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Home My Public Portal About9944 DAINES DR_Building__ APPLICATION �OF�y �' ~ COUNTY OF LOS ANGELES Ifl ,.b U I L D I N G PERMIT �� D BUILDING AND SAFETY DIVISION EPARTMENT OF COUNTY E R BUILDING �y FORQA�AjPPLICANT TO FILL IN ADDRESS `Y ^fAoA ADDREBUILDSNG S ! �7`�� NEAREST ! ` ,[ c LOCALITY / /A CITY ' Cj /' ZIP 17 0 CROSS ST NO OF BLOGS /� ASSESSOR SIZE OF LOT60 )C 1,f-6 NOW ON LOT MAP BOOK PAGE PARCEL_ 7 Gj G DISTRICT GROUP TYPE FIRE P OCE D BY TRACT �7 0 v�~ BL'OCK �1 LOT NO Q �1 Q CONS Zp�E OWNER jLj S A:Ie4, gp NOL. 'Ir G242 STATISTICAL CLASSIFICATION "7 SEWER MAP ADDRESS / ///1J, CLASS NO. 2DWELL UNITS <j BK PG CITY, C Lam` l'� ZIP /? d USE ZONE FN ��Q ARCHITECT OR TEL �/ SPECIAL ENGINEER NO - CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONTRACTOR TEL BLDG SETBACK FROM LIC FRONT PROP.LI NE OF (STREET) L ADDRESS NO HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF HIGHWAY EXISTING CITY LIC FRONT PROP LINE CLASS _ CONSTRUCTION LENDER + a� NAME AND BRANCH BLDG SETBACK FROM CD ADDRESS CITY SIDE PROP. LINE OF (STREET)- C SQ FT NO OF NO. OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING � SIZE d STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH W DESCRIPTION OF WORK Q NEW ❑ ' + - y ADD CORNER CUTOFF YES ❑ NO ❑ Z ALTER ❑ IN OPEN SPACE YES,❑ NO REPAIR[] ❑ USE OF EMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. , APPLICAN ��y� TEL (PRINT) ,O'/L1aL� /.�L-/Y NO BY (SIGNATURE) I HEREBY ACKNOWLEDGE TAT I HAVE READ THIS APPLICATION AND STATETHAT THE ABOVE-IS CORRECT AND AGREE TO'COMPLY -WITH ALL;ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION -I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY IO WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE I SIGNATURE OF FINAL BY /a17�LAM2 PERMITTEE DATE 1 ADDRESS TE L. P C. Fee$ Permit Fee CITY NO �J Issuance Fee VALUATION$ / - - Total Fee �Z-• PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M O CASH -S il. y 1 2.0 0 s 76AS38A CE*80313 12/75 y j•q WORKERS' COMPENSAT16N DECLARATION,• W APPLICATION FOR SUL®ING � PERMIT b I het�eby affirm that I have a certificate of consent to Self insyre, or a certificate of Workers' Compensation Insurance, dila certifted'copy,thereof (Sec 3800, Lab C ) yy COUNTY OF LOS ANGELES BUILDING AND SAFETY Po11cy No Company Certified copy is hereby furnished FOR APPLICANT TO,FJLL IN BUILDING i/ / ��. ADDRESS Y ` Certified copy is filed+with the county building inspec- BUILDING Q j j(/ ' tion department ADDRESS [ �7`l + l s Date Applicant CITY \ ZIP / / LOCALITY ' CERTIFICATE OF EXEMPTION FROM WORKERS' O X OT NEAREST COMPENSATION INSURANCE SIZE OF LOT J NOW ON OT L- CROSS 5T Lr� (This section need not be completed if the.permit is for one ASSESSOR hundred dollars'($100)or less,) - TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL OWNERlj��jj"-+ TEO LI 17 USE ZONE, MAP I certify that in the.performance of the work for which this NO ` permit is issued, I shall'not employ any person in-any manner �� ' SPECIALi ADDRESSCONDITIONS so as to become subject to the W r s'Co ensahomL s U Date " ""� Applicant -,C CITY �� ZIP NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT �/, !UC'�/ DISTRICT GROUP• TYPE FIRE PROCESSED BY O ENGINEER 4 ll_l u3 CONST ZONE Exemption, you 'should ,become subject to 'the Workers' - �, - c /) G, O CL Compens6hon provisions-of the Labor Code, you must forth ADDRESS-1 15- L Y J'w % W ^' with comply with such provisions or this permit.shall be TEL STATISTICAL CLASS ICATION APTENDO (q deemed ievoked , •' CONTRACTOR NO - Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO SEWER MAP (commencing with Section 7000)of Division 3 of the Business and a LIC Li 8 0 �,8,A7- 'Professions Code, and my license is in full force and effect CITY CLASS BK C—PG "7, VALIDATION # SQ F NO OF NO OF CHECK e o o e, License Number Lic Class SIZEffffi� STORIES FAMILIES ONE VALUATION o -0 3 a-2 5 ' DESCRIPTION OF WORK lrti NEW ❑ Coritractor Date 11 ll 1 . Jed ADD p $ ® e e o3825� I am exempt,under Sec 0. L gU St ` ALTER B 8P C'for this reason 1�1 N REPAIR ❑ S '`� USE OF - ,� 6 #10-"o' Date' EXISTING BLDG \ Qk L' DEMOL ❑ #fo 0 0 0 2 3 APPLICANT (� TEL h Signature PRINT I� ►� N0�1 Z l(�� FINAL OWNER-BUILDER DECLARATION ��!� DATE Z t� ,° 7 2 G 8 5 : I hereby affirm that I am exempt from the Contractor's License ADDRESS' "/4 ` ,Law for the following reason (Section 7031 5, Business and ��+ 'Z z -FINAL o o ]2 /a 8 5 Professions Code) . BY I, as owner of the property, or my employees with BUILDING D R SS p % &J <''+8 7 wages as their sole compensation,will do the work and ' ' OIC. vv' I-f � ��1 2 S •uq I the structure is not intended or offered for sale(Section LOCALITY Q - ; 7044, Business and Professions Code) MOVING , TEL ' ' CONTRACTOR NO 2 8 Q 1.9 A I, as owner of the property, am exclusively contracting with licensed contractors to construct the.project (Sec- ADDRESS V tion 7044, Business and Professions Code) #,e o 0,0,0 tJ REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY, PROP 'LINE WIDTH - I hereby affirm that there is a construction lending agency for FRONT r ` .� ° 9'0&2 5 the performance'of the work for which this permit is issued P L . ,k,A• _ �'t� (Sec 3097, Civ C ) SIDE '` ; , °�° 9 0 8'•2 5 P L Lender's Name l LDMA Ref # o 9,,2 9-8 7 P C Fee$ - �_ Permit Fee ` Lender's Address - j-certify that I have read this application and state,that the Issuance Fee LDMA P/C# above information is correct I agree to comply with all County Investigation Fee o ordinances and State laws relating to building construction, Total Fee LDMA Perm tt R and hereby authorize representatives of this County to enter on theove-mentioned roperty for inspectj n purposes Q � - SEE REVERSE FOR EXPLANATORY LANGUAGE � Signature of Applicant or Agent Date t