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Home My Public Portal About5203 CAMELLIA AVE_Building__ APPLICATION FOR BUILDING PERMIT Z COUNTY OF LOS ANGELES BUILDING DEPARTN= OF COUNTY ENGINEER ADDRESS MmDINQ AND SAFETY DIVISION LOCALITY JOHN a LAMBIE,CouNTY EN(zlmxxR NBARFET CASSATT D.GRIFFIN tur7 of EurLoiMa CROSS ST. DISTRI N G TYPE P BY CANT . FOR APPLIZO FILL IN CONST. BUILDING STATISTICAL IFICATION H "pADDR ____ •S� CLASH.N U TS 9 LOT NO. v BLOCK MAP STATIK NUMBER HW1• YHA NO. TRACT UHH ZONE SPECIAL NO.OF BLOT ! CONDI IONIi HrzE OF LOT NOW ON LOT 1 UBE OF BUILDING MUST. , SETBACK YARD HWY STREET MA M E( W I DTH OWNER , FRONT �7 MAIL P.L. c ADDR HIDR P ARCHITECT OR TEL. lNSP=ON RECORD ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SO.FT. NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGRf APPROVALS - O LICA NT DA - INSPECTOR'S SIGNAWAX ADDR FOUNDATIONS LOCATION f s � FORMS 6iATHR1ALH P.C. f FRAME: FIRE STOPS, FE BRACIN BOLTS / VALUATION FURNACEt LOCATION, FEE GAS VENT DUCTS - ,i• I HEREBY ACKNOWLEDGE THAT 1 AV9 RK,,$D THIS PLICATION AND TH T THE ABOVE IH HCT AND LATH Imo' AGREE TO COM I A UNTY OR CES AND - STATE LAWS I ILDI STR Ci•ION. LATH EXT. SIGNATURE OF HOU NUMBERCOR - DD.R_ R_NAND F9STED ADDR '�'-?i.t. �` y .•=tis . CL f=N. DIRLAM RIN &PAL L Ef4GINPLAN CE=VAIMATION EER CK. Y.O. CAJIH r vurnmoxCK Y o0. -GAYij 1�n 4 " a hEa'1 7 2 .0 �F 76A638A CE--F903 3-69 ~ APPLICATION FOR BUILDIN PERMIT" COUNTY OF LOS ANGELES BUILDING D DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. FOR APPLICANT TO FILL IN DIS��YTTRIAACT�NOO. GROUP TYPE CONST. PROCESSED BY (PRINT OR TYPE ONLY) J 'U17- BUILDING 5Zo- � A /�v� STATISTICAL Cu IFICAT10N SEWER MAP ADDRESS CLASS NO. DWELL.UNITS BK PG LOT NO. BLOCK USE ZONE MAP /� ` N0. TRACT /T J CONDITIOAL NS SIZE OF LOT S6 /L X 11 7� NOW ON LOT Z USE OF Lr,�e� EXISTING BLDG. DWbW fib- ,AB� BLDG. SETBACK FROM TEL. ! EXISTING PINE =(ST TAL) OWNER Cl��9 $• �f�C��Oh) NO. `].B7"'3 r7,6TYPE OF SETBACK HIGHWAY + YARD OT ADDRESS 5 03 CAA(0-tI AVE IA HIGHWAY WIDTH FROM C.L. CITY TE-MpL-l_= crrke + _ ARCHITECT OR TEL. BLDG.SETBACK FROM (STREET) ENGINEER N0. SIDE PROP. LINE OF TYPE OF EXtST14 SETBACK HIGHWAY + YARD TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + _ } CONTRACTOR NO. CL ADDRESS NO CORNER CUTOFF YES ❑ i.m0 ❑ 0 CITY L CLASS SEE EVERSE SIDE FOR SPECIAL APPROVALS I0 - CONSTRUCTION LENDER NAME AND BRANCH i LTi ADDRESS Z SQ. FT. NO. OF NO. OF SIZE t6o STORIES t FAMILIES NEW ❑ USE OF �,�gA_'& ADD STRUCTURE ❑ ALTER REPAIR ❑ f a SIGNATURE OFDEMOL ❑ APPLICANT + �►n VALUATION C/d I 4VAPPROVALS DATE III MSP Ton's 814MATURE FP.0 PMT EE $ FEES �� -O FOUNDATION: LOCATION F IALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS, AHD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCGAS VENT nUCTS - TION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I l WILL NOTEM PLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. (s• OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATIONINSURANCE. LATH, EXT. V SIGNATURE OF HOUSE NUMBER CORRECT PERMITTEE 2AA4= AND POSTED ADDRES ow-eFINAL JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. V.O. CASH LK 1 —PERMIT &T?ATICIN p c*j ->,010�sq 1(91Z� ❑ WORKERS'COMPENSATION DECLARATION afflrm that I