HomeMy Public PortalAbout6219 ENCINITA AVE_Building__ �—i?y el-'
76A638A CE0,8038.64'APPLICATION FOR BUILDING PERMIT - -
COUNTY OF LOS ANGELES BUILDING "f,DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALIT ' c
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,Bu pT.oF BUILDING CROSS SL OCA Ct
DISTRICT NO. GROUP TYPE P B
FOR APPLICANT TO FILL IN
BUILDING A - STATISTICAL CLASSIFIC O SEWER MAP
ApOR ESS V CLASS NO.�DW ELL UNITS BK PG
( B
LOT NO. LJ BLOCK IJf.� Z E MAP ,
A NO. `AL m..�
TRACT L� 7 SPECIAL
N0. OF BLDGS. - 30., CONDITIONS
SIZE OF LOT A_ U� NO w ON LOT
USE OF
D BLDG, SETBACK FROM
OWNER NOL'/ FRONT PROP. LINE OF �� - (STREET)
TYPE OF EXISTING SETBACKXIGX WAY + YARD - • TOTAL
ADDRESS '/ HIGHWAY ID I MC
-L.
ARC R TE BLDG. SETBACK FROM
ENG SIDE PROP. LINE OF (STREET(
q I, ' TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
A pORE55 ' / -y. ryIGK WAY WIOTX FROM C.I. O-
TE } o O
O
A E J C CORNER CUTOFF YES E] NO O
.clr t Aae_f— LICA �� -SEE REVERSE SIDE FOR SPECIAL APPROVALS A w
DESCRIPTION OF WORK ( (q / 0-
NEW
NEW v ADD ALTER REPAIR DEMOLISH
{'O.FT. NO. OF NO. OF '�
37ZE STORIES FA MIL(F_5 I/
USE OF Y
STRUCTU
`Y/PVLi�I•ly) T.'�ITf�J 9�v R"L /I/�i /iL/l�Y((p
I NATURE OF �%V/'� .t_�lACE, 3.
APPLICANT e
VALUATION$ Y 07j &e i
APPROVALS GATE (NBP EC TOR' IONATURE
P.C. / PMT. FOUNDATION, LOCATION z
FEE ALJ O FEE S FORMS, MATERIALS 11
^✓
FRAME, FIRE STOPS,
HEREBY ACKNOWLEDGE THAT HAVE READ`THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY OROINANCES AND STATE LAWS REGVLATING GAS VENT. DUCTS
9VILDIN```��f�```]]]]]]//////,,////�/�/'''7�JJJJONSTR VCTION. ERTIFY T IV. b THE WORK
AUTHO H�EARrE. I WI NOT E Y,/�N`f/PERSON IN v LA. LATH. INT.
TION O T CFH 5 �dVOKS
(NGT W K O NB SURANCE. LATH. EXT.
S IGNATU // HOUSE NUMBER COR-
PERMIT V& RECT AND POSTED
ADDRESS FI NAL /3 "y Y'G...__..
(� JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER
PLAN CHECK VALIDATION GK.. N.G. DABH _ PERMIT VALIDATIO GK. M.D. GASH
8 9 9 2e JAN 21 2 3 D ],5�� .�
LACo 8 9 9�3'� JAN 2_ 1 1' D 1 5.0 0� .v
gg�� ��jjpp ��pp 22 .1 ..�pp pp pp ��pp��ee ��jj��jj22 nn��
930126BG /li1PIrL� CAMOII�'1 I�ORBUOL���l IG IrLSRNT
COUNTY OF LOS ANGELES BUILDING AND SAFETY LuJ
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN - BUILDING PDORE55
I hereby affirm that I have a certificate of consent to self insure, BUILDINGADDRESS
SEncinita
or a certificate of Workers' Compensation Insurance,or a certified
copy thereof (Sec.3800,Lab.C.) CITY Temple City ZIP LOCALITY
Policy No.W2710598 Company Cal Comp. SIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy i5 hereby furnished, NEAREST CROSS ST.
I3Certified'copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO. -
Date7/1'/93 Applicant Virgin Roof Co. ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL YES NO
COMPENSATION INSURANCE Paul Snyder 2HSHLSO _,YJITH- 1000 FT OF SCHOOL?
