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Home My Public Portal About10634 DAINES DR_Building__ >........48..2/.. APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES ADDRESS L1-41 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION . LOCALITY .JOHN A. LAMBIE. COUNTY ENGINEER NEAREST' ' 'WILLIAM A. JENSEN SURA CL BVILDING. [CROSS ST. DISTRICT O. I GROUP TYPE. ESSED By FOA APPLICANT TO FILL IN /�'� co NST. t BUILDING - .. - STATISTICAL CLASSIFICATION I EWER MAP ADDRESS ` " SK PG �Qq� CLASS.NO. DWELL.UNITSza LOT NO 19' ParCe1L /-r �y �LOCKr� MAP STATE YES NO q NUMBER Y. TRACT 1690 USEZONE SPECIAL k�yyrr.. NOW ONLOGS ]_ CON DITION3 .L� SIZE OF LOT X767 �. USE OF EXISTING BLDG. , BUILDING EXIST. TEL SETBACK YARD HWY STREET NAME WIDTH OWNER R h- B Wm alf leld NO.Gi 33389 FRONT - ✓ P. L. _ �- ADDRESS 616 N. Pal Mal T. C. SIDE _ ARCHITECT OR - TEL. ENGINEER No. INSPECTION RECORD ADDRESS - TEL. CONTRACTOR S - No.GZ 02 O ADDRESS 825 Lower Azusa Rd. . — "--S V DESCRIPTION' OF WORK i "0, Alm 0 0 E. NEW X ADD - ALTER REPAIR DEMOLISH u7 SO.FT. __ NO.OF _ NO.OF a SIZE • STORIES FAMILIES In USE OF STRUCT URE Single Famj1 'Res Standard Plan No. 1 68 . Al SIGNATUREOF -� APPLICANT - VALUATIO APPROVALS DATE. INSPEC OR'S SIGNATURE PMT. FOUNDATION LOCATION FEE FEE $ �'�' FORMS, MATERIALS /')�./s-?A/ 1 EREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FBRACING, BOLTS RAME: FIRE S Ia Y/-!ice PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION. AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS r r ��4 [l STATE LAWS REGULATING BUILDING CONSTRUCTION. ^ _ % /iL-N♦ 1 CERTIFY THAT IN DOING THE -WORK' AUTHORIZED i LATH, INT. WILL.NOT EMPLOY ANY PERSON IN VIOLATION OF.THE WORKMEN'S COMPEttJSATIOON�LAWS 0 CALIFORINIIA LATH,EXT. SIGNATURE OF `� :, / J',' JGp HOUSE NUMBER COR- / A PERMITTEE V\ I �\ (((!!! LLL///_�i REST AND NUMBER CO �� .�/ !_(`AIL. ADDRESS 825 Lower Azusa Rd. FINAL 111 .. CLYDE N. DIRLAM. Pf INCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION (o M.O. C H PERMT VAUDATIO CK. M.O-. CASH 14jp90306 23 D 750 - M ` I ®. L 3L0 ' 7 NOV ?3 3 0.&0 76A636A CE#6033.63�,AP.PLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS— BUILDING AND SAFETY DIVISION LOCALITY ? 14 JOHN A. LAMISIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. / DISTRI Y NO. G P TYPE - -P O E B FOR'APPLICANT TO FILL IN J CONST BUILDING //}}�•��( STATISTICAL CLASSIFICATION / S ER MAP ADDRESS (1 / J //7p �� BK / PG/ /} 6 CLASS. NO. DW ELL.UNITS /� LOT NO: /7 BLOCK WATER NOT REQUIRED 1:1 1:1 1:1CERTIFICATE`. TRACT 1201-2!0 MAP (j n HIGHWAY STATE MAJOR SECOND. LOCAL NO. OF LID S. ` NO. L,/ (CIRCLE) SIZE OF LOT V ^ /J ( NOW ON LOT I USE ZONE PECIAL USE OF CONDITIONS EXISTING /BLDbGG./ es ? �Q�/gJ//C// OWNER &-/J. /rV /Q NO. %/.S�S.IO BUILDING EXIST. �•�j SETBACK YARD HWV STREET NAME WIDTH ADDRESS o"(' jr. l LI/ FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. > ADDRESS / �f // y TEL.//AJ.�f�13 �I�-)-�/ / /N .11/A l/h0�•../� 1 f! il'.t / ,4;JP V CONTRACTOR r NO. 77 d ADDRESS �/ -� G O DESCRIPTION OF WORK f -LI'' h Noy- !i/ k!2 n - Eaelcr4ry. f: fi�LG, (WWW NEW ADD ALTE REPAIR DEMOLISH i - " y SO. FT. (/ NO.OF NO. OF CJ IC- Ce,��G�N I b� Q to ". �L Alamo ? I SIZE 'j/OO Fv STORIES FAMILIES t U Y r 1 USE OF 1 rtna.bst.I• s , -- �,-u.t' �/ STRUCTURE t- .e h0 //l y°' Ot I " j�v/A d .