HomeMy Public PortalAbout10525 DAINES DR_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDINGCOUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY C { ZIP �$Q BUILDING AND SAFE DIVISION
NO OF BLOGS / BUILDING
SIZE OF LOT --/y(/�L/r NOW ON LOT g ADDRESS Q�
TR4!!� `I' BLOCK ) L T r0, �./ LOCALITY
OWNER at/ �y NEAREST
NOL 7�� � a CROSS ST
h ASSESSOR-
ADDRESS o{ r �J ,MAP BOOK PAGE 12AZCEL
c f y, DISTRICT GROUP TYPE FIRE PVROCSSED BY
CITY �` ry1�i,•_ n 1 ZIP a Q _ CONST ZON
ARCHITECT OR TEL I --- I
ENGINEER, O L,L1Y NO STATISTICAL CLASSIFICATION
_ SEWER MAP
ADDRESS CLASS NOEL_-DWELL UNITS /1/-BK/41G
CONTRACTOR TEL NO USE ZONE MAP
'� NO
LIC -�) UV SP
ADDRESS NO ECIAL
LIC CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER 5-t
NAME AND BRANCH rC ri-I BLDG SET ACK FROM -
/ FRONT PR P LI NE OF (STREET) d
ADDRESS_ LQ ►ti S CITY ,T.ti P �f �� TOTAL SETBACK FROM TYPE OF EXISTING U
HIGHWAY + YARD
SO FT NO OF NO OF CHECK _ _ FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE f=
CD
DESCRIPTION OF WORK NEW U
,�YJ t7/�
ADD BLDG SETBACK FROM d
G - /�� SIDE PROP LINEOF (STREET) Z
ALTER ❑ TOTA S TRACK F TYPE OF
REPAIR EXISTING --
❑ HIGHWAY } YARD = SIDE PROP LINE HWAY WIDTH
USE EXISOT NG BLDG DEMOL 1:1 +
APPLICANT TEL [ CORNER CUTOFF YES ❑ NO ❑
(PRINT)
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE)
IN COASTAL ZONE YES ❑ NO ❑
Q CQ
VALUATION��VV LI(J CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT_ IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY IWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE �-"& �5
01
LABOR CODE OF THE STATE OF CALIFORNI IN RELATING TO
WORKMEN,5 COMPENSATiON INSUR�
WORKMEN'S COMPENSATION INS URA NC • F T@�y 7F G� A� `P"
SIGNATURE OF_,
PERMITTEE
ADDRESS- ,;�9�Z2.5<11' � L r
/jam FINAL BY
CITY �G//&�7n IL NO LP.G DATE
Q �j
tl 11\L ( IIL( 1`S P 1),11317 10 FEE ✓ FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION cK M o ,CASH
5 6 8 JUN 17 1 D 2 8.55 0 A96
76A638A CE#803 12/72 _
76A638A CE 4803 12/69 � > `"
APPLICATION FOR BUILDIYV G PER;) T
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING A,�
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS GV
COLEMAN W. JENKINS, SUP T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
Print or tyDe only)
BUILDING DISTRICT N GR P T NS
ADDRESS d �z J — /9 ACS �'" ONSPE
T /
STATISTICAL C ASSIFICATION SEWER MAP
LOT NO BLOCK
I CLASS NO DWELL UNITS _ BK PG
TRACT USE ZONE MAP /�
NO OF BLDGS NO V -
SIZE OF LOT NOW ON LOT SPECIAL '
USE OF \ CONDITIONS
EXISTING BLDG
OWNER , �7 /L/ NOL
BLDG SETBACK FROM
ADDRESS
`(JS kr Df' LAVES PJQ FRONTPROP LINEOF (STREET)
TS 44�- C�i�J f G� 7 O TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY HIGHWAY WIDTH FROM C L
ARCHITECT OF4 TEL + _
ENGINEER NO
BLDG SETBACKOM
ADDRESS SIDE PROP LINE O (STREET)
TEL fYPE OF EXISTING SETBACK H + YARD = TOTAL
CONTRACTOR NO HIGHWAY WIDTH, FROM C L
LIC y + = a
ADDRESS NO
O
LIC V
CITY CLASS CORNER CUTOFF YES ❑ NO ❑
