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Home My Public Portal About10626 DAINES DR_Building__ 76A833q CER8033-68 APPLICATION FOR BUILDING PERM1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 10626.Daines Drive.-_- . - _ BUILDING AND SAFETY DIVISION LOCALITY, Te e Cit JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, 5UP'T.O1 BUILDING NEAREST, _ .. CROSS ST. DISTRICT N GRO P, TYPE, . ..PR ES BY FOR APPLICANT TO FILL IN CONS r. Print Or tY B only) '�.� 0ICONS BUILDING STATISTICAL CLASSIFICATION ,, $ ER.MAMAP ADDRESS 10626 Da Ines Drive CLASS NO.�'L DWELL,UNITS_ "BK PG LOT NO. BLOCK USE ZONE MAP - - --- - - NO. O 1 ' I TRACT 1 I SPECIAL ."- - - - - - NO.OFBLOGS. / CONDITIONS SIZE OF LOT NOW ON LOT I , USE OF. EXISTING BLDG. BLDG.SETBACK FROM , 1 TEL. FRONT PROP.LI NE OF.' (STREET). OWNER W. Strong NO TYPE OF JEXISTING SETBACK HIGHWAY: + YARD = NOTAL HIGHWAY WIDTH FROM C.L. ADDRESS Daines Drive CITY, Temple Cit BLDG.SETBACK PlkQM ARCHITECTOR TEL. SIDE PROP,LINE OF )STREET) ENGINEER NO. TYPE OF-EXISTING SETBACK- WAY }-- YARD- -_- TOTAL ADDRESS HIGHWAY WIDTH FROM L.L. TEL.CONTRACTORVir in Roof COoio. 287-0507 t + LL D ADDRESSS. G IND. 160650 CORNER CUTOFF YES ❑ NO U CITY San Gabriel 91776 c ass C-39. SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK y Z NEW ADD ALTER REPAIR xx DEMOLISH SQ. FT. NO. OF NO. OF SIZE 'STORIES 1 FAMILIES USE Reroof with rredium shakes SIGNATURE OF APPLICANT* VALUATION $ 13UNDAT 00.00 APPROVALS DATE INSPECTOR'S SIGNATURE FEE'$P. MT.J FEE $ 11A25 FO FORMS)MATERIALSION FRAME: FIRE STOPS, 1 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. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- - TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH, IN7. IND TO WORKMEN'S COMPE SAYION INSURANCE. /J _ LATH, EXT. SIGNATURE OF /_—/1/y� HOUSE NUMBER COR-. PERMITTEE' .ECT AND POSTED ADDRESS - - FINAL, � 76 JOHN F. LEWIS. PRINCI AL STF_y_C=PRAL'ENGINEER PLAN CHECK VALIDATION CK: M.O. CASH PERMIT. VALIDATION «. 'M:O. CASH Aryl 6 .1.4 9R AUG' 3 1 D 1 72: 5:` v WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to•self 1p� (/�1 //p�� FI�p,�p� gyp} I��qr �FI��Ip�'`/��-. gyp} ��pT�//AT� insure, or a certificate of Workers' Compensation Insurance (!'111 P LS�V'//'l1Ir 0011 V Il' OO�I LBUOL N PIS�IIV LL�� ' or a certified copy thereof (Sec. 3800, Lab ) (�/. Policy No. G.SZ ompany%�iC Come - COUNTY OF LOS,ANGELES - BUILDING AND SAFETY BUILDING Certified copy is hereby furnished. FOR APPLI NT TO FILL IN ADDRESS Q 6 R7 Cerfified copy is filed with the county,build: g inspec- BUILDING _z/1 /� LJ tion department. ADDRESS G LOCALITY L 1.j/� NEAREST Date�'�Z - L! Applicant CITY / ( ZIP CROSS ST. fild CERTIFICATE OF EXEMPTION FROM W RKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURAN SIZE OF LOT NOW ON LOT - MAP BOOK PAGE PARCEL - (This section need not be completed if the permit is for one `>'. USE ZONE - MAP . hundred dollars ($100)or less.) TRACT BLOCK LOT NO. , NO. TEL' SPECIAL G. I.certify that in the performance of the'work for which this OWNER 'NO. CONDITIONS " permit is issued, I shall not employ any person in any manner - - DISTRICT GROUP TYPE FIRE PROCESSED BY 0 so as to become subject to the Workers'Compensation Laws. ADDRESS - CONST. ZONE '� 71 -J�J�_ "-3 �— ix 0 Date - Applicant CITY zip STATISTICAL CLASSIFICA7]ON - APT- CONDO, o NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR _ TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. ..DWELL. UNITS_ d Compensation provisions of the Labor Code, you must forth- ADDRESS - - - - SEWER MAP H with comply with such provisions or this permit shall be TEL SEWER _ - Z_ deemed revoked. - CONTRACTOR L _ Nryip S W3A6 BK. PG, VALIDATION - LICENSED CONTRACTORS DECLARATION IC I hereby affirm that I am licensed under provisions of Chapter-9 ADDRESS O. V#JUATION (commencing with Section 7000)of Division 3 of the Business and pp LIC. r—} /Dd ^' Professions Code, and my license is in full force and effect. CITY F�� CLASS 76 D - Q��Z2 SQ. F7. NO.OF NO, OF CHECK . . License Number_ Lic.Class_ SIZE STORIES FAMILIES ONE �{ NEW $ Contractor Date J —�� DESCRIPTION OF WORK ❑ I am exempt u er Sec. ADD ; ALTER ❑ FINAL B.BP.C..for this reason lV6221 REPAIR ❑ DATE USE Date: EXISTTIING BLDG. QC� ❑ FINAL- DEMOL Signature " APPLICANT `� TEL. - By OWNER-BUILDER DECLARATION PRINT U � (. .N ZE600 - I hereby affirm that I am exempt from the Contractor's License /—�- - - Law for the following reason (Section 7031.5, Business and ADDRESS cC, JC f} Q D Professions Code): PRE E ro - ❑ - , I, as owner of the pperty, or my employees with BUILDING wages as their sole compensation,will do the work and , the structure is not intended