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HomeMy Public PortalAbout10420 DAINES DR_Building__ DEPARTMENT OF BUILDING AND SAFETY I APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO. PERMIT NO. ADDRESS LOCALITY / ^��e, J �'' RECEIVED BY DATE OF APPL. /DATE ISSUED/ NEAREST ST /rY ao'J �sCd(/ 'I' ' {(► �•` '�/1��J CA � � AUiLDINO OWNER I�AILI/g p�p fi /� ADDRESS ADDRESS J 0.4.2 N �J*A�;"A LOCALITY TEC L..y Q q NEAREBT ` - CITY �.Li�)9'1� C�,I i NO. ?° . A�Ja� )] ROSS 9T. ¢3'l FIRE NO.OF TYPE GROUP ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. BLDG. g�e�9No ADDRESS SETBACK LING � APPROVED TEL CONTRACTOR NO. BY DATE USE APPROVED ADDRESS ZONE BY DATE DESCRIPTION LOT NO.'?3 %5 BLOCK j � 'MONS TRACT30x, NO.OF SLOGS. I SIZE OF LOT NOW ON LOT , M, G �_ (��-•7RaQ UBE OF NO.OFNO.OF EXISTING BLDG, FAMILIEC ROOM DESCRIPTION OF WORK 9 NEW ALTERATION ADDITION O A REPAIR MOVING DEMOLISH p Sq.FT. NO.DF Z 9IZE ROOMS STORIES > WALL ROOF COVERING '� AA COVERING USE OF NEW BUILDING 29 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION,: LOCATION NBPECTOR DATE (� AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS.MATERIALS � 7J ���/ AND STATE LAWS REGULATING BUILDING CONSTRUCTION. „ A FRAME: FIREOLTR910NATURE OF L,• �A3216,� BRACING,BOLT®PERMITTEE �'�"�•�-'iGrLATH, INT. v AUTHORIZED AOT LATH, EXT. 76A63BA-3 2-5O $ 0 F C.* PLASTER,INT. FEE PLASTER.EXT. $ G VALUATION FEE ,fo FINAL J199-3 25M SETS 6-46 EPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY /// DISTRICT NO. PLAN CK. NO. PERMIT NO. BUILDING T DANA A, , ADDRESS �� ) / - LOCALITY RECEIVED BY DATE OF APPL. DATE ISSUED i NEAREST - CROSS ST. -- ' t BUILDING i OWNER ADDRESS W �,, r• ,.-<..E_-�,..g2,.�.^1Y �^I ADA'LDRE89 p u �~ � A `/ LOCALITY a �+ NEAREST _ TEL. CROSS ST. r t.•.. f ��•...� CITY NO. i FIRE NO.OF TYPE GROUP, ARCHITECT OR TEL. ZONE PLANS ENGINEER NO. "7 BLDG. f, /'� %RD. NO. ADDRESS SETBACK LINE TEL. APPROVED CONTRACTOR NO. BY DATE USE APPROVED ADDRESS ZONE BY DATE LEGAL DESCRIPTION I LOT NO. `� I BLOCK -"-"- CORRECTIONS TRACT f----- c _`i NO. OF BLDGS. c V ' SIZE OF LOT NOW ON LOT - ,-k�-`,�.�! ��^-�r • �, r e N�uc„� USE OFNG BLDG. I NO.OF, I NO. OF EXISTIFAMILICS ROOMS _ t-' .� /!.�C..` G�.�iiyA tJ "tom"• •�"Y !"�C,.;' DESCRIPTION OF WORK NEW ALTERATION ADDITION — o a REPAIR MOVING DEMOLISH �7 SO. FT. {'�/ NO.OF Z SIZE 7 - ROOMS STORIES / D r WALL ROOF COVERING 'v I COVERING USE OF NEW ,,:410 BUILDING - s� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION, INSPECTOR DAT[ AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF BRACING, BOLTS OWNER � LATH, INT.: AUTHORIZED A13T- 1 , �- LATH, EXT.: $ P. C. S PLASTER, INT. FEE PLASTER, EXT. VALUATION FEE �"��,, FINAL 1JEYAHTMENT OF BUILDING AND SAFETY ! [irrLl�,li a ivav r vaa roazaaa■ COUNTY OF LOS ANGELES '��� ® � WM. J. FOX, CHIEF ENGINEER ` NG FOR A<PP�LJICANT TO FILL IN FOR OFFICE USE ONLY ALiiLDI 9 S Q �vur.�-p-..