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Home My Public Portal About10018 DAINES DR_Building__ 78AG30A DBS-2 12.54 APPLICAT10N FOR,, BUILDING PERMI`i' - DIVISION OF BUILDING AND SAFETY BUILDING /00 /9, mariner 10r Deportment of County Engineer ADDRESS County of Los Angeles - -72F ^ ,J WM. J. FOX. COUNTY ENGINEER LOCALITY v1� ± .CASSATT D. GRIFFIN, SUPCROSS ST. T OF BUILDING NEAREST 3,4 D w/A/ FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE SEWER MAP BUILDING/-- /`Q %d �� r% - ``+ - �. �J( CONST. S Z ADDRESS ' (J II NUMAP MBER ER •p-0 0 5 STATE- YES NO yaCc.,T� oN O1� OT 3g dta" HWY t O: LOT NO$pL;pW�N'� +4�D�^q'j�S1y #1 �y� BLOCK jUSNE CONDITIONS A LF 5>tr�e r Tma a�a-Pas A wi•rot oL.cw4Y / TRACT -UI. .S3�DF F- 7,.0,E OF AJOVp I I I NO OF BLDGS. SIZE OF LOT ( NOW ON LOT BUILDING YARD HWY STREET_ NAME -EXIST USE OF - _ SETBACK WIDTH EXISTING BLDG FRONT / 30 4Y- OWNER {,, µ 6i. ,, !�Or,"aoyaer- SIDE ' MAIL T/ P L ADDRESS S (-4 S �Q, I-O to 1A . CITY - 'rr-�/(,F1_.� (, `I/ NO-k TEL WELL 1 UNIT 5 INDUSTRIAL AT �'-:Zg o A$Q W 4:6G$-6 R TEL. 2 -DUPLEX_UNIT 6 PUBLIC BLDG � � NO 3j APT UNITS 7 ADDN ,ALT.,'ETC: ADDRESS _ 4 'COMMERCIAL 8 MISCEL CONTRACTORGG -& _ O. ..3 3 -- .,0INS�P'ECTION RECORD ADDRE55SO�3 N T�AC.L F•F M� M DESCRIPTION.OF WORE NEW ADD ALTER REPAIR DEMOLISH - SFT. NO OF NO OF _ SIZE ( ��. STORIES FAMILIES ( , USE O STRUCTURE ' a � ra 5 Dr✓��c N��! SIGNATURE OF APPLICANT �� APPROVALS ADDRES _ /C oV r /♦ DATE INSPECTOR'S SIGNATURE �fFOUNDATION• LOCATION $ J •��fJ, ��Q� FEE 'S / y FORMS, MATERIALS S- FRAME FIRE STOPS. VALUATION J= too� s CPO _ BRACING. BOLTS / qwr FEE r FURNACE LOCATION, I' HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS D �� APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. - AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH. EXT. /D r, SIGNATURE OF Y HOUSE NUMBER CO RECT AND POS EDR PERMITT - - - EE •ADDRESS - "may ' ' I N A L - —I WM. J. FOX. Coumw ENGINa= .VALIDATION BY ��0 8 0 7 v, SEP 19 1 6 4.��0 Y 1 3 G �D�urY N _ DEPUTY' `"' ' ' 0 1 9 1 s SEP 0 21 P BY By DEP TY 9 DEPUTY WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION F O R S U I L D I N G PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company SSS94A,—b , BUILDING /�O / (� Al❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ` I d Certified copy is filed with the county building inspec- BUILDING /DO ' AIN tion department. ADDRESS qq (� �1, q Date��7!1 Z Applicant CITY r CC ZIP / / / LOCALITY NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION F M WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. I AJ ,S 44,b µ/ COMPENSATION INSTJRANCE ASSESSOR / p (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE fD PARCEL Q hundred dollars ($100) or less.) TEL. OWNER 4/ NO. USE ZONE MAP NO. I certify that in the performance of the work for which thisp r' SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS /00I'8 ry 2 CONDITIONS O so as to become subject to the Workers' Compensatiori Laws. �7 pq U CITY 1 0—d ZIP 1731 J Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE U Exemption, you should become subject to the Workers' w Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be ''// L TEL STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR(,(f /✓ !Y y NO. 73 Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. ✓ DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 9 Yl3� ( ND I NO.SSS7D8 SEWER MAP 2 (commencing with Section 7000)of Division 3 of the Business /� LIC. and Professions Code;and my license is in full force and effect. CITY CLASS ? BK. PG. VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number SSs7'0� Lic. Class SIZE STORIES IFAMILIES ONE VALUATION LlIA1NE c7C.�ID4Sk ate DESCRIPTION OF WORK',S7_k1, - NEW .t ❑ $ -7 L/ 09 Contractor pp cc n �` ' C� L 2 i1 D RE/WCr ADD ❑ ► ❑I am exempt under Sec. ❑ II'' ALTER B.&P.C. for this reason 44K.S AlrP REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Si nature — APPLICANT TEL. ��^-• FINAL g (PRINT). /� NO. �� 3�JD OWAR-BUILDER DECLARATION n u J DATE Z O I hereby affirm that I am exempt from the-Contractor's License ADDRESS 97 3.2 / FINAL Law for the following reason (Section 7031.5, Business and �O ;. Professions Code): PRESENT By ❑ BUILDING I, as owner of the property, or my employees with 9S ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ^- 7044, Business and Professions Code.) MOVING TEL. ) ;' CONTRACTOR NO. " ❑ I, as owner of the property, am exclusively contracting ,,..:...:.,1. ,,: �..-• ,- -•••• with licensed contractors to construct the project (Sec- i -t?='•� =' ==�`' ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM ]EX CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE I hereby affirm that there is a construction lending agency for FRONT L_ f 3i4 ji the performance of the work for which this permit is issued P.L.' (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name, _ ! 1/ ;:.v.L LDMA Ref. # _ P.C. Fee$ Permit Fee �•Lender's AddressPoo -'1 certify that I have read this application and'state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Feeordinances and State laws relating to building construction, Total FeeLDMA Perm. # a and hereby authorize representatives o this County to enter u on a above-m noon ro erty f r inspection purposes. a / p !f+"(Q2-- SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Date