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Home My Public Portal About4852 CAMELLIA AVE_Building__ �J c 76A638A CEOB03 s-65 APPLICATION. FOR BUILDI G PERMIT -COUNTY OF LOS ANGELES BUILDING G� "DEPARTMENT OF COUNTY ENGINEER ADDRESS O r BUILDING AND SAFETY DIVISION LOCALITY /J 6 JOHN A.LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W. J E NK I NSSUPT.OF BUILDIRG CROSS ST. ti�ff� OISJCTeNO G TYPE. �/• Y FOR APPLICANT TO FILL IN , _ ///1 coNST. BUILDING O 'l ZO ` (i STATISTICAL ASSI FIC ATION SEWER MAP ADORE (� .J CLA55 NO. DWELL UNIT$ BK /:_ PG LOT NO. BLOCK_ ll ON NOO , TRACT qzj_ �-� CONDIAL j72TIONS NO. OF SLOGS. SIZE OF LOT, NOW ON LOT USE OF EXISTING B D 0 A BLDG. SETBACK FROM TEL (K^� FRONT PROP. LINE OF , (STREET) OWNER OJ NIN S//w "` N�Df. O TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRE�SSSf; (��/'/�+�mq HIGHWAY. WIDTH [SETBACK 0.L. GCI�T /i�f/ `7 + �0 CITY./ _ ARCHITECT OR TE BLDG. SETBACK FROM ENGINEER ,lt d NO 510E PROP. LINE OF - (STREET) - TYPE OF EXISTING.. SETBACK HIGHWAY + YARD - TOTAL ADDRESS Ff ,1y HIGHWAY WIDTH FpOM LL. CONTRACTOR�y /moi +1/$T NOL' U .SOI + O ADDRESS )VA B/I NO CORNER CUTOFF YES NO V CL' CITr 1/ +�+/� CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS O DEStAIPTION OF WORK . 01414 ,2:f- L � �_ a NEW ADD ALTER REPAIR DEMOLISH v /'_/e�i� !/ t � .Z SQ.FT. Dp STORIES FAMILIES SIZE ��IO fG.Y VLiY�! �.Q•4.3""K- �f {:..�. USE STRUCTURE �� /✓ A/ BD / • _.+9,r_ SIGNATURE OF APPLICANT ' VALUATION$ APPROVALS DATE ' INSPECTOR'S SIGNATURE P.C. PMT. /}�+/% FO FORMS!MATERIALS LOCATI " FEES "FEES F •• `� FRAME, FIRE STOPS, f %/y//� '�� / HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING BOLT / E/I yfyyJ✓IA AN STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION / yr� `9 F • WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING GAS VENT. DUCTS RUILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK I AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PER50N IN VIOLA- LATH. INT. TION.OF THE LAPON CODE OF THE STATE Cl CALIFORNIA-RELAT - ING TO WORKMEN'S COMPENSA ON INS ANCE. - IF F LATH. EXT. �( +f SIGNATURE OFHOUSE NUMBER COR- PERMITTEE RECT AND.POSTED ADDRESS FINAL JOHN F. LEWIS PRINCIPAL STRUCTURAL ENGI EER. .PLAN CHECK VALIDATION CK. M.o. CASH _ PERMIT VALIDATION 'CN. MU CASH _ L Co,8A,4. .J MI 3 1 D . 6.0'0'' J - V�(01�KERS' COMPENSATION DECLARATION -_ mss r,� �; i ur affirm that have.a certificate of consent,to self ��PLOC .(n OON FOR RUMDONG PE'y'��.�ir�.� ,1 I ' Insure.pr a certificate of Workers Compensation Insurance, (/'l� u u�' u� Il�lu�u ll LJ or a certified copy thereof (Sec. 3800, Lab. CI) - .1 - COUNTY OF LOS ANGELES BU DING AND-SAFETY Policy No — - Company, - - - 0 Certified copy ishereby furnished. FOR APPLICA,,NT TO FILL IN euuDING Z ADDRESS . ❑ Certified'copy is filed with the county building inspec- BUILDING - tion department. ADDRESS Date 1, Applicant. - CITYZIP LOCALITY ' ' CERTIFICATE OF EXEMPTION FROM WORKERS' - NO. PBiDGS. NEAREST COMPENSATION INSURANCE -• SIZE OF LOT NOW ON LOT CROSS ST. - (This section need not be completed if the permitis for one . - ASSESSOR - hundred dollars ($100)or less.) - TRACT BLOCK LOT NO. MAP BOOK'- PAGE I PARCEL OWNER USE E MAP - I certify that in the-,performonce of the work for which th SPE permlPis issued, I shall notemploy on Pers in any manner SPECIAL - ' ADDRESS CJ �/ rl CONDITIONS so as 1 6 cam subject to the er C ensation Laws. U Date Applic nt CITY ZIP W NOTICE O PLICANT: If, after' ki this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE ROC SED BY 0 ENGINEER NO. - CONST. ZONE V Exemption, you should became subject to the Workers' /` . „ Compensation provisions of the Labor Code, you must,forth- ADDRESS / G ° Q'3a, with comply with such provisions or .this permit shall`ba - / TEL STATISTICACCLASSIFICATION APT. CONDO. to deemed revoked. - 'CONTRACTO "� NO. Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNIT$ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Divisioh3 of the Business and I LIC_ SEWER MAP ' Professions Code, and my,license is in full force and effect. CITY CLASSBK .,VALIDATION SO. NO. OF NO.OF CH CK LicenseNu er Lic.Class SIZE STORIES FAMILIES ONE ❑ VAL ATION g DESCRIPTION OF WORK NEW �L Contractor Date $ I am exempt under Sec. ,J/ ALTER LJ B.BP.C. for this reason \ �/ REPAIR $ - D U ❑ ate. EXISTING BL DEMOL ' Signature - APPLI EL. FINAL - OWN - ILDE DECLARATION - PRI DATE I hereby affirm that m exe pt from the Contractor's license _ Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): ' _ FB r - - By - - I, as.owner of, the property, or m employees with BUILDING p p y, ytADDRESS �/ �- wages as their sole compensation,will f o the work and LOCALITY D A /.A y1�Jq, f S 9 0 6 9.3 A - the structure is not intended or offered for sale(Section �k[/f/C V 7044,.Business and Professions Code). - MOVING TEL was owner.d the properly, am exclusively contracting , CONTRACTOR NO. ^' / /� with licensed contractors to construct the project (Seo- jl/!/(-�//// I( .• 049. 88 tion 7044, Business and Professions Lode). - - ADDRESS s CONSTRUCTION LENDING AGENCY - ff .YARD HWY TOTAL SETBACK - •° °,°,4 9,S 8 PROPAINE WIDTH hereby affirm that there is a construction lending agency for - -- - - - - -' Q 9.-1 6'. 8.8 . the performance of the work for which this permit is issued - - (Sec. 3097, Civ: C.). - .Lender's Name - %' LDMA Ref. R Lender's Address m •• - - P.C. Fee$ Permit Fee - 4 - � � .. ].certify that I have read this applicationand state that theIssuenceFea U - -5� LDMA P/ rrC R above information is come Iagree to comply with oll�County Investigation Fee q, ordinances and State I s r lacing to building construction, _ Total Fee / ' LDMA Perm.N $ and'h o hori repre •motives !lits County to enter _ n up ave property for i ectionppr ores. / //�J �� Ute/-/ SEE It FOR EXPLANATORY LANGUAGE a r Applicant or Agent Date - - - - -- - - - - '0•• RKERS'COMPENSATION DECLARATION in �l o affirm that have%a certificate of consent to self �� /n� l�0®11� FO-FDS I�ln nOLD��O PERn��(' flsl. or a certif' Ate. yyorkers' Compensation Insurance, fj=L\ u ��f LO V PERMIT ,..rvyerfi o PY thereof (Sec. 3800; Lab. C:) Policy COUNTY OF LOS ANGELES _ .., BUILDING ANDS ETY ❑ YM,. '•_Company - Certifies copy Is hereby furnished: - FOR.APPLICANT TO FILL IN— ADDRESS _ .Certif4@*d copy is filed with the county building inspec- BUILDING tion department. _ - ADDRESS ?