HomeMy Public PortalAbout10930 DAINES DR_Building__ VA.AA63RA"
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APP.LICAT[ON_FO'RIB, UILD ING .PERMIT .
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN ADDRESS c/ %
BUILDING /�-
ADDRESS / .G LOCALITY _
NET
AREST
CITY ZIP CROSS S . CZE .
N .OF BLD 5. ASSESSOR
SIZE OF LOT - WON LOT MAP BOOK' PAGE. PARCEL
�j / [� DISTRICT GROUP TYPE FIRE, FORCES BY
TRAC `(J BLOCK �-. LOT O .v� CONT - ZQNE-
T D[_7
OWNER( C-_ s!'L •/ N /
ASSI FI CAT]ON
SLATCLASS NOCL�DWELL.UNITS EWE/Ij P
ADDRESS n - •• Q ...�.BK! �P�
CITY � 'ZIP' 1/ A
ARC IT CTOR TEL. VALUATION
ENGINEER •- N0- -'
.ADDRESS _ _ BLDG.SETBACK FROM
L FRONT PROP.LINE OF (STREET)
CONTRACTOR ` Nj - - - TOTAI BACK OM♦' TYPE OF EXISTING
i LIC. y HIGHWAY + YARD = FRSET
ONh PROP LINFRE' HIGHWAY WIDTH °
ADDRESS/2y� ))jp� , NO./ �� -
CITY $/3/�" �CL SS + _
BLDG.SETBACK FROM
CONSTRUCTION LEN ER - SIDE PROP.LINE OF ISTREETI
NAME AND BRANCH - Y
.HIGHWAY HE YARD = TOTALSETBACKFR OM TYPE OF EXISTING b
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH O
SO.Fi, NO.OF _ NO.OF J_ CHECK + _ V
SIZE• . STORIES NO,
✓ "ONE - M
_-
DESCRIPTION OF WORK 4 1>zv7--.14A1J NEW O NO' l r J full
SPKIAL
Q LL ADD rrYI - " CONDITIONS - • ' "N
ALTER U DA EL- By Z
USEOF
EXISTING BLDG. �—`'� - � DEMOL � .< ZO
APPLICANT �^ TEL — _ -
(PRINT I [.. NO L
BY(SIGNATUREI >
HERE9 D E THAT HAVE READ THIS APPLICATION AND STATE Y
THAT iH" BOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _ -
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF 'u -
THELABORCODEOFTHESTATEOFCA RNIA,IN RELAT GTOWORKME SCOM _ _ Z .. ,
PENSATION INSURANCE.' Q ;98523A
'
6
SIGNATUREO -- •--' _ # e• o a e III y
PERMITTEE _ _ '
ADDRESS cS� /� Z 2 - 09700
TEL' __O q
Cli'C�1/i 6+'7f<Tf� L NG "' _ _ Q le,o a 9 .0 qi5
P.C. Fee$ Permit Fee O L > 0108-80
'
Issaonce Fee + oFs
• 6
... _ _ Total,Fee,.
DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
'""'-�"'(AUNTY OF LOS ANGELES
WM. J. FOX. CHIEF ENGINEER {
1
J FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
OISTSIRICT NO. PLAN CK.NO.
PERMIT NO.
BUILDING
q -6 T�
ADDRESS -7 R
LOCALITYG ECEIVEO BY DATE APPL. DATEISSUED
T / S s--
Q— Cl y
/
. � (lS, -
I
OWNER / ADDRESS
MAIL �/ Cj //// .q( /.a. .../. �j
ADDRESS / U dr`� 1.1JG(�fL / .�i LOCALITY
/� /'� .�C, �'J NEAREST �J
CITY t—�/)4'k)—& (2-;61 Np CR0889T. Or O(/�L� PW
CITY
NO.OF TYPE GROUPS•
ARCHITECT OR TCL ZONE PLANE
ENGINEER V NO. _
SLDG.
ADDRESSSETBACK LIN[ r ..
