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HomeMy Public PortalAbout9969 DAINES DR_Building__ 77 APPLICATION FOR 'BUILDING PERMIT FOR APPLICAN-7 TO'FILL IN (Print or type only) B U I EC71 j:99 � COUNTY OF LOS ANGELES"- AD RESSitz DEPARTMENT OF COUNTY ENGINEER CITY zIP - BUILDING AND SAFE DIVISION �J OF BLDGS BUILDING i— SIZE OF LOT J�� NOW ON LOT ADDRESS / TRACT � yGS BLOC LOT NO LOCA LIT w TE NEAREST _ OWNER NO CROSS,ST - ASSESSOR ADDRESS _ MAP BOOK - I \ 'PAGE PARCEL` - . DISTRICT IGROUP TYPE FIR SSED BY CITY /�/�•� ,Oe ZIP �� CONST ZO '�' ARCHITECT OR C TEL C� _ ENGINEER NO STATISTICAL CLASSIFICATION SEWERMA ADDRESS - CLASS NO -DWELL UNITS BK PG TEL . US ZONE MAP CONTRACTOR- NO LIC NO - ADDRESS NO SPECIALOe , L 2L CONDITIONS ' CITY - CLASS - ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDE NAME AND BRANCH BL G SETBACK FROM a FR NT PROP LINE OF (STREET) C ADDRESS CITY Hl G WAY + YARD ---TOTAL SETBACK FROM TYPE OF EXISTING a. SQ FT NO OF. - NO OF - CHECK FRONT„PROP .LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE - LL DESCRIPTION OF WO K / NEW ❑ + v ADD BLDG TBA FROM - Z U y/�/� ealkie SIDE PR LINE OF (STREET) LTER ❑ T SET CK FROM TYPE OF EXISTING HIGHWAY } YA REPAIR❑ IDE P NE WAY WIDTH USE OF - t i _ EXISTING BLDG DEMOL E] '" APPLICANT a TEL _ CORNER CUTOFF YES ❑ - NO ❑ , (PRINT) NO. _ BY (SI-GNATURE) IN OPEN SPACE YES ❑ NO ❑ T � IN COASTAL ZONE I YES ❑ NO, [], VALUATION$ �V �/ - - — -- - CATEGORICAL EXEMPTION•' YES[:]-- NO ❑ I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE-THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY - IMPACT EXEMPTION DECLARATION SIGNED - (DATE) , , WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTIOH 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED J IMPACT REPORT PROCESSED - (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR- CODE OF THE STATE OF CALIFORNIA IN ELATING TO WORKMEN'S COMPENSATION SURAN E SIGNATURE OF 1 ' PERMITTEE ADDRESS - NAL ''''77 TEL - IA BY DTE 1, ' CITY NO Q , M A KF- CHECKS PAYABLE TU FE-$EEE p HARVEY T. BRANDT. COUNTY ENGINEER 'PLAN CHECK VALIDATION CK M O- AS PERMIT VALIDATIO CK M O CASH I 2°3..6ti'4CT- , 7.,2�3�i - - 9.0�© �' _ - , - • - ( 7 6A638 CE#803 7/73 - - - 2 3 7=c XT, . 5.0:0-A90 DEPARTMENT OF BUILDING'AND SAFETY Y APPLICATION FOR PERMIT COUNTY OF LOS ANGELES U 1 L ® ' N G � WM. J. FOX, CHIEF ENGINEER - FOR--APPLICANT TO FILL' IN FOR OFFICE USE ONLY DISTRICT NO. /r�'PLAN CK.NO. PERMIT NO. BUILDING Gj ..P.�- V `, /FFG/ / ADDREB9 .fC'J '��,�," D l7-.� LOCALITY tiyy�•� 1 ,�J/� RE VED BY- - DATE OF APP(+LL. DATE ISSUED -NEAREST �• CROSS 9T: BUILDING , OWNER // /!//l ADDRESS r , MAIL ', - - LOCALITY _ - s ADDRESS _ CITY /'�/•-•�� �• NEAREST s /� NO.PIf�t7 CR09S 5T. • X FIRE NO.OF TYPE GROUP ARCHITECT OR a - TEL. - ZONE PLANS y. I ENGINEER NO. �! i BLDG. ORD.NO. ADDRESS - - SETBACKLINE •� 7'/ J APPROVED TEL - -}- BY DATE CONTRACTOR NO. -19 USE- ' APPR j'D •ADDRESS' /( // -ZONE J BY `. DATE ' LEGAL �!! // CORRECTIONS DESCRIPTION 'LJOT NO. `f' BLOCK V - ��® TRACT PFd'�jD l-4- / NO.OF BLOBS. ❑. LOT_ SIZE F LOT GD X /•ALJ I NOW ON LOT' �f UBE OF ✓! NO.OF. NO.OF EXISTING BLDG. .FAMILIES ROOMS ' ' �/J �•�,�1 - DESCRIPTION OF WORKf /-= _ / //= e NEW X ALTERATION ADDITION' _ _ ,,�'G(, (,0` ' A •-REPAIR MOVING 'DEMOLISH ] 13Q.FT. ,Q. NO-OF SIZEjj/// ROOMS [� STORIEBWALL COVERING/.tGCGA�(X.J). I COVERING USE OF NEW ///q-�J •• U - BU IvG, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION: LOCATION INSPECTOR