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HomeMy Public PortalAbout9554 DAINES DR_Building__ ©5 76A638A • APPLICATION F,OR BUILDING PERMIT_ COUNTY OF'LOS ANGELES BUILDING AND SAFETY, BUILDING RC OR APPLICANT TO FILL,IN ADDRESS NG ' ' SS }� 'S LOCALITY „ NEAREST �° (� ZIP CROSS ST ' _, NO OF'BLDGS ASSESSOR LOT �`O NOW ON LOT MAP BOOK PAGE• PARCEL r ' DISTRICT GROUP J'TYPE FIREi` ED BY , t BLOCK LOT NO CONST ZONE AA7, nn TEL 7,.: NEo J� STATISTICAL CLASSIFICATION, SEWER M SS / �i CLASS NO cJ"/ DWELL UNITS'1^ BI PG T , l ZIP ECT OR EL VALUATION � %1EER NO / C/t 'SS BLDG SETBACK FROM TEL -FRONT'PROP LINE OF (STREET) CONTRACTOR NO HIGHWAY + YARD 2 = TOTAL SETBACK FROM TYPE OF EXISTING 'LIC FRONT PROP LINE, -HIGHWAY WIDTH' ADDRESS NO t LIC ,CITY _ CLASS-- - DER BLDG SETBACK OF, CONSTRUCTION r _ ; v w _ , SIDE PROP LINE OF • '• � (STREET( NAME AND BRANCH TOTAL SETBACK FROM TYPE OF EXISTING r HIGHWAY_ + YARD ,_ ADDRESS CITY- SIDE PROP LINE' HIGHWAY WIDTH �eO FT t NO OF NO OF CHECK ' + = V SIZE S STORIES FAMILIES ONE 0 DESCRIPTION OF WORK NEW ❑ PC Fee,$ Permit Fee .{� ADD Issuance Fee y� ALTERS 1 _Z REPAIR' ❑ Totall4e' USED DEMO'' ❑ Z EXISTING BLDG - APPLICANT ' TEL rg� �* ` C ' (PRINT) s NO �ri. Q BY ISIGNATUR `I HERE , KNOWLEDGE THAT,l HAVE READ THIS APPLICATION AND•STATE THAT THE VE,IS'CORRECT AND"AGREE TO COMPLY'WITH ALLIORDINANCESr AND LAWS'REGULATING BUILDING CONSTRUCTION,I,CERTIFY,THAT IN DOING,THE - , y �� _ V WORK AUTHORIZED HEREBY,I WILL NOT.EMPLOY ANY PERSON IN'VIOLATION OF 's ' THE LABOR CODE OF THE STATE OF CALIFORNIAdN RELATING-TO WORKMEN S•COM ; Z "7 6 ' PENSATION INSURANCE - LI:C ,9 �'-i p, �rt}t -���r . t r `tv 1t , SIGNATURE'OF v' ,'v: E J� ti # o�oo o�° PERMITTEE �� ADDRE �, _f Fps' Z P'°r "'rrJn1 0 b �. 1 '-TEL' ,�/ rJ, 1, Q v CITY o '°NOP' / G US ZONE AP , /� D ` * p.,m,♦i �.r Q l 7 _ .2.6! 79 St fV' SPECIAL... . . CONDITIONS FINAL" «,,, .�. s..z. �,` BY•. •w:.'... ..::.+. st"'f,' _ d i DATE - ' APPLICATION FOR COUNTY OF LOS ANGELES OF BUILDING E PRMIT D BUILDING AND SAFETY Di)"IPN JER BUILDING FOR APPLICANT TO,FILL IN ADDRESS C �. BUILDING ADDRESS LOCALITY ' �j NEAREST CITY L ZIP, C� y4 CROSS ST OF BLDGS ASSESSOR SIZE OF LOT Q OW ON LOT MAP BOOK PAGE PARCEL , J� DISTRICT G UP TYPE FIREaESSEDBY TRACT Z`r BLOCK LOT NO `U CONST K(2 TEL 7. OWNER NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS r /Jk S CLASS NO DWELL UNITS BV-3/PG CITY—77� L ► ZIP ZONE MAP Q�j ARCHITECT OR TEL NO cJ ENGINEEP NOSPECIAL 7iQ CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONTRACTOR TEL.NO 6/. BLDG SETBACK FROM LIC FRONT PROP LINE OF (STREET) ADDRESS JC>Z ,, NO Sly HIGHWAY + YARD = TOTAL O SETBAC PROPKL ROEM HTGYPE OF HWAY EXISD NG LIC CITY �A c(l�j✓� C ASS CONSTRUCTION LENDER + - O NAME AND BRANCH BLDG SETBACK FROM U ADDRESS CITY SIDE PROP LINE OF (STREET) p SQ FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH h DESCRIPTION OF WORK 1041�0494 C— NEW ❑ T/fyC �,� u,,�p� ADD CORNER CUTOFF YES ❑ NO ❑ ALTER IN OPEN SPACE YES ❑ NOot ❑ REPAIR USE OF ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG ��/�-� DEMOL ❑ APPLICANT TEL (PRINT) JS NO BY(SIGNATUR ' 1 I HEREBY ACKNOWLEDGE THAT I HAVE R D THIS ICATION A STATE - THAT THE ABOVE IS CORRECT AND AGREE COMPLY ITH ALL OR ANCES - AND LAWS REGULATING BUILDING CONSTR ION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF LIFORNIA IN RELATING TO WORKMEN 5 COM - PENSATION INSURANCE - SIGNATURE OF FINAL BY PERMITTEE DATE ADDRESS TEL PC Fee$ Permit Fee CITY NO ' Q F^pp a Issuance Fee VALUATION$ -r / .r (((-�») v Total Fee PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION x �M o CASH 2 6,2o"2JUN 29 1 .D ®S 76A638A CE#803A 8/77 APPLICATION FOR BUILDING. PERMIT r COUNTY OF=LOS,ANGELESBUILDING AND SAFETY r FOR APPLICANT TO FILL IN BUILDING ADDRESS -WORKER'S COMPENSATION DECLARATION " /, , .BUIJ, �JG A DRESS �` S a I hereby affirm'that I