CONSTRUCTION LENDER c:)
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS w
ADDRESS CIO
SO FT NO OF NO OF ❑ Z
NEW
SIZE STORIES FAMILIES
USE OF /� ADD El
STRUCTURE C / U v u
ALTER •
OOJIt Ido p d �✓ A z> REPAIR❑
SIGNATURE OF
APPLICANT DEMOL ❑ r
VALUATION$ APPROVALS DATE INSPECTOR'S 51 GNA TU RE
P C PMT !FOUNDATION LOCATION `
FEE $ FEE $ FORMS, MATERIALS --i, -10
FRAME FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION,
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY_I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT '
LABOR CODE OF THE STATE OF CALIFO IA IN RELATING TO
WORKMEN'S CO NSAT10 INSURANC C LATH, EXT
v
SIGNATURE O HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS .S �`� �' FINALid
_f0 - 7 d
JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER
PLAN CK VALIDATION CK M 0 CASH _ PERMIT VALIDATION- CK -M 0 CASH
I-Pr,15-2.8 5R M g, 'b 1 D — 9.0 0^
BA CE #803 1/71 T % • `
,APPLICATION FOR'BUIL NG PEiV
MIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF,COUNTY ENGINEER I MAP'BOOK PAGE PARCEL
J
BUILDING AND SAFETY DIVISION a" BUILDING
ADDRESS /.O:2 ti
COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY
FOR'¢APPLICANT TO FILL IN . , NEAREST
Prmt�or t e�Onl CROSS ST
_ DISTRICT NO - GROUP 'TYPE .�P OC SSED BY
BUILDING D �y CONS
ADDRESS /v b
STATISTICAL CLASSIFICATION SEWER MAP
LOT NO
BLOCK y�CLASS NO �� DWELL UNITS BK SPG -
�TRACT, '(_, .i. _ •• , USE ZONE MAP
~ ' NO OF BLDGS - NO J
SIZE OF LOT _ - ,NOW ON SLOT _ / SPECIAL `
EXISTING
C - q__�� CONDITIONS' '
EXISTING„BLDG � �J'/' /�/L�
S t
OWNER Lie NOL G
BLDG SETBACKFROM
ADDRESS J Z �} - FRO -PROP LINEOF (STREET)
�, ` AJ� ` T TYPE.OF EX NG SETBACK HIGHWAY } YARD = 'TOTAL
CITY: L " HIGHWAY WIDT FROM C L
-ARCHITECT OR TEL } _
ENGINEER _ _ NO BLDG SETBACK FROM
ADDRESS �' t tisl- y a_~ SIDE PROP LINE OF (STREET)
TEL- TYPE OF EXISTING ''SETBACK HIGHWAY -
YARD = TOTAL 0
CONTRACTOR; NO HIGHWAY-,WIDTH FROM C L
6�
LIC
ADDRESS ,, , . C NO t _ �
O
CITY - 's CLASS d CORNER CUTOFF YES ❑ NO,vr Lu
CONSTRUCTION-LENDER N
NAME,AND,BRANCH', E DE SEE REVERSE SIDE FOR SPECIAL APPROVA z
SQ FT •' NO OF' ti NO OF NEW✓ ❑
VAU
SIZE 4, STORIES, r .FAMILIES
USE'OF ADD
9-3 v -7/ d w 1Jc Lt .D, wti l-L'
STRLTC TURE y. 1
AL XER-O GIF' L I AI 0 VA—V_5 J,:—,04
SIGNATURE
SIGNATUEOF k� /�i�/J� " Y t REPAIR❑ _ f`C! �G�� LrS/I✓ '//t i7[�I .t/l .S7✓°
APPLICANT , Z- DEMOL,❑ w !
VALUATION $' APPROVALS 5AT,E rsP TOR's sl N TORE
t
P C PMT FOUNDATION LOCATION
FEE S FEE $ , z, U FORMS, MATERIALS
-FRAME FIRE STOPS, y +
I HEREH
BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT ANDAGREE TO COMPLY FURNACE LOCATION,
WITH ALL ORDINANCES AND LAWS ,REGULATING IBUILD'INQ CON- L '. A -VENT, DUCTS '
STRUCTION I CERTIFY THAT IN DOING THE WORK 'AUTHORIZED� '
HEREBY WILL NOT EMPLOY--ANY•,TPERSON IN VIOLATION OF THE 'LATH, INT
LABOR CODE OF THE STATE OFCAL'IFORNIA IN+.RELATING-TO
WORKMEN'S COMPENSAT N•INSUR'ANCEI .J 3
_ +LATH, EXT.
SIGNATURE O C . 'HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED 77
ADDRESS ° FINAL . (�
JOHN+F ,LEWIS,nPRINCIPAL_$T TU RAL ENGINEER
— PLAN CIIECg VALIDATION CK M o ' cnsH _ PERMIT VALIDATION CK M O CASH
- I Q('_ 0. 9 5,6- &N18 .{ , 1 .D 12.0-0-
7YAB7BACE#803.9 60 APPLICATION FOR BUILDIN PERMIT
COUNTY OF LOS ANGELES BUILDING J
DEPARTMENT OF COUNTY ENGINEER ADDRESS/ 0
BUILDING AND SAFETY DIVISION LOCALITY ,
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUPT OF BUILDING CROSS ST
DISTRICT NO GP vj
YpE f
PR ESSE QY
FOR APPLICANT TO FILL IN CONST
BUILDING1/ STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS
CLASS NO DWELL UNITS
LOT NO — BLOCKMAP STATE
NUMBER ®� / HWY YES 10�
TRACT Q USE ZONE SPECIAL �/d�v
NO
�1�7
SIZE OF LOT�jOF BLDGS �. CONDITIONS r 1/
W ON LOT
USE OF
EXISTING BLDG
BUILDING I EXIST
/� /�,s /A�/te�,/��,�r�'EL t .tet SETBACK YARD I� STREET NAME WI
WIDTH
OWNERF67,4(s6a� W/Va O�'V(..� FPROL T / CC�C/I'(1./ r0�I!'. ( , Ill
ADDR E
ARCHITECT OR TEL L
ENGINEER )(a& NO
; INSPECTION RECORD -
ADDRESS - d
CONTRACTO /K& �_ �P ` 'V
ADDRESS c7/f// �.f� /V4 �fl'�/�' -�`•;�sv,?...,. e..�.z.s'L�G ,G..lA�stL,� a.t,.e? �o 0
DESCRIPTION OF WORK �f
w
•C:� - :moi ate' �-,�� ��/ta!ea� r"7'�_ �4 _�,?�`_.,.,,� � a
NEW FT ADD ALTER NO NOREP
DEMOLISH
E OLISH' ?S�^ _7� l �Telzg
SIZE �� STORIES FAMILIES fq
USE
EOCTURE O T—/�'r''' � � ��..Js-3l ,.'''� ®',�,�' ��' `-
—STRU
SIGNATURE OFAPPLICANT
VALUATION$ /�• 0 j ��^'�-1 1C1�Y1(.1'/ �r �E//'tL- .3 'I ! 1lYP'/l,+r"5C,-I
t APPROVALS y' DATE. INSPECTO "SIGNATURE
PC PMTFOUNDATION LOCATION-
FEE $ ��='• FEE FORMS MATERIALS
FRAME FSTOPS,
I HEREBY ACKNOWLEDGE II THATHAVE READ THIS APPLICATION BRACINGG BOLTS 66���J � {•' t`q.
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION 'I CERTIFY THAT IN THE PERFORMANCE ,� p
OF THE WORK FOR WHICH THIS PERMIT IS ISSU
D I SHALL NOT LATH, INT
EMPLOY ANY PERSON IN ANY 9NNER 50 AS T I COME SUBUECT
TO THE WORKMEN S COMP SATION LA�Ll F,rygNIA
\ LATH, EXT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE RECT AND POSTED /�"� [�[[/ ! ii .✓.
ADDRESS4���/Ar_f��-06(it�i FINAL
PLAN CHECK VALIDATION cK. M o. CASH
CLYDE
PERMIT VALIDATION
cK URM o'ENCASH ER
„ �',
1
4663 ;!A 3 -1 D , 3 9.0 0 4,
r,
f,y',
• . 'a. t r. ,. a ,.,., � .."v., ._ ..,_ ._ -• - .,. ,—r _ .. ,-. . ._. _,r.,� ,, ._ ». .'�,,.__ _,.., ..,
WtORKERS' COMPENSATION'DECLARATION
hereby affirm,than It have a certificate ofwconsent,to self -. +
insure, or a certificate of Workers"Compensation Insurance, APPLICATION- FOR B U I LIDI N'C� .PERMIT
or a'certified copy thereof (Sec 3800,-Cob C )' - " `' .r - r--`1
11 ,r . � , + ' COUNTY OF LOS ANGELES - BUILDING;'AND SAFETY ; f
Policy _11No • , Company - , + - __ , c._:,..-»_. - ,
a Certified copy is hereby.furmshed, ' FORS'APPLICANT,TO FILL IN BUILDING- V �+�" --�^ .9)4
;
: ADDRESS' (1 �/
�+ Certified copy is filed''wrth'the county building inspec- BUILDING F^ } `'' _`'" V
'tion"depbrtinent' ADDRESS, lJ - t
Date ' ^'.' ' - `'Applicant{ ?. ;,r - CITY'^�' ZIP LOCALITY ,n
s - - s = p N -OF BLDGS� -c F = NEAREST.
