HomeMy Public PortalAbout6250 ENCINITA AVE_Building__ 16A638A CE#8035-6I APPLICATION FOR BUILDING PERMI, 11LJ.11
COUNTY OF LOS ANGELES nooaess O
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY,
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST i
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT N . GROUP T E OCES `B
FOR APPLICANT TO FILL IN _ i 6 NST.'
/� I STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS jF4J 2V hl AV / BK P
CLASS. NO._-_l_DWELL.UNITS `
LOT . BLOCK ED NOWATER NOT REQUIRRECEIVED Li
'CERTIFICATE:
TRACT H MAP HlcHwaY STATE MAJOR SECOND, OCAL
NO.OF BL GS. N. (CIRCLE)
SIZE OF LOT I NOW ON L T USE ZONE SPECIAL (,�:
USE OF _ CONOITIO
'EXISTING BLDG.
OWNER LU fA 6 / NO. 17VAI" 3'A BUILDING EXIST.
C 1 �• SETBACK ' YARD HWY STREET NAME' WIDTH
ADDRESS ( C E A-�+ FN( FRONT /
ARCHITECT TEL P. L. ,C-✓L. / 6
ENGINEER [�(� NO. �� SIDE. /
E ) .P.i.' O
ADDRESS . ` �� r % V.
INSPECTION RECORD
CONTRACTOR 8Ay46i fE �'ad3 . t ~ y; �. v , °LO
ADDRESS P I 'SyO E 'r I 9lu
ESCRIPTION OF WORK
� f/ �z
SO. FT NEW AOQD ..ALTER REPNO.OFAIR DEMOLISH
) �S'Y ��✓L. J"'�i'�� Je /HJt G��+i4'I• r
SIZE 'I " J STORIES FAMILIES I
USE OF• 1 _ L(•CF,G �.�.•G.I+Y.L,.'�, lCr11 Gfn � ✓ ...+YRnh�
ST CTURE �� ~S l
1Q ( �j 1 /' /'
SIGNATURE OF A,A ����� � ��/
APPLICANT f I I / • /
VALUATION
eett ,�!! PMT. j APPROVALS I.I DATE INSPECTOR'S SIGNATURE
LOCATIO
F E $ FEE $ J L FO FORMS. MATERIALS:
ADATION'TERIIALS N
FRAME: FIRESTOPS, .l(1//7N� r y?o'j
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS LYI /L�� G�✓CL��
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,.
WITH ALL-COUNTY ORDINANCES ANO LAWS ULATING GAS VENT DUCTB
BUILDING CONSTRUCTION. 1 CEP THAT IN DOING'T WORK ,j �/�7j,,,.,�
AUTH O RI.ED,HER
EBY I W L ,
PLOY ANY PERSON VIOLA. LATHINT. �' �L /�/� Af'�'7iA i�
TION OF THE LABOR CO OF. H IS E CALIFORNI RELAY-
IN.
TOWORKME S NS N B A E. H'
LATH; EXT.
PERMSIGNITTEE TUREOF H RECT AND POSTEDR I/ll/Q
��I 1I. v
ADDRESS FINAL / "'1 1L/I Y
CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION cK x.o. cASN PERNIIT/1/ALIDATION cK M.G. CASH
LAC,o 9 5 3 2 0 MAR 1 3 2 3 D 2 1 .0 0 e M
r / } 19365R 1 1 D L. 2 .00 ,^
WORKERS'COMPENSATION DECLARATION
J' r P s -i
fy affirm that I have o certificate of consent to self O IpI (/(� //p�� M I��p I��[ �r��(1pI IpI IpI M O gyp} O
or o certificate of Workers' Compensation Insurance,' (/-llll P LS��y WTB O LI V Il O R 'V v�LS D I1 V 0 P IS O�III V 57
rnfied copy thereof (Sec. 3800, ob.
COUNTY OF LOS ANGELES BUILDING AND SAFETY
O. an
P Y
ertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
I Z 679C Gwt "TI
Certified cop is filed with Fun buildginc- BUILDING c
lion depart nf. ADDRESS �v a LOCALITY
NEAREST ♦ ^ �_ O
G Applica CITY ZIP � CROSS Si.
