HomeMy Public PortalAbout10218 DAINES DR_Relocation__ 76A639 - C� 879 -t1-62
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APPLICATION FOR RELOCATION BUILDING PE;r,
COUNTY OF,LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A JENSEN, 5UP•T OF BUILDING CROSS ST
DIST.NO GROUfc
PE SEWER MAP PR CESS���ggq
FOR APPLICANT TO FILL IN f BKPG
PROPOSED _ c
BUILDING WATER
ADDRESS J CERTIFICATE NOT REQUIRED RECEIVED
LOCALITY / MAP /,1/1 HIGHWAY LOCA
NO D (J (CIRCLE) TATE MAJOR SECOND
PRESENT ry.
BUILDING
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ADDRE /Vj, ZONE
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LOCALITY r / ^
N zLow. --
OWNER BUILDING EXIST
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MAIL SETBACK YARD HWY STREET NAME WIDTH
O
ADDRESS B FRONT �O
+ TEL P L
CITY NO SIDE
MOVING TEL sg `. P L
CONTRACTOR ` NO J G
l - S ETY DATE RECD
ADDRESS BO $,�—��-,—�tFI"— ?ev
BUILDING TEL ate' �' "� ` O�A+E ` *E d
CONTRACTOR NO FILED BY O
APPROVALS DATEI INSAfCTORS JSIGNATURE
ADDRESS
PRESENT FOUNDATION LOCATION
USE OF FORMS, MATERIALS B O
BUILDING FRAME FIRE STOPS, W -
PROPOSED BRACING, BOLTSCIL
USE OF BUILDING- FURNACE LOCATION Z
GAS VENTS, DUCTS
SO FT. JJ / M
NO OF LATH, INT
SIZE 10 x / IQ ROOMS 'q
STORIES
WALL ROOF LATH, EXT
COVERING COVERING
LEGAL HOUSE NUMBER COR-
DESCRIPTIIOO�N•p+ LOT NO I BLOCK RECT AND POSTED
TRACT �a� CJ L FINAL
NO OF BLDGS D RICT E G JEER
SIZE OF LOT I NOW ON LOT SURETY BOND
USE OF NO OF RELEASED
EXISTING BLDG I FAMILIES Ior
HEREBY.ACKNOWLEDGE EA L CATI
I HEREBY STATE THAT.THF INF MATT GIVEN IS AND STATE,THAT THE ABOVE S CORR AND AGREE TO COMPLY
CORRECT C WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
SIGNATURE OF BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
APPLICANT AUTHORIZED yERE BY I WILL NOT EMPLOY ANY PERSON IN VIOLA
TION OF THE ABOR CODL OF THE STATE F CALIFORNIA RELAT
ADDRESS ING TO WORK McO INSU CE ` -
VALUATION $ 41� SIGNATURE OF,��ENSATI
FEE V �/ I PERMITTEE
ADDRESS
VALIDATION CK. MO. CASH JOHN F LEWIS, PRINCIPAL STRUCTURAL� ENGI EER PERIM VALIDATION CK. M O. (:
2 c 8 ��; -5 � D -3, 5.0 0 A
. '775 - 6 0 42.00-