HomeMy Public PortalAbout5033 CAMELLIA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY ! APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
VN � ' D I 1
M. J. FOX, CHIEF KNGIN[[R
FOR.-APPLICANT TO FILL IN FOR OFFICE USE ONLY
DIOTR N0. PLAN OK.MO. - PERMIT N0.
BUILDING r
ADDRE M !V rP 3 /3
LOCALITY Y"' ,� 7"' REO[IVED BY DATE 0FAPPL. DATE IMU[D
NEAREST e+J F _ J �-- J
C DT
y BUILDING 'n
CWN[Rtq m tl.J a,• / , w - ADDR[BS
MAIL y! LOCALITY �•!�
ADD REB!! J' �I. r!L` .
� N;PJ![TT
T[L. CROM ST. S�4
FIRE N0.OF TYPE GROU�
ARCHITECT OR TEL ZONE PLANK
ENGINEER NO.
BLDG, _ RD. NO.
ADDR SETBACK LTH[
O
APPRV[Q
TEL ..
BY DATE
O O NTRACTO R NO.
USE APPROVED
ADD EBE ZONE ` QY DATE
D[BORIPT[ON LOT N0. ■LOOK ORAE +MONS
TRACT
N0. OF ■LDGS. H
■IZE OF LOT t HOW ON LOT I! .
US[CF NO.OF N0.OF
EXISTING■IDG. FAMILId I I RDOM■
DESCRIPTION OF WORK
NEW ALTE"TION ADDITION
O
T
REPAIR MOVING D[MOLIEH
O_
S>].FT. 1 MEL or
7IZ[ ROOM■ STORIES
WALL •�.r► ROOF �1
CDV[RING ! COVERING ` t
UB[Of NEW
BUILDING
1 HEREQY AOKHOWIJDG[ THAT I HAVE READ THIS APPROVALS
APPLICATION AND STAT[ THAT THE ABOVE IS CORRECT
AND ASREE TO COMPLY WITH ALL OOUWrY ORDINANCES FOUNDATIOMt LOOATIOM 'r OTOR DAT[
AND STATE LAWS REGULATING BUILDING OONSTRUCTION. FORM1% MATERIALS
FRAAFIR[BTO PB,
■IGNATURE OF ■RAmIN S
oOLT
PERMITTEE
LATH, INT.
AUTHORIZED AI7T _
LATHE DCT.
P.G 10 rLAITFJl. INT.
Ft[ PLATTER. [XT.
VALUATION FE[ FINAL XTI�
DEPARTMM-NT OF-AUILDING AND SAFETY- APPI A.._. O TI
COFNI`Y OF LOS ANGELES S U L\6 I N G
WWI. J. FOX, OHI[F EMOIN[ER
I
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
DISTRICT N0.y PLAN OK.N4 PERMIT M0.
■WAN
D C
ADDRESS / l7of,2z
7
E
LOCALITY RED[ DATOFAPTLL ¢ 1 UED
NEAREST . �,� ° , -S 7
CIRUM 8T.
BUILDIMM
0.,yNQ L ADDR[M J7
MAIL
ADDRESS O LOOALTTY r
T=L G a C "[Au.T o
DRDM eT.
FIR[ NO.OF TYPE 0R0
AROHIT•[OT13TIL ZONE -ti PLANS V
[l/S IN[rJ1
—NO..
■LDOL N0.
AnDRKM BVTNAOK LIN[ -
APTROV[D
T[L. BY DATE
O NTRADTIII! NO.
UBE APPROVED
ADDRXM ZONE (7 Z eY DATE
LKU L O / CORRFI�1'�ONS
D[SORIPTION LOT N0. BLOCK (o
TRADT
ra L� MO.OF eLDRL /
■IZI OF LOT 7 1 axe NOW ON LOT
US[OF , NO.OF No,OF
r&mlL IMP
DESCRIPTION OF WORK
NEW ALTERATION ADDITION O
REPAIR J—IMDVINO DEMOLISH G
Sq FT. NO.OF /
SIZE ROOMS BTflR10
WALL
OV[RINO Co I OOVIRIND C-_0Al rj d
i u LODFN 0I / ll(((loxJ
J / 0i
I HERESY ADKNOWLIDO[ THAT 1 HAVE READ THIS APP$OVALS
APPLICATION AND STATE THAT THE ABOVE IS OORREDT FOUNDATIONS LOCATION INer[OTOR DATL
AND XBRE[ TD COMPLY WITH ALL COUNTY ORDINANCES FORM!4 MATERIALS W 0
AND STATE LAWS RIOULATING ■UILDINO OONOTRUOTIOM.
