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HomeMy Public PortalAbout4804 CAMELLIA AVE_Building__ DEPARTMENT OF BUILDING AND SAfTTY 1 (APPLICATION FOR PERMIT COUNTY OF-LOS.ANGELES 6 NN (7 (� n LL, D �n WM. J. FOX. CHIEF ENGINEER U V , ll`cJ FOR ��AP/P\PLICANATyr TO FILL IN j FOR OFFICE USE ONLY ADDRESS / l/�''`• // ,T/�IZAIS J DISTRICT O. PLAN CK.NO. PERMITND. BIIILDINp �/ . LOCALITY L1 y� ,.q/J�'`Y/��I' .7 p/�/ lvlll .E.///ACJ 1'� RECEIVED'BY 2 -lel--cm OF APG�PLL'.. Y DATE ISSU/7E/,D/% NEAREST CROBB BT. Z Q A (/(E, K /�'\JT�/�L��o� /L�.y'4 �V 1 •,J_ � v/(� Lr `l e� / J JL_ /_ fes/ BUILDING OWNER Il'� ! /I J ✓l /[/a�ar ADDRESS MAIL �/ -/Y�•_ /y� LOCALITY �: e ADDRESS 1A AL4 // //�/�`nlLSsl.6rE./ A TELA CROSS NEAREST CITY/ .11l�.Gt f/.w.•/I'ZQ.. NO.�/ FIRE NO.OF TYPE GROUP ARCHITECT OR ` ' /1 Y_' TEL r`.� m I"'M ZONE PIANO ENGINEER �` FY G NO. y IY N r S LOG. 0. ADDRESS SETBACK LINE a'--O / 10, /- - ) 0 I HYQ ' n ^ APPROVED M fir, CONTRACTOR Il /Y rte/ NO. CA • / BY 1- DATE USE ,`�,L APPROVED ADDRESS J'A I��/ a ZONE/�.l BY DATE LEGAL -1,_ ICORRECTIONS 7 Vn LOT NO. BLOCK DESCRIPTION TRACT / 3 2 /)•)� y SIZE OF LOT 7o X /6 c i NOW ON LOTS//,/ 1-t- USE OF ND.OF I NO.OF EXISTING BLDG. FA.'LF ROOMB DESCRIPTION OF WORK NEW ALTERATION ADDITION — O REPAIR MOVING DEMOLISH p BO.FT. �� D ROOMS / Z fiIZE yWALL /�D J STORIES y//� f OOF COVERING /��DA, d. I COVERING iJ. i / . USE OF NEW r�� BUILDING h-XV C4r✓ r�L..a p� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR l DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS ✓ AND STATE LAWS REGULA�TI O B ILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE OF 1 ?BRACING. BOLTS A 3. PERMITTE ��(A / LATH, INT.: I ( AUTHORIZED AST LATH, EXT.: Des-3 5oM s"s 1-48 $ PLASTER,INT. P. ��7 FEE / �/1 o PLA5YER,EXT. 'I B VALUATION �� - IPI 4 0 FEE � U FINAL ���.F,_ F�t-q'p-�F DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT • COUNTY OF LOS ANGELES �{ S �7 (gip WM. J. FOX. CHIEF ENGINEER - U [LIDO lJ� FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY pUILDING f\ DISTRICT NO. PLAN CK.NO. PERMIT NO.. ADDRESS (//� LOCALITY //(/if�UN REEC�CEEIVED BY DATE OF APPL. DATE ISSUEDNEARESTCROSS ST./ ,./�IQI/Af..�I L/�./(�� Q� l-CY.I 4L,7 13UILDING _OWNER 1 //.� I W ADDRESSMAIL AD ORES ' /tr �j LOCALITY / h i CITY �f'!/T 'li/lR_ NONEAREBT- L T9/�2 J CROB6 ST. FIRE NO.OF TYPE GROUP ARCHITECT OR //�� TEL ZONE PLANS ENGINEER (.V NO. BLDG. 26 / ORD.NO. ADO RES6 � BETBACK'.LINE V �1 APPROVED �1\ � � TEL. _ +„ BY DATE CONTRACTOR V w�/7..J4/ NO. USE ,( APPROVED ADDRESS y ZONEA �I BY DATE LEGALL� qqj (o CORRECTIONS DESCRIPTION LOT NO. .S .G BLOCK , TRACT 1 NO.OF BLOBS. /!N/ SIZE OF LOT '/o �1 V O I NOW ON LOT USEOF NO.OFNO.OF EXISTI NO BLDG. "14 I Fw M,Li[9 / DESCRIPTION OF WORK NEWALTERATION ADDITION O REPAIR MOVING I DEMOLISH SO.FT. NO.OF - _ SIZE �/II? //i�� �}�. ROOMS STORIES / q Z WALL V A U•MZLl � I ROOF aMP & . C•. .. F COVERING COVERING /{ USE OF NEW • V BUILDING el 1 s�1 D/ Tyr 1.. to 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE I9 CORRECT INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 FRAME: FI RE STOPS, SIGNATURE OF / . //.