DATE 4 i AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. ✓a hS � �y FRAME: FIRE STOPS, SIGNATURE OF BRACING,BOLTS / PERMITTE _ f'' //J' LATH,INT.: h-? AUTHORIZED AOT-/ LATH, EXT.: , 9135'3,5oM SETB 7-47 $ w p C. PLASTER,INT. FEE PLASTS,EXT. �O (t7 •� 1 II `n�•I•, VALUATION FEE /� FINAL 76A638A CE 9803 3-69 APPLICATION FOR BUILDING PERMIT R COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER: ADDRESS (a vJ� S Qr BUILDING AND SAFETY DIVISION ° LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS, SUPT OF BUILDING NEAREST CROSS ST apI'C\ ♦h ('� U2• FOR APPLICANT TO FILL IN DISTRACT NO . GROUP TYPE C ST. CESS (PRINT OR TYPE ONLY) !!57<28 BUIL ►_ DING _ STATISTICAL CLAS5F C SEWER MAP ADDRESS �• „� . e,, E CLASS NO -•� DWELL.UNI S LOT NO D BLOCK USE ZONE- MAP NO. TRACT SPECIAL ON0. OF BLDGS. CONDITIONS SIZE OF LOT 4;5 X 3,SNOW ON LOT l -• USE OF EXISTING BLDG. o 4, e BLDG. SETBACK FROM 1 ' [� TEL.,Z FRONT PROP. LINE OF - - (STREET) OW NER a r ct r l �, \C O s S N0. 6 0 17 r a TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. 9969 CITY C.'w� �� � l� ARCHITECT OR TEL. BLDG SETBACK FROM - STREET) ENGINEER _ N0. SIDE PROP. LINE OF ( TYPE OF EXISTING SETBACK HIGHWAY + - YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + _ CONTRACTOR NO. } ADDRESS NO CORNER CUTOFF YES- ❑ NO ❑ C LIC. I' CITY CLASS SEEREYERSE SIDE FOR SPECIAL APPROVALS pd CONSTRUCTION LENDER / •C NAME AND BRANCH G ZJ• t ADDRESS Ll. SQ. FT. NO OF NO. OF SIZE STORIES FAMILIES / NEW USE OF r ADD ❑ STRUCTURE ❑ ALTER REPAIR ❑ SIGNATURE OF - DEMOL ❑ APPLICANT VALUATION $ ��'• APPROVALS DAT5 IHs oa's GNAT URE P C PMT FOUNDATION LOCATION e FEE $ FEE $ .�' FORMS MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS, BRACING, RACING BOLTS AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS ' TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING T WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT SIGNATURE OF HOUSE NUMBER CORRECT PERMITTEE AND POSTED ADDRESS FINAL 16j 7v JOHN F LEWIS, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M 0. CASH _ PERMIT VALIDATION CK. M.O. /CAA.H� i 44 1 3a Wn 9 1 D 6.00N DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION- , FOR APPLICANT TO FILL IN i' FOR OFFICE USE ONLY tu; Q .,yo N /� — DISTRICT NO. PLAN CK. OR REC.No. PER IT•N(OBUILDING �/ ADDRESS l 4�p 7 (n �VG1„(iyta,c �'1� '51" q ,O r S RECEIVED BY ` DATE OF APPL. DATE ISSUED LqCALITY - NEAREST _ - •�! ROSH BT. r, _ - Sb BUILDING ADOR EGO OWNER _I'VVip 7 ' U'6A MAIL —fi / 'n LOCALITY �• ADDRESS 9w (� 4 k;7' ,_ NEAREST ` p��y"�+' �wr�_ 1 CROSS ST. _CITY c�I2"'_ t... C.t..tM NO. ZFIRE NO.OF ONE - I PLANS TYPE GROUP ARCHITECT OR TEL ENGINEER NO. BLDG. ORD. NO. SETBACK LINE ADDRESS ,J/✓ /� ^ USE APPROVED CONTRAOTOR I I�J y�l �, � 'NO. a G 1131 ..•' ZONE BY DATE HOUSE NUMBERING ADDRESS p/ i MAP NUMBER NO. ASSIGNED BY LEGALCORRECTIONS DESCRIPTION LOT NO. BLOCK TRACT /� •- BIZE OF LOT I NOW ON LOT USE OF NO. OF EXISTING BLDG. FAMILIES L ` DESCRIPTION OF WORK NEWALTERATION ADDITION Z D r REPAIR DEMOLITION SQ.FT. NO.OF SIZE ROOMS STORIES � EXT.WALL ROOF i COVERING I COVERING USE OF STRUCTURE INSPECTION FOR - _; •;). APPROVALS OCCUPANCY AS I NSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION FORMB, MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-� FRAME: FIRE STOPS, PLICATION AND STATE THAT THE INFORMATION GIVEN IS, CORRECT. II BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANOEff1 FURNACE: LOCATION, ,J AND STATE LAWS REGULATING BUILDING CONSTRUCTION.