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HomeMy Public PortalAbout4841 CAMELLIA AVE_Building__ APPLICATION FOe— COUNTY OF LOS ANGELES s DEPARTMENT OF COUNTY ENGINEER !'BUILDING PERMIT BUILDING AND SAFETY DIVISION BUILDING / ' • FOR APPLICANT TO FILL IN ADDRESS BUILDING b N ADDRESS b LOCALITY CITU ZIP �7`�� NEAREST CROSS ST. OF BLDGS. - ASSESSOR - - - SIZE OF LOT N WON LOT MAP BOOK PAGE PARCEL �'/,\_ DISTRICT GROUP TYPE FIRE PRO SED BY TRACT 01,f, BLOCK LOT NO. / � J7�pA C E r+�- TEL Cl OWNER NO. (p STATISTICAL CLASSIFICATION /S3 WER�11MAP ADDRESS DI ,( CLASS NO.�- V DWELL.UNITS BK G CITY .C-p- - ZIP -, USE ZONE NADP /•- �O_v, / 6 ARCHITECT OR - TEL, �./ SPECIALd E NG I NEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TEL. CONTRAC( p/T]O9R) „/ LI BLDG,SETBAK FROM, /,t �� FRONT PROP. LINE OF (STREET) ADDRESS7G CL- NO. E7O 2- HIGHWAY } YARD TOTAL SETBACK FROM TYPEOF EXISTING LIC. FRONT PROP. LINE HIGHWAY WIDTH CITY CLA 55 CONSTR CTIO LENDER" } NAME AND BRANCH O BDG,SETB ACK FROM U ADDRESS CITY SIDE PROP. LINE OF (STREET) NO. OF NO. OF CHECK HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING Sq, FT. _ SIZE STORIES FAMILIES ONE SIDE PROP. LINE HIGHWAY WIDTH F DESCRIPTION OF WORK NEW } 1 N ADD CORNER CUTOFF YES ❑ NO ❑ 60 ALTER ❑ REPAI R❑ IN OPEN SPACE YES ❑ NO ❑ USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. �/ )/��//// ��JOEMOOL ❑ !!G/��////�,�/ l�fL }� /^ ,.� AP PRINT)' ^ l [Vjj/�(fe�OL f-Z(J I96'S / cZ &� t. ! `� C7'JG:.D U T BY (SIGNATURE( I HEREBY ACKN LEDGE T T HAVE READ THIS APPLICATION AND STATE THAT 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 I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPE TION INSURANCE SIGNATURE OF FINAL �� BY PERMITTEE DATE 7 ADDRESS / TE L. P.C. Fee$ Permit Fee CITY NO. Q Issuance Fee VALUATIONS D D Total Fee PLAN CHECK VALIDATION CN. M,O. CASH _ PERMIT VALIDATION N, M O, BRI 5 a�SEP ,21 r © 2 1.7 5 • ' 7GA838A CE#8038 12/75 ,,, ,. - - -. 76A638e CE P803 1/71 APPLICATION FOR BUILDING PERMIT fl COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE .PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS 4 COLEMAN W. JENKINS, •SUPT OF BDIL...G LOCALITY 'PPI_(3' FOR APPLICANT TO FILL IN NEAREST Print ort a onl CROSS ST. BUILDING - DIS TRIC TT.`NO. 'GRO.UIP E � P O SSED BY ADDRESS 4// i[. m ( Il Si 0 ) ' a ST. IS'—s // STATISTICAL CLASSIFICATION - SEWER MAP LOT NO. G4 BLOCK CLASS NO. DWELL.UNITS TRACT • USE ZONE MAP NO.OF BLDGS. NO. C� SIZE OF LOT NOW ON LOT _ I SPECIAL USE OF, EXIST NG BLDG. a� 6_ 1 CON OI TIONS TEL. OWNERO. L �9 BLDG.SETBACK FROM ADDRESS FRO TPROP,LINE OF ISTREET)H ,/ TYPE 0 ISTING SETBACK HIGHWAY } YARD- = TOTAL CITY /0�,"/�/L G 7,V HIGHWAY TH FROM G.L. ARCHITECT OR TEL. } ENGINEER NO. BLDG.SETEACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF 1EXISTING1 SETBACK HIGHWA } - YARD = TOTAL CL CONTRACTOR SSS/ NO. �� HIGHWAY WIDTH I FROM C.L. C, A DpREss LIC. _ Pj //Oysy2TG No. zys /L + o CITY,—.4d (�jQy//p�/�(� CLASS -Z-9 CORNER CUTOFF VES ❑ N yVj CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECI L AP A S ?. ADDRESS SQ. FT. NO. OF NO. OF NEW SIZE STORIES FAMILIES USE OF - ADD STRUCTURE ,e f-i ALTER ❑ , . `A`C �Cili iC/ REPAIR[] SIGNATURE OF APPLICANT �[, EMOL ❑ VALUATION S ©Q APPROVALS DATE -INSPEc ON'S-SI AIUNE FEES FEE S 1p), E.