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HomeMy Public PortalAbout10635 DAINES DR_Building__ .,TEMPLE:clw, sA63aAGEsao3 APPLICATION FOR BUILDING PER IT COUNTY OF LOS 'ANGELES euI"I'D DEPARTMENT OF COUNTY ENGINEER ADDRESS Q n BUILDING-AND SAFETY DIVISION LOCALITY �y JOHN A. LAMBIE. COUNTY ENGINEER NEAREST `�.,.- WILLIAM A. JENSEN. SUPT OF BUILDING GROSS ST. C _ DIST ICT N P TYPE P O FOR APPLICANT TO FILL IN y © � coNsr. - BUIL J L G /Jq N<f �T M /•! lj/ TATISTICAL CLAS IFICATION �.SEWER MAP ESS S BK= GLASS. NO. DWELL. UNITS__jj J LOT NO. BLOCK WATER NOT REQUIREDRECEIVED CERTIFICATE: TRACT .: MAP //�� HIGHWAY NO.OF BLDGS ,y NO. Z }u HGLE)' STATE MAJOR SECON LOCAL SIZE OF LOT .7�X} 7 NOW ON LOT USE ZOfIE SPECIAL_ ; USE OF L p (n �/� .CONDITIONS F - EXISTING BLDG. '9f/�".f�� � /^e a�e�ir �� � • , / r� .- . TEI-tr�37<,-. T OWNER - F ,f NO SUI DING EXIST. -t .O SETBACK YARD HWY STREET NAME WIDTH ADDRESS LC.7i O //�JG/ §' e,,F /"s� FRONT ARCHITECT OR TEL. P. L. C2 ENGINEER NO. SIDE �. 4". P L. a ADDRESS L O [� V CONTRACTORTEL (J NO. • ' ADDRESS' 0 DESCRIPTION OF WORK m a h NE .A7DD�-p ALTER REPAIR DEMOLISH Z SIOZET /J STORIES FAMILIES USE of GB�AYE.v< f v.� .�/�.Z[711• STRUCTURE a 'f `SIGNATURE OF':_p APPLICANT /y VALUATION SiLl _APPRO L TE �I CT SIGNATURE P.C. 4 .PMT. FOUNDATION: LO I - y FEE Pf �� J FEE S FORMS. MAT IALS FRAME: FIRE STOPS. ? I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRAC ING. BOLTS _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO cOMFLY`. ` ' . .FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING rY'L GAS VENT. DUCTS', BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK . AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLA- L,ATH. INT. TION OF THE.LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S C O MPENEATION,INSURANCE. • LATH, EXT, SIGNATURE OF HOUSE NUMBER COR. PERMITTEE — RECT AND POSTED , ADDRESSI r FINAL i,; JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER ` PLAN CHECK VALIDATION GK. MO. GASH _ PERMIT VALIDATION CK. M.D. GAB. • t tom, 8 5 9 3 'lAY E3 2 3 -0 3 025 " <r ,e 76A638P CEu8036-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ~BUILDING J DEPARTMENT OF COUNTY ENGINEER ADDRESS / BUILDING AND SAFETY DIVISION LOCALTY r. JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST. DIST JCT MO. GRO, UPPTYPE ESS D BY FOR APPLICANT TO FILL IN corvsr. < BUILDINGqq \/ STATISTICAL CLASSIFICATION EWER MAP A RESS fr ✓ CLASS. NO. DWELL UNITS BK LOTNO-_72 a'01-111 W TER NOT REQUIRED ❑ RECEIVED ❑ RTIFICATE: TRACT _ .(,�(yp /� P HIGHWAv / NO.OF LDGS. O. �.�°r.� �l IueCLEI STATE MAJOR SECOND OCA SIZE OF L T NOW ON LOT USE ZON SPECIAL USE OF CONDITIONS EXISTING BLDG. �r ✓.� � Y TEL. VI OWNER aI s _ BU IVDING EXIST. ®® SETBACK, YARD HWY STREET NAME WIDTH ADDRESS / ��/- - p FRONT in ARCH ITEOT OR TEL, P. L. ENGINEER NO. - SIDE P. 1- ADDRESS ADDRESS (J j' (� (( Y L V• r-PITTIFIR -DRIVEWAY APMOACH. O CONTRALTO AND PARKWAY T EE P.c1l;IP.7 V ADDRESS ef-A 46 e C DESCRIPTION°OF WORK dRw,i'.:, and d::c"I:y .p= sia!LT!iou ssmld k.:: taken oNj ai the L. A. (k, aW N ADD ALTER REPAIR DEMOLISH Q{jc0 Or T. C. Co. Engineer, Tike N11;114.•.•-••b ••• 'r-' IdN 'SQ. FT. NO. OF NO. OF C•.. sian work fakes time and Is not start dZ SIZE STO IES FAMILIES ' USE of until Permit hes been issued. Apply for parkway tree permit at T. G STRUCT RE �1 lic SIGNATURE OF - r -/wr s;� APPLICANT _ ' v�i� - - r:. VALUATION $ 1� �f/I 4C' I - r'•' r•° /) {.� APPROVALS DATE INSPECTOR'S SIGNATURE FEE,$. �' ' FEE $ (// ,J© FOUNDATION MATERIALS: LOCATION. FRAME: FIRE STOPS, I .r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, ID /1 ( !I. /" �1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE I LOCATION, WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING I 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- INGTO WORKMEN'S OMPENSATION INSUR NCE. LATH. EXT. yL. yyp�^ SIGNATURE O HOUSE NUMBER PERMITTEE RECT AND POSTED //n. In gDDR ESE FINAL JOHN F. LEWIS. PRINCIPAL Sr OJCTI(1 RAL ENGINEER PLAN CHECK VALIDATION (o M.D. GASH PERMIT VALIDATION CK. 