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Home My Public Portal About9713 DAINES DR_Building__ 12 76A638A CEOW011-67 APPLICATION FOR BUILD NG PER . COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST e COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST DISTRIC NO •GR TYPE P O p FOR APPLICANT TO FILL IN CONST c`l BUILDING �! STATISTICAL C IFICAT'ON SEWER MAP ADDRESS CLASS NO DWELL UNITS B PG,� -- LOT NO BLOCK - USE ZONE MAP �1 /� \ TRACT Z - NO' (/ SPECIAL NO OF SLOGS CONDITION SIZE OF LOT NOW ON LOT USE OF �,o1 e ' BLDG SETBACK FROM TEL FRONT PROP LINE OF - - (STREET) OWNER �+ NO TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL ADDRESS •yE-r T HIGHWAY O JJ''�� FROM C L CITY �'rYsF P �" + e V + - , ARCHITECT OR L BLDG SETBACK FROM ENGINEER NO SIDE PROP LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY i- YARD = TOTAL ADDRESS F HIGHWAY WIDTH FROM C L TEL _ CONTRACTOR / A/�.NO + ADDRESS / O ,.ZD4 NO /// CORNER CUTOFF YES � _ NO.O_ _C TY - Llc SEE REVERSE SIDE FOR SPECIAL APPROVALS 0: C ESCRIPTI OF WORK Ll NEW D ALTER REPAIR DEMOLISH f �/p1 I a f t- /�I v SIZE T NO OF NO OF GAlwy�i' II�f/�/� M fJ ztw 7 ? STORIES FAMILIES USE O STRUCTURE A&Ih SIGNATURE OF -�2- �-4 APPLICANT VALUATION �00 APPROVALS DATE INSP%tOR'S SIGNATUpE MT FO � LOCATIONPC ,,O� I"FEE$ EE$ FORMSi MATERIALS �� FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE, LOCATION 12 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 'JUILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT TION OF THEVSCO C OF THE STATE OF CAL RNIA RELAT / ry ING TO WORKE ATION INSURANCE LATH EXT P_ ( 1SIGNATURE HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL JOHN F LEWIS PRINCIPAL ST RAL ENGINEER PLAN &ECK VALIDATION-- CK M o CASH _ PERMIT VALIDATION CK M o CASH :'� LA[,o 1 6 7 2 f4Ov 13 1 .0 1 2.00- CQ 76A699 CE#809.7.88 A P p L C A T i O N FOR BUILDING P R M I T i BUILDING AND SAFETY DMSION BUILDING Departmeni of County Engineer ADDRESS County of LOS Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D GRIFFIN, SUPT OF BUILDING CROSS ST DISTRICT NO GROUP, .n,PE �_,� SEWER BK MAPPG FOR APPLICANT TO FILL IN J __w__I CONST BUILDING ��f :� ADDRESS ( �, - STATISTICAL CLASSIFICATION LOT NO BLOCK CLASS NO'-1.�DWELL UNITS MAP STATE' YES, O - l/' NUMBER 9 / HWY TRACT /,S-7 6 // USEZONE SPECIAL NO OF BLDGS CONDITIONS SIZE OF LOT:fz OK U NOW ON LOT Al USE OF - c• EXISTING BLDG BUILDING EXIST SEfBACK YARD HWY STREET NAME WIDTH OWNER FRONT /y MAIL r P L _ ADDRESS SIDE n P L , CITY !"�i71»'( Ct. TEL �I i. 7. ti �{ INSPECTION RECORD ARCHITECT OR TEL ENGINEER NO ADDRESS TEL. C0NTRACTO _'&'cNO - _ - - ADDRESS DESCRIPTION OF WORK NEW k ADD ALTER REPAIR DEMOLISH SO FT. NO OF NO OF SIZE STORIES FAMILIES USE OF bTRUCT APPROVALS SIGNATURE F. APPLICANT DATE INSPECTOR S SIGNATURE ADDRESS C FOUNDATION LOCATION ''ccam� FORMS, MATERIALS D ..D, P C S FRAME FIRE STOPS. ��11 FEE BRACING BOLTS S - FURNACE LOCATION. VAL TION FEE -� GAS VENT, DUCTS N_ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT S-7 PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORD ANCES AND LATH, EXT STATE LAWS REG �AG B DING STRUCTION SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS -' FINAL JOHN A. LPAMBIE. COUNTY ENGINEER, CLYDE N DIRLAM, PRINCIPAL STRU RAL ENGINEER PLAN CHECK VALIDATION K M o CASH PERMIT VALIDATION cK M o CASH d j G L`1,-, JUL 17, 1 6 1-6 5,7S MG26 1 3 $.5.0 ter' (APPLICATION FOt BUIL®ING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION " FOR APPLICANT TO FILL IN BUILDING A DRESS 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 copy thereof Sec 3800 Lab_C) CITY ; ZIP ' LOCALITY r Pollcyt No /`�•�L•_l Company eN e 1\ SIZE OF LCT, NO OF BLDGS WON LOT ' ❑ C�r ified copy is hereby furnished NEAREST CROSS / 3 TRACT BLOCK LOT NO i �YCertrfied copy Is filed with the county budding inspection.' USE ZONE MAP NO depa ment �G�, Date j�•; Applicant iv-,�/L/ ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNS TEL NO } COMPENSATION INSURANCE L i �1� .