © 129.75 tS 76A636B CE#6038 6/)6 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION, FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING O ADDRESS I hereby affirm that I have a certificate of consent to self insure,' E IIJ >�, 1 or a certificate of Workers'Compensation Insurance,Or a certified CI ZIPy C(1..9 f copy thereof(Sec.3800,Lab.C.) Cho C.J 1 T -1 O LOCALITY PolicyN6. '7(-2-3e73Q Company 5-r4TE Fu fJ U SIZE OF LOT NO.OF BLDGS.NOW ON LOT K1 Certified copy IS hereby furnished. I NEAREST CRY 55 ST. Vt� ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. LU' r✓ o I' USE ZONE MAAPP NO. department. Data 12-i I Applicant�L%RQ�J C e rUA 'EZ5 ASSESSOR MAP BOOK PAGE PARCEL p Qp ..I SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ' TEL.NO. /C• YES NO COMPENSATION INSURANCEEADDRESS G 7'7 WITHIN 1000 FT.OF SCHOOL? (This sectlon need not be completed if the permit is for one hundredC .Q DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) .ZIP I certify that in the performance of the work for which this permit ENGINEER IS issued, I Shall not employ any person in any manner s0 as t0 R ( TEL.NO. become subject to the Workers'Compensation Laws. µms. Id - 'V STATISTICAL CLASSIFIC TION APT CONDO Date Applicant CLASS NO. DWELL UNITS jr Z6 ji,<;T 4l2iA Ar E . CANOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exam tion, I _ TEL.NO. Exemption, you should become subject the Workers' P_ SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith C�JI"� — FRONT comply with Such provisions orthis permit shall be deemed revoked. ADDRESS /��- _ LIC.NO. 9 /I PL E is A V/t f G 4 G�CiY SIDE Cl- LICENSED LICENSED CONTRACTORS DECLARATIONCITY LIC.CLASS PL I hereby affirm that 1 am licensed under provisions Of Chapter 9 C0B.DIA SEWER MAP CC (Commencing with Section 7000)of Division 3 of the Business and SQ FT.SIZE NO.OF STORES NO OF FAMILIES Professions Code,and my license is in full force and effect. V I NEIN BK PG ,I DESCRIPTION OF WORK VALUATION D 1 License Number y 4'G!O-t Lic.Class I� ADD ❑ n - �r-zul�U �S 1`1 -11 l� `� CSC U C ALTER ❑ $ G 0 ?ii_T.4 Z Contractor Date 1C"I — CpJST REPAIR El 1:3I am exempt under Sec. $ B.&P.C.for this reason DEMOL ❑ LDMA P/CN I .TEN` Date: USE OF EXISTING BLDG. .URM ❑ /.� TOT.ti''� Signature APPLICANT(PRINT) TEL.NO. LDMA Penn M 'vi I�L�'1 ,y 7117 ❑ I, as owner of the property, or my employees with wages as 2P1R LJAN -" _ p (WINCE their sole compensation,will do the work and the structure is ADDRESS f not intended Or Offered for Sale (Section 7044, Business and j26 E I W 1 A121,4 "a: At-CAC>14 G4 FINA DATE - �� C PFOfasSlOna Code.) VALLTHEAPPUCANTOR FUTURE BUILDINGOCCUPANTHANDLE AHAZARDOUa MATERIAL M3 'j- 1j OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GflfATER THAN COAL!-IJI ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL _ licensed contractors to construct the project.(Section 7044, vEs❑ No( / $`}� 1 fii _ .._. Business and Professions Code.) - WILLOCC THE INTENDED USE MI THE BUILDING CT THE APPLICANT IO FUTURE BUILDING OCCUPANT REQUIRE MANAGEMENTT FOR DISTRICT (S NOMO)SEE PERM?MOMrING CHECKLIST FOR _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAQMD)SEE PERMITTING CHECKLIST FOO GUIDELINES El' I hereby affirm that there is a construction lending agency for YES No ' the performance of the work for which this permit Is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES W COUNTYCODE TITLEZ,CHAPTM2.20SECTION5220.100THROUGH 220.140 CONCERNING Lender's Name HA-ZAfl�DOU7S��ERIALS R/EP(�RTING AN Ofl0 TAININGAPERMIT FROM THE SCAOMD. Lender's Address ' """y ' � Tes o' I certify that I have read this application and state that the above RC.FEE PERMIT FEE information is correct. I agree to comply with all county ordinances and State laws rel r1g to building Construction,and Lv r'. *eth rfzere n Ives Of this