have a certificate .of consent to self r Insure, br a certl7lcate of Worker' Compensation Insurance, A P�L I CAT I O N F Q R BU I L D I N C P�RM I T or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS•ANGELES BUILDING AND SAFETY Policy No. Company BLIILOLNG Certlfled-copy Is hereby furnished. FOR APPLICANT TO FILL IN sppR 6 03 CAMKU4 A OCertified copy Is filed with the bounty building Inspec- BUILDING . tion department. ADDRfsS CA ROR Date Applicant CITY ZIP ( � 9 O LOCALITY CERTIFICATE OF EXE&u FTI.ON FROM WORKERS' NO. OF BL.DGS. tEAMT OF Lor COMPEN,SATIgN INSURANCE siz> (I Now ON LOT ST. (This section need not be completed if the permit Is for one '# ASSESSOR hundred dollars ($100)or leu.) TRACT BLOCK LOT NO. MNP BOOK PAGE PARCH I certify that In the performance of the work for which this OWNER k WM USE NO permit Is Issued, I shall not employ any person in any manner A BIONS so as to m subject to the Work Compe t (j O j ' Z_ CITY ZIP Q C� Dots Applicant NOTICE T APPLICANT: If, after Ing this Certlfl a of Ak rrECT OR Ta- DISTR1Ci 1YPE ARE BY Exemption, ybu should become subject to the Workers' NffR 1V0 OONST. ZOIE Compensation provisions of the Labor Code, you must forth- ADDRESS �" Rte/ t/ with comply with such provisions or this permit shall be TEL- _ deemed revoked. CONTRACTOR 1J0. _ STATISTICAL CLASSi TION APT. LICENSED CONTRACTORS DECLARATION , Ix CLASS NO. DWELL uNTfS I hereby affirm Shat I am licensed under provlslor'a of Chapter 9 ADDRESS NO. SEINER MAP (cornmerdng with Section 7000)of Division 3 of the Business and Lr— Professions Code, and my license Is In full force and effect. CITY CLASS BX_ PG VALMAMN SD. Ff. NO. OF NO. OF CI-EOC License Number LIc.Class SaZE ISTORES FAMIUES ONE, NIEV VAL T}ON d Contractor Date DESMPTION OF WORK ADD I am exempt under Sec. 1" To Htn,-c, TER , BAP.C. for this reason 4UAIR : USE OF Sh! Date: XISTING BLDG. DEhhO` 1 0 3 3 A Signature APPLK-ANT TQ FINAL W ONER-BUILDER DECLARATION : PRINT V DATE r #'0'0 •'e o,1 I hereby affirm that I am exempt from the Conhocto;'s License Law for the following reason (Section 7031_.5, Buslness and ADDRESS FIN Professions Code): by I • 0 6 63 BUILDING b'.�6 3 T5 I, as owner of the property, or my employe" with ADDRESS � o 0 wages as their sole compensation,will do the work and I, the structure Is not Intended or Qffpred for-sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL I, as owner of the o am exclusive) contrnctin l with llcersed contrators to construct the project (Sec- \ OR tion 7044, Buslness and Professlons Code}. ADDRESS CONSTRUCT}ON LENDING AGENCY YARD FLVY1 T �' 1 .�',J .1 �:` `•` t BACK PROP. UNE DTH ° . _>,J ?. I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit Is Issued P.L (Sec. 3097, Clv:C.)_ SIDE P.L. Lender's Name 3 Ref, i $ P.C. Fee$ Perm n Fee ' - Lender's Address I certify that I have read this application and'state that the Iseuano@ Fee ai �' LDMA P/C g above Information is corned. I agree to comply wkh all County InvepIgatt.Fee ordinances and State laws relating to building const-ructlon, Total Fee 63 LDMA Perm. R and hereby authorize representativee of this County to enter u on t e abdve-mentioned property far Inspection u o O I M RMM POR E001A. ATORY LANGUA04 I e of Applkant or J t Dah .