�D FOUNDATION: LOCATION FORMS, MATERIALS FRAME: FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, - WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STR UCTION. I CERTIFY THAT IN GOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH. INT. - - LABOR CODE OF THE STATE 0[ 'CALIFORNIA IN RELATING TO WORKMEN'S CO APE NSA, ON IN ANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE '��- RECT AND POSTED ADDRESS FINAL dU /2 2 ' JOHN F. LEWIS. PRINCI AL STR AL ENGINEER PLAN CHECK VALIDATION cK. M.D. CASH _ PERMIT ALIDATION Limo . CASH 5 2 7 Auc 1 f 1 0 15.00- va L1iLo _ _ T=A===a�e �a= _= APPLICATION FOR BUILDING PERMIT Y BUILDING-AND SAFETY DIVISION BUILDING - Department of County Engines[ ADDRESS 'County of Los Angeles LOCALITY ` JOHN A. LAMBIE. COUNTY ENGINEER NEAREST - CASSATT D. GRIFFIN, SOP'T OF BUILDING CROSS ST. L G DISTRICT NO. GROUP. ITYPE � .SEWER MAP FOR APPLICANT TO FILL IN BK Pc CONST. BUILDING' 11$(/ - BUILD' S �bSt rr STATISTICAL CLASSIFICATION ADDRESLOT NO. L�/✓�— �j BLOCK CLASS. NO. �I DWELL. UNITS TRACT /9` j (� / NUMBER ER C✓� HWY YES t O USEZONE SPECIAL 460r-111 � L/ �O I NO: OF SLOGS. CONDITIONS SIZE OF LOT it NOW ON LOT „ USE OF L, EXISTING BLDG. BUILDING EXIST. SETBACK YARD HWY STREET NAME W,DTH ' OWNER FRONT MAIL P. L - ADDRESS SIDE TEL. P. L. CITY NO. INSPECTION RECORD ARCHITECT OR -TEL. ENGINEER NO. ^1 DQAlcw R ADDRESS - T - 1 sEL. I�.I C. �-. )�t_L ��[nl- G^4 ♦ 1\.�tl-i'DhV. CONTRACTOR tEIO. _ /� n ADDRESS 71 DESCRIPTION OF WORN NEW ADD✓ ALTER REPAIR DEMOLISH � •w i�, [� „ `�_,P� SO. FT. JFi / STORIES FAMILIES USE OF STRUCTURE F �S ^_ttn � l.t"L • �sem/ � �-n i� �: C.an- � 'AIaT �n tl. APPROVALS SIGNATURE OF APPLICANT_ PPLICANT DATE INS ECTO S SIGNATURE ADDRESS FOUNDATION: LOCATION _ 7110 FORMS. MATERIALS , aY g FRAME: F IFIR ESTOPS, FEEC, � BRACING, BOLTSFle6Y VALUATION $ - UV FURNACE: GAS LOCATION. VENT. - /\ FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT. T�lQ I'S`} 4LJ.AO�LA-U_. _ PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND V LATH. EXT. STATE LAWS REGULATING BUILDING CO RU T N. SIGNATURE OF (' HOUSE NUMBER COR- . PERMITTEE RECT AND POSTED I _ ADDRES ! FINAL . JOHN A. LAMBIE. COUNTY ENGINEER, CLYDE N. DIRLAM. P INCIPAL STRU TURAL INEER PLAN CHECK VALIDATION CK. M.O. cA.H PERMIT VALIDATION cK. M.O. cwsH 1M5 7 5 2- MAR 5 1 12.0-0 '" COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure. BUILD? G ADDR S or a certificate of WorkersCompensation Insurance,or a certified ` copy thereQq�('SEec.38000,lab.C.) CITY t ZIP G ML9U -ACG 2 �C , C 1 / 1�0 o LOCA ITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT 'G ❑,/Cgrtlfied Copy is hereby furnished. NEAREST CROSS ST M Certifietl copy is filed with the c unty building inspection TRACT BLOCK LOT NO. department.