Ounly t0 enter upon ISSUANCE FEEnti prtion nt oses. � 9yINVESTIGATION FEE TOTAL FEE Apxx om SEE REVERSE FOR EXPLANATORY LANGUAGE, 'WORKERSitZOMPENSATION DECLARATION - I hereby affirm �thai I have a certificate of consent to self A�PdOC�ATU®N FOR Bn �JOn ®�(�nG �ERM�JT insure, or o certificate of Workers' Compensation Insurance, L.L V L.L N u or,a certified copy thereof (Sec. 3800, Lab.'G) COUNTY•OFLOS ANGELES BUILDING AND SAFETY Policy Na. - Company ILDING Cort copy is,hereby furnished.. , FOR APPLICANT TO FILL IN ADDRESS ADDRESS Certified copy is filed with the county build ing•inspec- BUILDING' G tion de artment. ADDRESS Date Applicant CITY ZIP RTI KATE OF EXEMPTION FROM WORKERS' NO. OF 8LDGS, NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON COT CROSS'ST.' (This section need not be completed if the permit is for one ASSESSOR - hundred dollars ($100)or less.) TRACT BL CK LOT NO. MAP BOOK PAGE PARCEL 77- TEL USE ONE MAP OWNER z I certify that In the performance of the work for which this NO. /' I NO. permit is issued, I shall not employ any person'in any manner •/(J� SPECIAL so as to become subject to the Workers' Compensation Laws. - ADDRESS CONDITIONS 0 Date Applicant CITY ZIP _ - - NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUPTYPE ENGINEER NO. FIRE PROCESSED BY O Exemption, you should become subject to the Workers' CONST. ZONE V Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be C 4] deemed revoked. —TEL STATISTICAL CLASSIFICATION APT. C DO. N CONTRACTOR ��. ° $l NO 86 Z LICENSED CONTRACTORS DECLARATION p /� LIC )/ CLASS NO. DWELL. UNITS_ I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS !/ !yC/J 1 NO.I—OCR ' (commencing with Section 7000)of Division 3 of the Business and _ - LIC SEWER MAP ' Professions Code, and rry license is in full force and effect. CITY s C! CLASS VALIDATION ' /Q SQ. FT. NO. OF - NO. OF CHECK BK. .� PG. ' License Number45 5 7� `'/ 'Llc.Class SIZE STORIES FAMILIES ONE O VALUA Contractor 1 TIONt dQ ` yin 1�s�Date 4 7 DESCRIPTION OF WORK _ NEW �"� " L.lir '❑ S . S� ADD am exempt under Sec. - - • ALTER B..BP.C. for this reason REPAIR $ - Date: USE OF EXISTING BLDG. C?/Z) DEMOL Signature APPLANT TEL- . FINAL /y ;28 2 6 7.A PR OWNER-BUILDER DECLARATION DATE v I hereby affirm that Iam,exempt from the Contractor's License - - - ! - '# e,e •.e ia,� Low for the following reason (Section 7031.5, Business and ADDRESS prypL Professions Code): - p N BUILDING BY I •ri 9 9,8.8 - - I, as owner of the property, or my'employees with ADDRESS wages as their sole,compensotion,will do the work and The structure is not intended or offered for sale (Section LOCALITY •;e 9 9„8 8 6 7044, Business and Professions Code). ' % MOVING - TEL... MI, as owner of the property, am exclusively contracting CONTRACTOR NO. (,A Q 3 8 7 with licensed contractors to construct the project (Sec- 'ADDRESS tion 7044,Business and Professions Code). ' REQUIRED TOTAL 5ETBA .� - CONSTRUCTION LENDING AGENCY -- -SET BACK YARD HWY PROP. LINE- WIDTH I hereby affirm that there is a construction lending agency far FRONT the performance of thework for which this permit is Issued P.L. (Sec. 3097, Civ. C.). SIDE Lender's Name - $ 2 a LDMA Ref. If Lender's Address P.C. Fee$ Permit.Fee UAL [> cmrtify that I.have read this application and state that the Issuance Fee V LDMA P/C 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 ^ c and hereby authorize representatives of this County to enter 3 upon the a ave-mentioned property for inspection rp yes. U •7 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or gent 6ot. APPUC ATOO l FOR QM LOONG PCXR MT � COUNTY OF LOS ANGELES BUILDING AND SAFETY - BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN I hereby affirm that I have a certificate of Consent t0 Self Insure, BUILDING ADDRESS n loZo4 GNG WI A �[lE t✓°� C or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP _LO` IFC copy thereof(Sac.3800.Lab,C.) Loc�'j-�� Policy No. 