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HomeMy Public PortalAbout9707 DAINES DR_Building__ 76A638A CE #803 4/70 �{ APPLICATION FOR .0 LDI G PER T �i COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE _ PARCEL BUILDING AND SAFETY DIVISIONBUILDING ADDRESS JOHN A. LAMBI E, COUNTY ENGINEER COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY _ FOR APPLICANT TO FILL IN NEAREST CROSS ST Print or tVDe onl BUILDING DISTRICT NO GTYPE STO SSED BY ADDRESS s`O ROU STATISTICAL CLASSIFICATION SEWER MAP LOT NO BLOCK CLASS NO —0 DWELL UNITS BTI �_—P1U--- TRACT 7 U ZONE MAP - SIZE OF LOT QS X/j3a NOWOONBLOTS SPECIAL USE OF CONDITIONS EXISTING BLDG TEL OWNER NO BLDG SETBACK FROM ADDRESS Q� FRONT PROP LI NE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY 111. HIGHWAY WIDTH FROM C L ARCHITECT OR v TEL e-4 } ENGINEER NO. BLDG SETBACK FROM ADDRESS SIDE PROP LINEOF (STREET) TEL TYPE OF EXISTING1 SETBACK HIGHWAY } YARD = TOTAL CONTRACTOR NO HIGHWAY WIDTH FROM C,L >,, LIC C- ADDRESSNO + = V LIC CC CITY CLASS CORNER CUTOFF YES ❑ NO ❑ p CONSTRUCTION LENDER c_> NAME AND BRANCH A4p,Alic_- SEE REVERSE SIDE FOR SPECIAL APPROVALS LQLJ h ADDRESS Z SO F7�jj,�� NO OF NO OF NEW SIZE�Gxs STORIES FAMILIES LVALUATION 'Ae ADD ❑ L E ALTER ❑ REPAIR❑ E OF T DEMOL ❑ $ .r APPROVALS ATE IN4P CTOR'S SIGNATURE PMT FOUNDATION LOCATION FEES �_ a FORMS, MATERIALS / FRAMEFIRE STOPS, I HEREBY ACKWOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT- DUCTS STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPE SATION INSURAN LATH, EXT SIGNATURE HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL JOHN F LEWIS PRINCIPAL STRUCTURAL ENG R PLAN CHECK VALIDATION CK M o cnsH PERMIT VALIDATION CK M o CASH err 0 1 3 6 IAlAy 7 1 D 6.0 0 L � 7GA698ACE#'809.7.58 APPLICATION FOR BUILDING PERMIT 1 BUILDING AND SAFETY DIVISIONAooREss j 0 - Department of County Engineer i County of Los Angeles LOCALITY A1 JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST DISTRICT N:j GROUP -1-TYPE EWER MAP FOR APPLICANT TO FILL IN BK PG BUILDING CONST ADDRESS CJ 7U �a i a/40 S �P' 1 STATISTICAL CLASSIFICATION- 11 ADDRESS //�� LOT NO J BLOCK CLASS NO�;L_DWELL UNITS MAP , STATE YES O TRACT 1s: USE ZONE SPECIAL HWY _ ✓ NO OF SLOGS �/ CONDITIONS ' SIZE OF LOT e- I NOW ON LOT42 _ USE OF _ EXISTING BLDG BUILDING EXIST YARD HWY STREET NAME J SETBACK WIDTH OWNER ��-/�JaJ FPOINT e� C� - MAIL ADI SIDE TEL I P L CITY NO INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO .} 5/ 7 ADDRESS - 6r 7' /J TEL. CONTRACT � L O ' ADDRESS GL— _ DESCRIPTION OF WORK NEW /ADD ALTER REPAIR DEMOLISH - SQ FT NO OF NO OF j SIZE �^ STORIEA, FAMILIES f USE OF STRUCTUFkE 4 'G APPROVALS SIGNATURE OF APPLICANT / .ice DATE INSiPECTOR S SIGNATURE ADDRESS ' ") L/ OUNDATION LOCATION - ",, FORMS. MATERIALS p C $ FRAME FIRE STOPS. ' 0 G- GJ FEE '�av BRACING BOLTS .v ♦ ..e..� '' // FURNACE LOCATION, VALUA ON 4� FEE L GAS VENT. DUCTS - µ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH L COUNTY ORD ANCES AND LATH. EXT STATE LAWS REG T BU ING STRUCTION SIGNATURE OF HOUSE NUMBER COR- PERMITTE 1 RECT AND POSTED ADDRESS ^ Avl FINAL JOHN A.LA IE, COUNTY ENGINEER, CLYDE N DIRLAM. PRINCIPAL STRUC RAL ENGINEER CHECK VALIDATION K M o CASH / PERMIT VALIDATION K M O CASH io 0 2 9 ,,J'JL 1.7 1 6 �+ ©�! A 6 ,5 5' AUG 2,6 1- . 