'M.O. CASH LI'J 0 7 2 1 3 JAN 4. 2 3 D 3 0 2 5 C", 7 3 4 8:o JAN 7 1 D 60.50- LAW a yy/�, #910206 SB APPU CATM FOR CSM D I O NG PERMT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADOflE55� BUILDING ADDRESS I hereby affirm that 1-have a certificate n consent to self insure, 10635 Daines Dr. or a certificate of Workers'Compensation In uranc ,yr a certified Cm ZIP Copy thereof(Sec.3800,Lab.C.) ITepu�11C Tem le Cit 91780 LOCALITY Policy No. FC 997500 Company Indemnity SIZEOFLOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy Is hereby furnished. NEAREST CROSS ST ❑Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. I I USEZONE MAP NO. Date 7-1-92 Applicant Virgin Roof Co. ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE Jeanette Hsieh WITHIN 1000 FT OF SCHOOL? YES NO ADDRESS (This section need not be completed if the permit is for one hundred 10635 Daines Dr. DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY - ZIP I Certify that in the performance of the work for which this permit Temple City 91780 Is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER TEL.NO. become subject t0 the WorkelaCompensation Laura. STATISTICAL C�LASS�IFICATION APT CONDO Data Applicant ADDRESS CLASS NO.!rFte DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers CONTRACTOR TEL.NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith Virgin Roof Co. 287-0507 FRONT comply with such provisions orthis permit shall be deemed revoked. ADDRESS LIC.NO. PL P.O. Box J 160650 SIDE Y LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L I hereby affirm that I em licensed under provisions of Chapter 9 San Gabriel C39 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE NO.OF STORES NO.OF FAMILIES O Professions Code,and my licensees in full and effect. 24 s s. one NEW ❑ BK PG D License Number 160650 LIc.Claw C39 DESCRIPTION OF WORK ADD ❑ VALUATION W Virgin Roof Cpate 6-30-93 Over existingroof apply Class Contractor ALTER ❑ $ 2786.00 z I am exempt under Sec. A Fiberglass Shingles. REPAIR El ❑ B.BP.C.for this reason 24 S S. DEMOL ❑ LDMA P/CA Date: O USE OF EXISTING BLDG. .URIM ElDwellin Signature - APPLICANT(PRINT) TEL NO. LDMA perm e . ❑ I, as owner of the property, or my employees with wages as Virgin Roof Co. 287-0507 _ s their sole compensation, will do the work and the structure is ADDRESS O etiS:(..F.s not intended or offered for sale (Section 7044, Business and Box J San Gabriel CA 91778 FINAL DATEit Professions Code.) WILLTHE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �j ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER TNAN Q S . I C.-.11 y conracg THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY; > licensed contractors to construct the project.(Section 7044, YES❑ NO 91 - r TOTAL S-71 _.€ 0 'Business and Professions Code.) WILL TNN INTENDED USE OF THE BUILDING BY THE RMODIFIC OR FUTURE BUILDING _"HECK� i v{_) OCCUPANT REQUIRE A PERMIT FORTDISTRICT (SCONSTRUCTION ORMODIFICATION FROM THESOUTH LJ CONSTRUCTION LENDING AGENCY COAST MR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST `, FOR GUIDELINES. I��ny - CHANGE IIYVL vL1f' I hereby affirm that there is a construction lending agency for .YES❑ NO® ' 'W the performance of the work for which this permit is issued(Sec. _ I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD EE {{ 3097,CIV.C.). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �� COUNTY CODTITLE Z,CHAPTERy�1e SECTIONS za)100THROUGH2.201CCONCERNING ' 3 Lenders Name - HAZARDO EMATERIAL REPOR IN1 F O T I �(iA T FROMTHESCAOMD. .Fr'IIt IAF' pv'].: Lenders Address o. o'miTAORA o' I Certify that I have read thisC oOc and state that the above P.C. EE PERMIT FEE information is correct. agreegreetto comply with all county . , ordinances and State laws relating to building construction,and $69.00 hereby authorize representatives Of this County to enter upon ISSUANCE FEE - - the above-me tjoned roperty for inspection purposes. 13.00 "n 7-15-91 INVESTIGATION FEE TOTAL FEE 17 or Rom ow SEE REVERSE FOR EXPLANATORY LANGUAGE. -