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HomeMy Public PortalAbout10533 DAINES DR_Building__ TEMPLE CITY 78A838A CE #803',26 APPLICATION FOR, BU I LDI NG PERMIT COUNTY OF LOS ANGELES ASSESSOR ' DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE 11�5� PARCEL UILDING BUILDING AND SAFETY DIVISION ADDRESS �" GKJw! JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY �} FOR APPLICANT TO FILL IN CROSS RT %- i� Pnnt ort a gI BUILDING DISTRICT NO ,.GROUP TYPE �- PROCES E-0 BY -- CONST 0 ADDRESS 5 4 Y� t �` STATISTICAL CLASSIFICATION,' SEWER MAP LOT NO BLOCK I CLASS NO _DWELL UNITS BKPG_ TRACT USE ZONE MAP 1-1-00 NO OF BLDGS I n NO SIZE OF LOT NOW ON LOT i fj� SPECIAL USE OF V� CONDITIONS EXISTING BLDG TEL OWNER M r s . M . D r a NO BLDG SETBACK FROM ADDRESS - FRONT PROP LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY 'HIGHWAY WIDTH FROM C L ARCHITECT R TEL + _ ENGINEER NO BLDG SETBAC ADDRESS SIDEPROP LINEOF (STREET) TEL ,TYPE OF EXISTING SETBACK HIG + YARD = TOTAL CONTRACTOR NO HIGHWAY WIDTH FROM C L ADDRESS 529 E . Valley Bly O 186D86 + LIC C� CITCLASS CORNER CUTOFF YES ❑ NO V ` CONSTRUCTION LENDER CD NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS LaJ ADDRESS a N SO FT NO OF NO OF Z NEW SIZE STORIES FAMILIES W I USE OCTURE Re-roof Dwl & ar ADD STRUCTURE ALTER ^❑ REPAIRIVI - LVALUA�TTION OF 777��C DEMOL ❑ $ AA APPROVALS DATE INSPECTOR'S SIGNATURE P C PMT FOUNDATION LOCATION - FEE $ FEE S q - nn FORMS, 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, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PER IN VIOLATION OF THE LATH, INT LABOR COD�F� HOUSE F IF RNI IN RELATING TO WORKMEN'S A E `LATH, EXT SIGNATURE ' NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 529—E --Ta11ev Blil-d .-sSan G*b ,FINAL // Mo CASH JOHN F LEWIS PRINCIPAL TRUC URAL ENGINEER PLAN CHECK VALIDATION CK PERMIT VALIDATION CK M o CASH ♦ 1 ' ^ I Ar� 7FD 5 '—".OGT J�i 1 D 9.0"0-- , I DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES ® �1 WM. J. FOX, CHIEF ENGINEER ®'� FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING ��yf //�� © DISTRICT NO. PLAN CK.NO. 00, PERMIT NO. ADDRESS e ` / iG�- N 15 P i LOCALITY RECEIVED aqv DATE OF APP/L.. DATE ISSUED NEAREST CROSS ST. ///` r • �- l BUILDING OWNER �� �MC/�y� �il/ ADDRESS Gw' v MAIL - - LOCALITY A'DDRE96 a� — NST TEL CROSS 9T. CITY NO. FIRE wNO.OF' / TYPE GROUP ARCHITECT OR TEL ZONE ®'� PLANS / ENGINEER NO. III cu— ____���,,,JJJ BLDG. ^-� - ORD.NO ADDRESS BETBACK'LINE /n w T APPROVED TEL. BY DATE CONTRACTOR NO. USE _/APPROVED ADDRESS ZONE J BY - DATE LEGAL DESCRIPTION LOT NOP BLOCK + l/V Q CORRECTIONS TRACT 9 k V "_� --� NO OF BLDGS. SIZE OF LOT I NOW ON LOT USE OF I NO OF I NO.OF EXISTINO BLDG FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O REPAIR -y, /MOVING DEMOLISH � So FT. �Aj �7 I y NO OF ` STORIES D SIZE �(, jl / a ROOMS WALL ., I ROOFr COVERING T COVERING USE OF NEW BUILDING VV 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE I9 CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION ® ® FRAME: FIRE STOPS, _ SIGNATURE OF /��IsS�i�J_". BRACING,BOLTS �1 ✓� l� y� PERMITTE LATH,INT.: AUTHORIZED AGT - LATH,EXT.: DBS-3 SOM SETS 1-4B $ PLASTER,INT. K VALUATION FEE PLASTER,EXT. 111 FEE FINAL WORKERS'COMPENSATION DFCLARATION, hereby affirm that I have certificate of con�Rt td -A P P L I CAT I O N+ F O R BUILDING PERMIT nsure, or a certificate of Workers' Compensation Insurancence,, -� >r a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY )olicy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS DING, Certified copy is filed with the county building inspec- BUILDING T , tion,depariment ADDRESS l0 �� L - 1 � T LOCALITY. p-� NEAREST )ate Applicdnt CITY �s ZIP 7Q CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' f NO OF BLDGS ASSESSOR• COMPENSATION INSURANCE SIZE OF LOT )� - NOW ON LOT I MAP BOOK PAGE PARCEL This section need not be completed if the permit is for one USE ZONE MAP iundred dollars ($100)or less ) TRACT BLOCK LOT NO NO TEL SPECIAL } 'certify that in the performance of the work for which this OWNER 14 & v'DL(�ry No 41f�'-�f3Z _ - CONDITIONS d DISTRICT GROUP TYPE FIRE PROCESSED BY O permit is issued, I shall not employ any person m any manner ADDRESS d •��� ` CONST - ZONE V ,o as to become subject to the Worke o pensation Laws �� )ate I Applicant CITY / ZIP STATISTICAL LASSIFICATION PT CONDO I- 40TICE TO.A PLICANT, If, after makin this Certificate'of ARCHITECT OR TEL :xemption, you should becomebsubject to the Workers' ENGINEER ���� NO CLASS NO DWELL UNITS miiiiJ a :ompensation provisions of the Labor Code, you must forth' ADDRESS SEWER MAP N vith comply with such provisions or this permit shall be A41,-4- //,, _Z Deemed revoked . • CONTRACTOR A41, 4- TEL BK PG, J VALIDATION LICENSED CONTRACTORS DECLARATION LIC hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO ALUATION- commencing with Section 7000)of Division 3 of the Business and LIC 'rofessions Code, and my license is in full force and effect CITY CLASS SQ NO OF / NO OF I CHECK ► icense Number Lic Class SIZ 39� STORIES FAMILIES ! ONE :ontractor Dare r DESCRIPTION OF WOR NEW ❑ $ f ADD j am exempt under Sec 1 ALTER El FINAL B 8P C for this reason / REPAIR ❑ DATE � USE OF t Date EXISTING BLDG Jt DEMOL ❑ 'BY FINAL ds Signature APPLICANTP /� J TEL f, u OWNER-BUILDER DECLARATION PRINT /v4�r4t f0S1C 'C40L17� NO hereby affirm that I am exempt from the Contractor's License ADDRESS �D J 33 / aw for the following reason (Section 7031 5, Business and 'rofessions Code) PRE NT BUILDING I,�as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended,or offered foasale(Section LOCALITY ;§276, 1 A 7044, Business and Professions Code) [ADDRE G TEL ] I, as owner of the property, am exclusively contracting ACTOR NO # 0 0 0 0 ° 1 with licensed contractors to construct the project (Sec- SS 2,° 1 6 2 3 8 'Tion 7044, Business and Professions Code) ; IRED TOTAL SETBACK FROM EXIST . CONSTRUCTION LENDING AGENCY ACK YARD HWY PROP LIN WIDTH pop. - ° ° 1 6 2 3 8-� hereby affirm that there is a construction lending agency for NT he performance of the work for which this permit is issued 0(� 1 G -8 3 Sec 3097, Civ C ) _ i . ender's Name .ender's Address e$ Permit Fee certify that I have read this application and state that the Issuance Feeabove information is correct I agree to comply with all County gation Fee rdinances and State jaws relating to building construction, Total Fee ind hereby authorize representatives of this County to enter ipon the ve- a coned property for inspection p rpos (p �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ol Applicant or Agent Date es t WORKERS' COMPENSATION DECLARATION `I here67 afFtrm that.I Have a certificate of consent oto self nsuce- or a certrficato te o of Workers' Compensation Insurance, APPLICATION FOR,80I.LIaIN'0, PERMITo or a certified-copy thereof !�& 3800, Lab C ) • - Poli- ! -ierk /Gt/_J� COUNTY OF LOS ANGELES , BUILDING AND SAFETY C MID y V BUILDING Certified',copy,is her,eby furnished �7. 3;F FOR'APPLICANT TO FILL IN ADDRESS Certified copy is filed with therccunty building mspec-` BUILDING ADDRESS .