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Home My Public Portal About10712 DAINES DR_Building__ 76A638A CE #803 1/71 `�✓' '. APPLICATION FOR BUILDIf�G PE/RM 4 COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY. ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING D `� ADDRESS / COLEMAN W. JENKINS, BURT of BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or type onl CROSS ST. DISTRICT N G TY E O ES BY BUILDING ,{- CONST. ADDRESS r ll STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO.-24DWELL.UNITS BK PG TRACT // USE ZZONE MAP 1-517 r+" No SIZE OF LOT d /!'Z..o NOW ONBLOTS 'I�" SPECIAL O USE •v 1 CONDITIONS EXISTITI NG BLDG. y EL. o OWNER {/� O. �G BLDG.SETBACK FROM A DDR ESS FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY C% r HIGH Y WIDTH FROM C.L. - ' ARCH ECT OR I TEL. } _ ENGINEER NO. BLDG.SETBACK FROM - ADDRESS SIDE PROP. LINEOF (STREET) .TEL TYPE OF EXISTING SETBACK HIGHWAY f RO = TOTAL d CONTRACTOR NO. HIGHWAY WIDTH FROM CIL. CJ U LIC. _ ADDRESS NO. f O LIC. U CITY CLASS - CORNER CUTOFF VES ❑ NO ❑ W NAMECONSA DTIDN LENDER - SEE REVERSE SIDE FOR SPECIAL APPROVALS NAME AND BRANCH ADDRESS SO. FT. NO. OF NO. OF NEW El STORIES FAMILIES ❑ USE OF ® ADD - - STRUCTURE ALTER SIGNATUREF APPLICANT DEMOL ❑ - VALUATION $ APPROVALS DATE INSPECTON'S-SIGNATURE P.C. PMT. / �fJ) FOUNDATION: LOCATION FEE $ FEES 6/C {/ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. --^_ - - -- - •- LABOR-CODE OF `TXF� STATE OF --'CALIFORNIA IN RELATING TO WORKMEN's'COMPEt N INSURANCE. LATH, EXT. SIGN I -,HOUSE NUMBER COR- - PE MI E RECT AND POSTED ADDR s FINAL' JOHN F. LEWIS. PRINCIPAL STR,UC URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION V M.0, CASH 6398 76A638A CE9803 9-65 APPLICATION FO BUILDIXPERMIT COUNTY OF LOS ANGELES BUILDING O 71 DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE; COUNTY ENGINEER NEAREST COLEMAN W. JENKINS. SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GR TYPE By CONST. (Print or tYPe only) z BUILDING STATISTICAL CLASS ER CLASSIFICATION SEWM ADDRESS 1071?_ Daines, Temple City - CLASS NO. DWELL.UNITS SK UPG LOT NO. BLOCK USE ZONE MAP NO. TRACT1-3 n SPECIAL NO.OF BLDGS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. / BLDG.SETBACK FROM TEL TE , 3-6QO2 FRONT PROP.LINE OF (STREET) OWNER , Harold Roesler NO. TYPE OF EXISTING SETBACK I HIGHWAY } YARD = TOTAL ADDRESS 10712 Daines IGHWAV WIDTH FRONI CITY /Ten_ple CltY + BLDG.SE KFROM ARCHITECT OR TEL. SIDE PROP.LI (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK } YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CONTRACTOR Virgin Roof1� CO. ryW7-0507 + ADDRESS 600 S. San Gabriel No1160650 CORNER CUTOFF YES ❑ NO E C clTv San Gabriel CLASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS 4 CONSTRUCTION LENDER 6 NAME AND BRANCH Z ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES Li OF n ADD STRUCTURE RerOofL'? — med. shakes ALTER 4 SIGNATURE OF REPAIRK] APPLICANT DEMOL ❑ VALUATION S 1597.00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. 17.25 FOUNDATION: LOCATION FEE 5 FEE$ FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STR UC TION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF 'CALIFORNIA- IN RELATING TO WORKMEN'S COMPENSATIO INSURAN E. 7 LATH, EXT. SIGNATURE OF / � HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS ��d �- FINAL JOHN F. LEWIS. PRI CIP L STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION(:.' M.o. CASH 7 - 4 �I50 .1 � 1 7 25 N WORKERS'COMPENSATION DECLARATION I hereb affirm that I have a certificate of consent to self - ! ////��\r11'l�rJ./�X11,:yryJ r11 X11 /\\//�� //�/��\\ 11rrr1��\�r1.X11 FOR ��FV\�((11t1, flit X11 r11 X11 IIIIr''I��p\r1 tI1/\/�\f.5�� r111�r.�III t4�{\/��///�� GI1''� y F. 4 YY Y IJ� �JY UM V� Y OR LJ�C/ �1. O VAC/ PERNET insure or a.