'T 0 30 30 Company S'T4 W AJ.o C T 9 I t/C/-( L SIZE OF LO NO.OF BLDGS.NOW ON LOT TT�' ff ❑ Certified Copy is hereby furnished. NEAREST C 55 / ❑ Certified Dopy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZON MAP O. department. 1 ASSESSOR MAP BOOK PAGE PARCEL Date Applicant r} 15 -3815 0O2 U.Q' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' (III OWNER ' TEL,NO. VES NO -COMPENSATION INSURANCE EP I Z 2 WITHIN 1000 FT.OF SCHOOL?. AD RESS (This 3801100 need not be completed if the permit is for one hundred CIJCA rJITA. UDISTRICT -GROUP TYPE CONST. FIRE ZONE P CESS BY dollars($1 DO)or less.) CITY' ZIP /1 I Certify that in the performance of the work for which this permit III'L � Ci L Y 7 5/D� k-3 -Z 3 TF is issued, I shall not employ any person,in any manner so as to ARCHITECT OR ENGINEER r TEL.NO. 1 , become subject to the Workers Compensation Laws. LAW46 _ b STATISTICAL CLASSIFICATION APT DO Date Applicant ADDRESS 1,' ,. CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after •making this Certificate of I Z& E `vI IST�Q14 AVEdE I-V' CA; REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR EL.NO. r SETBACK YARD HIM PROP LINE WIDTH T Compensation provisions of the Labor Code, you must forthwith �-c UA C.,JST. ca 46' FRONT comply with such provisions or this permit shell be deemed revoked. ADDRESS LIC.NO. P L Z!� C CV LS-! IA Z61 SIDE LICENSED CONTRACTORS DECLARATION ITS' - LiC.CLASS PL 0 AR CAprA I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Sadiron kens of Division 3 of the Business and 3'FT.��.ZE NO,i F STORES Ni.OF FAMILIES X Professions Code,and m��/ry licenseisin full force and effect. LCL( NEW BK PG License Number^_ 64 2�4' Lic.'Class a DESCRIPTION OF WORK - ADD ❑ YALUA O 0� � � Contractor CERVAIJTES Date 1-31-9 I� 2� " � ALTER ❑ $ ° z ElI am exempt under Sec. REPAIR ❑ B.&P.C.forth!$reason DEMOL ❑ LDMA P/C IF Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL.NO. ! LOMA Perm# 4 ❑ I, as owner of the property, or my employees with wages as _WWF= R Cc L/%NTLI — O their sole Compensation, will do the work and the structure is ADDRESS � _ m� /_ not intended Or Offered for sale Section 7044, Business and 2(v Gt WfS7aR1A ,A✓ 2cADJA C FIN ATE < ^[.7 _ _ Professions Code.) ( WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE HAZARDOUS MATERIAL ,�� ( `� O J', ... OR A MIKNRE CONTAINING A HAZARDOUa MATERIAL EQUAL TO OR GREATER THAN a i iTto °` ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINALE licensed contractors to construct the project ❑ (Section 7044, OI TOTAL .,� s •.D ES NO Ll Business and Professions Code.) - WILL THE INTENDED USE MI THE CONSBUILDING BY THE APPLICANT IO FUTURE BUILDING !, )_t{� OC Wr AIR QUAL(EA PERMITMENT DISTRUCTIO AOMD)SEE PERMITTING FROM THESOUTH _... CONSTRUCTION LENDING AGENCY COAST MR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLISTj 1 FOR GUIDELINES. CH�NUI_ I hereby affirm that there is a construction lending agency for YES❑ NO lel the performance of the work for which this permit is issued(Seo. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �. COUNTY CODE,TITLE 2 CHAPTER 22(1 SECTIONS 220.IW THROUGH 2.2e.1,1e CONCERNING' I_I�III, Il_L;1]t V/ I ,yl] 3 Lenders Name HAZARDOUS MATFAIALSREPPppggTING AN FOR O¢TpININGA PERMIT FIIOM THESCACMD. Lenders Address o E� /� ' � 1ts t 'S' f RM 7:15 0 1 certify that I have read this application and state that the above R information IS Correct. I agree to Comply with all County RC.FEE PERMIT FEE 3 ordin as State laws rel g to b tiding construction,and h y rile represe II is Count t0 enter Upon ISSUANCE FEE /'� JP. ntioned pr f inspect sea. °00 -- 0 INVESTIGATION FEE TOTAL FEE Lf mAoeN.n> ° I SEE REVERSE FOR EXPLANATORY LANGUAGE