FRAMES FIR[STOP4
■IONATURI OF ■RAOIN BOLTS
OWNER LATH,INT.1 ^�-
AUTHORIZED ADT. LATH,KXT.S ti V
DBa-a 2JSM erre 1-47 � P.0. PLASTER. INT.
0c) 1716L36 FIX
GNR BOO. PLASTER. rxT.
VALUATION Q'
VVE ll FINAL
•{ _, k. � .ICATIO V FA,,-. , ILDING PERMIT
• CQUNTY OF LOS ANGELES �� BOLDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPu¢ANT TO.FILL I BUILDME11 �
I hereby afflrm ttW I have a ate of content b stiff iria", b
or a certflcate of Vkrkers' Compeneston Insuranoe,or a cerdW + �G ,1
Z3..
copy, thered(3eKi 3800,Lab.C.) 'T-'Z- 9Lr ntto
PO"
NO.OF BLDG&NOW ON LOT
LAIf .Certified copy Is hereby fumb 'hed. Z )e L rEAREsT cTroe
El Cs sf
❑ CArGfied copy Is filed with the county binding hapeot on TRACT BLOCK LAT NO.
LSE ZONE MAP NO
depertTlenL ,
Date_ Appilaant ASSESSOR MAP BOOK RAGE PARCEL .
sPEcuL coNnlrtoNa
CERTIFICATt OF EXEMFnC>N FROM WORKERS' RTEL r�
COMPENSATION INSURANCE. � � 'AITHN 1000 FT.OF SCHOOL? vEa NO
(Thio section need not be conpfeted H the permit is for one tlLaldred� � C
DISTRICT GROUP TYPE CONST.. FRE ZONE PROCE BY
dofiare ($-100)or iess.) .
I certify [nat in the perbrntarm of the work,for which thb perm It t Cl Tj
b.beued, I shail not employ ery person b any manner so as to A OR TEL
become aub}eot to the Workers'Cornpenaatlon Lowe ` t Dl7ls-W APT CONDO
Date Appkant CLASS NO � DWELL UMTS
NOT)CE TO APPLKMrf.• H, after making thb Certifioate of i REOUFED TOTAL SETBACK FROM EX18T
Exemptbn, you sholtd become s b}ect to the Yrorkerd' CONTRACTOR TEL NO. SET BACK )ARD HWY- WIOP UE VMDTH
Compensation provisions of the Labor Code, you nisei kw&wltil FRONT
conx*y with such provolone or this permH sha[1 be deerfled revoked. ADDRESS uG NO. PL )-
a,
LICENSED CONTRACTORS DECLARATION qTy UC.CLASS P .O
I hereby affim that I am Ilcensed ulderprovbbr» of Chapter B
(cor rr*nck with Section 7000)d Dtvbbn 3 d the Business and Sa FT.SIZE . Na RI
OF STORIES Na OF FAAQtE8 SEWER MAP
g
Prdeeefons Code,and my Incense Is in tui force and effect NEW �. BK Pa 7; O
Lbenee Nklrnber LIC_Class DEBCRtPT,oN OFADD ❑ ON ACCT.i W
Contractor Date ALTER 6a $ OX 5 3303 ten.
