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HomeMy Public PortalAbout10202 DAINES DR_Building__ 7GA638A CE#803 E-08 APPLICA`T'ION FOR BUILDING, PERMIT COUNTY -OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER, ADDRESS , BUILDING AND SAFETY DIVISION LOCALITY ti JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN SUPT OF BUILDING CROSS ST. .La ; DISTRICT NO ,GROUP TYPE PR SED BY FOR APPLICANT,10 FILL IN .5.-o -- 'CONST. BUILDISEW R MAP ADDRESS NG, STATISTICAL CLASSIFICATION CLASS NO.�_DWELL. UNITS�I K PG LOT'NO. BLOCK MAP STATE YES _ NUMBER Ct HWY. TRACT USE ZONE SPECIAL �^ NO.OF BLDGS. CONDITIONS SIZE OF LOT J NOW ON LOT /044 USE OF EXISTILQB D _ BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT > MAIL P L _ I ADDRESS SIDE , . . - .• TEL P L. Iry NO INSPECTION RECORD ARCH EO TEL. (��'./•� ENGINEEERR NO. ADDRESS TEL. Il �c'a°r�+i TION cry CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF i NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE Y^ ~T SIGNATURE OF - - - '� /!1 APPROVALS APPLICANT q ATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION- LOCATION Q FORMS.MATERIALS FEE $ FRAME- S• BRACING, BOLTS VALUATION - _ $ FURNACE LOCATION- -FEE ' GAS VENT,DUCTS Vn / I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH.INT. PLICATION AND ATE THAT THE ABOVE IS CORRECT AND' o V i / AGREE TO COMPL WITH ALL COUNTY RDINANCES AND,' STATE LAWS R NG B 1LDl C RUCTION:;t LATH, EXT. SIGNATURE OF - HOUSE NUMBER COR- ` PERMITTE -RECT AND POSTED' ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENG14SER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK M.O. CASH IAC 9.0,0 lo o �r`�' > OF OBS-3 25M BETS 6-48 �—�' DEPARTMENT OF BUILDING AND SAFETY ; ` APPLICATION FOR PERMIT COUNTY OF-LOS ANGELES ' WM. J. FOX, CHIEF ENGINEER NJ ,FOR OFFICE USE ONLY . FOR'`APPLICANT TO FILL IN BUILDING ? "1//o. {'+ DISTRICT-,NO'. PLAN CK., NO. P�ERRMIT�JNO. LOCALITY- RE IV B BY DATE OF APPL.' DATE ISSUED NEAREST' CROSS ST. 1p BUILD NG OWNER[�V/""'^"/17p �/V / VG' ADDRESS ,I ADDRESS /431�/ �i y ,�yFj f LOCALITY C- NEAREST C1�/J�M D� Ci t.��� 4 ,NOL/1,1 OR095 tST. Cr f` G L�IAJ _ FIRE NO.DF, TYPE GROUP'r�- ARCHITECT OR TEL. ENGINEER NO. ZONE. - I .PLANE I" I •-+�^"" BLDG. �. ,�f/ ORD. NO. ADDRESS/S ,A ` SETBACK LINE TEt1 , BY, DATE, /�. / � APPROVED ' CONTRACTORNO;f/ ��' ✓ " �••/f�r+ .yam + USE / APPROVED ADORES 9 y lea sA'&a�@ l ,n� 1 b> + ZON r4 BY DATE' LEGAL DESCRIPTION I LOT.NO. I BLOCK - ,CORRECTIONS TRACT �() J' S P �� ! /J'3. S: r NO..DF BLDOB.�/j�l� SIZE OF LOT ,p r' I NOW ON LOT ` " USE OFNO.OR NO:'OF EXISTING BLDG. i FAMILICS -I'ROOMS - + DE,S/CRIPTION OF WORK' NEW Y ALTERATION ADDITION O REPAIR ��jj MOVING DEMOLISH 0^ So.-FT. dr NO.OF _ Z SIZE • ROOMS STORIES - + D WALL COVERING "�+W%�-V •I COVERIN USE OF NEW •• .- BUILDING !' F HEREBY ACKNOWLEDGE THAT I iHAVE READ THIS APPROVALS APPLICATION AND BTATE THAT THE ABOVE.19 CORRECT FOUNDATION: LOCATION, INSPECTOR' DATE FORMS, MATERIALS a AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES° *;-*F—,so AND STATE LAWS REGULATING BUILD ING'CONSTRUCTIDN: ME: FIRE STOPS, 4 FRA / BRACING, BOLTS SIGNATURE OF (014 �.p` ROWNER LATH, INTA "AUTHORIZED AGT`_ _ LATH, EXT.: /•O/�� ' P. C. S /dy. PLASTER, INT. _ n` .• _FEE �q �A PLASTER, EXT. f VALUATION 1 ./' FINAL ,„' -�''•`/� "�� FEE' ��iissCCYY'"'1'U WQPKERS' COMPENSATION DECLARATION T' I hereby affirm that I have r certificate of consent To self APPLICATION B U I L D I,N G ,P E RM I T insure, or a,certrficate of Workers' Compensation Insurance, - , or��eYtified copy thereof(Sec 3800 Lab yC ) COUNTY OF LOS ANGELES - 1 BUILDINGtAND SAFETY ._ Policy No` ompany AA•�f ❑ Certified'co � Fy u BUILDING O ^ py is hereby furnishe '/ FOR APPLICANT TO FILL IN ADDRESS •7 4/-1,.)