HomeMy Public PortalAbout10851,10850 DAINES DR_Building__ DEPARTIMNT OF COUNTY ENGINM
<' DIVISION OF BUILDING AND SAFETY D 0
COUNTY OF LOS ANGELES
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WILLIAM J. FOX, Courm ENGINEER APPLICATION '
r, CASSATT D. GRIFFIN. SUPT OF BUIL JNG
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
p` DISTRICT NO. PUN CC[.OR REC.NO. PERMIT NO.
ADDREISBG DOS• r� - - /
(�
LOCALITY RECEIVED BY DAT FAPPL. DATE.ISSUED
- n �//,
CROSS T 7 Y 3p/C 2�� -S3
BUILDING
- - - - - - .. ADDRESS
OWNER
MAIL !' LOCALITY---7 - C
ADDRESS ' I E/C NEAREST
TEL. CROSS ST. O Ah Y
CIT - -� NO, - ZONE I PLANS
ARCNITE R _ TEL, FIRE NO. OF TYP GROUP
C/
ENGINE ���///
` � d / C BLDG.
ADORERS' L-< v' SETBACK LINE
.
CONTRA , ` zl of • iJ"7 "1i ZONE A BYPROVED ., DATE B
ADDRESS/0 �yC U HOUSE NU MB\ER�ING
LEGAL MAP NUMBER_-J!%cs0 NO. ASSIGNED BY-
DESCRIPTION LOT NO. BLOCK CORRECTIONS
TRACT •
NO. OF BLDGS.
SIZE OF LOT7A i,_
_ / I NOW ON LOT -
USE OF NO. OF - - -
EXISTING BLDG. FAMILIES
DESCRIPTION OF WORK D -
_ A
NHW ` DEMOLITION ADDITION - D_
REPAIR
r
SO. FT. t NO. OF
SIZE ,�J/J J RR06MS STORIES
COVER ROOF
NLL ,.,[ZOA JX�-F+A' COVERING U
USE OF STRUCTURE
APPROVAJ S
C INSPECTOP'SSIGNATURE DATE
' FION
FORMS.MATERIALS
�' <` w/✓2 T
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRESTOPS.
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT.
I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION.
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS I
SIGNATURE OI•/`� /, ,L., G LATH, INT..
PERMITTEE . a"��//ccc!!!///LLLtt.Utt IST/�
U ` - I• l..J r_ LATH. EXT.
ADDRESS/&� 41
PLASTER, INT.
AUTHORIZED AOT.�^��'���. �-
PLASTER, EXT.
9HOUSENUMBES COR• W
J J FEE RECT AND POSTED •n�I.
VALUATION / FEE "It - FINAL
TlAW" OBB9 WGA
WORKERS'COMPENSATION DECLARATION
hereby affirm that !-have a certificate of consent to =elf - _ Qp p p�Q�p O I� FOR [�M p d D p C�, PERM17
insure, or a certificate of Workers' Compensation Insurance, -
or,a.certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES " _ BUILDING AND•SAFETY
.Policy No. - -Company BUILDING
' Certified copy is hereby furnrshed/;� FOR.APPLICANT TO FILL IN ADDRESS
TCertified copy is filed with the county building inspec- BUILDING - - - -
tion department. ADDRESS
CITY' L — ZIP LOCALITY
Date Appimnt NO. OF BLOCS NEAREST
N84RE5T -
CERTIFICATE OF EX
EMP N ROM WORKERS' SIZE of LOT .7 NOW ON LOT v CROSS 57.
COMPENS, -INSURANCE - ---- - _ _ ASSESSOR - r //��
(This section need not be amp feted if the Perri for one TRACT- - BLOCK LOT NO. MAP�BOOK 557 -PAGE J PARCEL
,.hundred dollars ($100) or less:) - ,_TEL [/
. r OWNER' - ,I NQ G-- 7 USE ZONEu NO SD f-/oT 7 7 .
certify that in the.performance of the work for which this yn� q SPEC 7
permit is issued, I shall not.employ.any person in any manner- ADDRESS �( - " "-P' CONDITIONS d
,so as to become subject to the Workers' Compensation Laws. O
CIN ZIP U
`Date' Applicant ARCHITECT OR ! TEL, - K
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER _NO ... " DISTRICT GROUP' TYPE FIRE PROCESSED BY O.
