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HomeMy Public PortalAbout10822 DAINES DR_Building__ APPLICATION. FOR BUILDING PERMIT'. - �. COUNTY. OF LOS ANGELES " BUILDING DEPARTMENT OF, COUNTY ENGINEER A°DREss — BUILDIN_ G AND SAFETY DIVISION LOCALITY `S 'JOHN A. LAMEME.,COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN,SOP•T OF BmLoINc CROSS ST. DISTRICT NQ GROUP TYPE P CESSED BY •- FOR APPLICANT TO FILL IN f I "cob r BUILDING- -'-`-- - `_ -- _' - -STATISTICAL.CLASSIFICATION SEWER MAP _ ADDRESS )- Z• LI P(/ - 2 BK- PG CLASS.NO.�DWELL. UNITS_ . X /B LOT NO. BLOCK MAP STATE YES' NO' NUMBE HWY. TRACT pN E/L/L .USE ZONE SPECIAL _ NO. OF SLUGS. CONDITIONS SIZE OF LOT NOW ON LOT - USE OF. EXISTING BLDG. SS -BUILDING - EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER P.LT 6 t.4�...J MAIL '� _ - ADDRESS I?nA ySIDE 1 L. - P.L. . CrcY-' L NO. . INSPECTION RECORD - ARCHITECT OR - TEL. ENGINEER /'1L d0 ey ovi, deG -. I h IariL✓': ADDRESS . - -/ _ . E CONTRACTOR TO. )Q U IJ /NADDRESS _ DESCRIPTION OF WORK NEW ADD ALTER 'REPAIR DEMOLISH. . SO. FT. NO. OF - NO. OF ,1 SIZE STORIES .FAMILIES' _ USE OF STRUCTURE . SIGNATURE OF APPLICANT ` ,I APPROVALS DATE INSPECTOR'S SIGNATURE ADDRESS p • �C{� FFORMS, MATERIALSLOCATION VALUATION.5 - _� I FRAME: FIRE STOPS, - 1, BRACING, BOLTS - PMT." 2 FURNACE: LOCATION. -' FEE $- I FEE $ V —� I - GAS VENT,DUCTS - 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- - LATH, INT. PLICATION AND STATE THAT THEA OVElS C AND AGREE'TO COMPLY WITH 'LL CO Y N ES AND STATE LAWS R G LAT BUI G N .ION. LATH, EXT. SIGNATURE ///1J HOUSE NUMBERCOR- PERMITTE ^-'--= a RECTAND POSTED .ADDRESS ) FINAL _ CLYDE N. DIRLAM, PRINCIPAL-ST CT RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION' CK. M.O. ,DASH , _ ELORKEVS' COMPENSATION.DECLARATION �p� •,�}rl��ny1'Lf1�ytLL1 •,I hereby affirm that I have a certificate of consent to self !/'ll pp��ICQ��OB V -Il OR' L' URDING •PIS11�111C9 7 insure, or o certificate of,Workers"Compensation Insurance, ;c or aCertified'copy thereof (Sec. 3800,-Lab. C.) �. " COUNTY OF LOS ANGELES BUILDING AND SAFETY "' - - t Polio No. '+ - Company ' ❑ BUILDING Certified co - i FOR APPLICANT TO FILL IN .. PY is hereby furnished. - ADDRESS O�r�s2- �-(ijLV . ❑ Certified copy is filed with theYounty buildinginspec- BU`DING - + tion department. ADDRESS �•� Vpl� /�II�G 12-• " n Date Applicant' - - CITY LC el ZIP. R_ LOCALITY GO!/4�ii _ NO.,OF BLDGS.. NEAREST CERTIFICATES OF EXEMPTION FROM WORKERS' SIZE of LOT NOW ON LOT CRO55 SL COMPENSATION INSURANCE -- _ .• .- ASSESSOR _ _- (This-section need-not be-connPleted'if the permit is for one TRACT BLOCK LOT NO. MAP BOOK - PAGE PARCEL hundred dollars ($100) or less.), • ' TEL. IN IML 11A NO.&LB)yq q02MUSE ZONE OP d a I,certify that in the performance of the work for which this n - permit is issued, I shall not employ any person in any manner ADDRESS- 't7 CP LJ JN�.S - SPECIAL j a CONDITIONS so as to become subject to the Workers'Compensation Laws. �t,/T _ n - 1�J „ _, - _ t O CIN 1"`Y 1.-C C ZIP J• /0 .. Cc Date Applicant ARCHITECT OR TEL. - DISTRICT - GROUP TYPE FIRE' OCESSED BY Q NOTICE TO APPLICANT: If, after making.this'Certificate of ENGINEER« - NO. - CONSi. ZQNE �'' ­ Exemption, you should become subject to the Workers' ceJ( ,,/� �l Compensation provisions of the Labor Code; you must forth- ADDRESS - Gril•C�c�-mel d with conn with such provisions or this _ STATISTICAL CLASSIFI ATION APT. CONDO."comply p permit shall be n NO Z deemed revoked CONTRACTOR �L'%IJ�, � NO. LICENSED CONTRACTORS DECLARATION UC. CLASS NO.ILW wnw t. UNI75 I hereby affirm that I am licensed under provisions of Chapter ADDRESS' - NO' SEWER MAP '(commencing with Section 7000)of.Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY. CLASS- BK i /�� - VALIDATION _ SO. FT.' • NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIE5 FAMILIES I ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ ❑I am exempt under Sec. EPa -1.009— w JOD LZ AS "ADD- ❑ D ' ALTER ❑ y r B,BP.C. for this reason c' G O T -+7 C IAAWGE Do `f tPAIR Date: USE OF .. _ _ EXISTING BLDG. DEMOL ❑ Signature- " APPLICANT - TEL. • FINAL OWNER-BUILDER DECLARATION. (PRINT) NO. .I hereby affirm.thot I am exempt from the Contractor's License - DATE _Z ";v Law for the following reason (Section 7031.5, Business'andADDRESS FINAL Professions Code): PRESENT - - B ❑ 1, as owner of the property, my employees BUILDING V - Gv - At-C I •4 the ADDRESS - Yee5 with wages as their sole compensation,will do the work'and the structure is not intended or offered for'sole(Section LOCALITY b - 7044, Business and Professions Code.) - - MOVING - ,t - - TEL. - o ©" "' - ! 11 Lhl ,• ' ❑ I, as owner of theproperty, am exclusive con trotting CONTRACTOR NO. r Y 9 TATAL yi:P m �� With licensed contractors to construct the project (Sec- ` tion 7044, Business and Professions Code.) ADDRESS + '� is 7 ,! REQUIRED - TOTAL SETBACK FROM" •NWID'51'11. -' CHEM '�--•r CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP,SETB LINE -hereby affirm that there is omnstruction lending agency for FRONT the performance of the work for which this permit is*issued "P.L. (Sec. 3097, Civ. C.), _ Lender's Name" _ - [h k(li I-i t;i(t i.• ' 7/ I i j t LDMA Ref. N t m - P.'C. Fee$ Permit Fee - ✓- 11,_. _f� r Lender's Address x D ' I certify that I have read this application'and state that the Issuance Fee LDMA P/C N 8 above information is correct. I agree to comply with all County ._ Investigation Fee ordinances a d State a'relating to building construction, Total Fee d LDMA Perm. p Q, and hereb uthori rep- sentatives.of this County to enter upon th bove- niio dprop r inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE _ _ Signature of Applicant or Agent Date -