'
❑ I em exempt Wider REPAIR ❑
er sec. $ 1
EAP.C,for thh reason i EMOL ElLDA4A Pic+ ACCT.i
Date: 118E OF EXISTNss BLDG. URM ❑ 3303 L
(PFN T) TEL NO, L)W Perm 0 - o+i •12
I, as owner of the property, or.rry anV4oyees with.wages as Cn <�D . 286-70243 2 I TEMr scie cortpensaft-4 will do:the work and &* etnKt" is Aoo MFTIJTA 676 - 62
not Insebne tended or offered for sane (Section 7044, Buenas and FML DJUE [ 1
p7Q
Pmfsof
11LL TFC APPLIC/J!r OR AFDWVBi
FUTLFE DM O=MNT HANDLE A FMZAOUs AL �' Ctr K - - .62
❑ I, ae owner d the property. ern exctuetvefy contracting wf h OR A LIXTU E CCNVYK943 A FMZAFFIDOL[e YATWWL EQUAL TO OR OF&UER TFM THE
AMOUNTS W-EGFED ON THE HAI7ARDOUe It4fJiMLs ORLWO)N GUI ET By
Uoeneed corlhriadore to construct the project (Section 7044, . res 13 No ElBLafness and Profeasions Code.)
1V1 THC!rr@DED UBE OP THE BWLMO W THE APPLCANT DR R1nlE 9L ��
OOCLPArlr FEOIi'E A PETW FOR COHIHTAJCTION OR 6000F9GUDN FRCM THE eDUTH. pYy�r�rrvn
CONSTRUCTION LENDING AGENCY oL�nEUEa�TY ANT DISTRICT W-AQW sE PB%4n7Mo CHECKLIST FOR + IL `�""' uvtrZ 3/11/96
1'•:.4°:
I hereby afnrm that there Is a corta>ructbn lending agency for ❑ No El All 9:52
ti10 peffOfTT1el1Ce d the work for wflnch ihb permit b lsaued(Sar- AN
READ THE FMZAFUOUe u4ffwJ7 MFORIMnON OUDE AND THE WAQWD PERLUTMO .
3087,CIV.C,) CFECKLIBT I UDEROMW WY FEOIlaA*DAENTD ODER THE LOS AMOELEB COUNTY COOL • -' !
TUNS 2.CHAPTER 220 SECTO"22Q 100 TWXXX1i 22a 140 CONCEFldNG FY2AFD0U8
n 6LU .
Landers ferMI&A REPOWVC AND FOR Off"dHO A PERI&T PROM THE SCA W.
Lenders Address
0.M.1 DA A3W4i
I pw7u tat I hffthe rove mb appInformation
Is n and stale under Icy RG FEE a „qtr Pt7�f FEE
d perJLay ti1ffi the above Yiomlatbn b correct.I apnea to coirlpty ✓r� d
with a6 County ordMncee ehd'State leve Mk*lg to bukkQ
0 oonsbucdon, end aUt wtze reproaent tlYas of 0* Co^ tssUAMCE FEE �j 7 O
b the for 1 /` /.
I A-10 La NVEST'KIKnON FEE TOU1L FEE . / d
W , !!`
SEE REVERSE FOR EXPLANATORY LANGUAGE
WC)RKE(t5'tOMI?ENSA1lON DECLARATION _ - 82-1621 Bros
I hereby affirm that Phave.a-�certlflcatp of consent to self
Irlsom, cc a oertiflcate of Worker`tom nstlon InsurG•ncet or APPLICATION FOR BUILDING- PERMIT
a c•rtlflood copy thereof (S•4. 3800, Ca C.) COUNTY OF LOS ANGELES BUILDING.AND SAFETY "
Pp178�5� _Comp eIDbIIt IDC�PDII1�t'�
Cedifled Copy Is hereby. BUNS_
[�::. FOR-APPLICANT TO FILL IN
�y
C:ertlfJed,ropy IsjJIhed'wlfh ihe'county bullding fnspec- BUILDING l
tion rcr"rfinent. �.{ ,� vim '„,,�,,,r ADDRESS-- 0. N Came iQ Ave-. LdGgLPrYNEAREST
`
Date', �1// /8? .Applicant ,1u- 4 1 g•. bVan (7TY Zjp'.J ] CR ST
CERTIFICATE Or E)CFMPTION FROM WOftI�RS.' NO. OF BIDC,S. ASSESSOR
COMRENSATION-INSURANCE SIZE OF LOT . _ NOW ON LOT. MAP BOOK PAGE' PARCEL
(Th1rsedion rase4 not'be com{�I tpd lf.the petrmlt is for one USE 40NE MAP
hundr dollars ( 400)oT leas!.
