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Home My Public Portal About10620 DAINES DR_Building__ 76A63 BA CEU803 9-67 -7 "V I 1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING / DEPARTMENT OF COUNTY ENGINEER ADDRESS / BUILDING AND SAFETY DIVISION LOCALITY _ JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKI NS, 5uP'r of BUILDING NEAREST CROSS ST. �[� I/ FOR APPLICANT TO FILL IN DISTRICT NO. GRO TYPE P gcessED BY L'—it,�/ CONST. !� (Print ort pe only) J V O BUILDING p /pp� STATISTICAL CLASSIFICATION SEWER MAP ADDRESS Orp� .✓ �9�f'i:(41' CLASS NO._�._�OWELL,UNITS BK PG LOT NO. W Q, BLOCK USE ZONE MAP TRACT p PECIAL NO.OF SLOGS. CONDITIONS SIZE OF LOT 1' NOW ON LOT USE OF EXISTING BLDG. _461,19141(47— BLDG.SETBACK FROM �7.'J�- TEL / FRONT PROP.LINE OF (STREET). OWNER r, vin. yy NO. S 4 }'7� TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL -/e,ADDRESS Q0r row;-yo 44;;4- HIGHWAY WIDTH I FROM C.L. CITY DG. I - ARCHITECT OR TEL. SIDE ACK FROM SDE PROP.LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS �n HIGHWAY WIDTH FROM C.L. TE CONTRACTO �/va•L /-�� NOL 10 } - 1 T q, O ADDRESS I�' ♦ .4/'•I NO. HISTO CORNER CUTOFF YES ❑ NO ❑ aryLIC. CO Qry�y( CLASS C SEE REVERSE SIDE FOR SPECIAL APPROVALS U DESCRIPTION O K `Ll N 1 Z NEW ADD ALTER REPAI DEMOLISH SQ. FT. NO. OF NO. OF 'I SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT VALUATION 5 /O�O e� APPROVALS DATE INSPECTOR'S slcganRL P.C. PMT. FOUNDATION: LOCATION FEES FEE 5 Y I FORMS, MATERIALS 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, 1 CE FY THAT IN DOING THE WORN AUTHORIZED HER EBV I WILL T MPLOY ANY PERSON IN VIOLA TION OF THE LABOR CODE F T STATE OF CALIFORNIA RELAT. LATH, INT. ING TO WO MEN'B COM ON INSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE' RECT AND POSTED ADDRESS 11nf=TL FINAL O , - JOHN F. LEWIS. PRINCI Al_ ST URAL ENGINEER PLAN CHECK VALIDATION CK, Mo. CASH _ PERMIT VALIDATIONCK M.o CASH LA[,02 5 2 a,- X23 1D 21.75- v Y•, WORKERS' COMPENSATION DECLARATION - - - - - hereby affirm that I haver certificate ns consent rc self APPn C res OOO-- N FOR, B Mr r�n� -PER �Tf -- - insure, or a certificate of Workers Compensation Insurance; (/"l� u u`� �J N U�u u o cer if' d m_y.thereon{Seca 3800, Lab. C.) /�,`�� '� � � COUNTY OF LOS ANGELES BUILDING AND SAFETY l calf Campo4 ❑ Certified-copy is hereby furnished.' FOR APPLICANT TO FILL IN Bu DRESS ADDRESS Certified copy is filed with the co my wilding Inspec- BUILDING S CD tion porlm nt. - 'ADDRESS � D�• . tpPI can - CITY �� ZIP LOCALITY .. .. RTIFI TE O E%EMP N FROM WORKERS' NO.OF BLDGS. NEAREST OMPENSA N INSURANCE SIZE OF LOT NOW ON LOT _ CROSS ST.(This section need'not be.completed if.the permit is for one ASSESSOR „ - hundred dollars ($100)or less.) TRACT 1. O BLOCK - LOT NO. MAP BOOK" <• - PAGE PARCEL, 4 � �--s TEL USE ZONE MAP I certify that in the performance of the•work for.which this OWNER �, L..