( GAS VENT, DUCTS v SPERM-ITTEEURE DF /I� LATH, INT. LATH, EXT. ADDRESS AUTHORIZED AOT. PLASTER, INT. PLASTER, EXT. FEE I HOUSE NUMBER COR- RECT AND POSTED VALUATION Q O FEE FINAL r v 76A63BA D63 3 1-52 � - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATIONFOR APPLICANT TO FILL IN BUILDIN D/�DR SS BUILDING ADDRESS , % 1 hereby affirm that I have a certificate of consent to self insure, ! r f1 I N E or a certificate of Workers'Compensation Insurance,or a Certified t2 I J COPY thereof(Sec.3800,Lab.C.) d CITY �, ZIP LOCALITY Policy No. Company SftTE I}-il � SIZE OF L T Y 40.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. - %-Certified Copy is filed With the county building Inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date L.,_�l_12 Applicant ASSESSOR MAP BOOK PAaPARCELSPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER COMPENSATION INSURANCE MP.S. L Ov P.q (9 0e) WITHIN 1DDD FT OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS r i,� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY 1- 7P Q 1 certify that in the performance of the work for which this permit 6 'F G -1 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 52 1 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, I CONTRACTOR TEL.NO. p you should become subject to the Workers' SETBACK YARD HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith < Lrl SSI t `b U' T-5 ��&" a FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. Lt t PIL I D�0 3 F ei=.e-& ST � `,3 SIDE d LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L CD I hereby affirm that I am licensed under provisions of Chapter 9 i� - 301 SO.FT.SIZE NO.OSEWER MAP Ca F STORES NO.OF FAMILIES (commencing with Section 7000)of Division 3 of the Business and .L4 O NEW ❑ BK PG � Professions Code,and my license is in full force and effect. v DESCRI TION OF WORK License Number 3���3 Lic.Class C--:" � ADD ❑ VALUATION Lo-i I-� O rN r ALTER ❑ S ® �_ Z Contractor L L aS�IC RACYfi Date _ L SS REPAIR ❑ � — ❑ I am exempt under Sec. B.&P.C.for this reason 5 f-{1 IV L DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# ❑ I, as owner of t e property, or my employees with wages as p their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE G Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL .T �! - _ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN -'�'�` Q +`'?`s`T ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BYt-� ` ' "`' licensed contractors to construct the project.(Section 7044, ❑ ❑ S% r Business and Professions Code.) YES No WILL THE INTENDED USE OF THE BUILDING 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(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES 1:1 NO El the performance of the work for which this permit is issued(Sec. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD w 3f)97,CIV.C.J. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES •' •' ' m COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a Lender's Address 11 OWNER OR AGENT o 1 certify that I have read this application and state that the above g information is Correct. I agree to comply with'all County RC.FEE PERMIT FEE N ordinances and State laws relating to building construction,and a. hereby authorize representatives of this County to enter upon ISSUANCE FEE th ove-me tinned prop rty for inspection purposes. 4—G+K INVESTIGATION FEE TOTAL FEE Sign of Ap011mnt or Agent Dete SEE REVERSE FOR EXPLANATORY LANGUAGE