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HomeMy Public PortalAbout9702 DAINES DR_Building__ 76A 638A Cg�*,8038-64 APPLICATION FOR bUILDIN }G P RMIT _ 'COUNTY OF LOS ANGELES ABUILDING DDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST -" COLEMAN,W JENKINS,BUP T OF BUILDING CROSS ST DISTRICT NO G OUP TYPE P=S ED BY FOR APPLICANT TO FILL IN CONST BUILDING C p'� STATISTICAL CLASSIFICATION SEVER AP ADDRESS Ll r S Y� CLASS NO DWELL UNITS 8 P,GA LOT NO BLOCK USE ZONE MAP • i NO '� TRACT 6 SPECIAL P BLDGS 666 CONDITIONS SIZE OF LOT b 3 NOW ON LOT USE O_XLSTIF ' r]� C / ! C. NO 81-00. �• ,(/ 4 /v BLDG SETBACK FROM ' A rk TEL FRONT PROP LINE OF E OWNER V"•'1 I. / I �/v NO TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL, ADDRESS : 12 a HIGHWAY WIDTH FROM C L CITY 5' 7 //+•1 (f1/7BLDG SETBACK FROM ARCHITECT OR TEL SIDE PROP LINE OF '�-' - (STREET) ENGINEER � NO TYPE OF EXISTING SE BACK H�HWAY + YARD = TOTALADDRESS Jj 7- H10 AY WIIDTTHH/ FROM C L CONTRACTOR L �IL G NOL /T /. DO �� v�- _ O ADDRESS ����/Tl� NO r, CORNER CUTOFF YES NO O F- C Al Lr 1913 /fk LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS W DESCRIPTION OF WORK _ i- n A--4. Z_ NEW ADD ALTER REPAIR DEMOLISH SQ.FT NO OF NO OF e R SIZE G, STORIES 4 FAMILIES USE OF' STRUCTURE 9 SIGNATURE OF •' ���} +++ APPLICANT �, x VALUATION$ oo0 -� APPROVALS ADATE INSPECTOR'S SIGNATURE P C PMT _ FOUNDATION, LOCATION I� FEE$ 7777 FEE$ FORMS, MATERIALS _ / FRAME, FIRE STOPS, II I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT A AND STTE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY URN'A"CE"'LO'CA."TTON WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING G•AS$VE•NT DUCTS V_ 9U ILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STATE OF,CALI,FORNIA RELAT. ING TO WORKMEN S CXA*IEN SATION NS4IRAN E / LATH EXT SIGNATURE OF ^ ,HOUSE NUMBER COR- PERM ITTEE OR-PERMITTEE RECT AND POSTED A e ADDRESS S FINAL Va3,la �' JOHN F LEWIS PRINCIPALS:CK U URAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATIO M O CASH LA *3 h 0 0 u-3JUL13 - 1 D 1 .50- 76Ae9eAC4#,9D3­-> APPLICATION FOR BUILDING PERMIT 1 BMDING AND SAFETY DIVISION BUILDING , ADDRESS � /{✓ Department of County Engineer County of Loa Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST DISTRICT NOLIkOUP TYPE SEWER MAP FOR APPLICANT TO FILL IN � ,1> [CONST /,r%O 5 ��r/Z BUILDING , STATISTICAL CLASSIFICATION •I ADDRESS O I q7 CLASS NO DWELL_UNITSI LOT NO /- , / BLOCK MAP Z �O LTJ STATE 1,S-76 ,YES O-J TRACT !S 7 6 I- NUMBER CJ USf ZINE SPECIAL SIZE OF LOT '�© r0 , NO OF BLDGS CONDITIONS NOW ON LOT n.i v USE OF ���• - EXISTING BLDG BUILDING EXIST , SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT MAIL � P L '-✓ �_ ADDRESS (] S SIDE P L L eA 4a- CITY a-r�->rvL_U TEL cis -o_ INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO JZ /2- ;77—<f ADDRESS ?�%—� f���r Y C_ G /✓�G G •T+ d/ rr TEL = _ CONTRACTO ADDRESS DESCRIPTION OF WORK NEW '1' ADD ALTER REPAIR DEMOLISH _ SQ FT NO OF NO OF SIZE i STORIES FAMILIES USE OF STRUCTURE APPROVALS SIGNATURE OF APPLICANT D TE CTOR'S SIGNATURE ADDRESS I J FOUNDATION LOCATION FORMS MATERIALS P C S Y,'` FRAME FIRE STOPS, c BRACING BOLTS /y / FEE 9 .