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HomeMy Public PortalAbout9478 DAINES DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANG LES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 7 TSO,',I eS PK I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS q* 74 47 �r or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab .C.) CITY ZIP !17 8� Te-nip/e C'Y "( LOCALITY Policy No. Company SIZE OF LOT // (rte NO.OF BLDGS.NOW ON LOT El Certified copy is hereby furnished. (0© x /3 O NEAREST CROSS ST. /v���� �� El Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Date Applicant ASSESSOR MAP BOOK �f PAGE PARC:U)o SPEC CON (TIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER n ���� J_ yry TEL NO. % COMPENSATION INSURANCE '(�j ��1nai'le i a / -� THIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS ��7yJ� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) CITY ZIP I certify that in the performance of the work for which this permit l `e C4' �/��' is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. 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 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRACTOR _ I _ > TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.'SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG , License Number Lic.Class DESCRIPTION OF WORK , ADD VALUATION O Contractor Date // ALTER ❑ $ ❑ I am exempt under Sec. r®n REPAIR E3 $ 0 BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ r'i Signature APPLICANT(PRINT) < < TE N LDMA Perm# 'i11 Z 004, Z I, as owner of the property, or my employees with wages as 0 ACCT.47 ,os their sole compensation, will do the work and the structure is ADDRESS L ® not intended or offered for sale (Section 7044, Business and R G3 hey e, FINAL DATE 0 ���? r} .�r Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - •� ' - OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE licensed contractors to construct the project (Section 704444,, Elas owner of the property, am exclusively contracting AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY lves El No El �f�•c•108 Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 3307 66.45 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. i ITEMS I hereby affirm that there is a construction lending agency for YES❑ NO❑ TOTAL a the performance of the work for which this permit is issued(Sec. 1-1 j{ �__ 3097,Civ.Ci.) CHECKLIST.I UNDERSTAND I HAVE READ THE UMY REQUIREMENTS S MATERIALS MUNIDER THE LOS ANGELES ON GUIDE AND THE OCOUNTMD Y PERMITTING � � !HL � � � �� TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS [] {,� i Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. CASH. 11C a 2.I Ck Lender's Address CHANGE ,1911 c, OWNER OR AGENT of I certify that I have read this application and state under penalty I Of perjury that the above information is correct.I agree to comply P.C.FEE �� PERMIT FEE Nwith all county ordinances and State laws relating to building ' i r� C 0000-000 ! '•2 '•'r3 construction, and hereby authorize representatives of this County ISSUANCE FEE00 i7 I•'.f'7•' to enter up h the above-mentioned property for inspection purposes. (P� 8172 1 Aid G a is a i ,tea —/J— Sig-70-1 _ INVESTIGATION FEE TOTAL FEE Sg- a pl-1 or Agent Dete (� (O SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR 'BUILDING PERMIT COUNTY OF LOS ANGELES � - BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS ��✓ or a certificate of Workers' Compensation Insurance, or a certified X417 4 t76L copy thereof(Sec.3800,Lab.C.) CITY ZIP -7 n„ �Q ���, CA � 3'" LOCALITY / ///f"•'�� Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. 000 S,F, NEAREST CROSS ST. Af ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO, Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS �/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ! TEL NO. YES NO COMPENSATION INSURANCE e rt NS; St/�— -�� /G�r WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS �a"-e ���� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) fC•.E/�e-,J CITY ZIP 1 certify that in the performance of the work for which this permit 07Z is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. ST ISTICAL CLA�SySI�FICATION APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 4-ele�ZA--) FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.F ISILE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. /� NEW BK PG License Number Lic.Class DESCRIPTION OF WORK qpp ❑ VALUATIONPoo. Q Contractor Date Z`Syd�Ci ALTER El $ �`� 0. U ❑ I am exempt under Sec. REPAIR 11 $ 0 BAP.C.for this reason ��� —/���� DEMOL ❑ LDMA P/C# U W Date: USE OF LEXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 1 Z *—,,heir , as owner of the property, or my employees with wages asZ ACCTogADDRESS 0 3303 125.55 sole compensation, will do the work and the structure is V not intended or offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYC5 licensed contractors to construct the project (Section 7044, TOTAL �20-2 .o '—e__e Business and Professions Code.) VES❑ No El WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING NECK 125.55 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR CHANGE .00 GUIDELINES. IlCtl'IV I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance Of the Work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING n 3097,Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, �V��—��1 � � ,1/�.1 `v TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. ;cV 4 1 AM i i e 3'7 IL Lender 's Address I 11 / O OWNER OR AGENT o 1 certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE it L with all county ordinances and State laws relating to building ate✓ construction, and hereby authorize representatives of this County ISSUANCE FEEoo 73� co to enter up n the above-mentioned property for,inspection purposes. / _��� INVESTIGATION FEE TOTAL FEE ^ sig­t,a Appk, o,Agem Daae , SEE REVERSE FOR EXPLANATORY LANGUAGE h COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS MP 0508 9808030004 • BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA r PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 9474 DAINES DR STRUCTURE: 91 1 VN R3 TEMP CA 917803112 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY 8588-028-020 EXIST BLDG USE: RESID THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY EXIST OCC GRP: R3 USE ZONE: R-1 TENANT: ISSUED ON: PROCESSED BY: EXPIRES ON: BLDGS. NOW ON LOT: VALUATION: 08/03/98 UT 08/03/99 2 0 OWNER: TEL. NO: FINAL DATE FINAL BY: C DE: YU;MORRISON,KATHARINE, SANDRA (626) 309-0088- LIST ITEMS: 7 O( 9474 DAINES DR f�I TEMP 917803112 DESCR TION OF WORK71 TO PERMIT THE ADDITI N OF BATHROOM FOR MASTER BEDROOM-91 OCCUP LOAD EXIST: SQ. FT. APPLICANT: TEL. NO: OCCUP LOAD NEW: SAME AS OWNER PARKING SPACES REQUIRED: SPECIAL CONDITIONS: PARKING SPACES PROVIDED: EXIT HARDWARE_ : CONTRACTOR: TEL. NO: LIMITED TIME USE SAME AS OWNER NBR OF EXITS: FROM TO LIC. NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCHITECT OR ENGINEER: TEL. NO: TRAILER USE - OA PERMIT: ISSUANCE 27.75 LIC. NO: 01 R/M-OCC/USE INSPECT 145.95 SAFETY PERMIT ;TOTAL FEES 173.70 TEMP. STRUCT. APPROVED MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP. STRUCT. REMOVED 147H265 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED TOTAL SETBACK FROM EXIST SET BACK YARD: HWY. PROP LINE: WIDTH: FRONT PL- SIDE PL- REPORT ID: DPR267 ROUTE TO: BS0508