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HomeMy Public PortalAbout10708 DAINES DR_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or tvoe .,IY) A...ss jele,' '� ` D DEPARTMTY OF LOS ANGELES ENT OF COUNTY ENGINEER CITY 6 ZIP 917Y19 BUILDING D _SAFETY'DIVISION NO.OF BLOGS. BUILDING A _ SIZE OF LOT NOW ON LOT ADDRES_ TRACT 1- BLOCK LOT NO, LOCALITY E TEL NEAREST �y - OWNER p G NO. G CROSS ST. Lc nn ASSSOR - - ADDRESS lc - MAPEBSOOK PAGE PARCEL - q - DISTRICT_ GROUP TYPE FIRE PROC SED By CITY. _ ZIP l `�(� CON1 El ST Z E ARCHITECT OF - TEL. ENGINEER NO, STATISTICAL CLASSIFICATION - /� 5E�ER AP ADDRESS - _ CLASS NO_Qe�T0C�_DWELL,UNITS - BKA�PG.. CONTRACTOR - TEL. - - ZONE MAP LI NO. LC. _ SPECIAL - ADDRESS- NO. - LIC. CONDITIONS CITY ?VVV CLASS ROA DEPARTMENT APPROVAL REQUIRED YES❑ NO.❑ CONSTRUCTION.LENDER NAME AND BRANCH SLD .SETBACK FROM > FRONTeROP.LINEOF (STREET) a ADDRESS CITY TOTAL SETBACK FROM TVPE�OF EXISTING U 50. FT. NO. OF NO. OF CHECK HIGHWAY RO - NT PR LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE _ } = U DESCRIPTION OF WORK NEW ❑ _ _ w BLDG.SETBACK FROM CL, ADD SI DE PROP. L I NE OF FEET) Z ALTER ❑ HIGHWAY + YARD TOTAL SETBACK FROM TYPE O EXISTING REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OF + EXISTING BLDG. DEMOL ❑ APPLICANT`. TEL J OORNER CUTOFF- .YES ❑. .NO ❑ (PRINT) E _ 0. - /i IN.OPEN-SPACE - YES ❑ NO 'BY (SIGNATURE) ✓ZE4 _ - _ C� IN COASTAC.ZONE. .. YES ❑ NO O _ VALUATION_s. ~ OO - CATEGORICAL EXEMPTION YES❑ 'fN0 ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL _ ^ ANO STATE THAT THE ABOVE IS CORRECT AND,AGREE TO COMPLY IMPACT - EXEMPTION OEC LA RATION SIGNED (DATE) WITH PLL ORDINANCES AND LAWS REGULATING BUILDING CON- ^ STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED-DATE) - HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE - LABOR CODE OF THE' STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. SIGNATURE OF PERMITTEE ADDRESS FINAL �/ BY TEL ` DATE �O CITY NO. PMT. .1rAKE CHECKS P..1IABIJ- 10; FEE • - FEE I.HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CN. M.D. CASH- PERMIT VALIDATION CK. M.O. •CASH '.76A638A_CE hB03.12/]2 3. 6 9-873, u-T3 1 ! 1 5.,0"0` -,1 76A638A CE#803 B-63 APPLICATIO.N.FOR BUILDING PERMIT COUNTY OF LOS ANGELES /: BU'LD' ( /Y 70 �a U/� DEPARTMENT OF. COUNTY ENGINEER ADDRESS J BUILDING AND SAFETY DIVISION LOCALITY U � ' JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. _ 'L DISTRICT ND, GR P TYPE PROCERS D BY FOR APPLICANT TO FILL IN, Q �r corvsr / BUILDING STATISTICAL CLASSIFICATION SEWER MAP O AiA✓6 G (p� ADDRESS CLASS. NO. DWELL UNITS K G LOT NO. BLOCK WATER CERTIFICATE: NOT REQUIRED El RECEIVED. El TRACT h / �_ MAP /�y� .