�. WITHIN 1000 FT OF SCHOOLS YES NO ADDRESS ' (This section need not be completed If the permit,ls for one hundred �j'•1 ' DISTRICT GROUP TYP ONST FIRE ZONE PROCESSED BY dollars ($100) or less) - CIT C ZIP t ' 3 T I certify that in the performance of the work for which this permit � iT' U a IS Issued, I-shallnot employ any person In any,manner so as t0 -ARCHITECT ORE GINEER - - TEL NO !J become subject to the Workers'Compensation Laws ` STATISTICAL CLASSIFICATION APT CONDO Date '� Applicant ADDRESS "' CLASS NO DWELL UNITS NOTICE TO APPLICANT If, afteP 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 9'2 114 _ FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS_ LIC NO P L LICENSED CONTRACTORS DECLARATION �G�iSfi OY}e �7 �1�-S� SIDE CITY _ _ _ - LIC CLAS" P L I hereby affirm that I am licensed underprovi ons of Chapter 9Cct f `-� SEwER MAP } (commencing with Section 7000)of Division 3 Df the Business and SQ FT SIZE --NO OF STORIES NO OF F,p,MILIES a Professions Code,and my.license Is in full force and effect - l_ NEW ❑ BK PG ; O U, License NumberyI� �1y1� Llc Class- �l DESCRIPTION OF WOPK ADD ❑ VALUATION Contractor V` Aw S I,&4. Date Z�3 ` ALTER $ 0 O �eot,v� LCf07C B�►�o� REPAIR ❑ ~ ❑ I am exempt under Sec ( J i - $ U B PC for,this reason Ir �} IC�SS �A�r► EMOL ❑ W LDMA P/C# O_ Date USE OF EXISTING L G 1 wt�I URM _ ❑ - Z Signature APPLICA T(PRINT) TEL NO f'- LDMA Perm#. n3 •;• 2. ❑ I, as owner of'the property, or my employees with wages as v� m��„ j�s �2f Sn� 2 their sole compensation, will do the work and the structure Is ADDRESS "1 _ _) not intended or offered for sale (Section 7044, Business and 2 k- C+ T �ct 6 FINALIDATE , a -•�;to PfOfeSSIORS Code) WILL THE APPLICANT OR URE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAI G A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE E1=' ❑ 1, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED N THE HAZARDOUS MATERIALS INFORMATION GUIDES Q !S X69 m 25 FINAL D TOT s`19,_ licensed contractors to construct the project (Section 7044, � ' 1 � � , Business and Professions Code) YES❑ NOV _ I E_ I_P �_=.-,C WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING. ' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH t f CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR f_.�t NGE GUIDELINES I'hereby affirm that there Is a construction lending agency for YES❑ No a the performance of the work for which'this permit is issued(Sec 3097,CIV C - IHAVE READ THEHAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 4'tt_ N ) , CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE - TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS _ h„I C Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD ��- IL Lender' s Addres's O , OWNER OR AGENT 0 1 certify that I have,read this application and state under penalty _ E of perjury that the above Information is correct I'agree to comply PC FEE PERMIT'FEE 'with all county ordinances and State laws relating to budding m constr , and hereby author -representatives of this County ISSUANCE'FEE ato p he a v ment property for Inspection purposes a�/• �� ' INVESTIGATION FEE TOTAL FEE gnoture of Aq,4can1 or Agent Deta �� ` f— ' SEE REVERSE FOR EXPLANATORY LANGUAGE