� BRACING.BOLTS PERMITTE - {XN•rt/ LATH, INT. I' AUTHORIZED AGT LATH, EXT. 76A63a! 9- DB9-3 !M SET. $ p,C.$ PLASTER, INT. �© Ct•-!, FEE PLASTER,EXT. $ VALUATION (oc' � FINAL APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (p,i N+ or 1YDe .,IY) Bw LDwc COUNTY OF LOS ANGELES AooREss O %�--Z- DEPARTMENT OF COUNTY ENGINEER CITv '' �('LE L7 ZIP BUILDING AND SAFETY DIVISION NO.OF SLOGS. BUILDING SIZE OF LOT QX Q NOW ON LOT ADDRESS .d TRACT/ 3z BLOCK LOT NO16-2' LOCALIT. /�� TEL.}( / ar NEAREST OWNER %A NO.Ljj�p V CROSS ST. —� ^J '1 C` ASSESSOR ADDRESS 21 MwL.� [1� �J�7/ MAP BOOK PAGE PARCEL. CITY _ C_ ZIP I ( 1 (1m ' J`- /T GROUP CONST ZONE ESSED BY ARCHITECT OR TEL. �J //ri ENGINEER NO. I �/ _ STATISTICAL CLASSIFICATION SEWER AP ADDRESS ���'' tt�� .`� CLASS NOnS DWELL.UNITS SK PG .CONTRA CtTt Oy t� Jr�yt< I TOL..i�L2 U ZONE NADP O/ ADDRESS 1 �O 1 C. C�✓�0/%(A NO. T��Z"C' SPECIAL LIC, y 1 COMOI TIONS CITY AdIj CLASS V ROAp pE PA RTM ENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION.LENDER _ Y NAME AND BRANCH BLDG SETBACK FROM - a FRON PROP. LINE OF (STREET) O U ADDRESS - CITY HIGHW Y } YARD _ TOTAL SETBACK FROM TYPEOF EXISTING O. C SFT. NO. OF NO. OF CHECK . - FRONT PROP. LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE } W DESCRIPTION OF WORK NEW ❑ Z AOD ❑ BLOG,S SIDE PR O OP.P.LIN (STREET( ALTER ❑ HIGHWAY } YARD OTAL SETBACK F M TYPE OF EXISTING = EPAIR SIOE PROP. LINE HIGHWAY WIDTH, USOFEXIST NG BLDG.SDEMOL ❑ + / APPLIC TEL 2Z CORNER CUTOFF YES ❑ NO � Ml1f � NO (PRI ) VVJJ BY ISI q U IN OPEN SPACE YES ❑ NO ❑ Q IN.COASTAL ZONE - YES ❑ NO El �. VALUATION A So C CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY 1 N'IL MPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE Of TN 5 TE OF CALIFORNIA IN RELATING TO .1,. W ORIMEN'S DM E TI (NSU INCE t ' SIGNATURE F — PERMITTEE ADDRESS FINAL BY jtWA— TEL. GATE CITY NO. •7- / PMT - >' h1A KE CHECKS PAYABLE. TU: FEE $ FEE +� HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CR. M.D. CASH _ )PERMIT VALIDATION ON. M.D. C,5„ 2.5.4i;Oci a .1 0 1.7 5 76A638A CE9903 ]/]3 2 H WORKERS COMPENSATION DECLARATION -- - ,"'I heroEly'affirm that'I have a certificate of consent to self � O O /ppb r,1� L� I��S I� ISL�I PER IOC insure or o certificate of Workers' Compensation Insurance, //PPLOCA MN FOR BLAUDIMCP PE(n(��� 6P6 certified copy thereof (Se<.'3800,'Lab. C') -• "' COUNTY OF LOS ANGELES BUILDING AND SAFETY - tcer .. Policy,No. Company - - - - - - ..Certified copy is hereby furnished:; s A�' FOR APPLICANT TO FILL IN BUILDING ❑ _ ADDRESS CO rtified'<opy is filed with the county building inspec- BUILDING ,// 'tion deportment. „ ADDRESS Date Applicant CITY 4�/T /`,ZIP LOCALITYl!