� QA2m g, SIGNATURE OF APPLICANT VALUATION .5 Af+ - L APPROVALS DATE HSFECIEASTS SIGNATURE ITCFOUNDATION: LOCATION FEE PFEE ��® FORMS. MATERIALS ��/3✓ /� - FRAME: FIRE STOPS. ,/Y�.,/ C ✓�` � � 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. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE- OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. - �j LAYH. EXT. (�V SIGNATUR O HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL 7Tg /( k JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENG PLAN"CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION GK M.O. GASH LAGo 8 9 6 7 0 JUA 8 1 D 2 2.5 0,. a APPLICATION FOR BUILDING PERMIT, COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS n �' BUILDING AND.SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,SUPT OF BUILOINa CROSSST. R DISTRICTNO. I GROUPTYPE �/ PROCESSED BY � FOR APPLICANT TO FILL IN _= I CONST,Y I -. �, dam` BUILDING. - STATISTICAL CLASSIFICATION SEWER' AP ADDRESS - 1 CLASS.NO.-DWELL.UNITS I LOT NO, / rr'' BLOCK_ NUMBER ER _ '� /J HWY.- ('/_YEAS _(-N�` _ TRACT 7� V _ + {USE ZONE SPECIAL' NO OF BLDGS y • CONDITIONS f�fk+ 4✓J) .��y. � ' - ... SIZE OF LOT NOW ON LOT ' (� �.,�� V/L USE OF . {C - /..ti/.�/1 EXISTING BLDG. BUILDING YARD HWY STREET NAME EXIST: 'SETBACK WIDTH - OWNER T FP.L: MAIL ADDRESS SIDE TEL CITY INSPECTION RECORD ARCHITECT OR TEL. -'ENGINEER - NO. ADDRESS- t,, - [ w- IT by CONTRACTOR A•• Scott NOLT7_ OZ IV ADDRESS - . ` DESCRIPTION OF WORK' NEW ADD ALTER • REPAIR 'DEMOLISH SO.FT. NO.OF NO.OF SIZE STORIES' FAMILIES USED - - 1 STRUCTURE nV761 1 l n Std- Plan No. #171W/ e� \ / SIGNATURE OF APPLICANT V _ APPLICANT p '• APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS 82ZA'SA - d FOUNDATION:LOCATION - FORMS,MATERIALS - - VALUATION S 1 O o .. FRAME: FIRESTOPS. BRACING,BOLTS P.C. 5P PMT. FURNACE:LOCATION, FEE S / I-FEE S Z U I - GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT,I HAVE READ THIS AP- PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE, LAWS'RE U TING BUILDING CgPSTRUCTION. LATH,EXT. SIGNATURE.OF W- HOUSENUMBERCOR- - @ PERMITTEE [i RECTAND POSTED. ' ADDRESS FINAL - CLYDE N. DIRLAM,.PRINCIPAL STRLi URAL ENGINEER PLAN CHECK VALIDATION m.o, CASH PERMIT VALIDATION K. �' =^s �[ D:a 3'1 9DEC 1 2 3 n' 7.50m - ;(Dr- 8 3 2 o D."832on DEC 1, 1 A 30 .00 WORKERS' COMPENSATION DECLARATION I�I�p /�1 /� r�p FOR I�p p p r� p/� (� /F. 'I hereby'`affirm that I have a certificate of consent to self �Irl�ll �LL —11MOIlpll FOR IX(II y�ll��D�llgFll( ur pl}:�IR T T or a.certificate of Workers' Compensation Insurance, LI B LS VrTU 11 U V Il0 LJ `t_J- ILSS U VU V/ Lei II C/4 or a certified copy'thereof (Sec. 3800,'Lab. C.) - i • - - COUNTY OF LOS ANGELES BUILDING AND SAFETY . Policy No. - Company BUILDING ❑ Certified cppy.is hereby furnished. . FOR.APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- - BUILDING - tion department. ADDRESS / , / CITY' iC C.r/ ' ZIPYl 7,222LOCALITY Date Applicant N . OF BLD S. NEAREST / � CERTI KATE OF EXEMPTION FROM WORKERS' SIZE OF LOT ' C NOW ON LOT -" CROSS ST, CsY'C___ •'t/�l�T' COMPENSATION INSURANCEASSESSOR ✓ (This section need riot be completed*if the