HomeMy Public PortalAbout9435 DAINES DR_Building__ TION FOR BUILDING PERMIT
79 A63�A CE#8'03 648 APPLDCA
COUNTY OF LOS ANGELES BUILDING
ADDRESS
I
DEPARTMENT OF COUNTY ENGINEER'
-BUILDING AND SAFETY DIVISION LOCALITY�-
�JOHN A.LAMBIE,COUNTY ENGINEER NEAREST—
CASSATT D.GRIFFIN,SUP-l;0FB'UlLDING CROSS ST;,
iow t�K
DISTRI 717 0. GROUP [TYPE P SSED*BY
FbA'APPIJGANT'tO FILL-IN CONST._V
BUILDING SE�kER MAP
STATISTICAL CLASSIFICATION
ADDRESS K pol
L. UNIIS
CLASS, NO�_g DWEL
L'OT 13LOC
N�r K MAP STATE, YES
r� _: . HWY.
NUMBER
a�
SPECI`AL
NO.OF BLOGS. CONDITIONS.
SME OF LOT NOWON LOT
USE OF
musil ug BLDG. elf PUILDING- EX,I ST.
SETBACK YARD. HWY R,EET.NAME'� WIDTH
OW EIR FRONT
MAIL
'P.L.,
9 ADDRESi SIDE
EL. P.L.'
0.
N .
—Ty / INSPECTION RECORD,
'ARCH'ITECT OR TEL-.
ENGINEER - NO.
ADDRESS
TEL
CO TRACTOR -�-O'f NO.*qG' VqJZj
DESCRIPTION OF WORK
E . -AD6 ALTER 'REPAIR DEMOLISH
NO.-OF NO.OF
SIZE STORIES FAMILIES
RE
USE 0
L)
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APPROVALS
SIGNATURE OF
APPLICANT-
DATE INSPECTOR*S SIGNATURE
ADDRESS' FOUNDATION: LOCATION
:FORMS,MATERIALS
P.C. FRAME: FIRE STOPS.
FEE
BRACING. BOLTS
'VALUATION FURNACE: LOCATION.
-FEE GAS VENT DUCTS
I�HEREBY ACKNOWLEDGE THAT I HAVE READ TH I S.AP- LATi`H,I NT;
PLICATION ANDSTATE THAT THE ABOVE IS CORRECT-AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
LATH,EXT.
STATE LAWS REGULATING BUILIaING CONSTRJJCTION�
I
SIGNATU.RE OF HOUSE NUMBER COR
PERMI RECT AND POSTED
TTE
ADDRES 1. Wj'"I VAA4 A NfVI&FI�AL
'CLYDE N. DIRLAM, PlmqllXAf '<T:?UCTUiRiZI7Em
PLAN CHECK VALIDATION CK. M:O. CASH PERMIT VALIDATION CK. M.O.
CASH
1�'A
OCT
6.0 0 49
WQRKERS' COMPENSATION DECLARATION
n r
I'h4rbby affirm tkot 1-have a certificate of consent to self Q (�
`insure, or.a certificate of Workers' Compensation Insurance,
U�1 V[J�1d(ONIJ
orci„'certifie8.copythereof:(Sec.-3800;,Lab C.) n .-.
COUNTY OF•:LOS APIGELES BUILDIWG.'AI11D SAFETY •
Policy No Company
•- BUILDING'
❑ Certified copy is.here furnished:. FOR APPLICANT.TO FILL IN ADQRESs
.'Certified,copy.'is filed With the county building inspec-
BUILDING
tion department. ADDRESS
.�
CITY - `n 1” ZIF• I~ d V LOCALITY �:' �/ T
Date Applicant `C N OF B D
NEAREST '
CERTIFICATE OF EXEMPTION FROM'WORKERS' .: SIZE OF'LOT" J NOW ON tOT CROSS ST.
COMPENSATION INSURANCE /� rr ASSESSOR
(This-section need not be completed-if'the' permit is.for one TRACTU d'J BLOCK LOT NO MAP BOOK 5 a O a -PAG'
�i. PARCEL
hundred dollars ($100) or less )'sTEL. '
. ._
OWNER fes` 1,1, NO: .
u USE ZONE MAP
NO.
I certify'that•in the performance of-.the work for which"this
permit.is issued, (:,shall not employ'any;person,in any manner ADDRESS9 35.: ,AQ• CONDITIONS
} ``. SPECIAL
a;
so as to,become subject to the Workers'Compensation Law's. 0'
a
_
_ CITY"' ' ZIP .. ., U
Date Applicant; ARCHITECT OR TEL F E g 0
NOTICE- TO,APPLICANT:. If, after'making this .Certifi'date,of ENGINEER_'' NO: . CONST ZRNE` _ •
Exemption,:,you'should become!subject•to. the: Workers'
:DISTRICT 'GROU PROCESSED Y
I LU
Compensation;provisions of the Labor Code,you must fofTh- ADDRESS } ` �C 5. /1
with comply with such provisions w,.,this permit 'shall 'be' TEL. STATISTICAL CLASSIFICATION AP,T. CONDO.
deemed revoked. !� —
N
CONTRACTOR NO.,
' Z
LICENSED CONTRACTORS DECLARATION.
