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Home My Public Portal About9844 DAINES DR_Building__ APPLICATION 1 OR BUILDING PERMIT _ COUNTY OF LOS ANGELFG • BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI�DqR I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS _ 1� • /��ff �✓ or a certificate of Workers'Compensation Insurance, or a certified eyq E' �///fU 0i2 copy thereof(Sec.3800,Lab.C.) CITY ZIP 7 E/,v,,0`6' G f;I'-Y q/7 f® LOCALITY Policy No. Company SIZE OFeLOT / NO.OF BLDGS.NOW ON LOT / Ell Certified copy is hereby furnished. 60 X 111 NEAREST CROSS Tr. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE " MAP NO. . Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ��,iJ0. COMPENSATION INSURANCE S T��F nP /TC�CC J�(i VK5)- WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS u /G �� • DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) 7 CITY ZIP f� I certify that in the performance of the work for which this permit �r1 ql7 o' C' -,5 J� is issued, I shall not employ any person in any manner so as to !/ Y subject to the Workers'Com ensation Laws. ARCHITECT OR ENGINEER TEL NO. become sub 1 P STATISTICAL CLASSIFICATION APT 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 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 PILE 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.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. //O NEW El BK PG License Number Lic.Class DESCRIPTION OF WORK ADD oe VALUATION o c Q Contractor Date o �� ALTER Elo m®per_ U cc /&/1r REPAIR ❑ O ❑ I am exempt under Sec. $ F— BAP.C.for this reason DEMOL ❑ V LDMA P/C# III Date: USE OF EXISTING BLDG. URM ❑ d U) �L Signature APPLICANT(PRINT) TEL NO. LDMA Perm# :F;"< Z lel I, as owner of the property, or my employees with wages as Z y `their sole compensation, will do the work and the structure is ADDRESS O �a not intended or,offered for sale (Section 7044, Business and FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ��7•�}'��ql� ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE a Y. Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FlNAL licensed contractors to construct the project (Section 7044, VES❑ No❑ µ Business and Professions Code.) NX WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR 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. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, _ i SS_ � 8 a r TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS [ x.•'_ 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a ^w_CL o Lender's Address OWNER 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 P.C.FEE PERMIT FEE with all county ordinances and State laws relating to building construction, and hereby authorize represen 'ves of this County ISSUANCE FEEQ _,_ to enter pon the above-mentioned proQerty o Inspection purposes. , INVESTIGATION FEE TOTAL FEE� —•�'-'• Ii j Sg-...of Applicant o,Agent Date SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT A -COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRES L 1 hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRES - or a certificate of Workers' Compensation'Insurance,or a certified P copy�hh reeo/f SeLOCALITY c 3800,Lab C) - CITYP ZIPA 1 ��• _/+, �— POIICy`Klo' ' Compan X11 _ SIZE OF L NO OF BLDGS NOW ON LOT ❑ Certified copy IS hereby furnish6d NEAREST CROSS ST rhhed copy IS fled with the ty b I g peCtlOn TRAC BLOCK LOT NO /J�t7Ps deepart�ment S USE ZONE MAP NO Date nt Appli( ASSE O MAP'BODK PAGE PARCEL_ �' LSA/ o SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL O YES NO COMPENSATION INSURANCE e 2- WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit 1s for one hundred ADDR S DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars ($100)or less) nc 'CITY ZIP - I certify that In the performance of the work,for which this permit Is Issued, I shall not employ any person In any manner so as to, ARCHITECT OR ENGINEER �' TEL NO become Subject,t0 the Workers'Compensation Laws STATISTICAL CLASSIFICATION APT CONDO Date Applicant , ADDRESS- CLASS NO DWELL UNITS NOTICE TO APPLICANT If; after making this Certificate Of Z S w• , i p-- REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become' subject to ' the Workers' CONT OR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �i - d 3 FRONT comply with such provisions or this permit shall be deemed revokedADDRES 1A'�'-I I NO P L LICENSED CONTRACTORS DECLARATION - SIDE ` LIC P L 1-hereby affirm that I am licensed underprovisions of Chapter CI 9 ` SEWER MAP >_ (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE - NO OF RIES NO OF FAMILIES a Professions Code,and my license Is In full force and effect NEW El BK PG , O DESCRIPTI N WO ,VALUATION — U License Number Z Llc Class — ADD /fie, AX Contractor ��' Date 3 f-g Y ' i_ ALTER ❑ $ �C/v _ W REPAIR ❑ $ ", O El am exempt under Sec _ •.