3'8".5 0 i WORKERS'COMPENSATION DECLARATION hereby'affirm that. I havecertificate of consent to Self insure, or a certificate of Workers' Compensation Insurance, -A P p L I CAT I O N ' F O_ R B U I'L D I N G, PERMIT _ or a certified copy thereof(Sec. 3800, Lob. C. - . COUNTY OF LOS ANGELES BUILDING ANDUFETY Policy No. •Company . . BUILDING �- 1:1Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN ADDRESS �1 ElCertified copy'is filed with the county building'irispec BUILDING �,� 1 „ tion department. ADDRESS Imo+ 'J, LJ(G.( UC A Date Applicant CITY Vi� ZIP LOCALITY _ CERTIFICATE OF-EXEMPTION FROM WORKERS' NO. F BLDGS. 1 NEAREST COMPENSATION INSURANCE' SIZE OF LOT NOW ON LOT CROSS ST. _ (This section need not be.cornpleted if the permit.is for one - - - ASSESSOR. hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE NE P (`J I certify that in'the performance of the work for which this OWNER NO NO. permit is issued, I 'shall not employ any person many manner SPECIAL �. so as to ecome'subject to the Workers'Compensation Laws. ADDRES / CONDITIONS Date Applicant V i CITY _ ZIP ARCHITECT OR TEL. DISTRICT GRO PE FIRE P CESSED BY NOTICE AP (CANT: If, after making this Certificate ENGINEER - NO. NST. ZONE Exemption, you should become subject to the Workers' i U Compensation-provisions of the Labor Code,-you must forth- ADDRESS �i with comply with such provisions or this.permit shall be - - - TEL. \/ STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTO }�JU1 NO&-Y) LICENSED CONTRACTORS DECLARATION _ G^ LIC- ' CLASS NO. y� DWELL. UNITS 1 hereby affirm that I am licensed under,provisions of Chapter 9 ADDRES( D . (v l� WVIIL�A10. _I (commencing with Section 7000)of Division,3 of the Business and _ _ _ .LIC. SEWER MAP Professions Code, and my license is,in full force and effect.. CITY �Nl.— CLASS BK. PG. VALIDATION SQ. FT. NO.OF NC..OF CHECK License,Number Lic.Class_ SIZE �� STORIES FAMILIES/ ONE VALUATION DESCRIPTION OF WORK `0- l � , NEW Contractor Date ADD a am exempt under Sec. k ,C;Lrk0 n�' (a '��r(Lc`�kr- ALTER �,B.&P.C. for this reason Q '•, REPAIR Q $ USL OF �� Dat EXISTING BLDG. DEMO' Signature � - APPLICANT1, '^� TEL. /, FINAL W ER- JI DER DECLARATI (PRINT) �( � _ ' C 1 NO. �' 4 r DATE G hereby affirm that I at empt from the Contractor's License Law for the following``�r ason (Section 7031.5, Business and ADDRESS ). d FIN Professions Code): PRESENT BY BUILDING I, as owner of the property, or my employees with ADDRESS _ .. . 1 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ' 7044; Business and Professions Code). MOVING -TEL: - - I, as owner of the property, am exclusively contracting CONTRACTOR NO. �L I with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 6 03,0A REQUIRED . TOTAL SETBACK FROM' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT # 0 0 0-0 0,1 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE Iaa6&63' p P.L. _ . Lender's Name 0 0 0 6 8.6 35 g LDMA Ref. # p -. P.C. Fee$ - Permit Fee-- _ - loop, 1,2 6-$6 Lender's Address > I.certify that I have read This application and state that.the Issuance Fee �-� LDMA P/C# Q above information is correct. I agree to comply with all County Investigation Fee a ordinances and State laws relating to building construction, /, m - 9 9 - .. Total - YJ �r �� LDMA Perm. # -- - , tj and reby uthorize representatives of this County to enter up he a o men ti pro rty for inspection urpos �^ 11 SEE.REVERSE FOR EXPLANATORY LANGUAGE Signatureo" plicant or Ag t -- Date..