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Home My Public Portal About10527 DAINES DR_Building__ City 01 :76A638A CE 48032-63 APPLICATION- FOR. BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER, ADDRESS /Q c,�—Z BUILDING AND SAFETY-DIVISION LOCALITY ,JOHN A`LAMBIE, COUNTY'ENGINEER NEAREST J WILLIAM A JENSEN'SUP T OF BUILDING CROSS ST' DIS TRI T NO GROUP, PE P OC BY Y FOR APPLICANT TO FILL IN . . C s BUILDING ' - •� - STATI ICAL C IFICATION`�- SEWER MAP ADDRESS• - Z ^ ` - ,p r r _ CLASS�'NO WELL UNITS „ + LOT-NO �,� Q t BLOCK f WATER ' • - �-' + _ _ r, „ ^ - , `CERTIFICATE NOT REQUIRED : _RECEIVED EJ TRACT , +,'• ":'< MAP, HIGHWAY STATE MAJOR SECOND CALi NO OF BLDGS //'' NO .f (CIRCLE) + SIZE OF LOT S�X NOW LOT + /i, USE ZONE` SPEC IAL, USE OF CONDITIONS ,EXISTING BLDG OWNER ,a,j' 0 UI DI G EXIST �r Z M ' YARD HWY STREET NA E. c �y J , SETBACK - _ WIDTH ADDRESS cFRONT ARCHITECT OR, TEL P L V�! ENGINEER NO SIDE - - '),• " P L C. ADDRESS e TEL t. �" .r• V ` CONTRACTOR •NOInd ADDRESS DESCRIPTION OF WORK F w NEW ADD A,ALTER REPAIR DEMOLISH SQ FT_ NO OF NO OF, r - - SIZE STORIES IFA NtILIESj USE OF STRUCTURE A1770 " r SIGNATURE OF GICN - } APPLICANT VALUATION S APPROVALS , - DATE INSPECTOR 5 SIGNATURE FOUNDATION' LOCATION..-yam " FEE $ / F_EE_ `, FORMS-MATERIALS '• FRAME FIRE STOPS' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT$ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE" LOCATION WITHALLI COUNTY ORDINANCES .AND STATE LAWS REGULATING i GAS-VENT DUCTS • BUILDING CONSTRUCTION I CERTIFY THAT.IN DOING-THE WORK I .AUTHORIZED HEREBY I-WILL NOT EMPLOY.ANY PERSON IN VIOLA LATH-'INT a TION OF THE LABOR COOC OF i HE STATE OF C_ALIFORNIA RELAT - - ING TO WORKMEN S CO PENSATIONSINSURANCE - LATH EXT I• SIGNATURE OF HOUSE NUMBER COR- Vx 0•-- - 4 PERM ITTEE RECT AND POSTED ADORES sFINAL JOHN F LEWIS PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK' M O CASH _ PERMIT VALIDATION' CK` M sCASH '78,6`73,%& 'AUG 8 1= o,, J . APPLICATION FOR- BYLDING PE MIT �< y!0!9 80 k' 7 COUNTY OF LOS ANGELES BUILDING 'DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUPT OP BUILDING CROSS ST D1S^RIC'[(/fI NO `•GR Typ PROCESSED BY FOR APPLICANT TO FILL IN Tc IV,' BUILDING � 5 � ` STATISTICAL CLASS FICATION KR MAP pG ADDRESS 6 CLASS NO DWELL UNITS LOT NO t y- BLOCK MAP NUMBER Q D H ATE YESNO , TRACT I/vG �j/f� y�O USE ZONE SPECIAL / %Cr / y SIZE OF LOT — !p.d I-NO OF BLDGS _ CONDITIONS PP a NOW ON LOT USE OF �— EXISTING BLDG BUILDING EXIST YARD HWY ,_ STREETNAME �1r �,,T,EL SETBACK - WIDTH OWN •W/V�S�i' K''blliO l�-N� FROL T (/ A R SS C!, w' /•� - SIDE ARCHITECT OR `�yw�F� VTEL P L ENGINEER e6.(G �-NO SPECTION RECORD a ADDRESS y-�► � may,', �yL, � J N/o d yy� :.2� COR ��`-'� C--G /, / p7EYU Nt�U,� `Y if✓ � iL[. d Y"E.�C.67 fP"�T'�� u ADDRESS /.r f s 1��1 / `D-�.0 �.C 'b� �E d' DESCRIPTION OF WORK ✓� "�� ' ® e-v�.I R O 'G NEW iV ADD ALTER REPAIR DEMOLISH N Z SQ FT 110 OF / NO OF IZ _ - SE �� -{f STORIES_ FAMILIES USE OF STR CTURE �{—V ,�=./�M SIGNATURE OF APPLICANT VALUATION APPROVALS DATE / INSPECTOR SSIGNATURE P C PMT FOUNDATION LOCATION / FEE $ FEE FORMS MATERIAL'S FRAME FIRE STOPS, IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS J /' 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 OF THE WORK FOR WHICH THIS ERMIT IS ISSUED SHALL NOT LATH, INT ( '! EMPLOY ANY PERSON IN ANY ANNER 50 AS TO CE SU BU ECT TO THE WNS COMP S ION L F AL ORNIA ORKMET CATH, EXT ��I '•"! / SIGNATURE OF HOUSE NUMBER COR- J p/fit PERMITTEE RECT AND POSTED ADDRESS FINAL CLYDE PLAN CHECK VALIDATIONOmo. cAsH P REIv �IT VALIDATION r cK. mo ENGINEER 1 