permit is for one r - TRACT - BLOCK LOT NO. MAP BOOK PAGE / PARCEL L_ hundred dollars ($100)or less.) TEL USE ZONE MAP OWNER NO. NO. I certify that in the performance of the work for which this - / ., SPECIAL y� _ permit is issued, I shal I not employ any person in any manner ADDRESS �dP} /x •- - 2 CONDITIONS so as to become subject to the Workers'Compensation Laws. CIN ZIP �d O Date Applicant - ARCHITECT OR TEL. DISTRICT GROUP TYPE _ FIRE PROCESSED BY 0 NOTICE TO'APPLICANT: If,-after making this Certificate of ENGINEER _ _-.NO... ._ CONST. ZONE J Exemption. you should become subject to the Workers' - w Compensation provisions'of the Labor Code you must:forth_ _ ADDRESS 3�� _ r G. with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT, I CONDO. Z Z deemed revoked CONTRACTOR NO. '' // _ LICENSEDCONTRACTORS DECLARATION, LIC. CLASS NO.. DWEIL. UNITS'_ I hereby affirm that am licensedmnder provisions of Chapteri? ADDRESS NO. (commencing with Section 7000) LIC SEWER MAP of Division 3 of the Business 'and Professions Code,and my license is.in full force and effect CITY 'CLASS BK PGVALIDATION ` 50. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE . VALUATION Contractor Date - DESCRIPTION•OF WORK NEW 1:100 , - ADD 1:1 $ Sec., S Or D ❑1 am exempt-under Sec ��. _ ALTER ❑ - B.BP.C. for this reason rr7• 'f$ PAIR ❑ S - Date: USE OF - EXISTINGBLDG: 'DEMOL ❑ Signature APPLICANT , // TE (PRINT) �L`'r L —S / . ' OWNER-BUILDER DECLARATION ' 'NO.� FINAL )96 1� q� DATE Ihereby affirm that I am exempt from the Contractor's License gDDRE55 s�y 19s WP(�7 - ' Law for the following reason•(Section 7031.5, Business and FINAL--.-f <�� ProfqAions Code): PRESENT ) a -BY: I,.as owner of the property, or m employees with BUILDING !'� / �� .Wrtl P P Y YADDRESS / L wages as their sole compensation,will do the work and LOCALITY G G D 't the structure is not intended or offered for sale(Section t; 7044, Business-ondProfessions Code.) MOVING AL.. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS '- tion 7044, Business and Profesiions Code.) REQUIREDTOTAL SETBACK FROM ..EXIST. CONSTRUCTION LENDING AGENCY I SET BACK 'YARD HWY PROP. LINE WIDTH - - .:Ax:r p0 'Phereby affirm that there is a construction lendingagency for .FRONT r{. . ; the performance of the work for which this permit'.is issued '" - _ P.L. (Sec. 3097, Civ. C.). SIDE - Lendei s Nome _ - t St v m .Address_ ./y. / .CDMA Ref..# Lender's " .r" a -�,' -� P.C. Fee$ Permit Fee ! - acertify that.l have read this application and state that the Issuance Fee LDMA P/C# D 8 above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee'A n LDMA Perm. # < .and hereby outhorize representatives of this County to enter upon the above-menti ed property for inspection purposes. — ' - - - i _� SEEREVERSE FOR EXPLANATORY LANGUAGE Signature of App b nt or`ADate COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING ADDRESS FOR APPLICANT TO FILL IN WORKER'S COMPENSATION DECLARATION ` y� BUILDINGADDRESS 1011 I hereby affirm that 1.have a certificate of Consent to self insure, O 6 or a certificate of Workers'Compensation Insurance,ance,or a certified CITYT ZIP Gr copy thereof(Sec.3800,Lab.C.) l G� e 9� 96 LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ' j ❑ Certified copy Is hereby furnished. O I ) NEAREST CROSS ST ❑ Certified copy is tiled with the county building inspection TRACT j` BLOCK LOT NO. - ^' department. O O 91 USE ZONE MA NO. ASSESSOR MAP 800K PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' DW_ ER � c I ` TEL.NO. 1 _ YESeSSED COMPENSATION INSURANCE (AWITHIN 1000 FT OF SCHOOL? ADDRESS (This section need not be completed if the permit is for One hundred b��/ DISTRICT 'GROUP TYPE ST.' FIRE ZONdollars($100)or less.) CITY .ZIP1 certify that in the performance of the work for which this permitis issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO.become Subjectl0 the Workers Compensation Laws. STATISTICAL 1 CATION Date AppliCaOt ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACE%emption, y0U ShOWd beCOnte SUbjeCt t0 the Workers' CONTRACT RBACK YARD HWY PROP LI Compensation provisions of the Labor Code, you must forthwith FRONT Comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION cin - uc.CLASS SIDE C 1 hereby affirm that I am licensed under Provisions of Chapter 9 '' SEWER MAP U (Commencing with Section 7000)of Division 3 of the Business and 'FT.SIZE NO., STORES NO.OF FAMILIES O Professions Code,and my,license is in full force and effect. 6 NEW ❑ BK PG DESCRIPTION OF WORK ADD VALUATION D a License Number Lia Class _ _ $ "� g_3 90 Contractor Date ALTER ❑ `� J (� z_ ❑ I am exempt under Sec. 2- REPAIR ❑ $ , B.&P.C.for this reason DEMOL ❑ COMA P/C p USE OF EXISTING BLDG. - Date: UR M ❑ Signature APPLICANT(PRINn TEL.NO. CDMA Perm e 1 � _ ❑ I, as owner of the property, or my employees with wages as ZO their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and 2 L D O /� FINAL DATE Q 01 Professions Code.) r _�- G _ WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ty Iy ❑ I, as owner.of the property, OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN J 1 p D rty am exclusively contracting Wllh THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? C Q STEPtSr licensed contractors to construct the project (Section7044, YES❑ NO r"A ?I_ITPiL ® ;' Business and Professions Code.) V V WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK (, i-L'e?- ' COASTA IR QUALITY MANAGFOR EMENT DISTRICT (SCA MD)SE ICATIONFROMTHESOUTH I:TlCldl ,� CONSTRUCTION LENDING AGENCY COAST IDE OUALITV MANAGEMENL DISTRICT ISCAOMD)SEE PERMITTING CHECKLIST '} �,i FOR GUIDELINES I.IIFI`IhL - 10113 I hereby affirm that there is a construction lending agency for YES❑ rvo'01 the performance of the work forwhich this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD .3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTYCODETITL "A"I" AAT 22]SECTIONS 22J.t0e THROUGH 221.1IOCONCERNING 2 Lenders Name DOUS MAT A SEPOINTING AND FOR OBTAIN G A PERMIT MOM THE SCAOMQ .. Lenders Address ?%66 1 AM Ivy{ o' I certify that I have read this application and state the t tP.C.he above FEE PERMIT FEE information is correct. I agree to comply with all county A �✓ ordinances and State laws relating to building nstruction,and T p - hereby authorize representatives of this C ty t0 enter upon ISSUANCE FEE 13, 0o 3. Oo the abo e-mentioned property for iI S n purposes. Altzq o- INVESTIGATION FEE TOTAL FEE ' �aAPp�m>AP.m SEE REVERSE FOR EXPLANATORY LANGUAGE