(This section need not be completed if the permit is for one hundred ADDRESS
6219 Encinita _.D1S aIC GROUP TYPE CONST. FIR •PROCESSED BY
dollars ($100) or less.) - - jQ - - i 9
CITY ZIP . �. / 2C .tl�
I certify that in the performance of the Work for which this permit Temple Cit 91780 — O/ 4� V .ys -
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO.
become subject t0 the Workers' Compensation Laws. STAT15TICALCL@SSIIFICATION I —"' — m•��
Date Applicant ADDRESS CLASS NO. L DWELL UNITS
NOTICE TO APPLICANT:. If, after making this Certificate of REQUIRED--' " '" -- --TOTAbS M EXIST
Exemption, you Should become Subject to the Workers' CONTRACTOR TEL NO. SETBACK YARD HWV PROty llllle"i WIDTH - .00
Compensation provisions of the Labor Code, you must forthwith Vir in Roof Co. 287-0507 FRONT _
comply with such provisions or this permit shall be deemed revoked. ADDRESS' LIC.NO. P L -08 1 93
PO Box 5010 160650 SIDE_
LICENSED CONTRACTORS DECLARATION CIzY UC CLASS, P� —�-- — - _ -"- ---"'-97: ,57
1 hereby affirm that I am licensed underprovisions of Chapter 9 Jan Gabriel 9 1 7 78-50 10 CS9 -SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SO FT.SIZE NO.OF STORIES NO.OF FAMILIES
NEW ❑ BK PG >_Professions Code,andmylicense is in full force and effect. 285 D.
'License Number 160690 Lic.Class Mo DESCRIPTION OF WORK 'ADD ❑ VALUATIOD N Q
Contractor Vir);in Roof CcOnte 6/30/93 Over existin a 1 28 s s. g U
ALTER ❑ Q
Class A composition shingles. REPAIR ❑
❑ I am exempt under Sec. $ V
B.&PC.for this reason - DEMOL -❑ LDMAiP/C* W
Date: US_OF F (STING BLDG. URM :❑ _ a
�welin (1)
Signature APPLICANT(PONT) TEL NO. .-LDMA Perm Z
El 1, as owner of the property, or my employees with wages as Vir in Roof Co. 287-0507 -- -- - -'- -- - ACCT:i
their sole compensation, will do the work and the structure is ADDRESS
_ __ .- Fl 5
not intended Or offered for sale (Section 7044, Business and PO Box 5010. San Gabriel CA 91778-501C "'FINALDATE ------ - _a 'J�� 'I, - -
Professions Code.)
WALL THE APPUG4,T OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOHN-TO OR GREATER THAN THE
❑ I, as Owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL.BY__
licensed contractors to construct the project (Section 7044, HL"
Business and Professions Cade.) YES O No ', _ _ 3-, 7 .._ iUg.0
WILL THE INTENDED USE OF THE BUIDUNGCONSTRUCTION
BY THE APPLICANT OR FUTURE E SO , '-' JJOI C r
OCCUPANT flEOWPE A PERMIT FOR CANSTRUCTION OR MODIFICATION FROM THE H"
CONSTRUCTION LENDING AGENCY COAST AIR DUALITY MANAGEMENT DISTRICT ISCAOMOI SEE PERMITTING CNELKUST F R—
GUIDELINES _
I hereby affirm that there is a construction lending agency-for YES El No t r" ----- ---- TOTAL 10 - �c
the performance of the work for which this permit is issued(Sec. - _ __ _ i,i�.,e
m (HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMO PERMITTING __,-_,_,.,-.. _ LIC {/
3097,Clv.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE.LOS ANGELES COUNTY CODE, 4HE4�i
�I TITLE 2.CHAP OR 220 CTION 22 100 THROUGH 2920.140 CONCERNING HAZARDOUS
aLender's Name _ MATER ws f�� IN F VG A PERMIT FROM THE SCAOMD. I ._. _ - - (•Ll Atlf - •U�)
o Lender's Address om Ue aR.eNT liltl�9
o _
certify that I have read this application and state under penalty 5/14/93
o Of perjury that the above information is correct.I agree to comply
P.C.FEE PERMIT FEE 1300 —I13 1
N with all county ordinances and State laws relating to building 92.25 F' - � i M ,}
m constr tion, and hereby authorize representatives Of this County ISSUANCE FEE 97_4 1 'j
ato en a upon the aboge-menti �I pm Iry or inspection purposes. 17.10
/
5/11 /93 INVESTIG1510N F TOI 85 /
sy�gw•n..wwo^ I �e
SEE REVERSE FOR EXPLANATORY LANGUAGE