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Home My Public Portal About10632 DAINES DR_Building__ Nj COUNTY OF LOS ANGEi BUILDING AND'SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILowG AooRE//ss ( hereby affirm that I have a certificate of consent t6-self insure, BUILDING ADDRESS or or acertificate of Workers'Compensation Insurance,or a certified ' - copy'thereof(Sec 3800•Lab-C.) CITY.,` 21P .. .. - . Policy No.I �'� Mt7 y '�� COmpanySTAT R)1J D C� rGA 1 D LOCALITY SIZE OFILCT 1 NO.OF BLOGS NO}'�ON LOT ElCertitiedccoy is hereby furnished. Q 'Z e2 NEAREST CROSS ST Certified copy is filed with the.county building inspection TRACT BLOCK LOT NO. - - '• depart�m-entC� USE ZONE MAP No, - Date jAppllCant kAH r,4� ASSES`RpMAP BOOK PAGE PARCEL - - • ? p L= �f•3D 111 7 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER Ey NO. - - . YES Cj No COMPENSATION INSURANCE , , Uo G ZEE WITHIN 1000 FT OF SCHOOL, (This section need not be completed it the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED DV dollars ($100)or less.) • - T -CE SE GI .ZIP -" I certify that in the performance of the.work for which this permit 9 '}fj-, is issued, I.shall not employ any person in any.manner so as'do ARCHITECT-0R ENGINEER NO/� .fl �� le 3 -�� ,P2 � , become subject to the Workers;Compensation Laws. �p STATISTICAL CLASSIFICATION - r' a CONDO N / ' t� .a Date Applicant ` ADDRESS / �//11�� •4�y.77O GLASS NO. DWELL UNITS - _ IV677CE'TO APPLIC4NE If, after making this Certificate Of L-' L # $G't REQUIRED TOTAL SETBACK FgOM, EXIST 1,. 21 Exemption, you should become Subject to the Workers' CONTRACTOR - •TEL NO. SETBACK YARD HWV PROP LINE A 2.I t WOTH Compensation provisions of the Labor Code, you must forthwith -C-' I FRONT tt••'�rr comply with such provisions or this permit shall be deemed revoked ADDRESS LID.NO. - P L TOTAL i 'E 0 m 2, LICENSED CONTRACTORS DECLARATION510E .jolt '1 Ga IJ,C:1 CITY LIG.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP ' TIT a .I (commencing with Section 7000)of Division,3 Of the Business and SO_FT.SIZE NO.OF STORIES NO.OF FAMILIES � 9 Professions Code,and my license Is In full force and effect. NEW ��❑ttl BK PG Y a_i I D r . -. {;70 License Number a Lic.Class �i DESCRIPTION OF WORK ADD ryl VALUATION D ' �� Q011�u C� ContractorN ea to -�7-�(0 tt.� l'TNCn I'✓'15 RH'�G4G- I-IZ'K 146) ALTER ❑ $ LL- 00 00I00tollill I/1'?/96aL� ❑ am exempt under Sec. wit it r ' �N aj I3G MS ' REPAIR ❑ TyI'.�-}� e3�� —Z B.BP.C.for this reason DAT: Ai*j1)-�q,-)I iCr'9 . - DEMOL ❑ $ lNt:7i 1 F :+f,1*`1� CDMA P/C# CHANGE .110 Date: USE OF EXISTING BLDG. o URM El- Signature APPLICANT( INT) /y NNO. n LDMA Perm# q�,r�r�� DA as OWDef,Of the property, or my employees with wages as /''l t ,/'! l"r U) 5-71- -1 9 d - Z f{yLyLyLj IHQ1 1/12/96 their sole compensation, will do the work and the structure is ADDRESSr f -- O tq� ec not intended or offered forsale Section 7044, Business and 7 V�Lj t/p - - r Q I Ail`•Iil m ( 5'CSM 77 FINAL DAT�ES�rr Professions Code.) WILL THE APPLICANT OR UTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL property, OR A MIXTURE CONTAINING A HAZARDOUS.MATERIAL EQUAL TO OR GREATER THAN THE 1 ❑-I, as owner of the re rt am exclusively contracting_with Q AMOUNTS SPECIFIED ON THE HAZARDOUS INFORMATION GUIDE? FINAL BY I' 1 8 licensed contractors to construct the protect {Section 7044, �Il•lT.a YES❑ NQryry�� - ,L 'Business and Professions Cotle.) - - S" ♦ WILL THE INTENDED WE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 2 �� `-330 810.39 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH . CONSTRUCTION LENDING.AGENCY COAST AIR CHATTY MANAGEMENT DISTRICT ISCAOMDI"SEE PERMITTING CHECKLIST FOR � � ^� Irlf� GUIDELINES - �` ITEMS I hereby affirm that there is a construction lending agency for YES❑ -NO'N - - - - ,z t' TOTAL 'Qj60 - 89' the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PEHMITTING 3097,CIV.C _ CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. CHECK 96LI 69 IlC-lr V__eV" • TITLE 2.CHgPj R.2 0 SECTIONS 220.100 THROUGH 2.20.100 