// T 1 -'CERTIFICATE OF EXEMPTION FROM•WORKERS'-' -' - - �j O:OF BLDGS. - , NEAREST - ' `COMPENSATION'INSURANCET SIZE OF LOT 'NOW ON LOT CROSS ST. (t T (This sectiomneed-not'be completed iftbe•permit,is for one - — - - - - -- - ASSESSOR' -� , - •- - ---' +• + hundred dollars ($100)or less.) TRACT BLOCK LOT NO. - MAP BOOK PAGE, PARCEL _ TEL ((,�`` J T`- - OWNER � /1/l/G NO. C�i�ev`� t USE ZONE MAP 2-16 - - - certify that in�theperforman<e of the work for which this / l NO. ' •t permit is issued, I shall not employ any person in any manner %1�.� If -may-. `'�- L•/ SPECIAL- - - - - -'11 so as to become su b'ecLlelfhe Workers'Co pensatiom Ldws. ADDRESS T CG_/ CONDITIONS + O / .. Date ' - APPlicantC� / - CITY . c./i - �J 2IP_ '( c i O NOTICE TOARCHITECT ORTEL UP PROCE ',APPLICANT� If, after making this Certificate of DISTRICT - GRO - FFIRE- SED BV- ., Exemption, -you 'should become subject -to the Workers' • - ENGINEER NO. _ f CONST. .ZONE � TYPE Compensation provisions of the Labor Code, you must forth- !� /,/(Ao With comply with,such provisions or,this permit shall be _ ADDRESS !J-s" i�1VQ ,�. _ _.`J ._ _ N deemed,revoked. - - - - CONTRACTOR TEL' STATISTICAL CLASSIFI TION APT. CO t Z Sa'. LICENSED CONTRACTORS DECLARATION - - LIC q /' CLASS NO. v DWELL I it., ' hereby affirm that I am licensed under.provisions of Chapter 9 ADDRESS C(.L- NO.��✓.�7` ' (commencing with Section 70DD)of Division 3 of the Business and _ - LIC. SEWER MAP Professions Code, and my license is in,f.11 force and effect. CITY T / (�'J'� /�L- CIASS _/- - -- tR J/gJ. / f SO. FT _ NO.OF" NO.OF CHECK BK' �'' VALIDATION + License Number _r 1 ic,Class r SIZE STORIES / FAMILIES ONE y 't ❑ VALUATION -" DESCRIPTION OF WORK -- "' -- -- NEW- Contract , ., 1_ L / Date ADD $ T I am exempt under Sec ALTER- - �- - • 2 _E $ D � 175'8A B.BP.C. for this reason � < PAIR l RE _ Date:•_ USE Of vC - /!- # e + e e e ti �� EXISTING BLDG. 0 - - - Siariciture - / / -�� APPLICANT r -TEL / FINAL . OWNER-BUILDER DECLARATION PRINT / - 'NO, _ '.DATE .1 hereby affirm that I am exempt.from.the Contractor's License Low for the following reason.(Section 7031.5, Business and ADDRESS FINA -'°• -•- `` --Y Professions Code): - '- PRESENT BY BUILDING - I,_as owner of the property, or my employees with ADDRESS _ _ I • 1,8 1; wages as Their sole compensation,wiltdo the work and 18 }. 