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Home My Public Portal About5419 CAMBURY AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT r,7 COUNTY OF LOS ANGELES MI R fl (� ® 4 @�fl ((? ILJI Al ;. WM. J. FOX. CHIEF ENGINEER V t'_..1- K Q FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN 7 `l /�/J DISTRICT NO. PLANCK.NO: PERMIT NO. u�[OWNER REBB If__ / (.a N P eOy.�G70 —y'OCALITY / ® / 1./ RECEIVED BY DATEOF APPL. DATE ISSUED EARESTR09B T ,/ \^ ////��- - //A��+� ADORE69 T' nJt �ILP.LF.I.L6�V'I�AIL �7 �J � C�K �/ /`! eLOCALITYlOREBB G / / GNEAREST ITY CROSSST. 'L ffz FIRE NO.DF TYPE / GROUPS ARCHITECT OR TEL ZONEPLANS ENGINEER O. BLDG. OR e , ADDRESS SETBACK LINE �� CONTRACTOR �_ Nktl' No - APPROVED - /J /� /7 [ 36// BY DATE r ADDRESS /,7�Z 5'a t'L (�/(JJp"/Q�/ b!7 USE APPROVED ZONE BY DATE LEGALCORRECTIONS DESCRIPTION .LOT NO. 2 BLOCK TRACT ioo � (vNO OF SIZEOFLOTS2 //O I NOWON LOTTS /� /{./U7'_USEOFNO. PIN i"/LR l: � • EX BTI IS BLDG. �-- FARM[a- ROOMS old .2,7.2-6 DESCRIPTION OF WORK NEW ALTERATION ADDITION O U REPAIR .MOVING DEMOLISH p 9O.FT. NO.OF Z SIZE /�WALL /1 //�1 R\\OOMS STORIES C, OOF COVERING S�r�C l'.V I COVERING r, - UI DI NEW 9 G - USE OF p I I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT IN PECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION FORMS.MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAMEI SIGNATURE OF Alk NG, BOLTS PERMITTEE LATH, INT. AUTHORIZED AST — LATH, EXT. 7GA63BA-3 9-49 $ (7 P.C.S PLASTER. INT. 7 ¢ OS 7/ DO I i FEE / PLASTER.EXT. / 6 VALUATION FINAL FEE I C� � WORKERS' COMPENSATION DECLARATION I hereL•y,of irm `,at I 'Kove a certlfica?e of consent to self . -injure, ora <ertiecate of Woikeis' ConJensation Insurance, nr a certified copy thereof (Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING 5 U ❑ Certified copy is filed with the county building inspec- BUILDING " ADDRESS tion department. ADDRESS �-- I Cl. Date Applicant CITY ` ZIP ^^ LOCALITY L t-4`•'� ` .t+ CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT' I ,_,) NOW ON LOTS O� • CROSS NEARESST. COMPENSATION INSURANCE (Thissectionneed not be completed if the permit is for one Z ASSESSOR - hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL USE ZONE MAP - OWNER I certify that in the performance of the work for which this _ Sc ' `- NO' p� NO. permit is issued, I shall not employ any person in any manner ADDRESS - J ��• SPE IAL so os'to become suObjgct to the Workers'Compensation Laws. CONDITIONS 0 /� o�(UXJy p.��3 . e. zip V Date 12- (1— �`' �" ARCHITECT OR TEL. I � 1 0 NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT UP TYPE FIRE PROCE ED BY O ENGINEER NO. 1 Exemption, you should become subject to the Workers- CONSt / ZOy1T U Compensation provisions of the Labor Code, you must forth- ADDRESS Vl• with comply with.such provisions or this permit Shall be - TEL. ' STATISTICAL CLASSIFIC TION APT. O f�q deemed revoked. CONTRACTOR ;1 . NO Q� �I Z LICENSED CONTRACTORS DECLARATION - ��''yy^^ LIC (� CLASS NO. v DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ,22 NO. (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS13 —19K. .PG, ��(7� SO. FT. NO. OF NO.OF CHECK License Number4tWoz Lia Class SIZE 5 ORIEE FAMILIES ONE ' &,� ,0r-61 0-�'1—� NEW ❑ fAWAT10N ;1 Contractor&:r, Date DESCRIPTION OF WORK �/� q D ADD ❑ / ❑ 1 am exempt under Sec. ALTER . ❑ 0.8P.C. for this teas ( - REPAIR ❑ $ Date: USE OF DEMOL EXISTING BLDG. ❑ Signature APPLICANT TEL �G• FINAL OWNE -BUILDER CL RATION PRINT NO. O DATE. I hereby affirm that I am exempt froisl the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS l \ V FINAL VV •�j Professions Code): - PRESENT N By /It' A Q 9 2 2 A ❑ BUILDING _ I, as owner of the property, or my employees with ADDRESS + �'. f� eee�e s•� wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY C • • - s.( ,e 2 A 6 7 5 7044, Business and Professions Code). - MOVING - TEL. R TNO. CONTRACTOR 1, as owner of the property, am exclusively contracting- CON • • 2 4 b 7 5 with licensed contractors to construct the project (Sec- ADDRESS _ tion 7044, Business and Professions Code). I al .7-88 REQUIRED TOTAL SETBA K CONSTRUCTION LENDING AGENCY SET BACK - YARD HWv PROP. LINE WIDTH - I hereby affirm 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 PF I. Lender's Name - - LDMA Ref. R m Lender's Address P.C. Fee E t Permit Fee I certify that I have read this application and state that the Issuance Fee 0..5 Q tDNA PyC R - above infor otion is correct. I agree to comply with all County Investigation Fee $ ordinance and State laws relating to building construction, - Tocol Fee t LDMA Perm. M R and here authorize representatives of this County to enter - - - - upon th bove-mentioned t for Inspection purposes {.,/�(� m L(� I��O" SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of A ticnl or Agent - Date