ER E OF EXEMPTION RK . OF BLDGS. ASSESSOR
1 COMPENSATION IN RANGE SIZE OF LOT Ic-'� - OW ON LOT MAP BOOK PAGE PARCEL
ection need not be completed if the p mit is for one -� USE ZO E MAP ' M
+d dollars($100)or less.) - TRACT BLOCK LWT NO. �/ .��/ NO. �✓
7Wa' SPECIAL Y
�y that in the performance of the work for which this OWNER — CONDITIONS C.
is issued, I shall not employ any person in any manner .. DISTRICT .I GROUP TYPE FIRE PROCESSED BY O
!o become subject to the Workers'Compensation Laws. ADDRESS J- ��N CONST.. ZONE 0 � V
Applicant CITY ZIP r� STATISTICAL CLASSIFICATION _ APT. CONDO. O
iE TO APPLICANT: If, after making this Certificate of ARCHITECT OR L.
;tion, you should become subject to the Workers' ENGINEER CLASS NO. DWELL. UNITS_
ensation provisions of the Labor Code, you must forth- gDDRE55 SEWER MAP H'-omply with such provisions or this permit shall be ?
'ad
d revoked. CONTRACTOR NOS c.J� BK. PG, VALIDATION
LICENSED CONTRACTORS DECLARATION
by affirm that I'am licensed under provisions of Chapter 9 ADDRE O VALU&TION
{encing with Section 7000)of Division 3 of the Business and LIC.'
scans Code, and my license is in full force and effect. CITY CLASS $ (/ -
2J��Lia.Class �' STO NO. IE NO.OFS CHECK D-, c
`e Number SIZE STORIES FAMILIES 9 ONE "6'0 9.31A
l - DESCRIPTION OF WORK / NEW ❑ $ # o o'o e 23
actor Date7 7717— ADD FINAL
_
m exempt under Sec.
rr
aALTER 7_
!BP.C. for this reason ❑ DATE I i �'�O :#1-'- 3;•7.5 O
REPAIR
Date: USE OF / �I DEMOL FINAL
EXISTING BLDG. //`�. ❑ By es..
`gnature� - APPLICANT
OWNER-BUILDER DECLARATION PRINT
sby offirm that I am exempt from the Contractor's License - D
For the following reason (Section 7031.5, Business and ADDRESS
scions Code): PRESENT
I, as owner of the property, or my employees with BUILDING
ADDRESS Z;° °'3iZ.5 0
wages as their sole compensation,will do the work and
.the structure is not intended or offered for sale(Section LOCALITY 'O1O'e•3 7.5 O
7044, Business and Professions Code). MOVING TEL •11Qf 1 '8-8 3
1, as owner of the property, am exclusively contracting CONTRACTOR NO. .
with licensed contractors to construct the project (Sec- ADDRESS •'.". b 0.9.4.A
tion 7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY SETBACK YARD HWY PROP. LINE WIDTH
REQUIRED TOTAL SETBACK FROM- EXIST.
#lee'e
eby affirm that there is a construction lending agency for. FRONT
Derformance of the work for which this permit is issued PAL �2 °l
°'(1 Qts 0
10
3097, Civ. C.). - - SIDE t
a,
P.L. ° ° e'4 0.5 0
Is
Name
��, .�/{-�� 7 11'0.18 -83.
ler's Address P.C..Feeb 2f/ `-' Permit Fee. 7�' C)
'! iify that I have read this application and state that the luuance Fee 'OTs `'
�e informption is correct. I agree to comply with all County Investigat on Fee:
,lances and State.Idws relating to building:construction, _ -:�0IT '
`h e6 out Drize prase tatives of chi County to'enter Total Fee. ,
f bo -me tioned pr party IF ins ecfion purposes. - -
S SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign r of Applica or A of Date ®sr
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRES�S-+l
INC ApDRESS cJ U G V I T
hereby affirm that I.have a certificate of consent to self insure, Bi
or a certificate of Workers' Compensation Insurance,or a certified .QITV - ZIP
copy thereof
(Sec.
33000,Lab. C.) 'y ( liz Olt � 6 LOCALITY
Policy N0. ` •-(.LL�� COmpan60 � �' SIZE OF LOT NO,OF SLOGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department.� USE ZONE MAP NO.
Date� � -y"�A Kant ASSESSOR MAP BOOK PAGE PARCEL
�'/a pp SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' owNER TEL NO.