+./ NO. NO permit is issued, I shall not employ any person in any mannerSPEC At �� v — / CONDITIONS so as to become subject to the•Workers' Compensation Laws. ADDRESS ttM�r �- • _ CITY C�1... ZIP Date ''Applicant ' ARCHITECT OR Qen TEL �7 NOTICE n, APPLICANT:should after subject to Certificate of ENGINEER 7-'T/( NO ( � O DISTRICT -GROUP TYPE FIRE PROLES ED BY Exemption, you should become subject to the Workers' CONST ZONE Compensation provisions of the'Lci Code, you must forth- ADDRESS (,moi with comply with such provisions or this permit shall be r - TEL STATISTICAL CLASSIFIC TION APT:. CONDO: deemed revoked. - .. CONTRACTOR S O. �'b� ' LICENSED CONTRACTORS'DECLARATION '7 LIC_ �p l CLASS NO DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9, ADDRESS3 U�C, PA NO. 6 /�•7 (commencing with Section 7010)of Division 3 of the Business and • - LIC pp SEWER MAP .' - .Professions Code; and my license is in full force and effect - CiTY CLASS J - BK - VALIDATION y Sp. FT. NO. OF NO.OF CHECK License Number�' Lic.•Class SIZE 2$a STORIES FAMILIES ONE Q r�trii i S s Y VALUATION U Conimctor S GOJ 1114- QCJV.A1 Dote DESCRIPTIONS OF WORK � 'A D ❑ f: '/ - T Q1.� _ _ 0z ❑ I am exempt under Sec �'' �x t fi - - . . - D ALTER' ❑ La B.BP.C.:.for this reason, _ \tSGri �O"G-1n - REPAIR ❑ 9 - Date: USE OF - DEMOL ❑ •Z, EXISTING BLDG. ^:.r Signature - APPLICANT TEL. '7 1 7� FINAL FRINT)-� (tuiST, NO. 1 OWNER-BUILDER DECLARATION • DATE I hereby affirm that I am exempt from the Contractor's License . Low for the following reason (Section 17031.5, Business and' ADDRESS FINAL' II•A Professions Code): PRESENT By. ❑ - BUILDING 1 as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and J=•rr '° the structure 1s not intended or offered for sale(Section LOCALITY 1�F' .. _ /.�Z.1 7044, Business and Professions'Code) - MOVING TEL / - ` ❑ I, as owner of the property, am exclusive contractingCONTRACTOR " - NO. i t T_TA.L 45 with licensed contractors to construct the project_(Sec- IF C _ tion 7044, Business and Professions Code). ADDRESS - l.HUX 455.Iv CONSTRUCTION LENDING'AGENCY REQUIRED YARD HWY TOTAL SETBACK WIDTH SET BACK PROP. LINE. - ., .I hereby affirm that there is a construction lending agency for .FRONT .the performance of the work for which this perm it is issued P.L. (Sec. 3097, Civ. C.). 'SIDE - - •. . P.L. F-+ Q f? O.L Z t I, Lender's Name - - 1^-j r.-t �•, Gt <-.,.H- - LDMA R;fE!_# ). rr Ca —I t,• m P.C. Fee$ Parmil Fee _7 _ Lender's Address - - - - f�'1R -4M 3 C - hcertify that hove Tea this application and slate thaYthe Issuance.Fee'. + LDMA P/C 8'=t -•J _ arrJ bove`information is c ecl. agree to comply with all County Investigation Fee F-^ ' ordinances and Stat laws relating to building construction, - j u7 and hereb autho a representatives ofthis County to-enter Total Fee LDMA Perm. q upon the bov en ti aned property for inspection purpose . - y. h4 t,•� ° • . ppp n h / SEE REVERSE FOR EXPLANATORY LANGUAGE - - co ignatare of Applicant or Agent Dat 1°'5r ,C•J 'WORKERS' COMPENSATIQN DECLAfrATION r" t. -I lhareby affirm that I have a certificate at consent to self ' insure or a certifimie of Workers, Compensation Insurance, • .or p certified copy therW4ec 3800, Lob.