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Home My Public Portal About10230 DAINES DR_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OFLOS ANGELES I N G 'SWM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS ID L4, LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST i CROSS ST, V y BUILDING owNfiR ADDRESS �v MAIL LOCALITY ADDRESS NEAREST -- . TEL. CROSS ST. CITY,.,.,- � NO. 1 FIRE NO. OF TYPE �}'TEGR "�. -AFaCHITECT OR TEL. ZONE PLANS �I/"' ENGINEER NO. BLDG. D,.`�,/ } SETBACK LINE '•f ADDRESS APPROVED 'TEL. BY �- _ DATE CONTRACTOR- 'NO. USE APPROVED ZONE BY - DATE ADDRESS HOUSE NUMBERING ' LEGALGy DESCRIPTION LOT NO. BLOCK MAP NUMBER Z ` FIELD CHECK BY TRACT ` �. NO. ASSIGNED BY Z�L/S.S IISATE NO OF BLDGS. - CORRECTIONS SIZE OF LOT_ 0 I NOW ON LOT I, - USB OF I NO OF EXISTING BLDG, FAMILIHS DESCRIPTION OF WORK NEW _ I ✓ALTERATION I 'I ADDITION I !l/ntlld G1 f2.-r`�r�+�.•>..l'2/b I/,'1 REPAIR - - I I DEMOLITION I I I X7 SQ FT. NO. OF Q SIZE 'r ROOM9 STORIES - D EXT WALL ROOF 1' COVERING �(f� COVERING - USE OF STRUCTURE , r V s APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY"ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION J/ PLICATION AND'STATE_THAT THE INFORMATION GIVEN IS - FORMS, MATERIALS r+/ CORRECT, a I AGREH TO COMPLY WITH THE 'CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULAT G BUILDING CONSTRUCTION. if FURNACE: LOCATION, SIGNATURE OF r�,//�((J//'� GAS VENT, DUCTS PERMITTEE LATH, INT. , - ADDRESS LATH, EXT. AUTHORIZED AGT. PLASTER, INT. 7awa38A, DBsa'' 10-60 $�G O-o P c. $ ® (p O B FEE , PLASTER, EXT. VALUATION r .t ' FEE $ �- Zd !j 3 � �'- ' I - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING n��es20 I hereby affirm that I have a certificate of consent to self Insure, 92:2 2tv BUILDING ADDRESS / OI✓ �. or a certificate of Workers'Compensation Insurance, or a certified CITY ZIP Copy thereof(Sec 3800,Lab C) 4� •7y -LOCALITY Policy No':7 J.?q !q � Company�,�, 7�?�p/"�� SIE F LOT ,NO OF BLDGS NOW ON LOT ' ❑ Certified copy Is hereby furnished NEAREST CROSS ST 1,07 Certified copy is filed with the county budding Ins tion TRACT BLOCK LOT NO department � USE ZONE MAP NO qq ASSESSOR MAP BOOK PAGE PARCEL Date�'/� Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTIO FROM WORKERS' OWNER TEL NO COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOLS YES No (This section need not be completed if the permit Is for one hundred - ADDRESS 1 0 DISTRICT GROUP TYP CONST FIRE ZONE PROCESSED BY dollars($100) or less) 13 1t C Y ZIP I certify that In the performance of the work for which this permit �� Q� -3 3 IS issued,'l Shall not employ any person In any masher SO as t0 ARCHITECT R E GINEER TEL NO e7 become subject to the Workers'Compensation Laws STATISTICAL CLASAPT APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTR TOR o— f. EL NO SET BACK YARD HWY PROP LINE WIDTH ' Compensation provisions of the Labor Code, you must forthwith 9 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L "s-0 2 SIDE LICENSED-CONTRACTORS DECLARATION CITY ) � OrI LIC,fL S PL L I hereby affirm that I am licensed underprovisions of Chapter 9 / SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT IZE NO OF STORIES NO OF FAMILIES a. Professions Code,andd my license Is in full force and effect q NEW ❑ BK PG U License Number �/�� Z LIC Class DESCRIPTION OF WORK I ADD ❑ VALUATION �_ $ ►- Contractor Date /� ALTER ❑ REPAIR ❑ L z ❑ I am exempt under Sec $ ❑ •- B&P C for this reason � 5 s DEMOL � LDMA P/C# Date USE OF E TING BLDG URM ❑ S Signature _ APPLI T(PRINT) EL No LOMA Perm# rt(=-r _ ❑ I,as owner of the property, or my employees with wages as ZO 1�I i AL 137 a 4-0 their sole compensation, will do the work and the structure is ADR S not Intended or offered`for sale (Section 7044, Business and FINAL DATE a :: sCr;f'. `!,y i f Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT NDLE A HAZARDOUS MATERIAL- OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner Of the property, am exclusively contracting with _ _ -AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed,contractors.t0 construct the project (Section 7044, YES ElNO " Business and Profesions Code) 'WILL THE INTE DED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 5 6 j1U.1 f 1/it,�f OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY �OUIDEAIR E SQUA MANAGEMENT DISTR CT.(SCAQMD)SEE PERMITTING CHECKLIST FOR LNi 1� i )1y o�oi I hereby affirm that there Is a construction lending agency for YES❑ No d/�YW W /C 1 the performance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,Civ C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE N TITLE 2 CHAPTER 2 20 S TIONS 2 20 100 THR GH 2 20 140 CONCERNING HAZARDOUS Lender's Name MATERIAPORTING F OBT IMG RMIT FROM THE SCAOMD o Lender's Address OWNE AGENT O o I certify that I have read this application and state under penalty PC FEE PERMIT FEE 0 of perjury that the above Information Is correct I agree to comply N with all county ordinances and State laws relating to building a construction, and hereby authorize repre ntatrves of this County hSSUANCE FEE �y / /O M OC(p `T to este u n the a e- Ze- S�t— y for Inspection purposes INVESTIGATION FEE TOTAL FEE m ^ a IDaa SEE REVERSE FOR EXPLANATORY LANGUAGE