�� HIGHWAY STATE MAJOR-SECOND. -CAL NO.OF SLOGS. NO. Cti InRCLEI - SIZE OF LOT Q ,V NOW ON LOT USTNE SPECIAL USE OCONDITIONS EX STING BLDG. 1'S / C.V • ' TEL. OWNER O T NO. ' BUI DING EXIST. �/ SETBACK YARD HWY STREET;NAME WIDTH ADDRESS Q �ryG J FRONT ARCHITECTO TEL. P. L. v /`/W✓/U ENGINEER NO.. SIDE ADDRESS // r �).a/L �l7 �� Arf/�/ O. CONTRACTOR dd TEL. 4. NO. If ADDRESS / / y C DESCRIPTION OF WORK ��f� W NEW ADD X ALTER REPAIR DEMOLISH `�. n 'OUl SQ. FT. NO. OF NO. CF 7 (, Gil• Z SIZE TORIES FAMILIES // V USEOF I�'Lf ST UOTURE '•) �+ �^ / j��� '^ 5 GNATURE OF,' In I2n6..Ak, ` AN J,. V APPLICA T- _ O ) Ij - VALUATIO , &r2/ rp APPROVALS DATE , INSPECTOR5 SIGNATURE FEES FEE (/ FOUNDATION: LOCATION' q-044 j `�/ 'FORMS; MATERIALS S' J -1J4 FRAME: FIRE STOPS, r `^ Y 1 HEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLICATION' BRACING. BOLTS (�ZZ-'p-per I\ l AND STATE THAT THE ABOVE 15 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 1 WILL NOT EMPLOY ANY RSON IN VIOLA LATH. INT. •J���� _l•1'1/"J )C.! TION OF THE LABOR ODE OF THE STATE OF LIFORNIA PELAT- ING TO WORKM`EN'5 MPENSATION INSURAN �I • LATH. EXT: p•�- SIGNATUR�JOF HOUSE NUMBER COR- PERMIT E RECT AND POSTED ADDRESS JOHN F. LEWIS. PRINCIPALS TU RAL ENGINEER PLAN CHECK VALIDATION CK. M.D. ,GASH PERMIT VALIDATION CK M.�GD CASH LI dJcl 7 C3 7 U v Ir I� 0 1 G 1 1 .5 0 APPLICATION FO ( COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER <3B U I L D I N.G PERMIT BUILDING AND SAFETY DIVISION BU I LLb;NG FOR APPLICANT TO FILL IN ADDRESS /v 70 p- iY) e ._17 /L BUILDING D LOCALITY ADDRESS CITY e C' ZIP NEAREST .t VIP. G K . CROSS ST. / �(K /� O.OF BLDGS. ASSESSOR SIZE OF LOT OW ON LOT MAP BOOK PAGE PARCEL / DISTRICT GROUP TYPE FIRE CESSED BY TRACT/,?6/-q BLOCK LOT NO. (LO CONST. ZONE �. OWNER O O NEDL7�T_//N( STATISTICAL CLASSIFICATION %� WER M ADDRESS 1076 CF' 7),A/Yle -72 ! CLASS NO,-2—/ DWELL.UNITS RK PG CITY C'Yr1 'e C I \ ZIP USE IZONE MA NOP ARCHITECT O TEL GT SPECIAL ENGINEER nn NO. I7 / CONDITIONS ADDRESS C. 2V6L.AA n DCOV I lnQ- ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONTRACTORe/� LI I0 NOL O SL B G.SETBACK FROM 1i LIC //�� F NT PROP.LINE OF (STREET) ADDRESSS�SJ� A rhCIL-) Nw( N0..Or4. CLA55 W HIG WAY + YARD p TOTAL SETBACK FROM TYPE OF EXISTING CITYCLeh QLIC /J FRONT PROP. LINE HIGHWAY WIDTH CONSTRUCTION LENDER _ + NAME AND BRANCH a BLDG.SET ADDRESS - CITY - SI DE PROP. LINE OF (STREET) U SQ. FT./ ( NO. OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYP F E%(STING � SIZE GOOD STORIES FAMILIES ONE SIDE PROP. LINE HIGHW Y WIDTH DESCRIPTION OF WORK 1. NEW ❑ + y ADD ,® CORNER CUTOFF YES ❑ NO ❑ Z re-re-E' ALTER El h � l-Ags I e+ REPAIR❑ IN OPEN SPACE YES ❑ NO ❑ USE OF � -IN COASTAL PERMIT ZONE' YES El NO ❑ EXISTING BLDG.^/\eS"I4eYI c- EMOL ❑ ,�/ q+ 9 APPLICANT TEL (PRINT) ✓� .] By (SIGNATURE) W�'o►) MN'�Cl2 ©AV770 OArl-% I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIIED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOC.ATION OF T E LABOR CODE THE STATE OF CALIFOR A /RELATING O WORKMEN'5 COMPEN AT NSURAN SIGNATU PEEp� FINAL DATE ADDRESS �s E. J E L. P.C. Fee S Permit CITY NO. Q �Y Issuance Fee VALUATION$ J t0O U 4 Total Fe PLAN CHECK VALIDATION OK..' CASH _ PERMIT VALIDATION CH. M,o. C.SH 4 6 Zn`apH. a� ei 1 7.V O s Q 4 6 5�A?R. 22 1 D 2 1.7 5 AW 76A630A.CEi803D13/]S