Loading...
HomeMy Public PortalAbout10414 DAINES DR_Building__ _ v DEPARTMENT OF COUNTY RNGMM - 4 ISM ION OF BUILDING AND SAF R lfo 1953U-1 LD COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER APPLICATION --- CA88ATT D. GRIFFIN, SUPT OF BUILDING i f FOR APP CANT TO FILL IN FOR OFFICE.USE ONLY BUILDING DISTRICT NO i PLAN CK.OR REc.fN�o. PERMIT NO. ADDRE88 ° .1 Lo s(.,.! V /(J(I 3 ,4 LOCALITY R CEI,VpE�D�BY/ ZDATE OOFAPPL. DATEISSUED NEAREST CROSS STps BUILDING ADDRESS f 04 GWaI/� I OWNER MAIL • LOCALITY ADDRESS TEL NEAREST ITY f CROSS ST. co ARCHITECT OR TEL. _ FIRE I NO OF I .TYP - - I GROUP + ENGINEER p - ZONE PLANS BLDG I I �A ,�" l ORD NO I ADDRESS SETBACKLINE TEL• ,� USE J� APPROVED ' CONTRACTO a ZONE T'I ' BY, PAT19 ADDRESS ;^ HOUSE NUMBERING LEGAL - - MAP NUMBERO. ASSIGNED BY� DESCRIPTIO T N BLC9V COR CTION TRACT NO. OF BLD SIZE OF LOT NOW ON LOTAic USE OFNO. OF EXISTING BLDG S FA [LIES / Lzi DESCRIPTION OF WORK " o — NEW J �I ALTERATION ADDITION 2 D REPAIR, DEMOLITION H r. SQ FT NO. OR _ SIZE } ROOMS STORIES EXT. WALL ROO COVERING I COVERING UB OF STdU70RE ,v s - O APPROVALS INSPE OR'S SIGNATURE DATE FOUNDATION. LOCATION FORMS, MATERIALS (o 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN 19 BRACING, BOLTS _ CORRECT FURNACE, LOCATION, J 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES` GAS VENT, DUCTS 7 AND STATE LAWS REGULATING BUILDING CONSTRUCTION v SIGNATURE OF LATH, INT + A�• PERM ITTE G� LATH EXT. ADDRESS PLASTER, INT. AUTHORIZED AGT. PP�J((�� PLASTER, EXT � FEE >$ J R Hous R RECT AND POSTED VALUATION O O FEE s J/ -FINAL r 76ASSBA 0863 9-92 �..- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN B L INGQAp)RESS /+ I hereby affirm that I have a certificate of consent to Self Insure, BUILD NG ADDS ` K or a certificate of Workers' Compensation Insurance, or a certified Y Z Q ZIP Q- - copy thereof(Sec 3800,Lab C) ` ,� (� l 1 QT �t�\Cty(� `l Policy NO Company SIZE OF LO`K.• v NO OF B N`OW ON LOT ` 4T ❑ Certified copy is hereby furnished N RESrT CF105S ST TRACT BLOCK LOT NO ^ h-� ❑ Certified copy is filed with the county building Inspection J USE ZONE MAP NO department � �/a Date Applicant ASSES �Q PACE � � " Cx� C] �SPECONDfTIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NER ` `—/ COMPENSATION INSURANCE AA RRQEEISS \e`�� e� ., I o��'4 WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed If the permit is for one hundred 1 O/1 ISA 1\ ` e S (\ j DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) �i Q.J v / I certify that in the performance of the work for which this permit e fj /SC7 j� J is Issued, I shall not employ any person in any manner so as to become bje t t0 the Worke 'Comp ation wS ARCHITECT OR ENGINEER TEL NO 3 STATISTICAL CL21 ATION APT CONDO Date Applicant LA, ADDRESS CLASS NO •G- DWELL UNITS NOTICE TO APPLICANT If, after making this Cer icate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR _ _ - TEL NO "" _ SETBACKYARD _ HWY A. � PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith ©CQ� FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO —PL LICENSED CONTRACTORS DECLARATION PILE CITY LIC CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP CL SQ FT SIZE NO OF STORIES NO OF FAMILIES (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG �O Professions Code,and my license is in full force and effect U License Number Llc Class DE IPTION OF wpRK� _/ ADD ❑ �� ® CD �,p VALVA ON Contractor Date ALTER v `�Q I am exempt under Sec a REPAIR ❑ $ N � � -q z BBPC for this reason boIct l.(' [61N DEMOL ❑ LDMA P/C# Date U OF EX ST G BLDG URM ❑ - Signature APPLICANT('6t) TEL NO LDMA Perm# L ❑ I,-as owner of the property, or my employees kh wages as Z 3 their sole compensation, will do the work and the structure is ADDRESS O 1'.°-i¢a not intended or offered for sale (Section 7044, Business and FINAL DATE QPoo, Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL (� a OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'SS• FINAL BY licensed contractors to construct the project (Section 7044, _ Business and Professions Code) VES❑ - NO❑ v WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES i I hereby affirm that there is a construction lending agency for VES❑ No❑ ITEM-:, a the performance of the work for which this permit is Issued(Sec - AND THE°D REQUIREMENTS 3097,CIV C) CHAZARDOUS OMIDE STII i — CHECKLIST I UNDERSTAND UNDER THLOS ANGECOUNY CODE TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS �) Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD -HEI_f�X o Lender's Address ONNER OR AGENT -x'11-V4GE 1} oI certify that I have read this application and state under penalty - o P C FEE PERMIT FEE of perjury that the above information Is correct I agree to comply �) �D awith all county ordinances and State laws relating to building (1 _) I�_, h! m construction, and hereby�authonzer ntatives of this County ISSUANCE FEE // - rt co I pon t� ab r rty r Inspectlo purp sly,' `t=4- i i11 rti, ,p 1 INVESTIGATION FEE TOTAL FEE ^ sq �a ropes«Agea oae SEE REVERSE FOR EXPLANATORY LANGUAGE _ APPLICATION F®R_,BVILUNG PERMIT r COUNTY OF LOS ANGELES ' - _, BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI GAD Ess UILDI DDRE �� I hereby affirm that I have a certificate of consent to self insure, t or a certificate of Workers Compensation Insurance,or a certified `/�+ • copy thereof(Sec 3800,Lab C) pYw4 ( -\ /\ ZIG , �g LOCALITY Policy No Company SIZE ..OF \ ((NfrO[OF BLD`S OW O LOT El Certified copy Is hereby furnished 4� (� NEAREST CROSS ST JF ❑ Certified copy IS filed with the county building Inspection TRACT BLOCK LOT NO department USE ZONE MAPOL, -73 Date - Applicant ASSESSOR AP BO K� PAGE PARCEL '1.4 7 C//� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' 0 R ` �� S \ 21 NQ/ 1_q 5 YES NO COMPENSATION INSURANCE, 50. d 1�Q WITHIN 1000 FT OF SCHOOLS (This section need not be completed,rf the permit Is for,one hundre �O/L�/I / 1 e� DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) _ I certify that In the performance of the work for which this permit v Is Issued, I shall not employ any person in any manner so become subje t t0 the WO rS'COm"abon S ARCHITECT R ENGINEER TEL NO STATISTICAL•CLP SI ICATION -APT CONDO Date` 2� TApplicant ADDRESS CLASS NO DWELL UNITS NOTICE"TO APPLICANT IC after,= making -this Certificate o _ REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become -'to the Workers' CONTRACTOR TEL NO- SET BACK--` YARD HWY PROP-LINE --- WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL ' LICENSED CONTRACTORS DECLARATION SIDE CITY LIC CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9• SEWER MAP (commencing with Section 7000)of Division 3 of the Business andS SIDE NO OF STORIES NO OF FAMILIES Professions Code,and my license is In full force and effect 6 NEW ❑ BK PG a License Number Lic Class 13N OF WORK ADD VALU tN O Contractor Date oh O �f U ALTER ❑ I am exempt under Sec e- REPAIR ❑ O B&P C for this reason � V Q C (C� e QS Z1111[to DEMOL ❑ w ' LDMA P/C# _ Date E F EXISTING BLDG ►i+Gt7�T� 3 'A&U2 CO❑ .._ CO Signature LI ANT(PRI )• 4 -• 13 'A -� LDMA Perm# { Z_ I, as owner'of the property, or my employees with wages as ` 44 S5 Z o their sole compensation, will do the work and the structure•is j DD not Intended Or offered for sale (Section 7044, Business and t 4( (�E'S e �I FINAL DATE` ` Professions Code) �1 !" In a WILL THE APPLCANT OR FUTURE BUILDING OC PANT HANDLE A HAZARDOUS MATERIAL In OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE `� ❑ I, as owner of the properly, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY i licensed contractors to construct the project (Section 7044, ves❑ No❑ `-T'4 Business and Professions Code) ' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING �!,_ �+ OCCUPANT REQUIRE A PERMIT FOR,CONSTRUCTION OR MODIFICATION FROM THE SOUTH ti' '� *°•E-' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR €- GUiDEUNES hereby affirm that there is a construction lending agency for Es❑ No❑ T^ —+ N, the performance of the work for which this permit Is Issued(Sec y f t h= 3` 4 ® a� Q. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE A PERMITTING N 3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE S EL CO Y CODEi— TrrLE 2 CHAPTER 2 20 S TIONS 2 20 100 ROU 0 0 NING HA ARDOUS 3 Lender's Name LS REPO T NGM FO NI FR AQ o Lender's Address -1= O ONNER OR AGENT o I certify that I have read this application and state under penalty o P FEE PERMIT FEE d of perjury that the above Information is correct I agree to comp) a . 1 7 € flt_i+—_;p51)� f', t a with all county ordinances and State laws relating to building V / / _ " 1 �= r Mconstruction, and hereby authorize representatives of this County ISSUANCE FEE ente 4Fte a eae-mentio roperty for mspectl n purp ses 2 � y.� INVESTIGATION FEE TOTAL FEE sgu�ve a AP W M o c Dere SEE REVERSE FOR EXPLANATORY LANGUAGE