��.a yDISTRICT NO. PLAN CK.NO. PERMIT NO. LOCALITY RECEIVED BY DATE OF APPL. DATE IB96ED NEAREST '> CROSS ST. BUILDING / I OWNER o .0 % cif. ADDRESS MAI ADDRESS LOCALITY / � NEAREST v TEL CROSS ST. CITY NO. FIREI NO.OF TYPE GROUP ARCHITECT OR TEL ZONE I PLANE ,� ENGINEER NO. ..1s� BLDG. ORD.NO. ADDRESS SETBACK LINE__17-..__1 APPROVED TEL BY DATE CONTRACTOR NO. USE �) _APPROVED ADDRESS - ZONE/-/� BY - DATE LEGAL DESCRIPTION I LOT NOCORRECTIONS_ 3 � I BLOCK — / TRACT NO.OF H SIZE OF LOT Q /� (J •I NOW ON LOT ` Le, / - USE OF I NO.OF NO.OF EXISTING BLDG. 'fig FAMILIES ROOMS,7? DESCRIPTION OF WORKa NEW ALTERATION ADDITION O REPAIRMOVING DEMOLISH p Sq.FT. NO. OF Z SIZE • ROOM9 STORIES r WALL ,�yam' ROOF �n COVERING !2^L�fJ�-�l� ( COVERING USE OF NEW ►I _ „ _ BUILDING i I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH.ALL COUNTY ORDINANCES FORMS, MATERIALS r AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE BTOP9, SIGNATURE OF BRACING,BOLTS OWNER _ � LATHr INT.: - AUTHORIZED AOT. DBS-3 2SM SETS 1-47 $� +I d co P.C.gi PLASTER. INT. ` FEE PLASTER, EXT. Z VALUATION .FINAL ~ ��x� � FEE APPLICATIONFOR BUILDING PERMIT r•-- -- .... ' FOR APPLICANT'TO FILL IN. •(Pnnt'brtype only) l . BUILD( c o COUNTY OF LOS ANGELES ADDRESS' / �' DEPARTMENT D, d) OF COUNTY ENGINEER CITYe ZIP- BUILDING A S FETY DIVISION NO OF BLDGS BUILDING SIZE OF LOT 7(7,0 Q NOW ON LOT- ADDRESS TRACT' , J`�L-W BLOCK LOT ' LOCALITY y TEL NEAREST A _ a OWNERM. NO Q CROSS ST , - , ADDRESS. ASSESSOR - y- � MAP BOOK, P E -PARCEL DISTRICT _GROUP.. TYPE FIRE PRO S$ED BY CITY (: ZIP` Q CONST ZONE /f . ARCHI T OR TEC - TEL - ' - •~�L� •�' �-_ �,�.�/ ENGINEER NO STATISTICAL CLASSIFICATION SEWER. AP ADDRESS - CLASS NODWELL UNITSK�'� PG TEL 'oo CONTRACTOR NO USE ZONE MAP - LIC " I NO ADDRESS NO �j SPECIAL LICa CONDITIONS CITY VY CLASS'" ROAD DEPARTMENT APPROVAL REQUIRED' _;@ - ;YES`❑•' NO CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRONT PROP LINE OF 'ISTREETI ADDRESS CITY TOTAL SETBACK HIGHWAY + YARD FROM. TYPE OF EXISTING _ SQ FT o- NO OF NO OF CHECK' — FRONT PROP LINE- HIGHWAY ,WIDTH ' SIZE yaa.T STORIES FAMILIES ONE DESCRIPTION OF WORK NEW + — - = O ADD BLDG'SETBACK FROM SIDE PROP _LINE OF (STREET) O ALTER TOTAL SETBACK FROM TYPE OF EXISTING w U) L+;j+' HIGHWAY + YARD = SIDE PROP LINE HIGHWAY WIDTH N USE OF REPAIR. ❑ ` .Z EXISTING BLDG DEMOL ❑ +` APPLICANT TEL CORNER CUTOFF.- YES 'NO , (PRINT) NO IN OPEN SPACE = YES NO BY(SIGNATURE) IN COASTAL PERMIT ZONE YES NO Q VALUATION p I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE G✓frGG- /v. +�GDi,S -THAT THE ABOVE IS CORRECTAGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDINGBUILDING O,NL�CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF _THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN,S COM - PENSATION INSURANCE - - '!��. �• S� , �� ®�, _ ' SIGNATURE OF PERMITTEE ' b ADDRESS FINAL BY- CITY 1L�.' Np� �'S~ DATE -MAKE CHECKS PAYABLE TO FEE - FET HARVEY T.BRANDT,COUNTY ENGINEER PLAN CHECK VALIDATION CK MO CASH PERMIT VALIDATION • cK M o r. 0,6,7rJ li . 