The URL can be used to link to this page

Home My Public Portal About9721 DAINES DR_Building__ -76;D99A�; #aD9.,.98 APP L I C A T I O IV FOR -BUILDING PEFIMIT - 1 BUILDING AND SAFETY DIVISION BUILDING ADDRESS lZild,.l Department of County Engineer County of Los Angeles LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS ST DISTRICT NO GROUP -.TYPE SEWER MAP FOR APPLICANT TO,FILL IN BK PG BUI /� ) CONST ADDRESS�jr �,/ V4 /��t �„�/ STATISTICAL CLASSIFICATION G` CLASS NO DWELL UNITS�I LOT NO BLOCK MAP - HVySTATE YES NUMBER Y TRACTl/ O,N U `Z E SPECIAL tx^, / NO OF BLOGS ! CONDITIONS SIZE OF LOT-<6) / �� NOW ON LOT USE OF _ EXISTING BLDG BUILDING - EXIST SETBACK YARD HWY_ STREET NAME WIDTH OWNER FRONT -49& MAIL ADDRESS SIDE TEL P L 'CITY No1 't- INSPECTION-RECORD ARCHITECT OR TEL ENGINEER NO /7 C�, /�e� ' 'ADDRESS ✓ " TEL CONTRACTO 4A,lb YAP, ' -- ADDRESS .�[ / - DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ FT `` ` NO OF NO OF - SIZE Y -.] STORIES FAMILIES USE OF STRUCTURE - APPROVALS SIGNATURE OF _ APPLICANT �+ ) DATE INSVECTOR S SIGNATURE ADDRESS 1 ?G M— FURNACE FOUNDATION LOCATION' ORMS MATERIALS �/ AME FIRE STOPS. / RACING BOLTS S I A VALUATION LOCATION _ L� AS VENT DUCTS 1k A N I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS RRECT AND AGREE TO COMPLY WITH L CO TY O ANCES AND LATH, EXT N STATE LAWS REGU T B INC N T CTION SIGNATURE OF HOUSE NUMBER COR- pA RECT AND POSTED PERMITTEE ADDRESS v Si FINAL JOHN A. A IE. COUNTY ENGINEER, CLYDE N. DIRLAM, PRINCIPAL STRL144VRAL ENGINEER CHECK VALIDATION CK rn o CASH , PERMIT VALIDATION C M o -CASH- C) CASH- SCC) 3 0 JUL 17 1 6 �Ei :' 116 2 i 38-50 -- APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY j BUILDI ADDRE S o WORKER'S COMPENSATION DECLARATION - _ � -FOR APPLICANT TO FILL IN 72 � / Hes, •�Q - - BUILD A DRE S, x l/ I hereby affirm that I have a certificate of consent to self Insure, , or a certificate of'Workers' Compensation Insurance, or a certified -O� e 1. copy thereof(Sec 3800,Lab'C) _ CITY ! ZIP / `D 'LOCALITY, Policy NO Company SIZE OF LOT _ v_ NO OF BLDGS NOW,ON LOT ❑ Certified copy Is,hereby furnished - / NEAREST CROSSsTI f _ - ❑ b Certified copy is filed with the county ull8ing Inspecrtion TRACT BLOCK LOT No department -USE ZONE MAP NO , - � 'Date Applicant ASSESSOR MAP B I$_&S PAGE PARCEL SPECIAL CONDITIONS M CERTIFICATE OF EXEMPTION FROM WORKERS' ER I -/) r TEL NO �j �' U COMPENSATION INSURANCE i0#4 v U A� /r O WITHIN 1000 FT OF SCHOOLS YES NO^/0' '(This section need not be completed If the permit-Is for one hundred ADD 5.2 CS pX /J DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY _ dollars ($100)or less) = r. I certify that In the performance of the work for which this perr it CIT. W / ZIP �/��O ,I 3, NT 2 Is Issued, I Shall riot employ-any person In a6y'manner so S t0 ARCHITECT ENGINEER TEL NO - (� J become ject the Workers'C pensahorn ors° / 4 ' ` r! ,STATISTICAL CLASSIFICATION, ' APT CONDO Date Applicant ADDRESS t CLASS NO DWELL UNITS �. 'NOTI ;TO' APPLICANT ter making Certificate Of REQUIRED - TOTAL SETBACK FROM EXIST= Exemption, you Should" ome subjeC to 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' SIDE s CITY .- LIC-CLASS P L I hereby affirm that I,am licensed'underprovisions of Chapter 9 SEWER MAP, (commencing with Section'7000)of,Division 3 of the Business and SQ T NO OF STO IES NO OF F MILIES a Professions Code,and my.11cense Is in full force and effect S NEW 11 BK PG V License Number LIC Class D RIPTION OF WORK ADD _ ❑ VALVA N Contractor Date ALTER El O e - El I am exempt-under Sec KE AC_T.JT1 � z B&P C for this reason 1 y DEMOL ❑ LDMA P/C Date USE OP&IXISTING BLDG, _ - URM ❑ ^ 5Wnature APPLICANT(PRINT) TEL NO LDMA Perm# - f s E_/3 L 12,1'_ 35 I,as owner of the property, or4my employees-with wages as Z the, sole compensation, will do the work and the structure Is ADDRESSEC .• y_ o not Intended or offered for sale (Section 7044, Business and FINAL DATF, _ E r PfOfeSS10rIS Code)• WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `/ •'�G 0 _''r��3y ❑ I, as owner Of the OR A MIXxTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ( - ' property, am exclusively contracting with AM SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE'S FINAL BY / licensed contractors to construct the protect (Section 7044, Lvt`(-J( �I Business and Professions Cdde) ves No,l] _l" !1—t ILE`.� WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING - •i ' jF''� _ OCCUPANT QUMANAGEMENTT DISTUIRE A PERMIT FOR RICT CT!(SCAOMDRSEEPERMITTING CTION OMODIFICATION O ECKUSTSOUTH FOR ii-+•= •� `�•�/°+� OASAIR AUTY CONSTRUCTION LENDING AGENCY GUIDELINES I hereby`affirm that there Is a construction lending agency for YEs❑ No2� w the performance of the work for which this permit Is Issued(Sec ` TTING 3097,Civ C) CHECKLISTD I UNDTHEiERS ANDD MV REQUIREMEN SATERIALS NUNDERGUIDT EE OS ANGE EST10N AND THEQCO UN PER CODE 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 SCAOMD Lender's Address ^ 0 OMER OR AGENT o I certify that I have read this application and state under penalty 0 of perjury that°the above Information IS correct I agree to comply. PC FEE - - - PERMIT FEE 'y N with all county ordinances and State laws relating to building �Z co construction, and hereby authorize representatives of this County ISSUANCE FEE- / � to ent upon the abov -me ned (� ty for Inspector�rp es • �(�• � 1 - � - °'` ` -' INVESTIGATION FEE TOTAL FEE /4 SEE REVERSE FOR EXPLANATORY LANGUAGE