�, �js tion departmentCA Date Applicant ', CITY Q ZIP -L LOCALITY NO OF„BLDGS NEAREST - CERTIFICATE'OF EXEMPTI N FROM W RKERS' SIZE OF LOTS ` NOW ON LOT CROSS ST -COMPENSATION INSURANCE ASSESSOR (This section need `not be completed if-the permit is for one TRACT BLOCK' LOT NO MAP BOOK PAGE PARCEL' hun&ecl dollars'($100) 6e,less ) . - ' - at r NO Z =OZc� USEIZONE MAP i} OWNER' fJ0 ' r I certify-that in the performance of the work for which this SPECIAL' permit is issued, I shall,not employ any person in-any manner ' - ADDRESS T CONDITIONS so as,to become subject'to the Workers,,CompensaTion'Laws. , , % O ' c',. CITY ZIP I U = Date Applicant ARCHITECT^OR TEL V DISTRICT GROUP TYP FIRE PROCESSED BY � NOTICE-_TO APPLICANT .I f, after- mak,ng,,this�Certrficate.of _ ENGINEER NO” " " ^_> _ ,, 0 _ Exemp�ion, ^you;should become subject'-to the Workers' /y�p /� CO ZONE �J U UJ 'Compensation provisions of the Labor Code, you must forth- . ADDRESS ' �/1�, ✓`j G'0 /[ 3• ��L4 LC�Gt z a- with 3com I with such rovisions'or,this permit'shall be / 1"TEL'! N deemed re oked P z CONTRACTOR 6 NO ri (,1Lo STATISTICAL CLASSIFICATION APT - CONDO Z LICENSED CONTRACTORS`DECLARATION,, a CLASS NO Al DWELL UNITS I hereby affirm that I am licensed'under provisions of Chapter 9 ADDRESS ' '=" "O - �I SEWER MAP i"(commencing with Section 7000),of•Division 3 of the Business, r LIC r and Professions Code,and my Iense,is in full force and effect' CITY CC°� BK PG' VALIDATION [� SQ FT" NO OF NO OF CHECK License Number° ' T' Lic _Class SIZE STORIES FAMILIES ONE VALUATION Contracior�[Ilz " - Dore �J _��� DESCRIPTION OF WORK NEW �❑ $ �0 0 0 � ❑I`am exempt under Sec r ADD El ►, ALTER t r• B&P_G`,for this reason , 4Date USE OF_ `4 a REPAIR $ - EXISTING BLDG, DEMOL ❑ Signature- ?APPLICANT(PRINT) PPLICANT -, TEL,-- FINAL �~ OWNER-BUILDER DECLARATION (PRINT) NO`" DATE I hereby affirm that-I am exempt,from the Contractor's License - = Caw for'the Jollo'ving reason (Section�7031 5,.Business and ADDRESS • FINAL, , Professions Code,)` _ ' PRESENT r By ACC8 eg BUILDING I; as owner,of,the property, or my employees rwrth 'ADDRESS 503.55 330 wages as their sole compensation;wi 11 do the work and o the structure is not intended or offered for sale(Section LOCALITY , 1 - { TTC115 7044, Business and Professions Code ) MOVINGi - =.r TEL i 1 G ❑ ;I, as owner of the property, am exclusrvel contractor CONTRACTOR NO ` T-�r _,�� P P Y, Y 9F ' a TOTAL �(33, vy, ,-with licensed-contractdrs to construct the project ($ec- ADDRESS �" r+ e�j ec tion 7044, Business-and Professions Code ) A - ,' `-- ,CWC � F .t REQUIRED - TOTAL SETBACK FROM EXIST ' A elI t �+ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY` PROP LINE WIDTH ' c} .�,4 t;�tt �� I hereby affirm that there,s a construction lending agency for FRONT 4 a- - r i the performance of'the work for which this permit isaissued (Sec 3097, Civ C ) SIDE r =', a°P L 1- _ �_ _ -01300-0001 7/10/96 L`ender's°Name = LDMA Ref # 7341 r 1 AN 11'29 Lender's Address P C Fee s, Permit Fee �/ 0 I"certify that I.have read this'apphcotion`ond state,that the Issuance Fee LDMA P/C# 8 above information is correct I agree to comply with.all County Investigation Fee y 4D ;,ordiriances and State laws relating to budding construction, Total Fee LDMA Perm # a and hereby authorize representatives of this County to enter - u on the above- 'ntioned property for inspection purposes IO SEE REVERSE,FOR EXPLANATORY LANGUAGE Signature of lkpplicant or A t - Date a