have a certrficate'of co sent to self Insure, IL `RE or a certificate of Workers' Compensation Insurance,or a certified `5 copy,thereof(Sec 3I QfJ�.L+ab'C); ,r � CITY -� �� f� ZIP LOCA ITY ((jf 1 ,r P011cy No q Company SIZE OF LOT NO OF BLDGS NO ON LOT x �r ❑ Certified copy Is hereby furnished NEAREST CROSS ST .I Ceitifled copy Is filed with the County building Inspech n TRACT BLOCK LOT NO rtment USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - y� ' ori, SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' - ��(p1ER TEL NO COMPENSATION INSURANCE `, AGS C/�/t WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADD SS �s-b 4kl DISTRICT GROUP •TYPE CONST FIRE ZONE PROCESSED BY , dollars ($100)or less) • I certify that In the performance of the work for which this permit G ,ErM P LIE �! ?'� `1 ZIP Is Issued; I Shall not employ any person In any manner So as t0 ARCHITECT OR,ENGINEER _ --� •TEL NO ' become subject to'the`WorKers'Compensation Laws - STATISTICAL CLASSIFICATION- AP_ r CONDO Date - Applicant ADDRESS, - - - 'CLASS NO DWELL UNITS ; ,t NOTICE TO APPLICANT' If, after-''making-this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST, ' Exemption, you should become subject t0 the Workers'+ CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,.you must forthwith comply with such provisions or this,permit shall be deemed revoked ADDRESS LIC NO FRONT , } LICENSED,CONTRACTORS DECLARATION SIDE ' CITY - - LIC,CLASS P L - I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP , (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO o FAMILIES Professions Code, n� ,�iGgns� Is m full force and effe NEW ❑ BK PG' Poo, a License Numb 3(� LIC CQB$CRI RSS PTIO F WORKT ^ E�S� ADD _ 11 VALUATION;� ads Q Contractor Date C ��� w ` ALTER ❑ (� ` �1��L2 CoLIASS NC-�CO S -low El am exe pt under Sec REPAIR $ F— 'B&PC for this reason DEMOL ❑ V LDMA P/C,#` W 'Date USE OF EXISTING BLDG •URM '❑ - - µ` `I' C0 Signature r ' ', EDDDRE A'NT/(PFUNT) �� O LDMA Perm# _ - r Z ❑ I, as owner of the property, or my employees with wages as ," MA their sole compensation,_wiII do the work and the structure Is S [(�, L ,ra4.. not Intended of offered for-sale (Section 7044, Business and ICA FIN DATE Q Professions Code) �� WILL THE APPLICANT OR F TURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J _ q ❑ I,.as owner,of the y, y g 'OR A MIXTURE CONTAI A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ' property, am exclusively contracting with AMOUNTS SPECIFIED THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY t'Tit - 4.5 licensed contractors to construct the project (Section 7044, • i `L Business and Professions Code) ves❑ No - ; d��L���r�� • , ,WILL THE IN N.E. USE OF THE BUIDLING BY THE APPLICANT OR_FUTURE BUILDING " OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ _ r CONSTRUCTION LENDING AGENCY COAST AIR QUAL TY'MA EMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR HANG GUIDELINES .. - '•t I_hereby affirm that there Is a construction.lending agency for YES❑ N N the performance of the work for which this permit Is Issued(Sec , rn (HAVE READ THE HAZARDOUS MATERIALS INFORMATI GUIDE AND THES ING i 3; f- •-t .I, rr 3097,CIV C) CHECKLIST UN ERSTAND MV REQUIREMENTS U R THE LOS ANGEL OU TY CODE w TITLER2 C PT 2 20 SECTIONS 2 20 100 TH GH 2 20 140 CONCER HAZARDOUS Lender's Name MATERI E RTING AND F STAINING RMI FROM THE SCA D , .'�I�/ > �•e _ o Lender's Address' - � o I certify that I have read this application and state under penalty o PC E PERMIT FEE of perjury that the above Information Is correct I agree to comply /� 7 O S o with"all county ordinances, and State laws relating to budding ,I 'construction, and,hereby autho e represen tNes of this Co my _ -ISSUANCE FEE , co toe ter n the above-menti d proper spe n pur ses to INVESTIGATION FEE -TOTAL FEE m to f SEE REVERSE FOR EXPLANATORY LANGUAGE d