TRACT BLOCK LO NO: NO.
owr�R ere Miller. o.�-6750 CONDITIONS
I cerflfy•lhgt-In the o maracq 01 the`work',for which this 10 151RICT GROtJp. TIpE. NRE pROCF55®BY {Qj
pe.f.. _
pe,rmitjI f14ued,1 khiall•not bfnpl'6 any erYon In an'X manner 8' AYE CDNS7, Z
'so Qs tp aecome'kublett tq fFd Workers;Compensaflon Laws. - pp
tate Appllcanf ICITYt ZIP 1 (JO STA fFIG4T10N.
NOTICE TO APPLICANT: of offer`~~Laking Yhi$°Certificafe.of ARCH rrECT OR r.� -T� _
�cemptlon, ydu 'zthould. be orrne'sublect'To tad yHorkera', NO' CLASS tJO: DWE1,L Nt7S
CoMpenscitiorYppvlslons of.the 4aborCode, you mpst.#orth-r ADD - a
with comply.•wlth such provlllona or tblk.pednJf,shall be ,
), deemed revpkpd: cOtJTRACTOR i. 26 181 9K PG, `VAUDATION
LICENSEp.CONTR.4�TORS-bECLARA-noN i,7 ,.,q LiC
I hereby affirm Thai'1 am licensed under provlsfons of Chgpier 4 _ ADORE$S .3 S.-W,O.OdB Ave...1 440.. 159496. - VALUATION
(comrAePclnp with Sgctlon 7000)of D•lvlslgn 3 of the Business and LC
Profesilor' Code;'arid•my license Is'In'full force and effect. C e1eEr C1ASS.�.'- 3 —75—D
7 Sq FT. NO.OF' NO. OF CHC�C
L(tenye7Jumber 15 _+L�c. osi G39. 512E STORIES FAMUES �
s
Canti;actor RiQi J;. f;Qza*V_ ,/ 86,. IPTiON of WORK _ t._ Rig
id `�"'
I ars •kempt'4rd)n TF e'llqqnslnp.requlremeots at I am anVA7 r n ADO
Ilcensid archltett or a rplst•redprofesailonal enpit»er _ f.LTER FI]NAC.
actlrig In my professional cap'05ky '(Section 7051 Y DATE
Business and Professions Code} USE REPAIR
EXISrlt6 BLbG: ReBidenc�. DEhhoL [] .FI AL
Llc.or Rep, No Date- f+PPll TEL
6WNER-BUILDER'OECLARATIQN PRINT �t -
I herby affirm that.Fam exempt from the Contrgctor's Llcensb
h�aaww for thk fgllowing reasIon (Section 7031.5, 8uslnessand ADDRESS
Prof"lons Code): } -
. 1, 'as ownir of the property, o� rny;employeei with 1 ADDRESS
WOO"as•thelr sole compensation,wllfdo rhe work and ' ,
the'strocture Is{sot Intended ofoff@red-forsal•(Settlon LOC�,L r?
7044. Business and.prpfessions.Cbde). MOVING TEL 27 Q O A '
I, as owner of the property, am exclusively controctin9
wit Ilceta #�•o'0 0 0 •
h std contractors to-construct the protect (Sec-- •- 1 ,
,tion 70.44, Business and Professions Gode).. ADDRESS ` -
REOUIRm TOTAL SETBACK FROAA EXIST. 2 0'0 3,4 0
CONSTRUCTION LENDING AGENCY SET BACK YARD }+SAM PROP. LINE..• WIDTH
I herebyafflFm that thdt'd Is ptonwt alon lendfng agency for p T Q Q
the performance.of.the,work.for-whlch this permif It luted p,U .is
(Sec.3097,CIv. C..). . SIDE . ,
�6.7 8.2
Ldttder's Name /�
Lende'r's Address P.0 Feet P•rnitFee p/�..5� -
I cgttlfy tf>Qt I have read'this application and state that theubance
ve
above I formation Is correct. I agree to comply wltfi all County Inves 1parlon Fee ✓
ordl es and State laws:relating to bullding'construdlon,
a h eby authorize'representa as of this County to enter rdtal Fye
on he-above-menttpn for Inspe0lon purp�yoses.
9 02 I_ SE REVERSE FM VTtA�IATORY LANGUAGE
v
grata o Appkant Aq•nt
Date _ 05