±ertificate of Workers= Compensation Insurance, ' or c.cerhfi -py thereof (Sec. 3800, Lab. C. - /' r .._COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N �� Compcm c AI Certified copy is hereby funis ed. FOR APPLICANT-TO FILL IN • • - - 'nooaes5 ' Certified copy is filed with the co t dm inspeo- BUILDING J� - pp tion parfine nt ADDRESS (/ 71� . , (]C••: LOCALITY- p !� /} NEAREST .Date 'G D c Applicant �I CITY _ 1-• ZIP ,QCC' CROSS ST. CERTIFICATE OF EXEMPTI N FR M ERS' - -� z.� NO OF BLDGS. 'ASSESSOR , COMPENSATION INSURANCE SIZE OF LOT 0 1 -i—`" NOW ON LOT / MAP BOOK PAGE PARCEL. (This section need not be completed if the p mit is for one USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCKLOT NO. / NO. N., - -TEL' SPECIAL I certify that in the performance of the work for which this OWNER C6 /a'�H' NO. I CONDITIONS IL permit Is issued, I'shall not employ any person in any mannerp• - - - - - - ISTRICT GROUP TYPE FIRE PROCESSED B ADDRESS Y Q `S - CONST ZONE so as to become subject to the Workers'Compensation Laws. .. _ Date Applicant J CITY �- ZIP STATISTICAL CLASSI ATION C D NOTICE TO APPLICANT: If, after making this Certificate of a ARCHITECT OR ENGINEER _ __ TEL. _ _ " NO. CLASS NO. DWELL. UNITS . W^` Exemption, you should become subject to the Workers' [ vT Compensation provisions of the Labor Code, you must forth- 'I ADDRESS -•— - - SEWER MAP Z with comply with such provisions or this'permit-shall be Q - deemed revoked.. - 06 •h�>r NO/2�'/7QI 'gK. PG, 'VALIDATION' ti CONTRACTOR LICENSED CONTRACTORS DECLARATION rr77 q .LIC QT I hereby affirm that I am licensed under provisions of Chapter9 .l ADDRESS -' ? " /`C?LE"o D cMO. 7l0 VALU TION j (commencing with Section 7000)of Division 3 of the Business and f �r LIG. 9 G(j(9 , Professions Code, an my license is in full force and effect '! CITY OCe+n�SStt» 1 � CLASS 9—/ $ . FT _- NO.OF INC. OF CHECK' D•- License Number ,y Lic.Cass 511ZE - STORIES FAMILIE�Si _ ONE ' r ' ! Ae 'Z. 1 5r! NEW ❑ $ Ov7 0.'2 A Contractd Dote DESCRI/PJTION OF WORK K7 � p, _ ADD '-2 ---d7103# e a • A ?3 am exempt under Sea 1 V NA fd ALTER ❑ FINAL ,(. 2o 7 �, 3 B.BP.C. for thisrect _ REPAIR E:] DATE �V. t i USE OF n FINAL ; - ° -t �• 3 ate: EXISTING BLDG.- __5 %"•'� - - DEMOI E] FINAL Signature .l APPLICANT TEL. - T - NER BUILDER ECLA ON lie PRINT 1' J<�E NO.qLDl7�.� I.hereby affirm that I am exempt fro a Contractor s License _ Law for the following reason (S ion 7031.5, Business and ADDRESS 'Z 1N K,E�£-Q)OB b. Professions Code): PRESENT I,.as owner of Theproperty, or m employees with BUILDING _ y - j ADDRESS - wages as their sole compensation,will do the work and r — - the structure is not intended or offered for sale(Section LOCALITY .. :0,1 ra 2.5 A 7044,,Business and Professions Lade). MOVING TEL I, as owner of the property, am exclusively contracting .. CONTRACTOR NO. e,o.e •`e with licensed contractors to construct the project.(Sec- i ADDRESS - 2 • 44'"7. 0 0 'tion 7044, Business and Professions Code).- , - REQUIRED TOTAL SETBACK FROM EXIST. a47.006- the 4 r.O O U CONSTRUCTION LENDING AGENCY t SET BACK YARD HWY PROP. LINE WIDTH D e ° t 6- - I hereby affirm a at of the w a<o r which this per it is cy forissued FRONT the performance.of The work for which this permit is issued P.I. O fV 0 7 s 8 4 (Sec 3097, Civ. C.). , , SIDE ., -_ - ".P.L. Lender's Name '?] Lender's Address P:C_Fee / 0 Permit Fee 1•�J SQ, �t, .. 