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HomeMy Public PortalAbout10941 DAINES DR_Building__ 96A090A DDS-3 8.00 APPLICATION FOR BUILDING PERMIT DIVISION OF BUMDING AND SAFETY 'BUILDINGDORESS / ��� Deportment of County Engineer --' ..I County of Los Angeles LOCALITY i Wm.j* FOX, COUNTY ENGINEER NEAREST '� CASSATT D. GRIFFIN,SUPT OF SUILOING CROSS ST. DI9TRICT O. O+R�UP TYPE SE BK MA PG FOR APPLICANT TO FILL IN L IcON9T., I //BUILDING 0 ADDRESS /0 9�/ D;9//v6sD6611 MAP .D .)�C� STATE IC/1 NUMBER Hwy [! orr L)i /Q BLOCK T7 USE ZONE SPECIAL CONDITIONS 'TRACT /099<9/ �}AA OQO SIZE OF LOT (0 J K "T� NOW ON LOTS ( BUILDING YARD HWY STREET NAME EXIST. L / SETBACK WIDTH EXISTOING BLDG. /�E��CT ental E�_ F FRONT • C . /7J_//�/CS©YV SIDE MAIL OWNER P L ADDRESS �/'/ / ¢� Gi/Up„J �/� - O TRACT DWELL. I UNIT , _inn 7J/Y /� 5 INDUSTRIAL CITY ��^'% /LO Lii NO. 1 DWELL. 1 UNIT 6 PUBLIC BLDG. ARCHITECT OR TEL. 2 DUPLEX t UNIT ADDN.. ALT.. ETC. ENGINEER NO. 3 APT. _UNITS MISCEL. ADDRESS - 4 COMMERCIAL CONTRACT'O�r 1 REi 1/ {�ciT�FJ'�No CH 5)0 INSPECTION RECORD ADDRESS / /�. Y y�I CDU DESCRIPTION OF WORK NEW ADD ALTER V REPAIR DEMOLISH SO. FT. NO. OF NO. OF SIZE STORIES FAMILIES USE OF ST UC E INSlai� �U� ]bar - /nsT/( ifs �Ir• SIGNATURE 0 APPLICANT APPROVALS ADDRESS DATE INSPECT911'S SIGNATURE $ to P. C. S FION FORMS. MATERIALS ' U FEE FRAME: FIRE STOPS. VALUATION O S �1 Oq BRACING. BOLTS - FEE / / FURNACE: LOCATION. 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT. DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT- AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH. INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTE_E I RECT AND POSTED d - ADDRESS FINAL "�l WM.J. FOX.COUNTY ENGINEER VALIDATION C. N.DIRLAM, CHIEF BLDG. INSPECTOR �Co 5 6 5 4 JUL 14 1 4 D 0 , m . DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES WIA. J. FOX. CHIEF ENGINEER BUOLDMNU FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO. PLAN CK.NO:." PERMIT NO; ADOREso ,331 13//2-�1oQ � yVGI >� 3 / 27c3 4/3 6p/3 LOCALITY �.✓Yl I L_ \T1 tL RECEIVED BY DATE OF AAPPL. DATE ISSUEDNEAREST CROSS ST. /6L�{•+ E. 1 -^'ICI �� �•+��5�^/ �/ �/ 'T, I BUILDING. RICG �N ADDRESS, r y�jyJ 91. OWNERc�.� I G .--�- _ Y, f MAIL I / (� A '� 'LOCALITY• 7 ADDRESS NEAREST T LlS eCL 1 J / NEAREST ^� TEL. CROSS BT. .g� N . r CITY 1J � �I N7 D. CC??�J/J p�J FIRU E PLANS TYPE ARCHITECT OR � y � TEL ZONE PLANS ENGINEER Na. SLDD. ��JJ � _ ORD.NO. ` ADDRESSSETBACK LINE LC/f APPROVED o'WneR, TEL' BY DATE CONTRACTOR NO. ' USE APPROVED ADDRESS Q ZONE�� BY DATE CORRECTIONS LEGAL - M b Wf>�+CTIONS DESCRIPTION LO NO. BLOCK /T TRACT �gy -'S.Q' 4 .as' �_fe�5 r�firr,r 4;v— No. ;y -No.of BLDG9. SIZE DF LOT (1,<'x `Y I NpW ON LOT , /✓/L ��F'1 USE OF NO,of ND.OF EXISTING BLDG. I 'AMl ues--k. MB �~I DESCRIPTION OF WORK NEW ALTERATION ADDITION '- O C A REPAIR MOVING DEMOLISH p SO.FT. NO.of Z SIZE 3o ROOMS STORIES I r WALL crf�'�- I ROOF /L i �^ 'I COVERING .? COVERING �•(•(.J'V USE OF NEW BU ILDINO -4 / fJ f U - 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS. APPROVALS// APPLICATION AND STATE THAT THE ABOVE IB CORRECT IN ECTOR _ DATE FOUNDATION: LOCATION AND AGREE T OMPA y WITH ALL CDU NSI" ORDINANCES FORMS.MATERIALS lI �!''✓"'"�Y f/G/jA AND STATE LAWS u UTA A-TING BrY BCTIpN. ' E.�%VC�.I FRAME:.FIRE STOPS. SIGNATURE DF BRACING-8 LTS PERM I E LATH, INT. AUTHORIZED AST LATH,-.EXT. I..639A-3 P,C.S ���. PLASTER.INT. FEE PLASTER.EXT. VALUATION FEE "l FINAL v ' L! APP�,� M®N F®R .BULMNG PERNT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD/p'REss I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS T/ -�C+'• or a certificate of Workers' Compensation Insurance, or a certified 10941 DATNES DRIVE copy thereof(Sec.3800, Lab.C.) CITY ZIP Policy No.