HomeMy Public PortalAbout9914 DAINES DR_Building__ TEMPLE CITY r w
76A638A CE#803 3-66APPLI FOR BUILDING PER IT
CATI N O
COUNTY OF LOS ANGELES ABUILDING
DDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST-_ • J
COLEMAN W JENKINS.SUP T OF BUILDING CROSS ST
DIS TR T NO. R TYPE P O S BY
FOR APPLICANT TO FILL IN (� CONST
BUILDING STATISTICAL CL SSIFICATION SEWER MAP
ADDRESS Axe CLASS NO DWELL UNITS BK- PG
LOT NO BLOCK USE ZONE MAP
TRACT /1"� -SPECIAL "
NO OFBLOGS /1 CONDITIONS -
SIZE OF LOT NOW ON LOT
USE OFG BLDG, Dwelling BLDG SETBACK FROM ,
TEL FRONT PROP LINE OF (STREET)
OWNER NO - TYPE OF EXISTING SETBACK HIGHWAY 'F' YARD = -TOTAL
ADDRESS 14 Daines Drive HIGHWAY I FROM C L
CITY Temple City z;a3 1 + t2 0
BLDG SETBACK ROM
ARCHITECT OR TEL _
ENGINEER - NO. SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY _ + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L'
CONTRACTOR Virgin Roo NOL 287-0507 +
ADDRESS S Gabriel e NO 6)06 O CORNER CUTOFF YES � NO � C��
CITY San Gabriel CLI` C-39— SEE REVERSE SIDE FOR SPECIAL APPROVALS o
DESCRIPTION OF WORK t
cna
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT NO OF NO OF
SIZE STORIES'l FAMILIES ✓ /
USE OF
STRUCTURE Rnroof House & Garaize wita-
235# ComP- Shin •les.
SIGNATURE OF
APPLICANT
• 1410 ti r
VALUATION$ 6' 8. •00 Y APPRO ALS DATE INSPEC TO 'S SIGN.T11 RE t
P C. pMT FOUNDATION, LOCATION
FEE$ FEE$ FORMS, MATERIALS
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE ORK
AUTHORIZED ALABR
WILL NOT EMPLOY ANY PERSON IN V LA. LATH INT
TION OF THEODE OF THE TATE OF CALIFORNIA R LAT-
ING TO WORKMPENSATION RAP{CE.' f LATH. EXT
.SIGNATURE HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS Fl NAL
• JOHN F. LEWIS.�PRINCIPAL T URAL ENGINEER
PLAN CHECK VALIDATION CK MO CASH _ PERMIT VALIDATION CK M.D CASH
L& 0, 0 1-a- .00T 3 1 0 9 .00-
v
' OR
KERS' COMPENSATION DECLARATION i
}•1 hereby firm that I have a certificate of consent to self
insure, or a cer;ificate of Workers' Compensation Insurance, APPLICATION, F®R:- U I L®I N O PERMIT
ora certified copy thereof (Sec'3800, Lab C )
COUNTY OF,LOS ANGELES , � BUILDING AND SAFETY
.Policy No " ompany
❑ 'er ifie'-c y hereby furnished FOR APPLICANT TO FILL IN BUDDING =�
ADDRESS
❑ Certified copy is filed with the county build-ng inspec- BUILDING
tionZpartment ADDRESS
Y
Date ` / III Applicant ` CITY, LOCALITY-
C RTIF LATE OF EXEMPTION FROM W99KERS' . OF.BL S NEAREST 117
,COMPENSATION INSURANCE / * t SIZE OF LOT OW ON OT CROSS ST rrGl 3y�
(This section need not be completed if the permit—is for one ^ , ASSESSOR
hundred dollars ($100)or less ) - TRACT Y BLOCK, LOT NO MAP BOOK PAGE b�� ARCEL
T USE NE MAP
I certify that in the performance of the work for which this OWNER NO
�(.— I SPECIALt
permit is issued, I shall not employ any person in any manner ADDRESS /� CONDITIONS
so as'to)become syblect to the Workers'Compens ion L s r U
Jr( - r CITY r ZIP 0 -0 W
Date 'Y Applicant ARCHITECT OR / TEL DISTRICT GROUP TYPE FIRE PROCESSED BY 0
NOTICE O AP LICANT If, after making this ica a of
Exemption, you should become subject ,to the'Workers
ENGINEER N CONST ZONE W
Compensation provisions of the Labor Code, you must forth- ADDRESS _
'with comply with such provisions or this permit shall be a
deemed revoked TEL / STATISTICAL CLASSIFICATION APT CO N
CONTRACTOR NO v .Ct b r) Z
LICENSED CONTRACTORS DECLARATIONLIC CLASS NODWELL UNITS
I hereby affirm that I am licensed under provisions'of Chapter 9 ADDRESS O 'O
(commencing with,Section 7000)of Division 3 of the Business and SEWER MAP
� LIC _-
Professions Code, and'my license is in full force and effect CITY CLASS BK VALIDATION
SQ FT NO OF NO OF CHECK
License Number' is Class— SIZE / STORIES FAMILIES ONE
❑ l VALUATION
Contractor —f Date u DESCRIPTION OF WORK n NEW $ �1
❑ t ,? ADD (�
I am exempt under SecE]
• ALTER -
B 8P C for this reason REPAIR ❑ $
Date USE OF
EXISTING BLDG �� � t l DEMOL ❑
APPLICANT A� TEL /J)
Signature PRINT / f NO FINAL
OWNER-BUILDER'DECLARATION — DATE',
I hereby affirm that I am exempt from the Contractor's License ADDRESS 4 ��� .
Law for the following reason (Section 7031 5, Business and FI
Professions Code)- • •• -, .
❑ BUILDING69
I, as owner of the property,,or my employees with ADDRESS l •1.'
wages as their sole compensation,will do the work and LOCALITY LIE
the structure is not intended or offered for sale,(Section
7044, Business and Professions Code) MOVING - TEL -
I, as owner of the property, am exclusively contracting CONTRACTOR NOt
with licensed contractors to construct the project (Sec-
tion 7044,.Business and Professions Code) ADDRESS
REQUIRED TOTAL SETBACK
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY- PROP LINEflMW' �• >o ti/
I hereby affirm that there is a construction lending agency for FRONT
the performance of-the work for which this permit is issued PL 3 ' z
(Sec 3097, Civ C ) SIDE
Lender's Name �y r
LDMA Ref M
PC FeeS Permit Fee %//•Lender's Address 3I certify that I have read this application and state that the Issuance Fee LDMA P/C q 'above information is correct I agree to comply with all County Investigation Fee ordinances and State laws arelati4bding construction, Total FeeLDMA Perm q
$ and hereby authorize repreis County to enterupon the above-ment nedpectto ur osesSEE REVERSE FOR EXPLANATORY LANGUAGESign re hca oto