'I certify that I h6v d this application and state that the Issuance,Fee O above informafi correct. I agree to comply with all County Investigation Fee _ ordinances t s relating 90 building construction, - Total Fee G and her put rize r resentatives'of this County enter -upo i p party for ins coon rp�ooses. - - . - - •) - - a �5 UE REVERSE FOR EXPLANATORY LANGUAGE - ign tore of Ap r Agent Dare ®t } WORKERS'COMPENSATION DECLARATION - hereby affirm that I haW a certificate of consent td self - - �,PPn �CAT�® ren -��R Bn n�n ®��n�. P�G�n/��1� LS insure,"or a ce ificate of Workers' Compensation'insurance, LL u�f lUJ LL• u�f �C �f�u )f or a certified opy thereof (Sec 3800, Lob. p.) COUNTY. OF LOS ANGELES BUILDING AND SAFETY Policy No Company IZAy,e YO�•7 - -1-'. '" - ❑ - BUILDING - Certifiedcopy is hereby f4nu FOR.APPLI6ANT SO.FILL IN 'ADDRESS'- Certified copy is filed wiinspec- BUILDING y /�/� tion department. ADDRESS - //i. _ J/L1'LS _ _ _ LOCALITY�_ NEARESTDate -'•� ApplicanCITV />V7 C.-!' ZIP CROSS ST. CERTIFICATE;OF EXEMPT' - NO.OF BL 5. 'A55ESSOR COMPENSATION SIZE OF LOT Z- NOW ON LOT MAP BOOK PAGE . PARCEL (This section need'not be completed.if the.permit is forpne - USE ZONE- MAP h, dred dollars ($100)or less.) TRACT BLOCK LOT NO., 7 NO. . - TEL-... SPECIAL. I certify that in the performance of.the work for which this OWNER , f�' NO. CONDITIONS d permit is issued,;l shall not employ any person in any manner �• - -- DISTRICT GROUP TYPE FIRE PROCESSED BV ',0 ADDRESS C___.- CONST ZONE so as to become subject to the Workers'Compensation Laws. '- C Date Applicant CITY ZIP STATISTICAL IF CATION NET. , CONDO. 0 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER - NO.- '• 'CLASS NO.�DWF11 UNITS_ W Exemption, you should become subject. to the.Workers' ly Compensation provisions of the Labor Code, you mustforth- _ ADDRESS -- - - - —• SEWER MAP - Z with comply with such provisions or.this permit shall be deemed revoked. - - c' EL' � 17OI - BKS PG, - VALIDATION - • CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION /" -aC I hereby affirm that Iam licensed under provisions of Chapter 9 - ADDRESS(p�2 //� L e NO. ;"ypLU TIO - - - (commencing with Section 7000)of Division 3 of the Business and t a�L LIC /J O - - Professions Code, and y license-is in full force and effect. CITY CLASS - _ SQ. FT. `" NO. OF NO.OF -CHECK _ License um r ill /• SIZE NSTORIES FAMILIES ONE D //gib/p/� $ '^ Contractyr�x`•�'/-r(2rx *�, are: 0 �-b DESCRIPTIO FWO _ - - NEW C I am exempt under Sec. _ - Ofl - - (/u ' ALLTEERFINAL L B.BP.C. for this reason _ H'L ��. y _ - -( � Z _ .REPAIR DATE- Date: USE OF .,,DEMOL .. - -FINAL:,. C7, Signature . - EXISTING BLDG �/ /J ❑ FI ��-�'•� Signature - - APPLICANT - TEL -• - _ _ ,_ OWNER-BUILDER DECLARATION .. PRINT _ O._. � I hereby affirm that I am exempt from the Contractor's License- - Law for the following reason (Section 7031.5, Business and A ADDRESS _ R•( - _ D- - Professions Code): - PRESENT O - BUILDING 1, as owner of the property; or my employees with - ADDRESS wages os their sole compensation,will do the work and - - - - ti 3t5 Q•7,/{ the structure is not.intended or offered for sale(Section LOCALITY _ - -- - - _ • 7044, Business.and Professions Code). - MOVING ,. TEL. # e.-e • ,o e _�. I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- - - 2Te e'5 9,,2'5 . . 'tion 7044, Business and Professions.Code). ADDRESS' REQUIRED. 'TOTAL SETBACK FROM EXIST. - .e CONSTRUCTION LENDING AGENCY YARD HWY b a•5'9,25 v ' t hereby affirm that there is a construction lending agency" - d P.I._• .-, - .•FRONT SET BACK -. - _ -PROP. LINE WIDTH r.D - ,. _ �.� . •-_-•. GHQ 1 5—.84 _ the performance of the work for which this permit is-issue .: ..(Sea. 3097, Civ. C.). SIDE 'P.0 - Lender's Name $ - - - P.C. Fee$" Permit Fee -- Lender's Address I ' I certifythatl hav re application and state that the - Issuance Feef - - - - - above y that I is ect. I pli to comply with all Court .. ~ 9 PY Y vestigotion.Fee j g ordinances a laws r Ott building construction, - - - - - - - - y u and hereb rize rep a tives of this County to enter Twat Fee uP - o d ropers o urposes. C/ � �_• _ SEE REVERSE FOR EXPLANATORY LANGUAGE n Ignatur of Applican Ag Data - _ - _ - -• ®E