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Home My Public Portal About10828 DAINES DR_Building__ 76A638A EEAR035-66 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES, BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS �f�j //{{� BUILDING AND SAFETY DIVISION LOCALITY �`c' JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS.SUP'i Oi BW LOIrvG CROSS ST. �(f DISTRR=GTNO. GROUP TYPE " PROCESSED BY FOR APPLICANT TO FILL IN _� CONST. BUILDING STATISTICASSI FICA TION SEWER MAP / ADDRESS /O CLASS NO. OWE LL UNITS BK PG /IO LOT NO. BLOCK USE ZONE MAP •'7� !��{�I NO. TRACT Q QSPEC1 �� CONDIAL TIONS N0. OF B OT SIZE OF LOT 7O NOW ON LOT USE OF �l� XISTING BLDG. BLOC. SETBACK FROM TEL /J/I ,/ q EL. ' (STREET) FRONT PROP. LINE OF EvV /V OWNE ,d 1 1%CLE2 NO. - TYPE OF E%I STING SETBACK J.HIGHWAY + YARD - . TOTAL ADDRESSffA � F HIGHWAY WIDTH FROM IC.L. + CITY ARC HI ECT OR TEL. SLOG. ETBACK FROM ENGINEER NO. SIDE PROP. LINE OF ISTREETI TYPE OF E%"STING SETBACK HIGHWAY + ',YARD o TOTAL ADDRESS r �HIGHW Al WIDTH FROM C.L. CONT NOL + - - LIC CORNER CUTOFF YES NO OV NO 19 CITY CL`A SEE REVERSE SIDE FOR SPECIAL APPROVALS G DESCRIFFTION OF WORK W a NEW efD ALTER REPAIR DEMOLISH H Sp.FT. rf L7 _ NO. OF NO. OF SIZE /� STORIES FAMILIF_S USE OF �(A,� Td STRUCTURE AC � Pow SIGNATURE OF ., APPLICANT �J VALUATIONS (OL' F�— APPROVALS DATE INSP ECA-S SI G NATURE P.C. PMT. .0 &I FOUNDATION, LOCATION FEES FEES Q FORMS, MATERIALS 'FRAME, FIRE STOPS, / �r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT / AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDING 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- ING TO WORNMEN'S CO PENSATION INSURANCE. �/�] 1SIRF H. E%T. SIGNATURE�7' // HOUSE NUMBER COR- PERMITTE _i' RECT AND POSTED ADORES 42H6441 FINAL //�. �•f JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VK.ALIDATION CM,O CASH uhu05 0 0 4 CFP 28 L D . 8.00- v WORKERS' COMPENSATION DECLARATION i -- su, i affirm that have a certificate of consent to self n PP �C��® ,�. n F®'R BURDI G P��,R 1T �insu� .r a certificate of Workers'Co mpenstion Insurance, or (/'l� L..L u�' u�' u�u u o,certttied copy thereof (Sec 3800, Lob. O.) COUNTY OF LOS ANGEL(E � BUILDING AND SAFETY - "Policy No. Company - 7�LI Certified copy is hereby fur'n fished• FOR APPLICANT TO FILL IN BUILDING �' ADDRESS/G� - �• _ L� •� '� Certified copy Is filed with the county building inspec- Bu LDING qq C, s• ( - '/ —� tion department. ADDRESS L,7 ��} '/v LOCALIi - v �_rx • + - - - Y.- //77 .NEAREST Date �Applimnt- T CITY�E LC ' l..I� ZIP. CROSS ST. _ CERTIFICATE OF EXEMPTION FROM WORKERS'. v NO. OF BLDGS. ASSESSOR" r' S COMPENSATION INSURANCE SIZE OF LOT. /dr 75 7.