�p/ USE ZONE MAP NO. Date N-//-'r Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER9 O�. TE I lb�,/ COMPENSATION INSURANCE r N J to ! WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESSIf / �y' r <OL DISTRICT GROUP TV CONST FIRE ZONE' PROCESSED BY dollars ($100)or less.) Y P permitCITY a LP I certify that in the performance of the work for which this a C V �✓nd _ g is issued, I shall 001 employ any person .A any manner s0 as t0 ARCHITECT OR ENGINE R TEL NO. become subject to the Workers'C pe n'Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.� DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACT _ TE NO SETBACK YARD RWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith r'�RV, N r/ef�/ /IKO ROM comply with such provisions or this permit shall be deemed revoked. ADDRESS _ LIC IN p BL 2 C r �� ��/ SIDE LICENSED CONTRACTORS DECLARATION Cay 4 UCCL sS P L I hereby affirm that I am licensed underprovisions of Chapter 9 — Y (commencing with Section 7000)of Division 3 of the Business and SO.FT:SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP y Professions Code,and my license is in full force and effect. NEW ❑ BK PG U /i DE RIPTION OF WORK (ADD ❑ VALUATION License Number � 1- Lic.Class C--3-I O Contractor r V FDate y ' � ��Sy e @� rib�f C� ALTER $ et�•.• /A- �d a REPAIR ❑ '- ❑ I am exempt under Sec. f3.8P.C. for this reason (/ , C S A' �� DEMOL ❑• CDMA P/C a US F EYNG BLD , URM ❑ r N!r 'Signature ��� f / er APPLIC (PI�Wtl go s -7�� T L NO.�� I! CDMA Perm♦ _ ❑ I,.as owner of the property, or my employees with wages as L(r-�! 63 Z -their sole compensation, will do the work and the structure is ADDRESS CO net intended Or offered for sale (Section 7044, Business and 2 C' a O rL� )• FINAL DATE F - - _- G Professions Code.) WILL THE APPLICANT NI FUTURE BUILDING OCCUPANT AIL T A R GREATER MATERIAL ❑ I, a5 OWOa1 Of the property, am C%CIUSIVQI contracting WIIh �A MIXTURE COtRA1NING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE P Y g AMOUNTS SPECIFIED E HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors ro construct the protect (Section 7044, I i(fi I Business and Professions Code.) YES❑ N1,421 - r WILL THE INTENDED USEOF THE aUIDUNG BY THE APPLICANT OR FUTURE BUILDING ,_� OLLUFKNT REQUIRE A FOR CONSTRUCTION OR MODIFICATpN FROM THE SOUTH l,i. _19� I, ^ (.� �.(tf is jC E C CONSTRUCTION LENDING AGENCY wgsr AIR ouqury GEMErvr olsrRlcr IscAOMm SEE PERMITTING cHECNusr FOR -jiuJ�' 'tWl VVI (/ ,. GUIDELINES. - I?f fuyi�� I hereby affirm that there is a construction lending agency for �rEs❑ //T ,11 the performance of the work for why h this permit is issued(Sec. - J W ?HAVE READ THE HAZARWU$MATERIPLSINFORMATgN GUIDE AND THE SLAOMD PERMITTING 3097,CIV.C.) CHECNLISc.'� ERUIREM TR THE LOS ANGELES COUNTY LOGE. TITLE 2.CTA 22 ECTIONS 220 THROUGH 2.20.I40 CONCERNING HAZARDOUS t II 11!!;—%1171 I j ki S.Li F Lender's Name MATERIALS ORT? AND FO BTA PERMIT FROM THE SCAOMO i o Lender's Address r'L_ 0 QVxEA,IN PGENL - — o I certify that I have read this application and state under penalty 4 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building m Constructi antl hereby authorize representatives of this County ISSUANCE FEE mto en[ above�lenf d property for inspe tion purposes. Q AAA � L INVESTIGATION FEE TOTAL FEE r p' so.n..a A.•µm.a Ao.,i o,.. a%. O SEE REVERSE FOR EXPLANATORY LANGUAGE