- B&PC for this reason DEMOL ❑ W LDMA P/C Date - USE-OF EXISTING BLD C� ,e URM ❑ 'a�3#'-' �t_�n•:'_ N Signature ' AP T( Ml')"'-�0TEL NO LDMA Perm# - � 2 _ . ' ❑ I, as owner of the property, or my employees with wages as ,��C S ate.__) ;' '^ �� OZ I t �;n a their sole-compensation, will do the work and the structure Is: . A S �� _ not Intended or offered for sale (Section 7044,"Business.and 3 .�. EFINNAL ATE Q _ I i PfOfeSSIOnS Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �..4/��9 - F_ , OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J '- { '-'- ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES Y licensed contractors to construct the project (Section 7044, i I f i_i ; � �I3_`tj Business and Professions Code) YES❑ No El WILL THE INTENDED USE OF THE BUOUNG BY THE APPLICANT OR FUTURE BUILDING EJ, 7 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ •L""T'�° '' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDEUNES 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 _ rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097, CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, t f• C -' TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS fs' +,,I—f :I�{ _i�L S + a Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lender's Address 5 424 L s� O ONNER OR AGENT , o I certify that I have read this application and state under penaltyO ` 0 Of perjury th a above in} anon IS correct I agree to comply PC FEE PERMIT FEE with all c nt or antes and State laws relating to building mconstrU 0 n home representatives of this County ISSUANCE FEE ��' � toe d property for inspection purposes � INVESTIGATION FEE TOTAL FEE 1q lwe d rani a Awnl Delo SEE REVERSE FOR EXPLANATORY LANGUAGE A 70A638A CE0803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDREIN 9 ` l lit( DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY �l�i4GZ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST s� WILLIAM A JENSEN, SUPT OF BUILDING CROSS ST DISTRICT NO GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN S p CONST BUILDING ()� G STATISTICAL CLASSIFICATION SEER-MAP ADDRESS OBK Px CLASS NO DWELL UNITS LOT NO Q BLOCK WATER CERTIFICATE. NOT REQUIRED RECEIVED ❑ TRACT III MAP HIGHWAY STATE MAJOR SECOND OCA�LL NO OF BLDGS NO 0 (CIRCLE) J SIZE OF LOT �jU NOW ON LOT U E�ZONE SPECIAL USE OF y,� CONDITIONS EXISTING BLDG .l ' OWNER -,&;rXr7_ ) '" NO �i 2-6 BUILDING EXIST SETBACK YARD I HWY STREET NAME WIDTH ADDRESS / +ES !/fP• G FRONT O D / J ARCHITECT OR TEL P L �V ENGINEER ''-•-- NO SIDE P L CURD, GUTTE , DRIVEWAY APPROACH ADDRESS AND PARKWAY TREE REQUIRED NO, Notes/p ( (� 41 J__WVA guffer sidewalk, '^d d,iyewpy approach n,� stallations should be taken out at the L. A. Co Roz-d Dop,t., Altade iao DESCRIPTION OF WORK ,dA U a'lengthy delay. Survey & Design work takes time and is not start da NEW A" DD / LTER REPAIR DEMOLISH until Permit has been issued. Apply for parkway tree permit at T. N SQ FT _ NO OF NO OF SIZE STORIES FAMILIES Hall. It USE OF p STRUCTURE ( 1w#-. -L — t I ANtl1.L tit _ V SIGNATU E OF _ - ,�r1a I>�i n' 2 _' •�`ar "'_ APPLICANT G-,,+^ 4 VALUATION $t5"_<'00 J ' APPROVALS 4 DATE INSPECTOR'S SIGNATURE r I PC PMT o< FOUNDATION LOCATION {{ FEE $ FEE FORMS, MATERIALS " FRAME FIRE STOPS, .g 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTSAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT TION OF THE LABO�Cr. HF'ST OF CALIFORNIA RELAT. ING TO WORKMEN N I U4CE LAVH EXT J SIGNATURE OF HOUSE NUMBER COR- PERMITTEE IRECT AND POSTED I ADDRESS < <u� FINAL JOHN F LEWIS, PRINCIPAL ST _'J RAL PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 CASH 'I _ 6 u 1`0v 17 1 02 L,tu: V