COMPENSATIONINSURANCE WITHIN 1000 FT.OF SCHOOL? YES NQ
(This section need not be not if the permit is for one hundred ADDRESS "
dollars (8100)or less.) '
S DISTRIG7 GROUP TV CONST. FIRE ZONE PROCESSED BY
CITY ZIP
is issue that h the tperformanceemploy
of the work for which this permit
is issued, shall not employ any person at any s0 as l0 ARCHITECT OR ENGINEER TEL NO. y� 3
become subject to the Workers'Compensation Laws.ws. STATISTICAL CLA 51FICATION APT CONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemptiol you should become subject to the WorkersSET BACK YARD HWV PROP LINE WIDTH
C NTRACTOR
Compensation provisions of the Labor Code, you must forthwith zil 3!q&lFRONT
comply with such provisions Or this permit Shall be deemed revoked. ADDRESS LIC.Ni P L
F6 I el Il 40j-LICENSED CONTRACTORS DECLARATION C-- lo_ SIDE
CITY LIC.CLASSP L
I hereby affirm that I am,licensed underprovisions of Chapter 9 't'• rlli— EWER MAP
(commencing with Section 7000)of Division 3 ol,the Business andSO.FT.SIZE NO,0)STORIES NO.OF FAMILIES
Professions Code,and my license is in full force and effect. NEW BK PG D d
License Number Lic. Class ' C 3h DESCRIPTION OF WORK - ADD ❑ VALUATIOONlL O
Contraclo �'� Date 3�_ �JS� U S` ��� ALTER ❑ $ F 7 vA U
cc
❑ I am exempt under Sec. ,/J' 1'� REPAIR C1 $ 0
B&P.C. for this reason /•7- DEMOL ❑ LDMA P/C e 1 W
Date: USE OF EXISTING BLOCS, URM ❑ _ s EL
Signature Hl4a ,T
APPLI NT(PRINT) TEL NO. LDMA Perm x _ Z
❑ I, as owner of the property, or my employees with wages as f�_ Z 730
their sole compensation, will do the.work and the structure is ADDREO y '
not intended or offered for sale (Section 7044, Business andIF—',- [.. FINAL DATE /� ! Q y 1 )Ell,
Professions Code.) WILL THE APPLICANT OR FUT,1 BUIL ING GUFANT HANDLE A HAZARDOUS MATERIAL Z"� JI\/ J TI ITn•L '€ 3 m 4C
OR A MIXTURE CONRAINNG A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE W I 1 1
❑ I, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5
licensed contractors to construct the project (Section 7044,
Business and Professions Code.) YEs❑ Not$
WILL THEINT DED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT RE LIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1 l -
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR
GUIDE LINES
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. READ THgNnzARoous mATERwLs wr AnoNculoE ANO THE scnomo PERMITTING I�I 1111�-I�hIJi 111110=,
�110=,
3097, CIV.C.) CHEC T. UNDERSTAND MV REQUIRE R THE LOS ANGELES COUNTY CODE. I���I �•
PILE 2. PTER 2 20 SECTIO 0 H�'� CERNING HAZARDOUS 9I 1=trj 1 �';I y._e 1 IFi
Lender's Name Or R PE OPTING AND F I A-PE TFROM TH
o
Lender's Address oweee off Aoem-�
0
o I certify that I have read this application and state under penalty
4 of perjury that the above information is Correct.I agree to comply PC.FEE PERMIT FEE
n with all county ordinances and State laws relating to building (O• 0
mconstruction, and hereby autl ize representatives Of this County ISSUANCE FEE
to n upon the abo m e pro rt or inspection purposes. dj�•(1 a
a I Z_I(,)-q V/ INVESTIGATION FEE TOTAL FEE
APPI-..ream r`=-+-K-=(-d J
SEE REVERSE FOR EXPLANATORY LANGUAGE
WORKERS' COMPENSATION DECLARATION
�pPdOCQ�00 1_ FOR.