CONST. ZONE
Exemption, you_should become subject to the Workers' pj
,Compensation provisions of the.Labor Code; you must forth- ADDRESS �10 '-J // - - GL�Zr-'.G, w
n.
with:comply with such provisions or.this permit shall be TEL. STATISTICAL CLASSIFICATION "APT. CONDO,. Z
Z
deemed revoked. CONTRACTOR / CDF LC,�9��`"�� CLASS
No. / DWELL. uMTs
LICENSED CONTRACTORS DECLARATION ADDRESSe" h//N Nog /
I hereby affirm that I am licensed under provisions of Chapter 9 _
(commencing with Section.7000)of Division 3 of the Business �.r UC /� //D y` _
t and Professions Code,and my license is in full.farce and effect. CITY C �� 5�7 - BK, PG,�O J _ VALIDATION
SQ. FL NO, OF NO. OF CHECK
License Number. l3yD� YD_Lic;Class /3 SIZE STORIES FAMILIES ONE
/K�I
VALUATION
qq DESCRIPTION OF WORK NEW 1:1CantracforcJn� l- ( 'Date
ils,ss ADD D
❑1 am exempt under Sec. it-G'v
' ALTER ❑ C
BAP.C. for this reason Y V REPAIR,'❑ $ _ it y3
nT
Date:' USE OF , - '
- - EXISTING BLD DEMOV❑ F1Ci.± .a
Signature i APPLICANT
PRINT t_4) ` ^ NF. - - FINAL Tv.l=
OWNER-BUILDER DECLARATION - '
3 DATE ..1
I hereby affirm that I am exempt from the Contractor's License - - - - -
Law for the followingreason. Section 7031.5, Business and ADDRESS 'tet' - FINAL +
Professions Code): PRESENT By
BUILDING
❑ I, as owner of the property, or my employees with ADDRESS - t" l.:bn� -
Y
• ,wages as their sole compensation;will do the work and •� �•
the structure isnot intended or offered for sale(Section LOCALITY - D - i\; C 1 i EIS
❑ .7044, Business and Professions Code.) MOVING - - 'TEL. - (� . Thi^! '�tF9._F a (fit
CONTRACTOR NO. _ t AL rLF "C
I;as owner of the property, am exclusively contracting a'•,. 4
with,licensed contractorsto construct the project-(Sec- - - / "i - v !:F�ECY 42ll _�
tion 7044, Business and Professions Code.) ADDRESS - f t,; r a•
REQUIRED - TOTAL SETBACK FROM EXIST." t t - - CHANGE
CONSTRUCTION LENDING AGENCY SET BACK YARD NWY PROP. LINE WIDTH ,C
hereby affirm that there is o construction lending agency for FRONT L ••f1''�'� �S i' v+' f' - _
the performance of the work for which this permit is issued P.I. t i
(Sec. 3097, Civ. C.). _ - '- SIDE ' MIL Q-1'0,1 ":z./ it 1
Lender's Nome. - •tIt 5024 1 Ali 8%4jI
I ADMA Ref: N _
Lender's Address
P.C. Fee$ Pcm.Fee
-
o 'I certify that I have read this application and state that the _ Issuance Fee 1 LDMA P/C F
8 above information is correct:I agree to comply with all County Invest'gotion Fee -
- ordinances and.Statelaws relating to 6uildi ng construction, TotoLFee V. O 7 COMA Perm..It - - -.
a
and,hereby Guth ize representatives of this County to;enter
m upon t o ov ent'o r Q for inspectio /
a Jr •'
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date t, - -