2 1 Qr 4 2.00 A`,6 ,®f 76A638A CE#803 3 75 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER mulLDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY ,,//` DISTRICT'NO. PLAN CK. NO. PERMIT NO BUILDq ADDRESS ' 6-c-, 1� Q[d."/ LOCALITY / ' RECEIVED BY DATE OF APPL. DATE ISSUED _ NEAREST T !/✓'s6 -' / -Z, Z �/ CROSS ST9, fkfkj a BUILDING /•� ^/ OWNER ..(1`�� .'✓' ADDRESS lO �? Q �� j //X �%✓�,� MAIL �/`•eL,�' LOCALITY- G ( �� ADDRESS ('j J 11 CLA-L-12q o� NEAREST TEL. CROSS ST. , `j CITY NO. - FIRE �NO OF----- TYPETf�' I GROUP ARCHITECT OR.- TEL. ZONE 'PLANS ENGINEER NO. ` BLDG. / C QR�kf. _ SETBACK LINE // ADDRESS APPROVED - TEL. BY DATE CONTRACTOR NO. - USE APPROVED\ _a - ZONE BY DATE ADDRESS HOUSE 'NUMBERING 1 _ LEGAL DESCRIPTION- LOT NO. -3 BLOCK MAP NUMBER-."�'- - IELD CHECK BY TRACT llhl l/LAsl'�_6 'NO ASSIGNED BY DATE �� I NO. OF BLDGS. - CORRECTIONS SIZE OF LOT; d NOW ON LOTUSEOF Z ' T � I FA LIF EXISTING BLDG, & FAMILIHS -DESCRIPTION OF WORK NEW .i I ALTERATION I I ADDITION I -• -• - REP-AIR •I I DEMOLITION I I I _. _. A_ SQ. FT. �`n. NO. 'OF D ROOMS STORIES Y EXT. WALL ROOF - r COVERING I COVERING " USE OF STRUCTURE e5Twe.� o S' o �' APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION ' PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. _ 1 AGREE TO 'COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH+ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING BUILDING CONSTRUCTION. FURNACE: LOCATION, ` SIGNATURE OF l GAS VENT, DUCTS PRRMITTEg'Q_ y/�C_ll.� i-i..i.�,61 p�•�p(j ADDRESS �� ^ PY��P �� n// LATH, INT. • r LATH, EXT. AUTHORIZED_AGT. _ PLASTER, INT. ' 76ASSBA• DOSS .,10-80 $ P. C. $ Q �7 S , FEE PLASTER, EXT. VALUATION FEE $ .4�ll FINAL �-- -f 04803(R: 111x/7 r APPLICATION FOR BUILDING PERMIT . . .• COUNTY OF,LOS ANGELES . BUILDING-AND SAFETY-~ _'BUILDING - FORAPP-LICANT.TO.FILLIN � - ADDRESS �( " - • BUILDING t^� ADDRESS, // V V LOCALITY„ , C /� NEAREST CITY j e C i ZIP CROSS ST NO OF BLDGS / ASSESSOR SIZE OF LOT J V NOW ON LOT / MAP BOOK l_ PAGE PARCEL DISTRICT GROUP TYPE FIRE PRO SED Br /rL L 1� B OT NO "o 'g y/ CONrST/ Z NE OWNER �l V' NO T/ �D/ �/Oa � .._ {� d r P-101 STATISTICAL CLASSIFICATION EWER MAP ADD ESS 3 r/ I� •GA )b CLASS NO DWELL UNITS_ BKG _ CITY R o-•1 �r11 Q •ZIP ' f TELL1 049,ARC ENGIiNEER OR e �(�I7! S �� NO 7?�� �. VALUATION $ ADDRESS • flJjV 7I A/ TQAI, /�/Z h BLDG SETBACK FROMTEL yFRONT PROP LINE OF (STREET) CONTRACTO 04(n ryf C NO h I t TOTAL SETBACK,FROM TYPE OF EXISTING C HIGHWAY + YARD = FRONT PROP LINE. HIGHWAY WIDTH ADDRESSJ/3 O © + 1v = _ Q J�y LIC .