, [ NJOd®DNG [�[�RG�10�
Pa er�bt�lirm that have ��� ificd�te�of consent fo self O O D
Insure o tificote o orkers Com ensation Insurance,
or certified c 1 ere. Sec 3800,'`La Cl
. _
L O C COUNTY-OF LOS ANGELES BUILDING AND SAFETY
nS
'Certified copy is here fur fished. BUILDING
FOR APPLICANT TO FILL IN ADDRESS - 2 V
-Certified copy is filed-w h t e county buil i c BUILDING -
tion deparlme '• ADDRESS /- -� � -
Date ApplicantCITY € ZIP YV72J0 LOCALITY
'CERTIFICATE OF EXEMPTION FROM W RS' '
1. - - - - - NO. OF BLDGS. - `- '+ NEAREST,
' COMPENSATION INSURAN �• SIZE OF LOT L NOW ON LOTCROSS SL r
•(This section need not be completed if the' ermil'is.for one - - - -- - -- -LOT -- - - + ASSESSOR t
hundred dollars ($100)or,less.) t TRACT BLOCK LOT NO. ^J' I. MAP BOOK' PAGE. PARCEL
,. • _. OWNER . .. /Lf/ - ' /cI /�� NO. .,
USE ONE
I certify that•in.the performance of the work for which this . >
permit is issued, I shall not employ any person in any manner _. SPECIAL - - - - d
so as to become subject to The Workers'Compensation Laws. ADDRESS ,</ -" -' - " -"^" CONDITIONS 10
V
ot, ; _. CITY-'". ... .. _.. .ZIP __. . .1 •. ad
' Date ' Applicdnt - � ~_' '-
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR A f� TEL /�r;j DISTRICT
Ekempvon •you should 'become subject to'the Workers' -- ENGINEER �7 - ZONE B W
.GROUP TYPE. `IR PROLES D V
CONST.• ti
Compensation provisions of the Labor,Code you"must forth
ADDRESSQubNO St. - d
with comply with such provisions or this permit shall be - --- - -- •--.��
o /�G-�,4zp/-. ,o- :3
deemed,revoked. ,• ' = • „ , y TEL STATISTICAL CLASSIFICATION APT. CONDO. r_ N
' CONTRACTOR /�l.J_ LC/H 31-5�- _ �
LICENSED CONTRACTORS DECLARATION • - �P � ilC.-J?afJij/'.. L CiAss NO.�DwELL UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/1 OV J NO. -�G SEWER MAP
(commencing with Section 7000)of Drviswn 3 of the Business and _ _ _ ._ LIC. _
Professions Code, and my license is in full force.nd elle CITY G/7r/!/ �•f� CLASS G. / -8K "-PG. - - VALIDATION 1.
SO. FT. NO.OF _- NO.OF _ '_,_CHECK
License Numbe--rr-� ` Lia Cla�ss/`- SIZE I STORIES FAMILIES ONE -�
/.G��Q C7/// y 8 _ .VALUATION
i• DESCRIPTION OF'WORK" ' -- ' NEW p✓r
Cont'ra' � Date ` ADD $
❑ I am exempt under Sec U � - L7- �l T�(1•- - _
,i , - - - /N ALTER*
�B BP.C. for thio reason -J G' G��Gl.. /
._ . REPAIR.. .I
- _ __ _ _ . - . USE OF
-Date:_' - S f� DEMOL El
EXISTING B - - -- -
Signature - _ "- - - -__ APPLICANT �7 TEL`` qq FINAL
OWNER-BUILDER DECLARATION (PRINT) .�C/Lr .�_EU NGLJ� C� DAT - / - "
.. . ___.. L/ z �• 4 4 8 1 A
- I hereby affirm that IamexempDfrom the Contractor's License /�`��� E�/✓S�!/�C1 L.i fry, i,i - t
- Law for the following reason (Section 7031.5, Business and ADDRESS FIN a e 'e a 'L
Profe'ssioris Code)` PRESENT Be W -
-
I, as owner BUILDING L'• e3750_
of the property, army employees with _ ADDRESS ..,j
'wages as their sole compensation,will do the work and - - _,. .
the structure is not intended or offered for sale(Section LOCALITY s s e 3 0'o
7044; Business and Professions Code). '- '- ' MOVING "-'"' - "-- -' TEL.-
I, as owner of the property, am exclusively contracting CONTRACTOR NO. , -
❑ 0421 86' ' ,
with licensed-contractors to construct the project(Sec- -' ADDRESS T ') I
.with
7044, Business and Professions Cade). - -.Y t •, t-' 'g'' 4 4 a 2'A
REQUIRED .-TOTAL SETBACK.FR .` 1 ' �, -�s_ ' _
-CONSTRUCTION LENDING AGENCY- - - SET BACK -YARD HWv PROP. LINE
WIDTH I
hereby off hat there is a construction lending agency for FRONT
the performance of the work for which this permit is issued - P.L'
'- - -' i
(Sec. 3097, Civ. C.). SIDE ' I • •'4 9, 8 8
P.L.- - e4- 8=- �
Lender's Name -- LDMA Ref. #
_ -. _ P.C. ee$ "C .�O' ' Permit Fee -. '"/- 3' - - .
0 _
- erider's Address _ D 4 21 9 $b o,
t
ce ify that I,h.ve.rea this otion.and state.that the _ :.__ '--_. .. _. Issuance Fee- - J -V' i� LDMA-P/C# L
a bo information is cc ct. to comply with all County' Investigation Fee
g din ces and State g.to-building construction,. _ - _ _ Total-Fee-' -- - LDMA Perm. #` - - -- -
o
If eby outhoriz ep fives of this County to enter
up t e ab ve- io perry for inspection purposes. _- - . _ _ T._
a SEE REVERSE FOR EXPLANATORY LANGUAGE
u
- - 'Signature o Ap cant or Agent- -• Date. .