APPROVED
TEL-/)/
CONTRACTOR N&& 1ANO• .3
BY DATE
ADDRESS /�uU/S20NE I BYAPPROVED�bz. DATE
LEGAL y. 0 y —o CORRECTIONS
DESCRIPTION p WL`OT NND, �� .Lr BLOCK
TRACT I U�.+d % ZS
SIZE OF LOT
aJ T G L►I NOW ON LOTS / (rYr�W ��� 7
USE OFI,.NO.OF NO.OF i,.. N ^
EXISTING BLDG. < FAMILIES ROOMS /
DESCRIPTION OF WORK
NEW ALTERATION ADDITION O
A
REPAIR g�-�'� MOVING DEMOLISHNo or z
t G
SG FT. 1 7 0 ROOMS Al STORIES / r
SWALLI2E fJ� yyrryy.. � {{�A ���� � //�� ��y
COVERING /crfJ/L1rL0�4/ I CDVOERINS 0_^-ww66G }
USE Or NEW
BUI LDiNG .✓l�/A:a' CS1 .�1.1a 1.�(�s11Ss'C./"'
lOff
'I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS/'
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTORVATIC
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
,/'� �//� FRAME: FIRE STOPS, �—
SIUNATURE OF /// p��.. I /�! L�r�� - yam, • BRACING.BOLTS
PERMITTEr L.�// /LN✓� / ` w+Vv�..+.
S /` Q rLATHr INT. q
AUTHORIZED AGT !/ ��0�l X
I �-. LATHr EXT. ✓ E�
7GA6MMA-3 2-5G $ 7S�„� P.C.S ' '� PLASTER.INT.
7 �
�Q_A FEE �/ A/n PLASTER,EXT.
VALIDATION O O-p FEE d;7_ FINAL
76A898A CE#809-8-57 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BuaoING' ���
DEPARTMENT OF COUNTY ENGINEER nooREss -
BUILDING AND SAFETY DIVISION LOCALITY r
JOHN A. L'AMBIE.COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST..
DISTRICT NO. GROUP TYPE .SEWER .MAP
FOR APPLICANT'-T0 FILL IN I BK PG
CONST
BUILDING, ' L STATISTICALF]LASSIFICATION
_LK
tS V4i (e
f�`,'I CLASS.NO. DWELL.UNIT
LOT NO. YV- OLD BLOCK MAP �q STATE
NUMBER l.J HWY. YES 'NO
TRACT l USEZONE SPECIAL
SIZE OF LO
�G NOW ON LOTS -CONDITIONS
USE OF p�yJ�q'/�
EX"TING BLDG.'% ARRC F - BUILDING YARD HWY STREETNR ME EXIST.
ii � -V'� SETBACK WIDTH
1
OWNER Wiks C FRONT gv'VIII
MAI LP.L:
ADDRESS izw�/I %VI " SIDE
CITY �T/ NO Z�G Ig7V P.L.
ARCHITECTOR TEL. 1 INSPECTION RECORD
ENGINEER NO.
Ili/ A
ADDRESS '� y,�/ q/
TEL.
CONTRACTOR NQ
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SIZE O STORES FAMILIES yy ��� �<USE OF STRUCTURE K � �/ s✓
To N p�+c
SIGNATURE - APPROVALS
APPLICANT
DATE y INSPECTOR'S SIGNATURE
A DRESS FOUNDATION:
ORMS. ION
MATERIALS
$ /
PFRAME FIRE
STOPS
FEE $ BRACING,BOLTS
VALUATIODO $. FURNACE: LOCATION.
-� FEE .r GAS VENT,DUCTS
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH, INT.
PLICATION AN TA BOVE IS CORRECT AND
AGREE TO CO - Y WITH ALL CO ORDINANCES AND
STATE LAWS -GULATING SUILDIN CONSTRUCTION. LATH. EXT.
SIGNATURE HOUSE NUMBER COR-
PE TTE RECT AND POSTED
.ADDR S FINAL
JOHN A. MBI .COUNTY ENGINEER. CLYDE N. DIRLAM,'PRINCIPAL STRUCTURAL ENGINEER
CHECK VALIDATION CK. M.O. cAsw PERMIT VALIDATION CK. - M.O. SH
L'Coj 5 2-1'M FEB25 1 .A 4.00
d avc-c-�
r
WORKERS'COMPENSATION DECLARATION'
L;herebyi affirm that Phave a certificate of consent is self • D D
�P�r�y�fps �(�,.a//p�� �rf��Ip� gyp} �I�y �I'r��( M��`p�-z PERM07 insure or cofi thereof
(Sec. s C:'Labl .hon lnsurgnce, 11 ll LS��y!/"L\��O11V Il �U_U U_ ���D�D V'V �'�LIUY011��
of a certified copy thereof (Sec 3800;'Lao' C )
.T1uL a•t: •s .ti:'tr.,. . COUNTY OF LOS ANGELES t BUILDING.AND,SAF.ETrY' � •
Policy No Company - BUILDING J -a� /�
Certified.copyd s'hereby furnished:,, ,•, FOR APPLICANT TO FILL IN - ADDRESS
/d•/ 3G' t
i Certified co is filed with the'count building ins ec-
PY Y 9 P BUILDING -
1� - � hon department - . ' a - ADDRESS (.✓ �, �Qj,.
