HomeMy Public PortalAbout5932 CAMELLIA AVE_Building__ 70A838A CE 0803 1/71 / �
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT 'OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING p
ADDRESS 6 3 Z-
COLEMAN W. JENKINS, BUP'T OF BYILDINO LOCALITY
F�ORA,PPLTCANT TO FILL IN NEAREST W d p YJ V
(PrI6"tvoe only) CROSS ST.
D TRICT GROUP TYPE "MAP
BUILDING f O CONST ADDRESS / STICAL CLASSIFICATION LOT NO. BLOCK CLASS NO DWELL,UNITS
TRACT 6 USE ZONE MAP O 7
NO.OF BLOGS, y� _ NO.
SIZE OF LOT NOW ON LOT Z /t SPECIAL .
USE OF CONDITIONS
EXISTING BLDG. '
TEL
OWNER NO. BLDG.SETBACK FROM I �J
ADDRESSeff
% FRONT PROP.LINE OF' ,
L L - TSTREET)
TYPE Of EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY HIGHWAY WIDTH FROM C.L.
ARCHITECT OR TEL.
+ l _
ENGINEER NO, BLDG.SETBACK FROM
ADDRESS SIDE PROP.LINE OF (STREET)
TEL. TYPE OF MX13TI NG SETBACK HIGHWAY + YARD = TOTAL
CONTRACTOR E, NO. HIGHWAY WIDTH FROM CA_
ADDRESS .f LO A.S^+r/Cr' + = Ckz
,}•.
LIC.
CITY / CLASS CORNER CUTOFF YES ❑ NO ❑
CONSTRLtCTIOWLENOER Ia
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SQ. FT. NO. OF NO. OF Nay ED STORIES FAMILIES
USE OF 0
Q� 01060 ADD ❑
STRUCTURE /"
A TER ❑
PAIR❑
SI NATURE OF
APPLICANT DEMOL ❑
VALUATIONS D APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATIONI LOCATION
FEE f FEE f � ? FORMS MATERIALS
FRAMEI FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND /TAT[ THAT THE ABOVE 12 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAW/ REGULATING BUILDING CON- GAS VENT, 4UCT9
STRUCTION. I CSRTI FYTHAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE .LATH, INT.
LABOR CODE OF THE STATE_,QF •CALIFORNIA IN RELATING TO
WORKMEN'E COMPS NSATIQy I A
F LATH, EXT,
I SIQNATURE OF- HOUSE NUMBER COR-
PE MITTEE RECT AND POSTED /If
ADDRESS FINAL
I
I JOHN F. LEWIS. PRIN IPAL STRUCTURALG EER
I. PLAN CHECK VALIDATION cK. M.o. cArsH _ PERMIT VALIDATION CK. M.O. CAGN '
2475+ X21 1 •D 9.00N
WORKERS'COMPENSATION DECLARATFON
Insure, orafficertr ottsofWorak&n'.Compe w onIntwrob: APPLICATION FOR BUILDING PERMIT
or a certtfled copy thereof Sec. 3800, Lab. C.)
Poll No6M,24Q `Company' S ;2"CoI-�a f D COUNTY OF LOS ANGELES BUILDING AND SAFETY
Certified copy Is hereby fumished. R APPLICANT TO FILL IN �gDORESS
❑ Certified copy Is filed with the county building Inapec- gUtLp{NG i
tion department. ADDRESS � ,, /� LOCALITY
NEAREST
Date /-F'3 Applicant �G'�iS CITY 7 E Cr7' ZIP CROSS Sr.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OFBLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 3 MAP BOOK PAGE PARCH
(This section need not be com feted If the permit Is for one TRACT USE ZONE
hundred dollars (;100)or less. BLOCK LOT NO.
l TEL SPECIAL >
I certify that In the performance of the work for which this �LW�� DivZ.(o NO. COtAMot"S a
permit Is Issued, I shall not employ any person In any manner ISTRI GROUP TYPE Z PROCESSED BY
so as to become subject to the Workers'Compensation Laws. 'DDRB 7S i1 CONST'
F'/ /710.
Date Appllcant L - . . CITY ffECT OR ZIP TEL STATISTKAL F
NOTICE TO APPLICANT: If, after making this Certificate of V
Exemption, you should become subject to the Workws ItEER NO. CLASS t DWELL UNITS CL
Compensatlon provlslons.pf the Labor Code,you must forth- ADS - SEWER MAP H
with comply with such provisions or this permlt shall be Z
deemed revoked. OONTRAC7 S QD 1CI�1 '- NO. 7t yy BK- PG, VALDATFON
LICENSED CONTRACTORS DECLARATION - /� p
I hereby affirm that I am Ilcensed-umlerpeovblonsaf Chapw 9 ADDRESS/-p O e,< 14 mUATIO N0.3�67s AL
(comendng with Section 7000)of Division 3 of the Business and NO N
Professions Code, and my license Is In full force and effect. CITY tc_ ay5S`
SQ. FI. p NO OF tJb. of r CFECY
License Number 7S u,Clm C-39 sig O D('� SlpRIES/ FAMIUEES ONE
y n NEW $
DESC3t1PfION OF WORK ❑
Contractor) S rl,�t�' Date 5 Rg3
❑ I am exempt under Sec $ �O -.2-�3 =- c'/ ADD - ❑
ALTER ❑ R NAL
B.BP.C_ for this reasonper'yJr—CA� REPAIR ❑ DATEU fQ`
USE of
oaSTING BLDG. Dfi1AOl. El �''`L- �'�}
Signature APPUCANT C
OWNER-BUILDER DECLARATION D /S' /WK NO. tY
I hergby affirm that I am exempt from the Contractors License
Law for the following reason (Section 7031,5, Business •'j q`(�a and .CJt OX ITL -/(�7f�NOA �'.f., / j
Professions Code): FRU&N I #t
OF O'o 0`0 1
ElBUILDING 2'o49. 88
I, w erty
owner of the prop , or my employees with ADORES
wages as their sole compensation,will do the work and
the structure Is not Intended or offered for sole(Section - LOCALITY �0 0 0 [� 9.',9'81
7044, Business and Professions Code)_. - ANG DNTRACrOR r L. '.050.9-83
4
❑ I, as owner of the property, am exclusively controolnq
with licensed contractors to construct the project (Sec-
Ilan 7044, Business and Professlons Code). ADDRESS _
CONSTRUCTION LENDING AGENCY gRJE7le YARD Itvw TOT yy , .
I hereby affirm that there Is a constructlon lending agency for FRONT
the performance of the work for which this permit Is Issued P.L
tSec. 3097, Cly. C.).
iAnder's Name
Lenders Address P.C. Fee$ Permit Fee
I certify thcrt'l have read this application and state that the I..FM d
above Information Is correct. I ogree to comply with.all County InwatlQatton FN �f
ordinances and Stag laws relating to building constructlon, Total FM fJ
and hereby authorize representatives of this County to enter
upon tt�p Ove m tloned property for Inspection purposes,
4a tetrvrlesa POR KMANATORY LAPOGUAGI
S4gnature of Appllcvnt or Agent Date