1i c3 r-' the structure is not intended or offered for sole(Section LOCALITY • • T -7044, Business and Professions Code). -- -- -' - MOVING - - TEL [) 3,•2 9_80 , -❑ CONTRACTOR NO. T + I, as owner of the property,am exclusively contracting with licensed'contractors to construct the project.(Sec- - - tion 7044, Business and Professions Code). ADDRESS REQUIRED _ TOTAL SETBACK FR M _ -EXIST. 5 s \L C -- -' CONSTRUCTION LENDING-AGENCY- SET BACK YARD Hwv PROP. LINE WIDT -_:tib P '- •-` I hereby affirm that there is a construction lending agency for FRONT - -the-performance of the work for which'this permit is issued P.I. (Sec. 3097;Civ. C.). SIDE ` m P.I. Le .. ........t - - _. , nder's Name - $ LDMA Ref k . " ' P.C. Fee$ ' - - Permit Fee- • dr 3 Lender's Address - f LaerLfy.that 1 have read.th is application.and state_that the ._ _ - Issuance Fee- Q J O - -IDMA P/C N •-- t- -- - D1 t --! a above information is correct. I agree to comply with all County Investigation Fee - - - - $ ordinances_and State laws relating to building construction, _ • + " ' Totob Fee'- -� -IDMAPerm - u and heretalh!�* ves of th's�County to enter pon t r 'sty.fo pection purposes.i/ SEE REVERSE FOR EXPLANATORY LANGUAGE _ ` •X` _ _ _.t - ---Signatu o Applicantor Agent ^- -- Date Ltc. v�Ss7 - r WORKERS tCr [OMPENSATI �CLAtATION µ y w �ryTy.� J, e!y affirm.imat I hove a certificate of consent to self //p�� O O ��(//(,�aa ////pp�� �FF�fI����IIpp�� I��}OR �FI�pIp�,/`��• PER �fp��///LT� insure d'r d certificate of Workers Compensation Insurance, A PP H ICIrU7��I1 V �Il OLIO B U��D�U V V ' P L�U�111 V 11 cv r oruIcertified copy thereof'(Sec 3800,'Lob. C ) ' ' "- . - - - - - .' ' 4 .':4 �. r• t• ..>:�,.. r ,. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy.No. . ... ._.....Company. ... Certified copyeis'hereby furnished. ••o•_ FOR APPLICANT TO FILL IN BUILDING ADDRESS •� Certified copy'is filed wlth'the county building inspec- - [BDING "tiondepariment. " ESS Date,:';.�. ' ..L. APphcont- + --�-Y/ nP ' - LocnuTv 'CERTIFICATE OF EXEMPTION FROM WORKERS'-*, - - NO.OF BLDGS. NEAREST .. _ ..-..._ COMPENSATION INSURANCE•'• ' ,, OF LOT NOW ON LOT CROSS ST.(THis,section rieed,nol be'completed if the•permit is.for one -' -- T BLOCK. LOT NO.. - ASSESSOR , .s . .. hundred dollars ($100)or less.) - ,. MAP BOO 1 K - PAGE PARCEL EL. ncertify that in the performance of theworkfor which'I is --� OwNER - --N - �'' USE ZONEOP 2 / }• - - , 6 permit is rssued, shall not employ any person in any manner _ gDDRE55 - - �`�/ _ //}/�/I SPECIAL so as to become su ect to the Workers Compensation Laws 1 f V } ,I Y,t t •.'' epi - _ /' CONDITIONS - - .S' _y// S. PP � CITY, T e _ _ _ _ _ ... t. ._ f 1 at O Date A licant ' / //� ARCHITECT OR 's; TEL. NOTICE'TO'APPLICANT!' If, after making this Certificate of ENGINEER NO. DISTRICT61X-_ _GROUP„ TYPE_ J '„FIRE_ PR ESSED.BY_._ IF. Exemption;,%you 'shou Id become subject.to•the Workers' - - CONST.' ZONE �� W Compensation provislans'of gfie Labor Code you. forth- ADDRESS ✓ ' 3 • with•comply,with' such provisions on this-permit,shall he - - - - - - - - - -- - - TEL /�•y STATISTICAL CLASSIFICATION APT. ONDO - Z deemed revoked:. .