`49-fM034ComCAL QMP - TEMPLE CITY 91780 LocquTv pany SIZE OF LOT NO OF BLDGS.NOW ON LOT - G ❑ Certified copy is hereby furnished. ���� NEAREST CROSS ST Ltl Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. de/pYartmmeentfl�� imr iw� -rnv USE ZONE MAP N0. Date 09/01/1- Applicant rSIE i'L- FLC �+ M. ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. - COMPENSATION INSURANCE STEVE HERNANDEZ 818 448 4023 WITHIN 1000 FT.OF SCHOOL' No T'E' (This section need not be completed if the permit is for one hundred 1��E4i A s dollars($100)or less.) DAINES DRIVE DISTRICTp GROUP CONST FIRE ZONE PRoeesSeD By CITY I certify,thaLin the performance of the work for which this permit, MIPLE CITY CA 91780 Q� is issued, I.shall not employ any personIn any manner s0 as t0 ARCHITECT OR ENGINEER TEL N0. ✓ �f become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.. If, after making this Certificate of - REOUI RED TOTAL SETBACK FROM EXIST Exemption, you should become subject 't0 the Workers: CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you most forthwithP�IASSIE ROOFING CO TNC 8/796 3928 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC NO - p L 2548 E. WALNUT ST 501048 SIDE LICENSED CONTRACTORS DECLARATION {'A:SADENA CA 91107 ..LIc,.,ryASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 HJ Cil SEWER MAP } (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES CL Professions Code,anccTRT�I Nli�cOense is in full force and effect. NEW ❑ BK PG 0 License Number _11I1L`rO Lic. Class G-39 DESCRIPTION OF WORK ADD ❑ VALUATION D V ContractoFvL� FMFEC (D Date 7-1/3)/9+ HOUSE & GARAGE: remove ride $ 1 900.E ALTER. - 0 Elam exempt under Sec, shingles, install shingle REPAIR ❑ '$ _ 0 BBP.C. for this reason uArlaynait &Fiberglass shirgles DEMOL ❑ - - W LDMA P/C Date: USE of EXISTING BLDG. URM ❑ N Signature - :�_L'', IIJU U Z APPLICANT(PRINT) TEL NO. CDMA Perm x �- sr.�Ir ❑ I, as owner of the property, or my employees with wages as � 1 1 i C!i✓ their sole compensation,will do the.work and the structure is .ADDRESS - _ .JLC Tl -E .:F not intended or offered for SBIe (Section 7044; Business and � FINAL DATE G 111TAL � v •_E Professions Code.) -_❑ _ Zc WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT MANGLE A HAZARDOUS MATERIAL ,FINAL BY J !_�.H�i'I El 1, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Ht licensed contractors to construct the project (Section 7044, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?.. t']L I> Business and Professions Code.) res El No El i'I L WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ny..y/. ,( CONSTRUCiTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(BCAOMD)SEE PERMITTING CHECKLIST FOR `/,N'�j4 D Q/�• .'1! GUIDEUNEs. i'ill))J'OQ1]i rj�—Pt��" I hereby affirm that there is a construction lending agency for YES❑ NO❑ - - m the performance Of the WOfk for WhlCh this permit l5issued($20. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERM ITTING 1856t'111UJ+vJ� N 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE --- - - - - . Lender's Name TITLE 2,CHAPTER 2.20 SECTIONS 2.20100 THROUGH 220.140 CONCERNING HAZARDOUS 3 MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. a Lender's Address Q dvrvEF OP AGFrT - o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply PC.FEE - PERMIT FEE with all county Ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE to enter,upon tIIB abpve-mention party for ins pNcti n purposes. U�AAd � INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE