HomeMy Public PortalAbout9717 DAINES DR_Building__ 7GA598A CE*809-7-58 A 'P P L I C A T I O ISI I.O R , B U I I_®I N(a PERMIT rfd
BUILDING AND SAFETY DIVISION ABUILDING
DDRESS Q
Department of County Engineer
County of Los Angeles LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST �p
CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST L
DISTRICT NO GROUPIBK PG
TYPE SEWER MAP
FOR APPLICANT TO FILL IN
� CONST
BUILDING _ „� ' I
ADDRESS ���f/tl/ STATISTICAL CLASSIFICATION'
CLASS NO DWELL UNITS
LOT NO BLOCK
MAP STATE YES O
NUMBER + HWY
TRACT 7 SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT I NOW ON LOT }
USE OF _
EXISTING BLDG BUILDINGEXIST
17/ SETBACK YARD HWY STREET NAME WIDTH
OWNER OW A FRONT
.MAIL P L _� - j 07-
ADDRESS - S SIDE
TEL P L
CITY' / 4,tjw fd/ NO ifl7+�itiF t
ARCHITECT OR TEL INSPECTION RECORD
ENGINEER NO / / 4 el 7
ADDRESS
TEL
CONTRACTO4&6( O '
ADDRESS 1 7 Sc
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ FT. NO OF NO OF
SIZE �--"[ STO ES FAMILIES - -
USE OF STRUCTUR
' f APPROVALS
SIGNATURE OF
APPLICANT DATE IN PECTOR S SIGNATURE
,ADDRESS �j (� >, O'ORMSTMATERIIALSION
A -
PC
$ FRAME FIRE STOPS. v
$ � •� � ' FEE BRACING BOLTS 7
VALUATION $ FURNACE LOCATION,
FEE GAS VENT, DUCTS d�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT SZ
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH kLL COUNTY O NANCES AND LATH EXT
STATE LAWS REG G B DING N T UCTION HOUSE NUMBER COR- /
SIGNATURE OF RECT AND POSTED J - A
PERM ITTE
ADDRESS FINAL
JOHN A. LRMBIE. COUNTY ENGINEER, CLYDE N DIRLAM, PRINCIPALS' RAL'ENGINEER
a PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION , K M o CASH
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APPLICATION FOR-BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION :_ , FOR,APPLICANT,TO FILL IN 13'511-DING ADDRESS Q y D
BUILDING ADDRESS - - - { I I w 1
I hereby affirm that I have a certificate of consent to self Insure, y�S �
or a certificate of Workers' Compensation Insurance,or a certified
copy thereof (Sec 3800,Lab C) CITY ZIP- C,
/l,O p[! r � � �� 7(.?,5 LOCALITY
Policy No T OT J Company SIZE OF LOT NO OF BLDGS NOW ON LOT Ie CZ-1
M,Certified copy Is hereby furnished NEAREST CROSS ST
TRACT BLOCK ,
❑ Certified copy Is filed with the county building Inspection LOT NO USE ZONE MAP NO
department � � DD����
* Date Applicant G/r17�« �-� 'f(�G ASSESSOR MAP BOOK PAGE PARCEL - SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER n TEL NO &1Q YES NO
COMPENSATION INSURANCE _ E� WITHIN 1000 FT OF SCHOOLS
(This section need not be completed If the permit is for one hundred ADDRESS
DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
dollars($100)or less)
2/7
_ - ,Z 19 ^
I certify that the performance of the work for which this per � � �� IP`7/l� 5 D�' p,?� 3
Is Issued, I shall
to CITEall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NO
become subject to the Workers'Compensation Laws * STATISTICAL C S FICATION ; APT VONKO
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 to the Workers' CONTRACTOR - JE:�NQ SET BACK' YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith _ GC�� �ca(�ti6 ;19/ S?W FRONT
comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL
LICENSED CONTRACTORS DECLARATION LIC CLASS CL S SIDE -
CITY P L
I hereby affirm that I am licensed underprovisions of Chapter 9 ��`� LG C e • G SEWER MAP
(commencing with Section 7000)Of Division 3 Of the Business and SO FT SIZE NO OF S ORIES NO/F FAMILIES
Professions Code,and my� license is In full force and effect NEW ❑ BK PG a
90 S�.2 9 C 2/ DESCRIPTION OF WORK ADD ❑ VALUATION ® O
License Number Llc Class coo'
Contractor -�AGLG
�!�Date �G fy�/tiG DFS ALTER ❑ $ Z!5�R $vr_ U
U GS0
❑ I am exempt under Sec REPAIR ❑ $ F-
B
B&PC for this reason DEMOL+❑ LDMA P/C# , W
Date USE OF EXISTING BLDG - URM ❑ IL
Signature APPLICANT(PRINT) TEL NO LDMA Perm# 1 j Z
❑ I, as owner of the property, or my employees with wages as OZ AUT.a
their sole compensation, will do the work and the structure Is ADDRESS
not Intended or offered for sale (Section 7044, Business and FINAL DATE Q �Jo� 1,55.65
Professions Code) �Z3� 1- ITEMS
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J _
❑ I, as owner of the property, am exclusive) 'contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE
P P Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'S FINAL BY > TOTAL 1 m 65
licensed contractors to construct the project (Section 7044, YES❑ NO❑
Business and Professions Code) CACK lbs,b5,
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING -
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR OUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKUST FOR CHANGE
GUIDELINES
I hereby affirm that there Is a construction lending agency for YES❑ NO❑•
N the performance Of the work for which this permit Is Issued(Sec IHAVEREADTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING aaaa-aaol 10/19/95
3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE 0000 00 (� (�
N - TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS gab 1 AM 1L1'�7
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD
CIL Lender's Address
OWNER OR AGENT
O
oI certify that I have read this application and state under penalty
o of perjury that the above Information IS correct I agree t0 comply PC FEE PERMIT FEE
with all county ordinances and State laws relating to building SIAJ S
construction, and hereby authorize representatives of this County ISSUANCE FEECO
'
to enter upon the above-mentioned property for Inspection purposes
INVESTIGATION FEE TOTAL FEE /^ '
I Y/�•
� sy,>awre It Aop�m or Agem Dare C 1
SEE REVERSE FOR EXPLANATORY LANGUAGE I