• - CONTRACTOR / NO 7!// LICENSED CONTRACTORS DECLARATION' , , ------ - _ I _._. _ :. CL.455 NO. DWliu UNITS I hereby affirm that I am licensed.under provisions of Chapter 9 ADDRESS (commencing with Seciion 7000)of Division 3 of the Business and _ _ _ .LIC. - - MA I / /,j SEWER P . . Professions Code, and my license is in full force andeffect. CITY `%G. C1A551I� '. - • " -" "VALIDATION - /7/ a. (/ SQ.-FT. NO.OF NO OF _ CHECK License Numbera /Lic.Cross SIZE - STORIES FAMILIES ONE VALUATI ontrdc� ON ` �I DESCRIPTION OF WORK '- - CDate �'__ " _ _' NEW ADD ❑ $ I am exempt under Sec. ALTD ER ❑ I B 8P C,for this rens n USE G .REPAIR._❑ '$ ""' '"'- '- - - •_' _ ._._ _. __ E% DEMOL ❑ _ _ ... _ .. ^- ' Ave,? - .. APPLICANT TEL _ S__ aFINAL '11 8 2 7_A nnn ^ OWNER-BUIL DECLARATION (PRINT_ y NO. - DATIq - J- - I.hereby offirm.that-1 am exempt from the Contractor's License w � # e ee e � A• I Law for the following.reason-(Section 7031.5, Business and ADDRESS - FIN 'Professions Code : - - - t ,.---- _ _... - )..._.._. _ __ .. . ._ .. - PRESENT : . - ) eIt _ - ••-: _r BUILDING• ; 1 os owner of the property, or my employees with ADDRESS '` •yl • ••4'9.88 r I wali, ges as tFieirsole compensotwn will do the work and the structure is not intended or offered for sale(Section LOCALITY - 7044; Business and Professions'Code)' --- _ - -'^ MOVING' ' ' `-'-' -' TEL - D '- _ - e v 'e 4 9.8 8 I, as owner of the property, am exclusively contracting CONTRACTOR NO. 1, with licensed'contractors to construct the project (Sec- ' ' -'-- "- - -0 4,-1 ''1'-8 5 tion 7044, Business and Professions Code)., ADDRESS ' _ '- 'CONSTRUCTION LENDING AGENCY `- -"' - RORF SETOBACR YARD 'HWY ' - TOTAL SETBACK F I 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.I. - -'- - - - --- - - - - ' - - •' - -' - ' (Sec 3097, Civ. C.). SIDE ' P.L. m Lender's Name• _ r _ - r , 2 LDMA Ref. It t - . P.CFFee$ - - - - Permit Fee. Lender's Address -✓ !' I.certify.thot I have read thisapplicationand_state thot.the _. _ _ Issuance Fee' .D -J �•- , LDMA P/C K a above information is correct. I agree to comply with all County Investigation Fee • i`-. ordinances and State laws relating to building construction, d _ _ _v 9.;__. _ _... _ _ —_ . Total Fee - -4-9 _ - iDMA-Perm R v .an�fl rives his County to enter • < ' upen r inspection urpos a 00 SEE REVERSE FOR EXPLANATORY LANGUAGE -Signature of Applicant or Agent- - - Dote'