� .NOW ON LOT - MAP BOOK I PAGE• PARCEL l - ra / USE ZONE MAP ) - ,(This section need not be:completed if the"permit is for one TRACT D��n 0 BLOCK LOT NO. / NO. - V hundred dollars ($100)or less ) Y / ' TEL =� SPECIAL- _ - a certify that in the performance;of the work for which this OWNER(() LL / � FIG N7 NO. J CONDITIONS - O. perm it is issued, I shall not employ any person in any manner pp.. DISTRICT GROUP TYPE FIRE PROCESSED BY V iso as.to become subject to the Workers Com ensatio Laws. ADDRESS��ps� /�//ff. S - v CONST%' d• i'�1- g �. .L CITY G _ t E T zip O Dote'q" 0 Applicant STATISTICAL CLN APT CONDO: U NOTICE'TO-APPLICANT( If, offer making this Certificate of ARCHITECT OR TEL ELL. UNITS_ Exemption, ENGINEER NO. CLASS NO DWC•on,.you should become' subject to the Workers' y Compensation provisions of the Labor Code, you must forth- Z with comply with such provisions or this permit shall be ADDRESS n SEWER MAP _ deemed revoked. CONTRACTORLES NARK/NS4JNnNO.S7� 'I443 BK. ,/O VALIDATION -LICENSED CONTRACTORS DECLARATION 7� LIC - - - hereby affirm that I am licensed under provisions of /e.Chapter 9 ADDREss-201 5W11) AJ-O N I d_ NO..f3�2s-Zq S_ VALUATION (commencing with Section 7000)of Division 3 o the Business and �+ LIC. F ^O O Professions Code, and my license is in full forceand effect. CITY CLASS' �/ SQ. FT) Ll NO. OF �T NO.OF CHECK. License Number -,352.98 tic Cd,s ttI , t SIZE /�lb STORIES G FAMILIES ONE \ LES Hff Wei�!$ 1r 7. d Q DESCRIPTION OF WORK OXO 5 (�pOt 1 NEW � g Contractor- Date 1i r - ADD - am-exempT from the licensing requirements as I am a �T�"tchf� fir{/N�a �ol5in ALTER _ FINAL censed architect or a registered professional engineer �— ! DATE acting in my- professional capacity (Section 7051, /V'tW Z $ "� G E REPAIR ❑ Business and Professions,Ccde). . USE OF �p�5 _ DEMOL FINAL' _ EXISTING BLDG. h y Lic.or Reg. No. _Date APPLICANTTEL. eil - - OWNER-BUILDERDECLARATION - - (PRINT) ,5 WfLJrJS NO -141-ICI3 ' I hereby affirm that I am exempt from the Contractor's License ' Law for the following reason (Section 7031.5, Business.and ADDRESS S 6N'1 D Professions Code). - PRESENT --sr, BUILDING • I, as owner of the property, or my employees with ADDRESS" - " wagesas their sale compensation,will do the work and -the structure is not,intended or offered for sale(Section LOCALITY ,7044, Business and Professions Code).' r MOVING' TEL V D " I, as owner of the property, am exclusively contracting CONTRACTOR ' - NO. �/ ` 2'4 3 0 A with licensed.contractors to construct the tiproject (Sec- ADDRESS _ ,�, L ✓/�i 7 f�U - - - on 7044,Business and Professions Code). ( REQUIRED - TOTAL SETBACK FROM EXIST. ti �"p( It CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH /1 I hereby offirmahal there is a"construction lending agency.for .FRONT 2 • 3'5 3.5 0- the performance of the work.for which this permit is issued P.L. 7✓ !�( .. (Sec-3097,.Civ. Cj., 510E - 1 va✓ ° - 5 5 3.'5 0 v - - LenPA. Lender's Name - 0, 02-80 P.C. Fee Permit Fee' - i t Lender'sAddress ' p certify that I have read this application and state That the Issuonce Fee a above.information.is correct. I agree to comply with all County Investigation Fee �` - _ �•C-- • - �/ - ordinances-and State lows relating to building construction, �" Total Fee - o t and-Hereby authorize,representatives,of.this County fo enter -Z c _ r -� ___ •_ 1 - _ - _ `upon the above-mennone ropedy for Inspection purposes. / Q SEE REVERSE FOR EXPLANATORY LANGUAGE -_`` �'�ature of Applicant or Agent Date _ /� �/`� ti �V - Os