*+�� CITY IF CLASS d CONS RUCTION LENDER BLDG SETBACK FROM SIDE PROP LINE OF (STREET) NAME AND BRANCH O�/� >' HIGHWAY + YARD = TOTAL-SETBACK FROM -TYPE OF EXISTING c. - ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH Q V SQ FT NO OF / NO OF CHECK + - ' ad SIZE O STORIES FAMILIES / ONE q 0 USE ZONE _ MAP y C� _ _ A DESCRIPTION OF WORK Q-- Yi NEW ❑ // Sp n MA OS �� ('j'V+ hL- ` Ih0 Q Sr C. �(%, ADD PECIAL 11( Up CONDITIONS ALTER FINA r� /� BY l g REPAIR' ❑ DATE �/ k USE OFx/ ❑ EXISTING BLDG -�N Q ,� m .; DEMOL ; •aZ - APPLICANT TEL C (PRINT) NO ti BY(SIGNATURE)_, _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y 1'0 2 A ` THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES •AND LAWS REGULATING BU' NG CONSTRUCTION 1 CERTIFY THAT IN DOING THE _ y� 0 WORK AUTHORIZED HEREBY ILL NOT EMPLOY ANY PERSON IN VIOLATION OF V N o 0 0 0 0 1 THE LABOR CODE OF THE ST T OF CALIFORNIA IN RELATING T ORKMEN S COM ,�- '�' Z _ _ •_ PENSATION INSURANCE r - rT V p 1•�L nt 0 O - L 7 SIGNATURE OF- o 0 l 6 9 0 I�1'� , V' PERMITTEE ' ADDRESS L�YV w 0703-80 , Z TEL CITY ) 6 NO PC Fee$ Permit Fee Issuance Fee a, _ d Total Fee R WORKERS' COMPENSATION DECLARATION 0iitiereby affirm, that I have a certificate of consent to self � APPLICATION FOR BU I L D•I-N G,-PERMIT irmure, or a certificate of Workers' Compensation_ Insurance, 'N)r a ce t�fied'copy thereof (Sec 3800, Lab C ) 7 COUNTY OF LOS'ANGELES' BUILDING AND SAFETY -Policy No- I Company 5�� FI/ AA BUILDING - Certrfied.copy is Hereby furnished - - FOR'APPLICANT TO FILL IN, ADDRESS ❑ Certified copy is filed with the county building'tnspec- BUILDING - _ tion department ADDR`E�S�S' fj/I " CITY" f, '~ -ZIP LOCALITY Date p'licarit NO OF BLDGS - NEAREST -• . CERTIFICATE OF EXEMPTION FROM KERS' SIZE OF LOT NOW ON LOT CROSS ST t COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK, PAGE PARCEL t,hundred dollars ($100)br less.) ° TEL OWNER - NO of i� USE ZONE OP �'r' -1 certify that,intthe performance of the work-for which this SPECIAL >_ permit is issued, I shall not,employ any person in any manner ADDRESS �1 ,S / CONDITIONS so as to become subject to the Workers' ompens tion Laws ; �- O CITY ZIP ' Date Applicant i ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY' 0 NOTICE TO APPLICANT If, after,making is ertificate of- , ENGINEER NO / CONST ZgNE t- Exemption, you, should become subject to the.Workers' 0�D� 1�{ _ - a - U Compensation provisions of_the-Labor Code, you,must forth- ' ADDRESS �/ ✓ V c J _ R with comply with such provisions or this permit shall be TEL _ STATISTICACCLAATION'_ APT CONDO Z deemed revoked t CONTRACTOR Q NO Q`YL — LICENSED-CONTRACTORS DECLARATION' , y LIC pp,� CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS y� N 7�0.�' LIC SEWER MAP (commencing with Section 7000)of Division 3 of the Business 'and Professions Code,and my license is in full force and effect, CITY CLASS i� BK VALIDATION SQ-FT_ NO OF• NO OF CHECK License Number ?}�.