HomeMy Public PortalAbout5715 CAMELLIA AVE_Building__ A
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APPLICATION FOR BUILDING PERMIT
-COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN ADDRESS /ING57
ADDRESS LOCALITY
NEAREST
CITY —Mlzip CROSS ST.
NO,
OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICL' GROUP"I,TYPE HRE
TRACT BLCK7C LOT NO. �� CONST 13 ZOfJE -
OWNER ,Y
STATISTICAL CLASS]RCATIONPG SEWBKER MAP
ADDRESS /— �I
Clg55NO. DWELL UNITS Lc
O ZIP 00-790
ARCHITECT OR Ta- VALUATION D Q O
ENGINEER NO.
.ADDRESS BLDG.SETBAO(FROM
TEL FIRdNT PROP.UNI=OF--44
CONTRACTOR NO. D TOTAL SETBACK FROM TYPE OF EXISTING .
LIC HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS NO. O + 20 - d W/�
LIG � /
CITY CLASS BLDG.SETBACK FROM
CONSTRUCTION UBjIJfR SIDE PROP.LINt OF (STREET)
NAME AND BRAN(}(
HIGHWAY + YARD - TOTAL SETBACK FROM I TYPE Of EXISTING
ADDRESS CITY SIDE PROP.LINE 1HIGHWAYI WIDTH-.
SQ. NO.OF NO.OF CHECK +
SI ZE STORIES FAM(U ES ONE
USE ZONE MAP 9 O�
DESCRIPT}ON OF WORK (oi NEW r� �' O�
ADD n 03r1D,f(MONS
ALTER RNAL r n BY _
REPAIR DATE
USE OF DEMOL
EXISTING BLDG. . _
APPLICANT TEL
(PRINT) NO. `
BY(SIGNATUREI 7
IHERBY A004DWLEDGE THAT I HAVE READ TWS APPUG+TIO-N ATE .
THAT THE ABOVE IS CC�AND AGREE TO COMPLY WITH ALL ORDINANCES.
AND LAWS RECD TING BULDING CONSTRDCTION.I CERTIFY THAT IN COTHE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PEZON IN VKXATK)N OF
THE LABOR CODE OF THE STATE OF CAUFORNIA IN RELATING TO WORKMEN'S COM _ - - ' ;9 0 '1 6,9 A
PENSATK)N INSURANCE.'
o 0 0•e o
SIGNATURE OF 2,1
PERMITTEE 2 e - 5200
ADDRESS
TEL . . 5200.6
'
CTY NO 0 Q 0.2-8-0
P.C. Fee$ Permit Fee >
Issuance Fee
Total Fee
irWOKR$'COMPENSATON DECLARATIONntreboet �
-N FOR BlJILDING PERMIT
cRrote ;� f wa �o ,aa ro APPLICATIO
.
Or a certl 3800,lab. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy N
State Fund
G wed. FOR APPLICANT TO FILL IN �'AD n71 5 N Camellia
Certified copy Is filed with the county building Inapec- BUILOI
tion deporfinent. 571 5 N. Camellia Temole City,- Ca. 917'80'
Date 8-2-8$' Applicant Q, crrr Temple City zip 91780 Locum
ffkiIHCKFE OF E)cEMPTION Rs' of LOT NOW QN PTOF
NO.
NEAREST Live Oak-
-COMPR4SATION INSURANCE SLZE
(This sectlon-need not be comleted If the permit is for one ASSESSORhundred dollars ($100)or less.. TRACT BLOCK LOT
PARCEL
,,Na MAP BOOK PA(3f
I certify that in t'I1e performance of the.'work for whlth this: Gtivr d SChOe l Z . ; 86-6623Nfa USE
NO. }
permit Is'Iwued, r steal I not employ any�iko,,n,In any manner 5715 N. Camellia SPEaAL CL'
to as to become wblept to the Workers Compensation Laws. - ADDRESS Ca. 91 7 8 0 mrnlTICta
CITY Temple City r ZJP
Dat: - Applrcanr ARCHITECT OR Te,
NOTICE To APPLIC !-if, after'making thlr.Cerrlficate df. NO DISTRICT TY�K � F�� BY
Exemption, you (should became'subject tothe Workers'Compensation provisions of the Labor Code, you must forth- ADDRESS
with comply with.such provislons or this permit shall.be R.WatpOn Cons- T� STATISTICAL CLASSIFICATION APT. fn
deemed revoked.- CONTRACTOR Ncl.9 9-$3 91 z
UCENSE D CONTRACTORS DECLARATION. 2053 Mi 1 an uc_ CASs NO. DWEU_ UNITS —`
I hereby affirm that I am Ilcq�d and r provisions of Chapter 9 ADDRESS NO.
(commencing with Section 7000)of DtvWpn 3 of the Business and LIC. B 2 5 MAP
Prof. on*Code,and my license b In full fora and effect. CITY .Pasadena,Ca. CLAM VAMAnON
FT* 1,1101.01Gly nse Number 3.2 6 7.2 5 uc.oma. STORIES ._ NQ ONE Bx Pc3
��ftactor R.Watson - Cons. 8-2-$8 DESal NoPwo4acFireplace earth ;�,, - $6,,5 0_00
quake damage repair_ ADD
I am'exempt under Sec ,
ALTER .
B.BP.C. for this reason r REPAIR f
USE OF DEMOL
Date: ExksnNG BLDG.
Sl9nature APPLICANT TEL FINAL
OWNER-BUILDER DECLARATION PRI _ �.
I hereby affirm that I-am exempt from the Controctors License
Law for the following reason (Section 7031.5, Buslnew and S FINAL
P.of code): . .- . -. . . . BUILDING'
.. . w 10 3 4,5,A
ti �_.
I, cis owner of the r or m em I with , 7,i . o o e o .o
�. Pr°Perp' Y' P aX� .. _ � �' � `t�`jl. •ti•#� . S�
wagerers i{ielr sole compensatlon,will do the work and 1 a Y
the structure Is not Intended or offered for sale(Section `� 1 'I�(. 'o 'a 8 7.3 8
1
_ 7044, BWlnea and Profess]ornCode� Ah0'VIN10 TEL
� } 2
I, as owner of the am excluilve(,contractln •= NO. '.o'o o 8 7,3 8 U
Pr . i Y g. ,
opq�ty, . ..
with Ilcertsed conirocTer� lo'ronstruct this Pcolect (Sec' --
tion 7044, Buslness and Prafeplons Code).. ADDRESS
SETBACI(FROM
coNSTRucrtoN LFND(NG AGENCY YARD HWYTOTAL PROP. LIRE
I hereby affirm that there u a conatrucNon lending oQbrxy for �p{17
the performance of the work for-whlch this permlt Is Issued P
(S*c 3097, Ov. C. ., SIDE
P:L
Lender's Nome -
. LDr1AA . I
$ P.C Fee j Permit I"
I,.ender's Address .
I orWtfy that I have rood this application'and state that.the lasuanu FN LDMA P/C/
46overnformatlon is correct. I agree to comply with all County Irtvwtpatlon Fee �. '• ti
$ ordinances and Skrh krws relating to building corudructloTt, Total Fee LDMAIPeim.'i -� 1
Q and hereby authorise roproaeotativgs of this County to enter'
u the above�rienti ed property for Inspection purposes_
8-2-88
o iter"V00 KM otnAruro*Y LuiauAfya ,
siprwhrr.of Imrrr
Date
or.