� VALUATION s e' FURNACE `LOCATION FEE' +-- GAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT PLICATION AND STATE THAT THE ABOVE IS ORRECT AND AGREE TO COMPLY WI H LLC UNTY O ANCES AND LATH. EXT 'L STATE LAWS REG T G I DING ONS UCTION OF HOUSE NUMBER COR- SIGNATUREPERMITTE RECT AND POSTED ADDRESS__SS FINAL JOHN A.LAMBIE, COUNTY ENGINEER, CLYDE N- DIRLAM, PRINCIPAL STRU2±VRAL ENGINEER PLAN CHECK VALIDATION K M o CASH PERMIT VALIDATION -m o -CASH �;'}o0293� J'JL17 16 _1 }..' Jt � LACO 1"6 ,5'1 rb-1 AUG 2 6 1 3 $`5'0 'M WORKERS'COMPENSATION DECLARATION , ' ,insure' or aI hereby ffirm certificate tof Workers've a lifirate of Compensa ion Inswance, � r P I CAT I�� FOR B U"I`�D'N G PERMIT �- or acertified copy thereof (Sec 3800, lab C ) COUNTY OFAOS ANGELES BUILDING AND SAFETY Policy No F-5119 Company Fnirmnn' ' Certified copy is hereby furnishe FOR APPLICANT TO FILL IN ADDRESS,BUILDING '� - S © Certified copy is filed with th Ty, uildmg i ec- BUILDING tion department ADDRESS` LOCALITY- 4 NEAREST !' Date 9-5-84 Applicant clrY Tem Ie Cit ZIP 7 CROSS ST C° NO OF BLDGS ASSESSOR ` CERTIFICATE OF EXEMPTION OM WORKERS' rk SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL • COMPENSATION INSURANCE •r,., a; _ USE ZONE, MAP ((This section need not be completed if the permit is for one' r{ hundred dollars ($100)or less ) TRACT BLOCK LOT NO NO f ' TEL' �/ SPECIAL J „ I certify.that in the performance of the work for which t' OWNER C & V R NO — '/ CONDITIONS 0. ;permit is issued, I shall not employ any,person in any manti _ DISTRICT, y RE E PROCESSED BY ONE 7 GROUP TYPE FV so as to become subject to the Workers'Compensation Laws ADDRESS 9702 Danes �r IVe1 CONST ZONE CITY Temple Cit CA ZIP n o o Date - Applicant 71 7oO STATISTICAL C1ASSI (CATION �: r CONDO NOTICETO APPLICANT If, after mdkmg this Certificate of ARCHITECT OR T 'ILO U Exemption, you should become subject to the Workers' CLASS NO DWELL UNITS LU `- Compensation provisions of the Labor Code, you must forth- ADDRESSr SEWER MAP N with comply with' such provisions or this permit shall be _ w; V Z -deemed revoked TEL BK VALIDATION CONTRACTOR NO LICENSED,CONTRACTORS DECLARATION' I hereby affirm that I am Icensed under provisions bf Chapter 9' ADDRESS 222 Footh i I I Blvd No` 353614 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 Glendorp CLASS B-1 $ 18,000.00 n SQ FT'« - NO OF ' NO OF - - CHECK - �3 Q 7,O SIZE STORIES FAMILIES ONE #1, o -m-o a 2F3 License,Number 35361� " � Lic Class B-1 - I, . Contractor, T. A. Russell' 9-5-84 DESCRIPTION OF WORK NEW $ t Date ADD 2le, )�`6 R;9 7 I am exempt n er c ,2nd sto addition ALTER El FINAL 2 �; o 1 ,6 0,9 7 m � B&P C for th son � REPAIR � DATE O•��•�—�U USE OF DEMOL ate _ . EXISTING BLDG - - - FINAL Signatur APPLICANT TEL By PRINT T.- A. Russell NO 331-315.7 ER-BUILDER DECLARATION - _ I hereby affirm that,l am exempt from the Contractor's License' -1 .2-7- law 7- ( Law for the following reason (Section 7031 5, Business and ADDRESS 222 W. FOOthi I I Glendora 91740 _ �' Professions Code) PEEN > ❑ BUILDING - I, as owner of the property, or my employees with ADDRESS t L��l 1 �,6 R wages as their sole compensation,will do the work and #� o e,'m o,e�1 the structure is not intended or offered for sale(Section LOCALITY > 70", Business and Professions Code) MOVING TEL CONTRACTOR NO . . r 2'° 1',9 9'`8 8 I, as owner of the property, am exclusively contracting with licensed,contractors to construct the project'(Sec- ADDRESS ° ° 1 91'9 8 tion 7044, Business and Professions Code) ," ' REQUIRED _ TOTAL SETBACK FROM ' - EXIST' CONSTRUCTION LENDING,AGENCY SET BACK 'YARD HWY` PROP LINE WIDTH, 09. 1 �—8 4, I hereb affirm that there is a construction lendin y, lendingagency for FRONT _ , the performance of the work for vihch this permit is-issued P L - (Sec 3097, Civ C ) SIDE ^: t; t Lender's Name « nder dress P C Fee E Permit Fee :l 4aneat I ave read t a (cation and state that the PP Issuance Fee matio is come a ree to com I with all Coun 9 P Y- tY Investigation Fee and ate r lating'to buildingconstruction, Total Fee out r e e s ntattves of,this'County to enter bo - re n roperty for-inspection purposes 9•-5-84 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applhcan or dkent Date ®s