�C_ ) COUNTY 01 ANGELES BUILDING AND SAFETY '-Policy.Na/ u erc4a6 pang ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING PY Y ADDRESS ❑r-. Certified copy is filed with the county building spec- BUILDING,, - - - -" - - - i tion department- - ADDRESS zipy r ';Date Appi<a nt CITYNO F B DGS _ _ - LOCALITY -CERTIFIC) OF EXE TIO FROM WORKERS' SIZE OF LOT NOW ONLOT" - CROSSNEAREST, - - -CROSS ST. ' C MPENS 10 INSURANCE ASSESSOR - _ ` (This'sedion need not be co pleted-if the permit is for one - TRACT. BLOCK LOT NO. MAP BOOK ' " PAGE PARCEL hundred dollars($100) or ess ) - TEL .C ''. OWNER NO, _ US//FF�/,)ZZ.ON OP - ,I certify that In the performance of'the work for which this ,p L\�^^'� SPECIAL permtl Is Issued,a shall not employ any person in any manner ADDRESS F_- as d so as to become subject to the.Workers' Compensation'Lows. - Q .. - CITY...:. -- ZIP' / �a _ : .. u , V Date - Applicant - ARCHITECT OR, - TEL ` DISTRICT. GI TYPE FIRE OCESSED BY Q NOTICE TO APPLICANT: If,'after,making this,Certificate of — ENGINEER,-m - NO - /'� //�]]'��+ Exemption, you,.should .become subject to Y the Workers' - I'�r y CONST. ' I/ 'ZONE a Compensation provisions of the Labor Code,= ou must.forth ADDRESS.. ct/1 with comply with such provisions.or.this permit.sholl be TEL'. 57ATISTICAL CLASSIF CATION APT. - CONDO. N deemed revoked. -- CONTRACTOR O. — `�,� Z „ ` '' LICENSED CONTRACTORS DECLARATION ` - uc. cuss NO. OC DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS D Y iL C ; DC SEWER-MAP- . (commencing with Section 7000)of Division 3 of the Business CITU , ;and Professions Code,and my license is in full force and effect. 'v - CLASS BK. '= PG. �5 VALIDATION - SQ. FT NO. OF NO. OF CHECK " SIZE s STORIES FAMILIES ONE License Nu tuber -Li c.'Class. r, In VALUATION Contracrd 'D 61 Cc. _ Date�u p_ DESCRIPTIOI WORK � NEW ❑ ,$ ❑ am exem t under Sec !� ADD ALTER .❑ $BP.C. for this reason - w- PftIR ❑ S Date:lC'•--- USE OF EXISTING BLDG DEMOL ❑ --Signature � APPLICANT _ FINAL _ (PRINT) NO. /' W R-BUILDER DECLARATI N - DATE _ q ):1 f,I, I hereby a rm th- I am exempt from the Contractor's License - - "- - - 'y - Low for S e f owing reason (Section 7031.5, Business and ADDRESS' O ! L L FINAL ACCT. de)' PRESENT- - . . .._. ., By. - :a %.-' t ' ,•.c Professions o x� f��l r, ❑" I, as owner of the property, or m employees with BUILDING // ,J'.:rV/ �9V`_�" P P Y, YADDRESS . /wages ds their sole compensation,will do the work and - /' - I- ITEMS the structure is not intended or offered for sale(Section LOCALITY - 111 ' - ' .7044, Business and Professions Code.)• - MOVING - - - - - - TEL - �- -� ,h z, Q TOTAL _29 . 25 - ❑ 1, as owner of the property, amexclusively contracting CONTRACTOR NO. 913 a .1` with licensed contractors to construct the project (Sec- — - -' -- , v CHECK - ESS ADDIR tion 7044, Business and-Professions Code..) - - }� .0 RCHANGE .01, .- REQUIRED -TOTAL SETBACK FROM EXIST. - CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. UNE WIDTH: I hereby affirm thof there is construction lending agency for FRONT theoperformonce of the work for which`this permit is issued - P.L. - - • s r QI]41�_QQI]1- �- I0�2GJur (Sec. 3097, Civ. C.). SIDE \ '1'. Lender's Name" - P.L. .. _ .. -. . r. ,t 6309 I AM 8*N P.C. Fee$ Permit LDMA Ref. #Feer Lender's Address D - acertify that I have read this application and stateihat the - .Issuance Fee ' LDMA P/C# - 8 above.information is correct. I agree to comply with 611 County. Investigation Fee,•', -. -ordinances'ond.State.jaws reloHng to!building construction, Total Fee F I LDMA Perm # areby authorize represen o`livesof this County to enter u ant above=mentioned pro rerty for'inspection Pu0 -- 'OLAO SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or A ent - Date '