Loading...
HomeMy Public PortalAbout10637 DAINES DR_Building__ 76AB38A CE4803 8-63APPLICATION FOR BUILDING PERNjIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. LC DISTRI T N GROUP TYPE ESSED BY FOR APPLICANT TO FILL IN CONST. BUILDING ® STATISTICAL CLASSIFICATION S WER MAP ADDRES , CLASS. NO. DW ELL. UNITS BK36 S LOT NO. WATER NOT REQUIRED .RECEIVED ❑ CERTIFICATE: TRACT /ZiA;lGQ. LCA L� MAP HIGHWAY ' NO.OF BLDGS. .0_9 O ¢IactEl STATE MAJOR SECOND. CAL SIZE OF LOT Y� NOW ON LOT USE Z NE SPECIAL USE OF �1'-�-' CONDITIONS _ EXISTING BLDG. TEL. OWNER NO. 8 ILDING EXIST. SETBACK YARD HWY STRE T NAM WIDTH ADDRESS FRONT ARCHITECT OR TEL, P. L C� J ENGINEER - NO. SIDE P. L. ADDRESS TEL. ) 6S- FI S O CONTRACTOR f.444f, NO. 1 U © SJ M15 .O -MU S.1m ADDRESS Q DESCRIPTION OF WORK ri NE ADD ALTER REPAIR DEMOLISH N 50. FT. ISD IO ) _ tj c� STORIES FAMILIES ? SIZE V USE C / `,EC OYI ll IC _ STRUCTURE �( ^� fl V-7 )) lT� AAA( I SIA . S) 'T) . SIGNATURE OF - "r,5 A2 )2E -L� APPLICANT 1 VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. ()(I FOUNDATION: LOCATION FEE $ '� FEE S FORMS. MATERIALS FRAME: FIRE STOPS. y I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING. BOLTS JJ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. u WITH ALL COUNTY ORDINANCES ANO'$TATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. 1 CERTIFY i!A AT 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. LATH. EXT. SIGNATURE OFAl HOUSE NUMBER COR- PERMITTEE_ V RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPALS; RAL ENGINEER' PLAN CHECK VALIDATION DK. M.D. cnsH PERMIT VALIDATION DK M.G. CASH Ll'Uo 7 1 9 8� DEC 31 2 3 0 3 5.50d Luo 7 3 r3 6`0 JAN 7 1 D }7�,�1.0 0 WORKERS COMPENSATION DECLARATION / t ` /0 b' IIsi . ''I her' affirm t�'at i,have ertifimte of consent Jo self - ////pp���� O O ��[//[,�aa////UU���� �rr�LI����I�pI�� FOR I�P�r�P���(( �pp�ff �rP�1I����pp����//((����rr O �p}I��(�///�� s insure bU certi}i'ate,c�Wc..'�rs' Compensation Insurance, - - 'lrq����V ���BV t1 'OIIp L/��LS��UV�/ �l5U�l11V LL�� ;ora certified copy thereof (Sec. 3800, Lab. C.) ., p o� c/ r� / COUNTY OF LOS ANGELES BUILDING AND SAF TY Pol icy No72( D Company � YY/ruf - Certified copy is hereby furnished. FOR APPLICANT TO FILL IN - ADDR ss' 3 I� Certified copy is filed with the county wilding inspec- BUILDING / �J 11 tion department ADDRESS- Q:b3/ G.. n Q LOCALITY 6 I A licant CITV, Te" C;� NEAREST y ,- Date pp /C ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO, OF BLDGS, ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one , - USE NE MAP �•�� hundred dollars ($100) or less:) - TRACT BLOCK [LOT 7I�� I NO. -TEL.. - Ih SPECIAL I certify that in the performance of the work for which this OWNER QS U�t NO. ' VVV �" CONDITIONS 1 permit is issued, I shall not employ anypersan in any manner q - DISTRICT OUP TYPE - FIRE PR ESSED BY 0 so.as to become subject to the Workers Compensation Laws. ADDRESS /O ' ITIS iy�Ty CONST, ZIE / CITV^ -(e 19 O. Date - Applicant - SIA715TICAL CLASSIFICATION APT:, rDO. 0- NOTICE TO NOTICETO APPLICANT: If, aftermaking this Certificate of ARCHITECT OR /f - TEL. - .. Exemption, you should become, subject to the. Workers" ENGINEER •!-1 r�..' NO.C'J7T`+u+7 a s CLASS NO. - DWELL. UNITS_ Compensation provisions of the Labor Code, you must forth,- ADDRESS d4.0 ✓Pxc-- SEWER MAP - W with comply with such provisions or.this'permit shall be TEL. deemed revoked.- - t VALIDATION - CONTRACT Q 4t, NO. '�d�7Y BK:, �PG, �/S LICENSED CONTRACTORS DECLARATION �s r,�LLIC. I hereby affirm that am licensed under provisions of Chapter 9 ADDRESS ,J, b Ci• NC VALUATION (commencing with Section 7000)of Division 3 of the Business and e LIC Professions Code, and my,license is in full force and effect. CITY :GO I0 PAev-` CLASS. 8 ' (/ /�r SQ. FT./' NO.OF NO Of.'_ CHECK D, License'Numbers 3 y l 7/ 'Lic.Class , SIZE !J STORIES FAMILIES ONE - �•F[ ��/I /' T NEW $ Contractor /1, 1 p��P "r Q�'Q r+ Dote b���1 DESCRIPTION OF WORK .27269 A - �1om exempt under Sec. vi J Ab wk- .ADD ALTERFINAL # s'•.a,e B.BP.C. for this reason REPAIR DAT I- • • 59.215 USE OF Data: EXISTING BLDG. DEMOL F AL Signature - APPLICANT TEL. � °-° ° 5 9,2 5 m OWNER-BUILDER DECLARATION. PRINT ; C{+ /L d{Llw TEL . , I hereby affirm that I am exempt from the Contractor's Licenser Oat �/ /� .0 Q'� 7 $7 Law for the following reason(Section 7031.5, Business and ., ADDRESS 96-1S. GWL£ITX, 'PrEl/e-C_,O 0, - Professions Code): - . PRESENT - . ❑ _ - I, as owner the property, or my employees'with ADDRESS wages as their it BUILDING sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code).. - MOVING TEL. • ' �. I, as owner of the property, am exclusively contracting CONTRACTOR - NO. .. with licensed contractors to construct,the project (Sec- AL:�, 'tion 7044, Business and Professions Code). ADDRESS - REQUIRED' TOTAL SETBACK FROM EXIST. I ' CONSTRUCTION LENDING AGENCY .SET BACK YARD HWY - PROP. LINE WIDT nagency H - - hereby affirm that there is a construction lending agency for FRONT the performance of-th`e work for which this permit is issued "8 L. (Sec. 3097, Civ. C.). - . . SIDE .. - .. _ P.Lf ,. Lender's Name " Lender's Address P.C. Fee$ Permit Fee - 'I certify that I have read this application and stateAhat the Issuance Fee J V - r Ir above information is correct. I agree to comply with.all County Investigation-Fee " g ordinances and St laws relating to building construction, - Total Fee C and here out riz representatives of this County to enter upa the bov me t ed property for inspection purposes. - - - - - - - 6-19 u- SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicanl or Agent Date - - - ,es