�� _Lic Class SIZE, STORIES FAMILIES ONE 7 VALUATION Contrdctor Date L DESCRIPTION OF WORK NEW ❑_ s ❑1 am exempt under Sec" - ADD Poo- ALTER ALTER ❑ - B&P C'for this reason ( l G '- REPAIR ❑ $ - Date*-- USE EOIF BLDG DEMOLEXIST ❑ Signature APPLICANT TEL FINAL OWNER-BUILDER DECLARATION (PRINT) - NO DATE //'o , I hereby affirm that I am exempt from the Contractor's License - - _ w . ' Law for the follow-ing§reason'(Section 7031 5; Business and ADDRESS FINAL U S .. Professions Code) '• • . PRESENT - - - - BY \ '• ❑ BUILDING I, as' of the property,.or my employees with ADDRESSt-k dog' wages as their solecompensation,will do the work and the structure is not intenddeor offered for sale(Section MOVING LOCALITY TEL , a� ' 7044, Business and Professions Code ) : CONTRACTOR NO ,F f El Ci I,'as owner of the property, am exclusively contracting ' with,licensed contractors to construct the project (Sec- ; TOTAL _ ADDRESS i 1 HL d" tion 7044,.Business and:Professions Code ) REQUIRED YARD HWY TOTAL SETBACK FROM 'EXIST " !;� Ecr CONSTRUCTION-LENDING AGENCY �;j o-_ SET BACK PROP LINE WIDTH L; I hereby affirm that there is a construction lending agency for FRONT ` the performance of the work for which this permit•is issued PL (Sec 3097, Civ C ) SIDE PL. . . Lender's Name LDMA Ref Lender's Address P C Fee$ Permit Fee "75 � ° 'I certify that I have 'ead this application and state That the' Issuance Fee B C7 LDMA P/C# ► o t 8 above information is correct I agree to comply,with all County Investigation Fee R ordgn nd State to - +relati To building construction, Total Fee D a� LDMA Perm # anduthorize a esZnives-of this County to enter upove en on rty for inspection purposes� SEE REVERSE FOR EXPLANATORY LANGUAGE ^� re'o Applican r Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0903160015 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ON FILE SQ FT STORIES TYPE 10420 DAINES DR ISTRUCTURE 2600 V-B TEMP CA 917802811 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET. HALLOWELL 18586-028-013 THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY, Cl ITENANT JEXIST BLDG USE RESID USE ZONE- R-1 JISSUED ON PROCESSED BY EXIST OCC GRP 103/16/09 SR I OWNER TEL NO IBLDGS. NOW ON LOT. VALUATION IFINAL DATE FI AL BY CODE IGAO, JOANNA (626) 452-9156- 1 3,500 1 110420 DAINES DR I� ITEMP 917802811 FEES PAID IDESCRIPTIO14OF WORK IREROOF OVER THE EXISTING WITH SHINGLES IFEE DESCRIPTION QUANTITY UOM AMOUNT (APPLICANT. TEL NO- I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 75 1 IAB STATE GREEN BLDG FEE 3500 00 VAL 1 00 ISPECIAL CONDITIONS 1 ID2 PERMIT W/O EN-HC 3500 00 VAL 115 80 IFR INV WORK W/O PERMIT 257 00 DOL 257 00 TOTAL FEES 401 55 ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1 ISAME AS OWNER I1 LIC NO i (LOCATION AND SETBACKS ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL NO I IFOUNDATION/TRENCH FORMS I I I LIC NO I ISLAB/UNDER FLOOR IRAISED FLOOR FRAMING I 1 IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDERFLOOR INSULATION I I I 1147H273 3 001 I I I I I I IFLOOR SHEATHING I I I INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS- I I I I NO 21 1 (ROOF SHEATHING I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I 1 (AIR QUALITY 1000 FEET MATERIALS I I I NO NO NO 1 (FRAME INSPECTION IREQUIRED TOTAL SETBACK FROM EXIST IFIRE SPRINKLER HANGERS ISET BACK YARD HWY PROP LINE WIDTH I I I IFRONT PL- I IINSULATION/WEATHER STRIPI I I SIDE PL- I I I I I I (INTERIOR LATH/DRYWALL I I I (EXTERIOR LATH I I I IRATED FLOOR/CEIL ASSEM I I I IRATED WALL ASSEMBLIES I I IRATED SHAFTS/OPENINGS IT-BAR CEILINGS I I I ILOT DRAINAGE I I I IREPORT ID DPR261 ROUTE TO SS0508 I I I I I I I I API='L.ICAI'ION FOR .I3U ILD ING PERNttT FOR,�PPlICAN?TO FILL IN. (Print or type only) t i roe i� �L ✓ t. b COUNTY OF LOSANGELES _ I►OORESS acOa6s/&1yx40 �; DEPARTMENT OF COUNTY ENGINEER - • ; CITY zIP `�.. £ BUILDING A S FETY DIVISION • OQNER y f NO OF ILOO BUILDING 4S�A SIZE OF L r ��( O Q NOW ON LOT ADC } TRACTM , �S--(op BLOCK LOT ' LOCALITY �`1•J�N c: /lJ4T TEL NEAREST --_•--...�� OWNER NO Q CROSS Si U -�` 712 7a OJT710� — ASSESSOR ADDRESS a AAP BOOK ! E PARCEL DI TRJCT.f GROUP TYPE FIRE P ED BY SILL I i CITY ZiR CONST ZONE _.. ARCHITECTOR TEL Q •. �___ —. ._.t......___..__...._.—_.__.________..-._....._._..._.___....... ENGINEER NO STATISTICAICLaSSIFICATIpN S ER P ADDRESS CLASS.•:^ DWELL UNITS PG TEL ' CONTRACTOR NO USE ZONE AAP ��/�Z� i✓��21/S�G _ LIC ♦O 773 - _....._— _ ..... _...._.... - -- -._....__........_................ ADDRESS NO V 14 UC C VDIirONSCITY �j ONSTRUCTIp (ENDER CLASS ROAD DEPART.w�ENT APPROVAL REQUIRED 'YES ❑ NO C] < f NAME AND BRANCH BLDG SETBAuc FROM J I FRONTPROP LNEOF (STREET( k - - _..__.._... ADDRESS GTY TOTAL SETBACK FROM TYPE OF EXISTING t �t / / /!J- 50 FT 00 NO OF NO OF CH[{K HIGHWAY_ - YARD , FRONT PROP LINE HIGHWAY WIDTH L�� D A�- T f E �� T. .. .. — SIZE po.i STORIES FAMILIES ONE �� +: /Yc? .Grp DESCRIPTION OF WORK NEW O /.. :_ BLDG SETBAC:=40M .............. ADD S,OE PROP LIN_OF (STREET) O - ALTER TOTAL SETBACK FROM TYPE OF EXISTING uVi {` #EOF�T HIGHWAY T YARD SIDE DRQP LINE HIGHWAY WIDTH k REPAIR ❑ T EXISTING BLDG DEMCI ❑ / Q J(stx C APPLICANT TEL .COR,VER CC,TOFF YES NO ❑ IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) IN COASTAL PER.+AIT ZONE Y6 ❑ NO ❑ •- VALUATICN S / � ��. r n?/,�r'.�C /�J 14.1 s':�i^"'�c�• � � � . I HEREBY AC04OWLEDGE THAT I HAVE READ THIS APPLICATION AND STATC -••••••---•••• •-••- •- ••••-- •••--• —' -' 1 THAT T'HF ABOVE IS CORRECT AND AGREE TO CO h4AlY WITH ALL ORCINANCES !� - -i -AND LAWS REGULATING BUILDING CONSTRUC'ION 1 CERTIFY THAT IN DC.NG THE O.�l _'•�; -�-%="'^-� - - /I�' • _ - ` WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN V!OLAT OWN OF `� i V _THE LABOR CODE OF THE STATE OF CALIFORNIA,N RELATING TO WORKMEN 5 COX . .. -. - _.... _ ::_ ... ........._ - - PENSATION INSURANCE - �G1 /y� ;.?i. of 7 OAC SIGNATURE OF _ l t _ _. i _------------- 'ry----------------------- _. PERMITTEE ADDRESS _ L - — - r) TINA( BY 1 QTY 4feqfgIO DATE .......—...._ _ ` _ c " MAKE CHECKS PAYABLE TO p ', FEET $F HARVEY T.BRAN DT.COUNTY ENGINEER Y;. a - ^•s_ f ( i j PLAN CHECK VALIDATION - CK. cs+. _ °ERMT VALIDATION uc w o. =="' = -