CONCERNING HAZARDOUS r, 9 Lenders Name. MATERIALS REP NG AND F R OSTAIN,ING A PERMIT FROM THE SCAOMD. .t_H/'I'1(E Lender's Address - - - - CHANGE !JJ - avx¢P OR 1 certify that I have read this application and state under penalty PC F PERMIT FEE �'n 'n n p 'of perjury that the above information is correct.I agree to comply - jam/ D OOO r-H0!U1 1/17/96 m with all county ordinances and Stale laws relating .tobuildingvo ASI -1 m 'construction, andherebyauthorize representatives of this County n •�(� -ISSUANCE FEED Q - 42195 1 ryt11�!n.jl] to enter upon- 'above-me ioned property for inspection purposes d (INVESTIGATION FEE' TOTAL FEE ' 9ro,„e1v SEE REVERSE FOR EXPLANATORY LANGUAGE =enaos,=-ae' APPLICATION FOR BUILDING. PERMIT COUNTY OF LOS`ANGELES BUILDING. 63 2 �� DEPARTMENT OF COUNTY ENGIIVEER AD°REss - BUILDING AND SAFETY DIVISION LOG LI_ JOHN A. LAMBIE. COUNTY ENGINEER NEAREST` CASSATT O. GRIFFIN; SUPT OF BUILDING • CROSS ST. •T1 - ; -TYPE, PROCESSED BY -- FOR APPLICANT TO F 1 IN ti I'CONsr 17RK DING STATISTICALCLASSIFICATION SEEWER MAESS 06' ./tJ(? r CLASS.N0.O.. BLOCK - MAP STATEyE5• 0` NUMBER cOL3 .HWY.o USE ZONE SPECIAL T - AY �- CONDITIONS �NO.OF.SLOGSOF LOT - Q$ 2 NOWONLOT "P•IOReOP TING BLDG. • ----------- BUILDING EXIST. SETBACK YARD HWY _ STREET NAME WIDTH ER C B• MC Don 111 RESS SIDE TEL.. P..L.' " INSPECTION_RECORD.ITECT R TEL.NEER TEL.ESS LL.�, 11 (RACTOR T A. BCO ti�'i NO(il LIOZL6 - 0ESS 825. Lower Azusa Rd. , / ` DESCRIPTION:'OF,WO RB IL V P (� I .1 hit) AJJA : 1 r 1 NEW Y ADO ALTER REPAIR DEMOLISH I' jelly1 /I I' / SQ..FT. NO.OF NO.'OF SIZE PA61 858STORIES I FAMILIES -, n/1 I I/ USE OF STRUCTURE Tion StIl SIGNATURE O i \ / - APPLICAN -� ... APPROVALS DATEINSPECTOR'S SIGNATURE ADORESmausa,gd j. -- FOUNDATION: LOCATION - rFORMS.MATERIALS - VALUATION.$ d FRAME: FIRE STOPS. " BRACING,BOLTS - - p O _ _ FURNACE:LOCATION.' _ FEE $ j o'I FEE $. G' GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STAT HAT THE.ABO IS CORRECT AND LATH.INT. _ - AGREE TO'COM PLY HALL COU DINAN AND 1 STATE--LAWS /PPgyyyLLLNNN G. I 3 CTION. LATH,EXT. SIGNATURE O `� - _ HOUSE'NUMBER COR , PER MITTEEti_A� SCO, RECT AND POSTED "'ADOREss t.,`_ FINAL - CLYDE N. DIRLAM, PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION cK:. Wo. CASH PERMIT VALIDATION �-N.o. CASH 08 3 1 7 DEC ' 'l 2 3 A Rr08318 'DEC 1 1 A 3j00V• «; TaAau cc$em s/eo APPLICATION FOIA B ULLDING -PERMIT COUNTY OF LOS ANGELES BUILDI s P r DEPARTMENT OF COUNTY ENGINEER zz BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JEN6EN 6UP•T OF BDILDING CROSS ST. DIS�T ICT N �xBQile TYPE P ESSED BY FOR APPLICANT TO FELL IN Sid CONST. BUILDING STATISTICAL CLASSIFICATION S WER MAP ADDRESS D / BK PG 11•-��•/,r -T��, _ CLASS.NO. WELL.UNITS MAP LOT NO. I�arC BLOCK NUMBER t� HW STATE YES O TRACT US/EZONE SPECIAL NO.OF BLDG SIZE OF LOT 0X26 I NOW ON LOTS CONDITIONS USE OF EXISTING'BLDG. - - BUILDING EXIST. TEL. SETBACK YARD HWY STREET NAME WIDTH OWNER NO. FRONT t .. - ADDRESS 5616 N. Pal Mal P.SIDE ' 1 ARCHITECT OR TEL. P.L. ENGINEER- NO. INSPECTION RECORD ADDRESS - _ TEL /l /7 /✓a lnwT¢ - o7'i,A/-� W CONTRACTOR NO. r o ADDREss825 Lower Azusa R "'�"-�"—•v DESCRIPTION OF WORK .2l .0 ✓ _/ 0 NEWA ADD ALTER REPAIR . DEMOLISH r Sp.FT. p NO.OF 14 //IJ.7..../,ce 512E 8 8 STORIES l FAMILIES 1 `f v y STROCT STRUCTURE Single. Family Dwelling an No.#17968 51GNATUREO / CANT L APPLI VALUATION$ _ APPROVALS DATE INSPECTOR'S SIGNATURE PMT. �J [J[� FOUNDATION: LOCATION // /f FEE s �'j '�• FEE S 3C FORMS, MATERIALS /1 (em J'x..R.J� FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS.AP- BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS -Z, STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT. 3s'GO WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S COMPS TION LAWS CALIFORNIA. LATH.EXT. L 9'GO w SIGNATURE OF HOUSE NUMBER COR- P y PERMITTE RECT AND POSTED 2 6/ .L//. ADDRESS Azusa Rd.- FINAL CLYDE N. DIRLAM, PRINCIPAL STR,pCTCIIAL ENGINEER PLAN CHECK VALIDATION cK. M.o. CASH PERMIT VALIDATION CK. M.O. CASH LLo9034 NOV 23230 15.00 L�io9'v 1 D 30.00