- BUILDING '' 1 � ❑ Certified copy is filed with the county,building inspec- ADDRESS tion department - �/ T -Dater ApphcanT Cll��/i�I/-9 . CITY ZIP' l �y LOCALITY C`T _ / NO'OF BLDG NEAREST', CERTIFICATE OF EXEMPTION,FROM WORKERS' ' SIZE OF LOT /'�p )C NOW ON-LOT ' ' CROSS ST-� �� o COMPENSATION INSURANCE ``• ASSESSOR (This'section need not be completed if the permit is"for,one TRACT BLOCK- LOT NO MAP BOOK PAGE PARCEL d© hundred`dollars ($100) or less ) TEL •� � OWNER USE ZONE OP I certify that in the=performance-of the work for which this SPECIAL permit is issued, I,shall'not employ any person m any mariner . ADDRESS (/ CONDITIONS so as to become subject,to'the-Workers;Compensation Laws - O CITY b L�G!T ZIP ! O. U Date ApphcanT ARCHITECT OR; TEL NOTICE•TO.APPLICANT If, after,makin this Certificate of ENGINEER NO DISTRICT, - GROUP TYPE FIRE PROCESSED BY g CONST ZONE O Exemption, ,you should become subject to the Workers' U Compensation provisions of the Labor Code, you•must forth- ADDRESS �13 3 �C(f�ti a with comply with such provisions br'this permit 'shall be 0 IB STATISTICAL CLASSIFICATION APT TCONDO N deemed revoked CONTRACTO NO Z LICENSED CONTRACTORS DECLARATION'' x LIC /— CLASS NO '�-� DWELL UNITS I hereby affirm that I'am licensed under provisions of Chapter 9 ADDRESS Z NO (�j _ ;(commencing with Section 7000)of Division 3 of the Business �y� �/ -, LIC SEWER MAP and Professions Code,and my license is in full force and effect CITY airy CLASS EiK VALIDATION /n� //- SQ FT NO OF NO OF CHECK License NumberAS—s e , Lic Class SIZE STORIES FAMILIES ONE •' - - VALUATION Contractor � ['s jQ(aS ate DESCRIPTION•OF WORK NEW ❑ S(�j y � 'ADD $ ❑Tam exempt under Sec ALTER B 8P C for this reason �r f Fey'! -�OD�' ❑ :$ • - , REPAIR ❑ D USE OF /--L MOL EXISTING BLDG DE Signatu a APPLICANT TEL FINAL ER- ILDER DECLARATIO` (PRINT) NO DATE I hereby affirm that I a exempt from the Contractor's License r Law for the following reason-(Section 7031:5, Business'and ADDRESS . '' FINAL P y -Professions Code) PRESENT. Ely,•, ❑ 1, as owneerY. r*of the ro t " or •- to BUILDING P P i ADDRESS - �"'' " '� _•' wages as their sole compensation,mYemP Yees with will do the work and �-- - �• a ;, j ' the structure is not intended or offered for sale(SectLOCALITY ;1 ion p ' 7044, Business and Professions Code ) r MOVING TEL ► l- ❑ CONTRACTOR NO - }1, as owner of the property, amiexclusively contracting with licensed contractors to construct the project (Sec- ADDRESS " ' I #- k tion 7044, Business and Professions Code•)' REQUIRED TOTAL SETBACK FROM - EXIST, CH E'.L CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH' I hereby affirm that there is a construction lending agency for FRONT = ('HAN,SE 'the performance of the-work for which this permit is-issued P L - ! (Sec-3097, Civ C ) SIDE ti'= Lender's Name i_x LDMA Ref # ' Lender's Address PC Fee$ Permit Fee "T O%' 6 3 I certify that I have read this application and state that the Issuance Fee /r�i LDMA P/C# 8 above information is correct I agree to comply with all County Investigation Fee D ordinances acid State laws relating to building construction, Total Fee fT LDMA Perm # ' a and hereby authorize representatives of this County to enter upon thea ove i t n pperty for inspection urposes SEE REVERSE FOR EXPLANATORY LANGUAGE ^ Sig re of Applicant or Agent Date