Date •.Applicant. CITY . r ZIP �7 p LOCALITY 1
-NO.-OF-BLDGS. - NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS"' - - --• - -
• COMPENSATION'INSU RANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This'section need'not be,completed if the permit-is for one - - --- - ASSESSOR•. -t
..-. - - ._T__- " _ -__-
hundred dollars ($100)or,less..). v TRACT BLOCK LOT NO. MApBOOK- - r PAGE PARCEL
TEL
USE ZONE MAP
OWNER-
.
NO. .. . i
.L'cerhfy tha(in"the performance of the work forv✓hich this NO. + y
permit is issued, I shall not,employ any person in any manner _ -�- SPECIAL
sa cs ro b ' r* bl" t tc the Workers'Compenscition lows. ADDRESS - Cp - CONDITIONS O
a
Date Q 1• Y'G A,:11 c6nl '+' 7 CITY - ZIP
NOTICE/TO AFtPLICANT. If, after akin this Certificate of ARCHITECT OR TEL. DISTRICT GgOUP TYPE _ FIRE PRO SSED BY
Exemption r you',should becom 'subject'to the Workers' ENGINEER NO. ,`) q CONST ZONE W
Compensation,provisions of.the Labor Code, you must forth- ADDRESS ✓l ✓. •� .. ...._ 'd
with co mply,with,,such. provisions or this permit shall be _._ _ -
deemed revoked + - TEL. STATISTICAL CLASSIFICATION - APT ONDO.
CONTRACTOR �E=r(�CT-LL NoLA86J 6-r
LICENSED CONTRACTORS DECLARATION _ . _ q _ - LIC )) CLASS NO. UNITS
Thereby affirm that Iam licensed under-provisions of Chapter 9 ADDRESS `:�.� 1. (L NO /6 i3�1-
(commencing with Section 7000)of Division 3 of the Business and ,,ee�z LIC zN.. pp SEWER MAP
Professions Code, and my license is in full force and effect. CITY 1.,. - .CLASS ` 9K. - "VALIDATION __a
- "
_ SQ.'FT. NO. Of _ _ NO.OF CHECK
'• SIZE STORIES FAMILIES f ONE V ,'
'License Number Lic.Class'" ,
"' - - O VALUATION
N, DESCRIPTION OF WORK' - NEW.
r .Contractor Date j +SGS�/ $
i - ADD
am exempt under Sec _ - -
, ^ - - ALTER ❑ D "I' • .
B.BP.0for this reason .REPAIR ❑ $- t-• ---- -9389,2A USE OF
{{////jj EXISTING BLDG. DEMOL ❑ # e_ a--�. �
" -'S anature C]7_GG'LLGP APPLICANT- - _ -- - ' TEL - FIN r� n
O ER-BUIL R DECLARATION
ha PRINT . No. _ DAT - O kJ '. I . - 59.25---,.
Lhereby affvm that.l am exempt from the Contractor's License - •
Law for the following..reason (Section 7031.5, Business and ADDRESS FIN
'Professions Code).' "- -" " " - PRESENT - - - BY' .-* 5 9.2
-O BUILDING - •l '
I, as owner of the property, or my employees with ADDRESS _ _ X I t
wages as their sole compensgtion;-will do the work and -" L� L + + l I„Llll ii )' - 0 1 2"2=8 6' t .,
the.structure is not intended or offered for sale(Section LOCALITY - 1iL
7044,•Business and Professions Code). ' '- - - ' MOVING- -- -- - - - - 'TEL.
