HomeMy Public PortalAbout9827 DAINES DR_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPL'fCANT TO FILL IN (Print or type only)
BUILDMG COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER '
CITY BUILDING ZIP �"� BUILDING AND Y DIVISION
► rLIO OF BLDGS BUILD IN
SIZE OF LOT aC 117 O NOW ON LOT ADDRESS
BLOCK LOT NO 6-3 LOCALITY
TRACT/390-5
TEL NEAREST
OWNER D�( �� 6-Q I,-h I Lk NO CROSS STASSESSOR
ADDRESS 3;k.-7 A I h $ r', MAP BOOK PAGE �� PARCEL
7ew l-Q / T ZIP -78� DISTRICT G OUP TYPE CONST FIRE ESSE BY
-CITY `G Ci
ARCHITECT OR TEL D 8
ENGINEER- NO STATISTICAL CLASSIFI TON SEWE " AP 4 -
ADDRESS
TEL CLASS NO DWELL UNITS BK PG
'
CONTRACTOR NO U E ZONE NOP O f
LIC
ADDRESS NO SPECIAL
LIC CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL RE UIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND,BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
ADDRESS CITY HIGHWAY + TOTAL SETBACK FROM TYPE OF EXISTING
SO FT NO OF ii NO OF i CHECK YARD FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES 1 FAMILIES ONE }
DESCRIPTION OF WORK NEW ❑ + o2O - 0
_ O
�/ BLDG SETBACK OM
OO IT►a`1 — f VOOHn ADD SIDE PROP LINE OF (STREET) O
1 ALTER [3 TOTAL SETBACK FROM TYPE OF EXISTING w
OL sn r ❑
HIGHWAY +. YARD = SIDE PROP LINE HIGHWAY WIDTH
USE OF REPAIR + _ I Z
EXISTING BLDG Cj'&a t-li a DEMOL ❑
APPLICANT ^ 0 II �k NL CORNER CUTOFF YES ❑ NO ❑
(PRINT) fJ N O
I _
BY(SIGNATURE) a� IN OPEN SPACE YES ❑ NO ❑
QQ IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION P" I D
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES ,
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE '
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM ,
PENSATION INSURANCE
SIGNATURE OF /f ~-
PERMITTEE v'
ADDRESS C4 9 )L-'j D a H C SFINA`
CITY Gtr' NOL DATE
���`��• BY
FMAKE CHECKS PAYABLE TO
--j PCFEE ,! FET $
PM
HARVEY T.BRANDT,COUNTY ENGINEER
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK mo CASH
®s 76A638A CE#803 3-75
V
WORKERS'COMPENSATION DECLARATION -
I,hereby affirm that I have a certificate,of coto self
nsent' a APPLICATION FOR B U I L D I�N G PERMIT
.
insure, or a certificate of Workers'Compenstion Insurance, or ,
a certified copy thereof (S c 3800, Lab C ) COUNTY OF'LOS'ANGELES•`'- BUILDING AND SAFETY
Policy 'Ah U 1) /� ompany t-�/h 111 t '
BUILDING
"Certified copy is hereby furnished �,_�� FOR APPLICANT TO FILL IN ADDRESS
aCertified copy is filed with q'county building inspec BUILDING
- tion depaftment ADDRESS �oC LOCALITY T r
r� NEAREST
Date Appica� CITY 1 ` ZIP CROSS ST Q
CERTIFICATE OF EXEMPTION FROM'WOR RS' NO OF BLDGS ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL'
(This NO section-need not be completed if the permit is-for one ? USE ZONE, MAP
�J
hundred dollars'($100)or-Jess = TRACT BLOCK LOT NO n Cl
' _ � r TEL ,� SPECIAL •r 0
I ecertify_ih�at-m the performance of the work for which this OWNER C- NO, CONDITIONS-
pe
ONDITIONS.
permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE P C D BY d 11
so as to become sublect to the Workers'Compensation Laws ADDRESS 1 Pre i , �/ CONST ZONE
Lid- e,3 �
Date ApplicantCITY 7ZIP STATISTICAL CLASSIFICATION ` APT CONDO
TELLU
NOTICE,TO APPLICANT If, after making this'Certrficate of ARCHITECT ENGINEER NO
CLASS'NO c71 DWELL UNITS �` 4
'Exemption, you should become sublect to the Workers' N
Compensation provisions of the Labor Code, you must forth- SEWER MAP Z
ADDRESS
with comply". with'-such•provisions or this permit shall be �/ -—
deemed revoked r r NO 7 7 BK ,� PG, /r VALIDATION
CO NTRACTO
LICENSED CONTRACTORS DECLARATION LIC ,/
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO Y VALUATION
(commencing with Section 7000)of'Division•3 of the Business and LIC /� y
Professions Code, and'my license is m full force and effect CITY Q } CLASS yCJ $
i
SQ FT � NO F NO OF CHECK
-License Number ��� LicClass SIZE "S STORIES FAMILIES ONE -
2
DESCRIPTION OF WORK �/yt a `,/ NEW
t Controcto Date - `
a _ - _ - ADD ® - r• -
I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer '. ALTER � FINAL
'acting in my professional capacity'(Section 7.051, " A - DATE `
Business and Professions Code REPAIR ,
USE OF- c- .- J
J J DEMO FINAL
EXISTING BLDG eik/Pam, ! e
By
Lic or Reg No '--Date APPLICANT 1 J NO V "'
OWNER BUILDER DECLARATION. ' PRINT / vVir1kc, TEL
,
I hereby affirm that"]am exempt from the Contractor's License ;
Law for the.followin reason Section 7,031 5, Business and ADDRESS �_ r Qtr^ _
Professions Code) PRESENT
BUILDING - i'o 0 0,01
�. 1, as owner'of the property, or my, empldyees'with ADDRESS
wages as their sole compensation,will do the work and •
the st�ucture'is not intended or offered for sale (Section LOCALITY
7044, Business and Professions Code) - MOVING TEL '
Q1, as owner of the property, am exclusively'contracting CONTRACTOR - NO v o o,1 6 0,0 0 0
with licensed contractors'to construct the project (Sec-
ADDRESS O l5 2 5"-'8 2
tion 7044, Business and Professions Code)
N REQUIRED ' TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK. YARD HWY - PROP LINE WIDTH '
-1 hereby-offirm that there is a construction lending agency for. FRONT
the performance,of the work for which this permit is issued P L
(Sec 3097, Civ C ) SIDE'
P L
Lender's Name, r t~
P C 'Fee$ Permit Fee
Lender's Address
w I 'certif that I have read this application and state that the
Y PP - Issuance Fee
Q' above information is correct I agree'to comply with all County- Investigation Fee
�- ordinances-and State laws relating to building construction, Total Fee
and herepy authorize representatives of this County to enter 1"
a uj �ve-mentianecf"property for inspection purposes �
SEE REVERSE FOR EXPLANATORY LANGUAGE
a f
Signature of Apple ant or Agent Dote _ - is
•• ! { .e ,