9.500 M ��2b SEP 1 1 D 5 9. Cl / + WORKERS'COMPENSATION DECLARATION l 1� ,.byaffirm that I hay. a certificate of consent to self y Y" �"\•� ure, or o cerhflcate of Workers' Compensation InsuAPPL]CATI®N FOR BUILDING EMIT rance, - or a certified copy thereof (Sec 3800, ob„C �� COUNTY OF LOS ANGELES' BUILDING AND SAFETY Policyt:cM No WqL23 Company ' ❑ Certified copy is hereby furnishe FOR APPLICANT TO FILL IN ADDRESS ds i ' ❑. Certified copy is filed with the county building inspec- BUILDING :4, /� tion deportment a ADDRESS /y5-,:47 4i I OFA' Date I Applicant CITY e.f ,fie. G/'1 ZIP. LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' i �s', :�: NO'OF�BLDGS a.^,r >« A, ' NEAREST COMPENSATION INSURANCE ' SIZE+OF LOT A t NOW.ON LOT' CROSS ST 4 :^7 l`� �`'-` `9 ASSESSOR Z° i..� `� , (This section need not be completed if the permit is for one Jzz,'1:,t R TRACT ` '�> BLOCKY 0 LOT NO ; i` �i MAP BOOK PAGE PARCEL hundred dollars ($100)or less ) a „%\ � TEL ' I certify that in the performance of the work for which this OWNER G O NO �/ USE ONE MAP permit is issued, I shall not employ any person in any manner ADDRESS O Z e SPECIAL + so as to become subject to the Workers'Compensation Laws CONDITIONS C) CITY �i/�/ le Ci� ZIP U Date Applicant NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL DISTRICT G��ppUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO �f / CONST, / Z NE b U Compensation provisions of the Labor Code, you must forth- ADDRESS ; L V5) W with comply with such provisions or 'this permit shall be d TEL STATISTICAL CLASSIFICATION APT deemed revoked CONDO fn' / 3:6 CONTRACTOR ( / � NO •{L/ Z LICENSED CONTRACTORS DECLARATION '"� LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS vv. 7H NO 7 77 1SEWERTP (commencing with Section 7000)of Division 3 of the Business and / LIC Professions Code, and,my license is in full force and effect CITY CLASS P> BK VALIDATION n SQ FT NO OF NO'OF CHECK License Number 7 V7,7�Lic Class SIZE�/. STORIES FAMILIES ONE r VALUAT,,IION 0 ' Contractor Date DESCRIPTION OF WORK NEW a $ O /�J► t/ ADD �J (�U ❑ I am exempt under Se ❑ ALTER B&P C for this reason M ' REPAIR ❑ $ C req f7�dt° DEMOL USE OF EXISTING BLDG l�" ✓ �. � Date ❑ Signature - APPLICANT(PRINT) T NO Z�3� FINAL �9 7 6 7 A OWNER-BUILDER DECLARATION �2 ��// /� DATE y #,o • o • o I hereby affirm that I am exempt from the Contractor's License ADDRESS Z V W tj�'� ��' Law for the following reason (Section 7031 5, Business and FINAtj ( - 27 7 5 Professions Code) R MIN By /! BUILDING - - 273,756' ❑, ` r I, as owner of the property, or my employees with ADDRESS s wages as their sole compensation,will do the work and _ 3 —8 8 the structure is not intended or offered for sale(Section LOCALITY ' 0 7044, Business and Professions Code) MOVING TEL t ? f ❑ CONTRACTOR NO 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- t tion 7044,-Business and Professions Code) ADDRESSwa CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK SET BACK PROP LINE' WIDTH t •� �, t 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 pL ° Lender's Name 2 LDMA Ref ft m _ P C Fee$ Permit Fee Lender's Address c'j� I certify that I have read this application and state that the Issuance Fee v LDMA P/C ff o above information is correct I agree to comply with all County Investigation Fee o ordinances and State jaws relating to building construction, Total Fee S LDMA Perm # and hereby authorize-representatives of this County to enter upon the above-mentio ed property for inspection pur oses m LSGL1�1 l� /l v SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Apphcant Agent Dote'