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Home My Public Portal About5233 CAMELLIA AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES 04"L 1 C T E BUILDING WM. J. FOX. CHIEF ENGINEER PC -) 2.S* FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY -ADDRESS /O L7 /n / �� Y DISTRICT NO. PLAN CK.NO. PERMITNO. BUILDING T LOCALITY / t� RECEIVED BY DATE OF APPL. ,rDATEEIISSSUUED NEAREST �`"�-/�` CROSS ST. BUILDING OWNER ADDRESSMAIL /V ~ A3 3 DDRESS 2 LOCALITY Z NEAREST TEL. CROBS ST. CITY NO. FIRE NO.OF TYP •- GROUP ARCHITECT De TEL. ZONE •- PLANS ENGINEER vil NO. BLDG. ORD.NC. ADDRESS SETBACK LINE y0 / b /y �p APPROVED. � CONTRACTOR i EL. BY DATE o. E USE APPRO ADDRE ZONE BY DATE LEGAL CORRECTIONS _ DESCRIPTIONI y/L�OT NO. �O I BLOCK _ TRACT 1:51V J p Q 3 �'O OF SLOGS.�--- SIZE OF LOT S NOW ON LOT USE OF NO.OF NO.OF EXISTING BLDG. "�^- FAMILIES ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION D A REPAIR MOVING DEMOLISH O SQ.FT. NO.OF Z SIZE ROOMS STORIES y WALL OF r COVERING COVERING USE OF NEW BUILDING Ile Pc 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION;: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. /) FRAME: FIRE STOPS, SIGNATURE OF-� 0 BRACING,BOLTS PERMITTEE I � � LATH, INT. AUTHORIZED AOT LATH, EXT. 76A638A-3 7-49 $ Qv P.OPLASTER,INT. ��-(J 0 ll FEE .� IA FVV=AT dWo.ION �L r FEE , Q<r ' rFINAL ADDREIBS BUILDING _ APPLICATION LOCALITY I DIVISION OF BUILDING AND SAFETY NEAREST +Z CROSS ST. Department of County Engineer DIS7T NO. RECEIPT NO. PERMIT NO. County of Los Angeles S WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISSUED CASSATT D. GRIFFIN, SUPT Or BUILDING / FOB APPLICANT TO FILL IN TYPE CONST. RECEIVED BY ISSUED BY OWNER L MAP STATE MAIL �7 1. NUMBER /(" HYNO '�� W ADDRESS I�9E ZqNE SPECIAL TEL. CONDITIONS CITY V NO J" r ARCHITECT OR TEL. ENGINEER NO. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS FRONT CONTRACTOR NO. —_._ 51DE P. L. ADDRESS DATE CORRECTIONS INSPECTOR BUILDING ADDRESS y / Li ejw LOT NO. / BLOCK /I TRACT r'- X NO.OF BLDGS. SIZE OF LOT �/ / NOW ON LOT USE OF FXIRTING BLDG. DESCRIPTION OF WORK a NEW ADD ALTER REPAIR DEMOLISH Z SO. FT. NO. OF / NO.OF D SIZE STORIES / FAMILIES r UBE OF TUR NO. OF EMPLOYEES 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN 19 APPROVALS INSPECTOR'S SIGNATURE DATE CORRECT. IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION ` AND STATE LAWS RE ULATING BUILDING CONSTRUCTION. FORMS,MATERIALS FRAME: FIRE STOPS, - SIGNATURE OF SPACING, BOLTS PERMITTEE' FURNACE: LOCATION, GAS VENT,DUCTS ADDRESS LATH, INT. AUTHORIZED AOT. LATH, EXT. FEE HOUSE NUMBER COR- 4 ///J/� /� RECT AND POSTED VALUATION v �G..L �r FINAL LI FEE 76A638A DBS 3 Ob 5-54 WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to elf APPLICATION F O R YLDING PERMIT sure, or a certificate of Workers'Comp nstion Insura e, r certifjgd�y h reof (Sec. 3800, La ) COUNTY OF LOS ANGELEBUILDING AND SAFETY l i c P/3d// "�,�,, y Certified coBUILDING py is ereby furnished. _j FOR APPLICANT TO FILL IN ADDRESS c Certified copy is filed with the county building inspec- BUILDING Cr tion department. ADDRESS k 0 LOCALITY ` NEAREST ate_ —Applicant CITY C ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM W KERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL his section need not be completed if the permit is for one USE ZONE MAP undred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. >_ TEL. ECTAL certify that in the performance of the work for which this OWNER (,�`^� NO. ONDITIONS 0 STRICT GROUP TYPE FIRE C CONST. Cg ermit is issued, I shall not employ any person in any manner ADDRESS �� / Z D BY o as to become subject to the Workers'Compensation Laws. CITY J (�1��-e ZIP )ate Applicant STATISTICAL CLASSIFICATION APT. CONDO. u ARCHITECT OR TEL. JOTICE TO APPLICANT: If, after making this Certificate of LU xemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS H .ompensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP vith comply with such provisions or this permit shall be leemed revoked. //\\ NOTEL. �Ul V 1� CONTRACTOR � 1. BK PG VALIDATION 1 . I LICENSED CONTRACTORS DECLARATION LIC. hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION commencing with Section 7000)of Division 3 of the Business and LIC. 'rofessions Code, and my license is in full force and effect. CITY J.. CLASS $ SQ. FT. NO. OF NO. OF CHECK icense Number –1 Li .Class 1+ SIZE STORIES FAMILIES ONE A44Q DESCRIPTION OF WORK ` e NEW $ :ontractor A&4–Ate �—(" ADD ] Iam exempt fr4m the licensing requirements as I am aYCC licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, {` DATE Business and Professions Code). USE OF �1 REPAIR s EXISTING BLDG. J DEMOL E] By ic.or Reg. No. Date APPLICANT TEL OWNER-BUILDER DECLARATION (PRINT) L (� NO. L(3 j/��j hereby affirm that I am exempt from the Contractor's License r aw for the following reason (Section 7031.5, Business and ADDRESS cA 'rofessions Code): PRESENTBUILDING J l I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 2 9 9, 1 A 7044, Business and Professions Code). MOVING TEL. I, as owner of the Pro property, am exclusively contracting CONTRACTOR NO. # • • • • • 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2 • 1 1 5 Q EInvestigation TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for • • 1 1 5 0 0 he performance of the work for which this permit is issued Sec. 3097, Civ. C.). 0 2.18-82 ender's Name ender's Address $ Permit Fee O _( certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County ee rdinances and State laws relating to building construction, Total Fee I nd hereby authorize representatives of this County to enter ipon the abov -mentioned property for inspection purposes. L — 1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature dV App icant or Agent Dote ®s