QI, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed Business
and
to construct the project (Sec- - ADDRESS
• tion 7044, Business and Professions Code),
REQUIRED TOTAL SETBACK RUM _
-" CONSTRUCTION'LENDING AGENCY - SET BACK YARD HWY PROP. LINE - -WIDTH ' ^• - -
I hereby affirm that there is a construction lending agency for _ FRONT '
` the performance of the work for whichthis permit is issued P.L.-
(Sec. 3097, Civ. C.). SIDE
P.I, -
-
Lender's Name LDMA Ref. It '
P.C. Fee$ -... Permit Fee
1
Lender's Address - - -
w {/(
.-I certify that I have.read this application and state that the ._ ., _ Issuance Fee �•/•(/ ' v/)
-� - � IOMA P/C q
above information is correct. I agree to comply with all County,' Investigation Fee Y, ti _• "I .
ordinances and State taws relating to building construction, Q S�^ s i tLL
- - Tota6Fee �J- % - LOMA Perm't!i -
and'hereby authorize representatives of this County to enter -
m upo he above-menticme+d property for inspection pure ses. -
o ff_C -6.e I /LC&441-- ' 2.1 SEE REVERSE FOR EXPLANATORY LANGUAGE ,
- IF Signmtb7e of Applicant or Agent ... D61¢
' I,
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self //y�� p 0O O I���Ip���-r O app RO ///LLQ �.
insure, or a certificate of Workers' Compensation Insurance, aPPLPCAcWH FOR BOURONG P150�1L1f 'T
or a-certified copy thereof (Sec. 3800, Lab. C.)
COUNTY, OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company BUILDING _e
copy y FOR APPLICANT TO FILL IN ADDRESS
Certified co is hereby furnished. � (.�
Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS LOCALITY
NEAREST
Date Applicant CITY ZIP CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one )A USE ZONE MAP 6
hundred dollars ($100)or less.) - TRACT (` BLOCK LO NO. � _ NO. �� -
TEL. - SPECIAL }
I certify that in the performance of the work for which this OWNER NO.. 4NI / CONDITIONS It.
permit is issued, I shall not employ any person in any manner DISTRICT .GROUP TYPE FIRE PROCESSED BY O
so as to become subject to the Workers'Compensatio Laws. ADDRESS UP CONST. ZONE V
ft ZIP Z O
Date 'Applicant'
CITY C _ APT. CONDO. V
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR - TEL. STATISTICAL CLASSIFI��Cf� ,,
ATION
Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS OW.
Compensation provisions of the Labor Code, you must forth ADDRESS - - SEWER MAP2
with comply with such provisions or this permit shall be
deemed revoked. CONTRACTOR NO. BK. PG,/�� VALIDATION
LICENSED CONTRACTORS DECLARATION - LIC.
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION
(commencing with Section 7000)of Division 3 of the Business and LIC.
Professions Code, and my license is in full force and effect. CITY CLASS
SQ. IT. '',^.s N06 OF NO.OF CHECK D•
License Number Lic..Class SIZE !� STORIES FAMILIES ONE
$
Contractor Date DESCRIPTION OF WORK NEW -
ADD
I am exempt under Sec.
ALTER ❑ FINAL / 2
6.8P.C. for this reason � ' REPAIR � DATE
Date: USEOF I - DEMOL FINAL /�
EXISTING BLDG. ❑
By
Signature APPLICANT TEL. '
. 'OWNER-BUILDER DECLARATION PRINT NO.
I hereby affirm that I am exempt from the Contractor's License :D
Law for the following reason (Section 7031.5, Business and ADDRESS
Professions Code): PRESENT
ElI, as owner of the property, or my employees with BUILDINGADDRESS _-22-73A
wages as their sole compensation;will do the work and t
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code), MOVING TEL. .. .
ElI, as owner of the property, am exclusively contracting CONTRACTOR NO. ,21< • 4 9. 8 8
with licensed contractors to construct the project (Sec- gDDRESS
'tion 7044, Business and Professions Code). - - • 4 98 8�
REQUIRED TOTAL SETBACK FROM EXIST. ( ,
CONSTRUCTION LENDING AGENCY' SET BACK YARD HWv PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT D - - .0 52 6-8 3
the performance of the work for which this permit is issued P.L.
(Sec. 3097,.Civ. C.). _ SIDE _
' :-P.L. -
Lender's Name -
Lender's AddressP.C. Fee$.' Permit fee
I certify that I have read this application and state'that the Issuance Fee
a above informmion is correct. I agree to comply with.all County Invesligation Fee ?
$ ordinances and State laws relating to building construction, Total Fee �
u and hereby authorize representatives of this County to enter
uPon tt a^bawe-mentiio�necLpro erty for inspection purposes. -
Z1fJ IY + SEE REVERSE FOR EXPLANATORY LANGUAGE
/ oily ®s
Signature of Applicant ory Agent � Date