CERTIFICATE OF EXEMPTION FROM WORKERS: t
°'COMPENSATION-INSURANCE` SIZE OF LOT (Q U� r _NOW ON LOT CROSS ST
(This sect on•need'not,,be'cornpleted if-the-perm it'isifor'one - = l� :.� "- ? ASSESSOR ti t,. :' _ k,• -
hundred dollars($100)or less ) TRACT' BLCCK, LOT NO MAP BOOK - r :'PAGE PARCEL t
1 .. OWNER. C _ NO o[ fJ TEL TZOk4E
, MAP
I certify that in the.perforrmance of the work for which this NO
L.. # > d. '
permit is issued, 1 shall'not employ dny person in any manner _ /���� r - -�; 3 SPECIAL - , - -" -
ADDRESS- 'GIYY� 1' CONDITIONS Tf»" 0.
so as to b6' b; to the Workers'Compensation Laws V, '
Date t.Tit,+ } s^`Applicant+- ..r} CITY.w. :;� ZIP _ -- ." -• r ` Oma»
ARCHITECT OR' TEL DISTRICT _ ,GROUP TYPE,
' NOTICE TO'APPLICANT 'If,'afte� making this Certificate of f ; FIRE , _' PR ESSED,BY_:,-. _
rr ENGINEER �! �! NO CONST ,/ ZONE ' Z `
Exemption, you should become subject td' the 'Workers' LLI
Compensation,provisions of,the Labor+Code, you must forth-
ADDRESS X:7
with comply,,with,,such provisions.or, tl4is�permit,shall be - - :- - - -• - - - --- r H '
deemed'revoked' w TEL t STATISTICAL CL`ASSIFICAT,ION APT, CON I' 3f Z
b CONTRACTOR �, NO _
LICENSED CONTRACTORS DECLARATION --- -- -- - -- - -ILIC - •-w ,-- CLASS NO DWELL UNITS
hereby affirm that 1 am li_cen'sed under provisions of Chapter 9 ADDRESS NO t
(commencing wA Section 7000)of Division 3 of the Business and .__ _, __ LIC'—- - SEWER MAP
Professions Code dnd my'license'-,',,n"full'fofce and<effect CITY ~, Y = CLASS BK �"`- =VALIDATION T`
y� ,• rT�,t p14 7 s Vt. . SPG
Q Fr NO OF NO OF -CHECK - 1
License Number Lic Class SIZE' 'STORIES FAMILIES O'NE- - •* ,„
t. v i bR r VALUATION
Contractoi't"" .117. ' '' - DESCRIPTION OF WORK- -Q ; �O
Date
I am exempt under Sec x - VtO
e �� ADD ,_ --� ;? 1 4 3,2 n _
B 8P C for this reason ^�-� REPAIR.-'.❑ $
- -- t - " - #'0 0 0 o s -
- Date USE OF
EXISTING BLDG e s ((^��DEMOL j o-,0 2 5 O' '
Signature r.�J. -- - _ _.� _ APPP _ TEL NO 4'i� IS FINAL i
OWNER-BUILDER,DECLARATION _ _ DATE'. -- o.e o-
1^hereby affirm that I am-exempt from the Contractor's,License _ C __ � 2 BrJc O,Ft'
Law for the fol lowirig,reason (Section 7031 5, Business and ADDRESS 5 � �'� Z'.0 _ 1 FINAL ^fig 5
Professions Code) T_ ""' PRESENT
BUILDINGS
I, as owner of the property, or my employees with ADDRESS
their sole - �; , •, �' r;
r wages as- cffompensation,will doe wk a
thornd z ' )-
the structure is not intended or oered for sale(Section LOCALITY ?
-'7044,-Business and Professions Code)-'- -' MOVING - - r -TEL y,
-�-- I, as owner of the property, am exclusively contracting CONTRACTOR`` - - NO r - - T = r µ i, t
—with-licensed-contractors to,construct-the project (Sec-
ADDRESS
tion 7044, Business and Professions Code) - - - �..•'+ y:.
REQUIRED- TOTAL SETBACKWY FROM EXIST
CONSTRUCTION LENDING AGENCY------ SET BACK YARD HPROP LINE WIDTH i
.I hereby'affirm that there is a construction lending agency for FRONT
the-performance of the work for,which this permit is-issued P L
(Sec 3097, Civ C ) SIDE
-Lender's Name - L
LDMA Ref # n'
_ - - - - - P C-Fee$-- - `•y- Permit Fee L(✓ - - -
Lender's Address d
_.I certify that Lhdve read this application-and state_thatahe ___ _ �'. -- Issuance•Fee �1^U LDMA-P/C# - _•- �` -i�`- °` _L _ -a%� - �'
a
above,informatron is correct I agree to comply with all County Investigation Fee j
Q `
ordinances and State laws relating to building_construction, •TotaI-Fee "` O LDMA Perm # -- r,•= 5- S
ul and hereby authorize representatives of this County to enter f
upon the above-mentioned property for inspection purposes'
-SEE REVERSE FOR EXPLANATORY LANGUAGE
,Signature of Appl,cant:or Agent-- - - D.16 "• ^ -` '^• :•` -�T-- =aJ_ .. _ _. _ _ _ ,__ _. _ _ .+._ _ i _ . _ _ __ -