ADDRESS NO. NO.
CLASS DWELL: UNITS
I hereby affirm thatd am licensed under.pro„visions of Chapter 9 SEWER MAP
and Profe'ssio s Code,With odnm000ense is in full fo ce and effects CITY CLASS VALIDATI
Y BK. PG
SO. FT O. OF NO, OF CHECK
License-Number Lic.'.Class SIZE. STORIES / FAMILIES ONE ,
VALUATION '
DESCRIPTION OF WORK NEW 0
Contractor Date _ D} `
❑I dm exempt under Sec:
Lk—
ADD $
ALTER_;❑° _
.. B.&P C. for this reason �Q' 1" � REPAIR 0_ $'
USE.O
Date EXISTING BLDG. �� r, t .r V. '!T 'DEN10C`❑.
Signature • :' FINAL
APPLICANT ` Y TEL.
OWNER-BUILDER DECLARATION (PRINT). ,U r,• ] ,NO Q CJ _
I hePeby affirm thaiTam exempt,frori,i the Contractor's License DATE
- ;
Law f the follov✓in'g,reason (Section 7031.5, Business and ADDRESS / / L 3 /\. � ' FINAL >� i
Prof signs Code) PRESENT' By i _
BUILDING
LYl I, .as owner of the'property, or..my employees with ADDRESS
wages as their sole compensation;will do the workand ' 'y� ;:�� '� ,s 1 r`•_i 1 ;' __6 s
the•structure isnot intended or offered for sale(Section LOCALITY
7044, Business and Professions Code.)'' MOVING. `n TEL.
❑ I, as owner of the.property; am exclusively contracting CONTRACTOR. NO. _t �-
with licensed contractors to.construct the project'(Sec- "'
ry ADDRESS
tion 7044, Business and Professions Code.): x •` _
REQUIRED TOTAL SETBACK FROM EXIST:
CONSTRUCTION LENDING AGENCY SETBACK, YARD HN%Y PROP. LINE WIDTH, ' t• ^��y:-r
I hereby affirm that there;is a construction lending agency for FRONT.
the performance-of the work-for which.this.perm-'it is'.issued P.L: "f
(Sec. 3097, Civ::C.).• . . SIDE,
Lender's Name.
m _
P.C..Fee't Permit Fee- LDMA Ref. # i'' f
Lender's Address
o I certify that I have re6d.this application and state that the Issuance Fee. a"/' 7S" LDMA P/C#' D•
o
8 above information is correct. I agree to comply with all County Investigation Fee o .
ordinances.and State laws relating to building construction, Total Fee Q• LDMA Perm. #
a and hereby authorize representatives of'this County to enter
upon the above-mentioned property for ins purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
ignatur ,A pli ant nt Date -
76A663-cE80619-64 APPLECQ40ON FOR*Q* C�.dL�C��QOC� � d 'pCQllv��4
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS '— c ty�S
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
REC EP T. TOTAL NO. EACH FEE
OUTLETS FIRST 20 $.20 $ OWNER Q /
LIGHT MAIL
ADD'L 10 ADDRESS
SWITCH. OVER 20
LIGHTING
TOTAL FIRST 20 .20 CITY TEL. NO.,
I
FIXTURES AOWL
10 ELECTRICIAN Gx Zb -C-
_
OVER 20 .
RANGES CLO.DRYERS WTR.HTRS. 1.00 ADDRESS ` •+�
GARB.DISP. STA.COOK n --
CITY (' TEL.NO. AT -'30 S 4 -
DISHWASH. AUTO.-WASH. , STATE I� C
SPACE HTRS. STA.APP.(+/x H.P.MAX.) .50 LICENSE NO. ( D V / J�
5 GP T�E, PRO SS BY
MOTORS: OVER NOT OVER H.P. DISTRI(U
O 1 1.00
3 1.so S INSPECTION RECORD
3 8 2.00 n-
O
8 15 2.SO CJ
15 50 3.00 GC
50 100 5.00 0
W
SIGNS: NO.TRANS CL
NO.LAMPS h
z
SERVICE 0.600V-NOT OVER 200A 1.00
" SERVICE 0.60OV-OVER 200 A. 2.00
SERVICE OVER 600V 5.00
MISC.
PERMIT ISSUING FEE 2.00 f, '
SUPPLEMENTARY PERMIT ISSUING FEE 1.00
TOTAL FEE $ 3 !
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION APPROVALS DATE - INBP OR' IGNATURE /
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CONDUIT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
ELECTRICAL WIRING. WIRING
I HEREBY .CERTIFY THAT I AM PROPERLY REGISTERED AND/OR FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I' THE LEGAL OWNER F, AND INTEND T
RESIDE IN, THE ABOVE ES IB RESIDENTI L P TY. POWER
SIGNATURE UTILITY CO.NOTIFIED
OF PERMITTEE FINAL
VALIDATION JOSEPH C. ROOHAN
C V MO CASH SUPERVISING ELECTRICAL ENGINEER
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[;�9666 'FEB 14 2 D 3.5 0-