- -CA- MV_-U `• AVE:", LOCALITY • - �•' NEAREST Date Applicant CITY sZIP: _ CROSS ST, CERTIFICATE OF EXEMPTION FROM WORKERS' q,-q, � NO. OF BLDGS ASSESSOR COMPENSATION'INSURANCE SIZE OF LOT .7liLJ NOW ON LOT MAP BOOK 11GE PARCEL y (This section need not be completed if the permit.is'for-onelqqh 71 USE Z E MAP _ hundred dollars ($100)or less.), TRACT. BLOCK LOT NO." NO. - L. � SPECIAL. y I'certify that In the per formance.of the work for which this OWNER - CONDITIONS 1 permit is issued, I shall not employ any personin any manner - +f - - - DISTRICT GR UP TYPE FIRE PROCESSED BY CI so as to become subject to the War ria Com nsahon a 1. ADDRESS ` - O ,L /1� CONST Z05 OV CITV / E/J+ K ?J' Date��T: If, c after - , G 6A. ZIP STATISTICAL CLASSIFICATION APT. ONDO, - I- NOTICE TO APPLICANT: If, after makig this Certificate of ARCHITECT O TEL. t j_,5 y . Exemption,, you, should become subject. to the Workers' ENGINEER O -f CLAS NO. DWELL. UNITS_ CL Compensation provisions of the Labor Code, you must forth- ADDRESS �"[ - SEWER MAP Z with comply with such .provisions or this perm it'shall. be - deemed revoked. •_ _ TFL' BK, PG,� VALIDATION CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION - UC, 2776, hereby affirm that I am licensed under provisions of Chapter 9` ADDRESS NO. 'ypLUATION — •$ ° e t - (commencing with Section 7000)of Division 3 of the Business and - - LIC rr a �j Professions Code, and my license is in full force and effect CITY CLASS 8 SQ. FT. NO:OF NO. OF CHEEK D • . 3 1 4 9-3 6 License Number Lic.Class SIZE STORIES FAMILIES ONE v'I I /,/f ' DESCRIPTION OF WORK NEW ❑ $ " -7 M 1"' Q 6'2 7�8 7, Contractor Da - _ I am exempt under Sec. - 13 -. ADD -� ALTER ❑ .. DAT L� :2 9 6 4.7 A- ' B.BP. FINA C. for this reasonAAV4REPAIR ❑ . Date:. USE OF OL ❑ B `Z 3 EXJE BLDG. .Signature - APPLICANT - TEL .;� L56.-10 OWNER-BUILDER DECLARATION PRINT) __ NO. _ "!( thereby affirm that I am exempt from the Contractor's License D x Law for the following reason (Section 7031.5, Business and ADDRESS - _ - _ - - 'O ° - 50, 1 ,0 5 - rofessions Code):' PRE EN e "0 5.201-8 8 I, as owner BUILDING of the property, or my employees ADDRESS + 1 wages as their sole compensation,will do the work and _ the structure is not intended or offered foi sale(Section LOCALITY 7044, Business and Professions Code), MOVING TEL ^' �"+•'. "t�` \�' 9 b U.8 A ElI,as owner of the.property, dm exclusively contracting CONTRACTOR NO. �- L_. , with licensed contractors to construct the project (Sec- # 'tion•7044, Business and Professions Cade), ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. i �� \ Ta( •. '4 4 7 0 0 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 vihich this permit is issued P.I. �, _ T �; ° 4 4 7, 0 0':r0 , (Sec. 3097, Civ. C.).' SIDE - • 'i m , 'P.L. �`�\v 052,088 Lender's Name / P.C. Fee$ 4 a -l� Permir Fee t�(Jr5 � - Lender's Address � !, _ �1yj -.•� '•+ - .< I certify,ihot I have read this application and state that the •r / Issuance Fe a above information is correct. I agree to comply with.all County In Fee •21 � g ordinances and State laws relating to building construction, Total%Fee / tl and hereby authorize representatives of this County to enter $ upo the -m ntioned.property inspectio purposes. - - - - t •s 'Yv V .\ r + { T. SEE REVERSE FOR EXPLANATORY LANGUAGE 5tgnature of Applicant ar Agent Dote