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HomeMy Public PortalAbout9708 DAINES DR_Building__ 76ABSEIAI�CE sr@OS-7-56 AP P L I CAT I ON FOR BUILDING-PERMIT . 1 BUILDING AND SAFETY DIVISION BUILDING ADDRESS Department of County Engineer ✓� County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST, f DISTRICT NO. GROUP TYPE EWER MAP FOR APPLICANT TO FILL IN BK PG _ CONST. BUILDING © / ADDRESS STATISTICAL CLASSIFICATION CLASS. NO.___0_DWELL. UNITS LOT NO. BLOCK MAP STATE YES O TRACT �� Lj NUMBER /' HWS' U§iEzQNE SPECIAL NO. OF BLDGS. ` CONDITIONS SIZE OF LOT 'j 2 X r/2 �� I NOW ON LOT „/h � USE OF _ EXISTING BLDG. BUILDING EXIST. YARD HWY STREET NAME SETBACK WIDTH OWNER re J�/� FRONT MAIL P. L. � ADDRESS I I/ G SIDE TEL. ` P. L. CITY ?ryl? !kJ NO. �f�— INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ' r ADDRESS TEL. CONTRALTO O. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. FT. I NO. OF NO. OF SIZE / STORIES FAMILIES USE OF STRUCTURE APPROVALS SIGNATUREOF APPLICANT DATE INSPACTOR•S SIGNATURE ADDRESS S r OUNOATION: LOCATION /t 4 ) FORMS. MATERIALS P. C, S /p FRAME: FIRE STOPS. FEE BRACING. BOLTS VAATION ,,,,r ,6L $ FURNACE: LOCATION. / FEE _ GAS VENT, DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. O " PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH L CO NTY OR . .DI NCES AND, LATHEXTA STATE LAWS RT BU ING C STR TION. - --- - — SIGNATURE OF HOUSE NUMBER COR- PERMITTEE EGU RECT AND POSTED )-, _–•�/ FINAL ADDRESS 7 �� JOHN A. AYBIE. COUNTY ENGINEER, CLYDE N. DIRLAM. PRINCIPAL STRU RAL ENGINEER N CHECK VALIDATION K. M.O. CASH 1 PERMIT VALIDATION CK M.O. CASH 0 3 0 5 J1,2 1'7 16 L. J 3V;` AUG26 1 38.5.0. APPLICATION- FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL-17= BUILDINMS$. I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS f or a certificate of Workers' Compensation Insurance,or a certified 9309 ��/�C A I V4 copy thereof(Sec.3800,Lab.C.) CIT-reM'' Pl-c �T ZIP-ioeo LOCALITY Policy No. Company SIZE OF LOT 77 `'7 NO.OF BLDGS..NOW ON LOT ❑ Certified copy is hereby furnished. 5by/o 2 I NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT L BLOCK LOT NO. department. p,Z USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL 02• / SPECIAL CONDITIONS '�' �' ©o CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER P, , TEL NO. COMPENSATION INSURANCE �``vliv Z-/ io-9-296 WITHIN 1000 FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS Q, p PA lmss AR ib�.' DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) / �7 I certify that in the performance of the work for which this permit CITY er �nL� C` ZIP �I 7-ea � � is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. -4,y -4 4 become subject to the Workers'Compensation Laws. STATISTICAL CLASSI (CATIONAPT 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 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. P L LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT. IZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. - / NEW ❑, BK PG , d License Number Lic.Class DESCRIPTION OF WORK • ADD ❑ VALUATION Q ^ ^ $ �o U Contractor Date �a A f ALTER EltJ � f1 f?H&j REPAIR ❑ Ir O ❑ 1 am exempt under Sec. $ V B.&P.C.for this reason �� DEMOL 13 LDMA P/C# III Date: USE OF FIXISTIN epLDG. URM ❑ ----� - a- T is 0 Signature APPLICANT(PRINT) .r TEL NO. �LDMA Perm# a y� z XI, as owner of the property, or my employees with wages as Jl Al Y41 ��'� z -zc� Z - their sole compensation, will do the work and the structure is ADDRESS ^. �+,,,/� O ` ` not intended or offered for sale (Section 7044, Business and 10�AhE /'Q 1�r (FM.Ple G/t FINAL DATE a ACC*T.n a Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _•:II.�J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE .. Ell, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY v 5 r' i C MC licensed contractors to construct the.project (Section 7044, YES El NO El _ y S � Business and Professions Code.) t WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 42en �+` OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ®®� L�yy-- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ``�� � ire BNS '_Ears is 'Ii 56 CONSTRUCTION GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ 1 /1 E N the performance of the work for which this permit is issued(Sec. \ ��' n=' IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING g�`Z3 �.' }` 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, `v TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Address { {_ £ O - OWNER OR AGENT 1 I}IE I�f�f f?,I I i~y o I certify that I have read this application and state under penalty `)-i O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE P .•I L°yf __ r -7 N with all county ordinances and State laws relating to building lJ• � :47 construction, and hereby authorize representatives of this County ISSUANCE FEE j to enter` the`abo�e/(�entioned property for inspecti/pur s y / V V�yy., /vj1?-3 INVESTIGATION FEE TOTAL FEE Sgnature of Applicant or Apenl 1e I SEE REVERSE FOR EXPLANATORY LANGUAGE