HomeMy Public PortalAbout10214 DAINES DR_Relocation__ 76A6�f9-'CE 87,8`- 8-62
APPLICATION FOR RELOCATION BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 11—C .
BUILDING AND SAFETY DIVISION LOCALITY % i C-%
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUPNEARESTT OF BUILDING CROSS ST /
DIST NO GROUP TYPE SEWER MAP PROCESSED BY
FRR
R APPLICANT TO FILL IN ,[`�r7 CON SK PG
�- J
WATER ❑
CERTIFICATE NOT REQUIRED RECEIVED
_SENT NOP 4 Z9 L? HC R �L
CLE) STATE MAJOR SECONDOCA
BU
MAIGHWAY
ELD NG ��'' ��may' (��/� '�1/ USE SPECIAL
ADDRESS
CONDITIONS
LOCALITY ,./_
OWNER l ( BUILDING YARD HWY STREET NAME EXIST
MAIL �/--� % SETBACK WIDTH
ADDRESS
nv FPROL T f l \ V C,TEL !
CITY /iCi1��' .AI�� NO -/F+1�.� SIDE
MOVING TEL. P L
CONTRACTOR NO
SURETY DATE RECD
ADDRESS (✓� I BOND $ FILED BY }.
CL
BUILDING TEL. / CASH DATE RECD O
CONTRACTOR / NO �O D DEPOSIT $ FILED BY V
ADDRESS APPROVALS DATE INSPECTOR S SIGNATURE
PRESENT FOUNDATION LOCATION O
USE OF FORMS, MATERIALS V
BUILDING FRAME FIRE STOPS, d
PROPOSED BRACING, BOLTS N
USE OF
FURNACE LOCATION z
BUILDING-
GAS VENTS, DUCTS
i
SQ Fle. NO OF LATH, INT
SIZE ROOMS STORIES
WALL ROOF LATH, EXT
COVERING COVERING
LEGAL _ HOUSE NUMBER COR-
DESCRIPTION LOT NO. BLOCK RECT AND POSTED
TRACT �i' FINAL
NO OF BLDGSI TRICT ENGINEER
SIZE OF LOT SURETY BOND
I2` NOW ON LOT RELEASED
USE OF NO OF
EXISTING BLDG FAMILIES I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
1 HEREBY STAT6THAT THE 1NFORMATI GIVEN IS AND STATE THAT THE ABOVE IS CORRECT AND AGREE ATO COMPLY
CORRECT �A �/� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
SIGNATURE OF /�'II I,� / _/I' ,��`/' BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
APPLICANT 8L-, �� AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA.
TION OF THE LAPOR CODE OF THE STATE OF CALIFORNIA RELAT
ADDRESS INC TO WORKME S COMPENSATION INSURA E ,
r
VALUATION $ P C $ �+ �1 SIGNATURE OF
�® _FEE ®1�.� PERMITTEE
FEE /J . ADDRESS
VALIDATION CK. MO. CASH JOHN F LEWIS, PRVCIPAL STRUCTURA GINEEI�\
PERMIT VAIAdATION K. M CASH
7 3,1c-_A?R � 3 0.0 0 •- .�
f% ' '
! I
8 €B 20 6 0 1 5.0 0 A9c
7 3,2c--APR 26 2.5- D 3 5.0 0 m��