or offered for sale(Section LOCALITY - 7044, Business and Professions Code). MOVING - TEL. - _0 1, as owner of the property, am exclusively contracting CONTRACTOR NO. _ with licensed contractors to construct the project (Sec- ADDRESS 'tion 7044, Business and Professions Code). - REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. UNE WIDTH - _I hereby off irm that there is a construction lending agency for -FRONT D - - - z;017,3..5 A ihe performance of the work for which this permit is issued P.I. Sec. 3097, Civ. C.): SIDE - #•°I°,° °1° P.L. Lender's Name 2)°L° 68.6*3 Lender's Address P.C. Fae$ Permit Fee ^ 'e•°•° (iA.63'cs> N Q certify that have lead this application and state that the Issuance pee 0 4,2 5—8'4 a above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, - - Total Fee 6ti /0 u and here y authorize representatives of this County to enter _ m upon e v en In d propyfori ction purposes. - - - n y 23 7 - SEE REVERSE FOR EXPLANATORY LANGUAGE. Signature of Applic nt.or Agent Date .®s H` WORKERS'.COMPENSATION DECLARATION p /� /�� Ip�I�� FOR L�T,�;sL , I hereby'affirm that I have a certificate of consent'do self' ��II �L( /arno 1 V Il OR ✓UMM II V V P1SR11�T insure, ora certificate of Workers'Compenstion Insurance, or f /r�111011 LS VIrU O D a certified copy thereof (Sec. 3800, Lab. C.) : COUNTY OF LOS _ANGELES BUILDING AND-SAFETY Policy No. Company Certified copy is hereby furnished. _ FOR APPLICANT TO FILL IN ADDRESS Q(0 4 JAL'&es Certified copy is filed with the county building inspec- BUILDING _ - tion department. ADDRESS Q /y/F LOCALITY NEAREST Date ''Applicant CITY -- �E'' eiT zlP 9/78 — ceoss sT. l 6�h ' CERTIFICATE OF EXEMPTION FROM WORKERS' '/ NO. OF SLUGS. ASSESSOR - COMPENSATION INSURANCE SIZE OF LOT 6 /U-•/ NOW ON LOT MAP.BOOK I PAGE PARCEL (This section need'not,be completed if the permit is for one hundred dollars•,($100)or less.) p USE ZONE MAP �. TRACT 76/0 BLOCK LOT'NO. NO. 4� ' - - _ - TEL [/s 1 SPECIAL O I certify that in the,performance of thew rk for.which this OWNER �L/IV/j/ IN 'f//1y T/i./� CONDITIONS - permit,is.issued, shot) not employ any p son in any ma e� DISTRICT GROUP TYPE FIRE PROCESSED BY V sous to be me bject to the Work Compenso 'o a ADDRESS / /,l/ /'d� CONST ZONE O CITY � /. _ c/? ' ZIP //d O /V� //� 0 Date Al - A �C�r� STATISTICAL CLASSIFICATION - APT. 'CONDO. V NOT E TOAPPLICANT: If, t making this "If of ARCHITECT OR TEL. W ENGINEER NO. CLASS NO. '�DWEIL. UNITS_ S Exemption, you should be � e subject to the Workers' N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER M AP with comply, with such provisions or this permit shall be TEL �/ *deemed revoked. _ - 'BK./Y / VALIDATION CONTRACTOR NO, PG, LICENSED CONTRACTORS DECLARATION Y - LIC.- - I hereby affirm that I om,licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (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 $ _ SO. FT. No. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES / ONE . -- $ MEXISTINGBLI)G. F WORK — NEW ❑ Contractor Date - " am exempt from the licensing requirements as I am a r ADD - licensed architect or a registered professional engineer ALTER FINAL � � acting in my professional capacity (Section 7051, ❑ DATE Business and Professions Code). REPAIR DEMOLFINALLIC.or Reg. No. - _Date ' TELBT OWNER-BUILDER DECLARATION NOI hereby affirm that I am exempt from the Contractor's LicenseLaw.-far the following reason (Section.7031.5, Business and A/NUJ -T6A/ Professions Code):. - PRESENT - 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 for sale (Section LOCALITY _ —'. 'i5 3:9'8 q' y�7044, Business and Professions Code), MOVING TEL L.10 1, as owner of the property, am exclusively contracting CONTRACTOR - NO. #.e Le a e:•,� withlicensed contractors to construct the project (Sec- ADDRESSj,e1 8 7 0`O. tion 7044, Business and Professions Code). REQUIRED TOTAL'SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY - SET BACK YARD HWY PROP. LINE WIDTH • • 5.7.0,0;� Ihereby affirm that there aconstruction lending agency for FRONT _ f - r 7 ' the performance of the work for which this permit is issued P.I. Q 8„0_4,T-8'2 (Sec.3097, Civ. C.). SIDE P-L. - _Lender's Name P.C. Fee-S Permit FeeLender's Address - I / •/ V i� I certify that I have read this application and state that the Issuance Fee ty a above information is correct. I agree to comply with all Coun • Investigation Fee p ordinances and State laws relating to building construction, m and hereby authorize representatives of this County.to enter Total Fee upon the above-mentioned pro y for inspection purposes. s a - - ; �/'�/,(J�[ SEE REVERSE FOR EXPLANATORY LANGUAGE . -Signature c Appll ant or Agern Date - - its