HomeMy Public PortalAbout4919 CAMELLIA AVE_Building__ /Yv&q • .,APPLICATION FOR BUILDING PERMIT
FORIAPPLICANT T, FILL IN (Pdnr., (Yoe ..IV) '
B U I LOINu /} COUNTY OF LOS ANGELES
ADDRESS ((� �E�F DEPARTMENT OF COUNTY ENGINEER
Y ZIP 11 BUILDING AND SAFETY DIVISION
NO
O BUILDING
'SIZE OF L0O( CJ TS - *76 NOW ON LOT S - ADORE SA /rl+��•
TRACT• •/6 / BLOCK LOT NO_d } LOCALITY ( r
TEL_. NEAREST
OWNERN CROSS ST.
ASSESSOR
ADDRESS - -�� �i� MAP BOOK PAGE CEL
DISTRICT IGROUPITYPE FIR PROC SSEO BY
CITY CONS Z
ARCHITECT OR - - TEL. �V
ENGINEER NO.
STATISTICAL CLASSIFICATION 1// SEWER M
S�/
ADDRESS CLASS NO.LL_DWELL,UNITS G B bzrpG
TEL.
CONTRA CTOR4I' /v6 ( NO U ZONE NADP CU J
LIC. 1
ADDRESS NO. J SPECIAL
LIC. d CONDITIONS _
CITY
CONSTRUCTION LENDER CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
NAME AND BRANCH Q 6' BLDG. ETBACK FROM C
FRON PROP.LINEOF (STREET) U
ADDRESS CITY i _ TOTAL SETBACK FROM TYPE OF EXISTING C
SO. FT - NO. OF NO..OF / CHECK HIGH Y + YARD - FRONT PROP. ,LINE HIGHWAY WIDTH
.SIZE STORIE FAMILIES ONE L
+ - LL
1:110-
DESCRIPTION
DESCRIPTION OF WORK NEW SIPROP,
.Z
ADD BLDG.
SIDE PROP. LI (STREET(
ALTER ❑ _ TOTpL SE K FROM TYPE OF E
XISTING
HIGHWAY + YARD - HIGHWAY
REPAIR❑ SIDE PROP, L
USE OF - + _
EXISTING BLDG. DEMOL El
APPLCANT TEL �y�^ CORNER CUTOFF YES ❑ NO
,PRINT) NO. 'y76 .
BY ISIGNA TUR E) / IN OPEN SPACE - YES IJ NO E3r 9,_ 6 0
�j IN COASTAL ZONE YES C-] NO [:]VALUATION CATEGORICAL EXEMPTION YES❑ NO ❑
I I HEREBY ACKN LEDGE THAT I HAVE HEAD THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNEDIDATEI
WIT MALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT INDOINGTHE WORK AUTHORIZED A IMPACT REPORT PROCESSED (DATE)
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE J
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSPT INAURANCE.' C w
SIGNATURE OF IIJ ){ a \ rlP Pox
PERMITTEE ! /�
ADDRESS 6L:ZO {%- �
- FINAL BY /� -
TEL•.., DATE �/
CITY NO • 6d
M;1KF CHECKS PAYA l3LL-" ETo
N - FEE � i, FEE
HARVEY T..BRA NOT. COUNTY ENGINEER
PLAN"CHECK VALIDATION CH.. CAG. PERMIT.VA DATIO fC J 'M.o.- C'AGH
6 1 6�JUN•. 19 2 3 D 3 7.3 5
4-2 10�AUG 6 2.3 U. L/��i 4 0 5;A
76A638A CEp903 ]/J3 '�� 4 2,1P AUG 'U6 1 D 6 9.0 0 &"'