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HomeMy Public PortalAbout6029 CAMELLIA AVE_Building__ WORKERS'COMPENSATION DECLARATION hereby ,a APPLICATION �F O R BUILDING P E RM I T self : rocertificate ers that I have a certificate of consent Insure, or a certificate of Work ' Compensation lnwronce, �__ or a certified copy thereof (Sec. 3900, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No � � Company �'C' � �T.• sukDlNc ❑ Certified copy Is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Q2 ,4VFe— Certified copy Is filed with the county building Inspec- BUILDING '( l '1 tlon department. ADDRESS � -1 Q �+'�^H� -L L ) �►V Date Applicant �►ZA D@ll�l-QP£R3 1+�1 CITY plFi . Cr 4' zip LOG.Lm MPL� cr CERTIFICATE OF EXEMPTION FROM WORT EIZY NO.OF Sig OF LOT NOW ON L� NST. COMPENSATION INSURANCE (This sectlon,need not be completed tf the permit Is for hundred dollars (;100)or less.) TRACT LOT NO. MAP BOOK PAGETEL PARCH I certify that In tis• perfor�rwnc�'of the work for whl this � C O-n r. N�.�-�'t 163 USE ZONE NO, SPECIAL �1 permit is.laued; I shall not em loy'any person In any nner ADDRESS O 2 L S Q 1Z 4_ S Lw — COtDMONS so as to become subject to the Workers Compe n Laws. Cm 8 6.K3 <; la`s 5 l-. zip Ut Date Appl lcant NOTICE TO APPLICANT: if, after makl�rg this ificate of ARCHIn T NNOO TACT GROUP TYPE BY Exemption, you }hould become subject the Workeri �`�� �� CONST M ' Compensation provisions of the Labor Code you must forthADDRESS- with comply with such provisions or thl permit shall be 6 deemed revoked. CONTRACTOR A- U L n Ta 3 CP-27 STAnSnCAL CLASSI noN APT. tq LICENSED CONTRACTORS T)ON l2 CLASS NO.�L�L_,DWE1L UNITS I hereby affirm that I am Ilursed under isiors of Chapter 9 ADDRESS It O VAI+U.� tJO.�0 ZZ (tomrrps l g with Section 7000)of Div 3 of the Bushes and � SEWER M Profesalors Code, and my License b full force and effect. Cm0 01 CLASS' BK ! VALIDATION s V J �' LIc.Class SCI. IT. � M f OM NO.OF , C� I License Number S� w 1 ([ VALUATION Contractor Z A ✓"' t pQ}e DESCRIPT10N OF woRK r� ; I am exempt under N O U T 1 o N . �• I ADD B.BP.C, for this �"��' ALTER >j USE of REPaR 0 5&9 A D&e: D(IST1NG BLDG. Signature APPLK' Su,vk p,aR •� NCO. ri-n RKAL _O # e °.o v o .1 Oy $UILDER DECLARATION (PRDAT! I hereby affirm I am exempt from the Contractofs License I V�`L� �� r Z-0 Jl - -1- 60.50 Law for the foil Ing reason (Section 7031.5, Business and ADDRESS 19 Profeeslons PRESENT by ° ° .-.b Q 5 0 6 �j BUILDING jJ 1, as ner of the property, or my employee• with ADDRESS 0 9,.0 2�-8 8 as their sole compensation- will do the work and , the, ucture Is not Intended or offered for sale(Section LOCALITY 7044, Business and Professions Code}. MOVING Tri 1, as owner of the property, am exclusively contracting NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professlons Code CONSTRUCTION LENDING AGENCY BACK Y'� FWY uNE DTH I hereby affirm that there Is a construction lending agency for. FRONT the performance of the work for whlch this permlt Is Issued (Sec. 3097, Civ. C. SIDE P.L. Lenders Name L)AAA Ref. / 8 P.C Fee i Perm it Fee ' i Lenders Address I certify that L have read this application and state thqt the tseuance Fee LDMA P/CA o above Information isflarwt. I ogre*to comply with all County Invest4atL«r Fee ordinances and S relating to building construction, and reby authorl ntatives of this County to enter Total Fee IDMA Perm. I , 1 upo a bo tlo ed prop"for Inspection purposes. ell L of 29, 7 I �t�0 ✓(J RN.w Poe W-LAVATORY UUIIGL o I r �ilf�iL �}'� Jf4 Ugno un of Agent Dole e- i APPLICATION FOR BUILDING. PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORICE"COMPENSATION DECLARATION KM APDL ICAW To nLL IN Buslonra ADORI'98 sui No I hereby affirm that I have a oardkefe d consent to�inane, �— or a oerttM1oale of Nbnimrs'Compensobw Inou arK^or a corned oopy thereof(Sea 3500,Lab.C.) llp Eaf`O. Company Y OF NEAREST CROSB NO. BI DaS NOW ON LOT v Certified oopy Is hereby fumiei»d NO. copy Is Hied with the oounty bukkV TAT BLOpc LOT NO. UR MAP NO. Tt- DW � ASSE36M MM BOOK PAGE PARCa SPECL,L COND(TKM CMTIFICATE OF MMMPTION FROM WOMCdW TEL.ra YES NO COIIHE MATION INSURANCE 9ge wmiN Iwo Fr.OF ScFrooL7 (This section need not be corrrpbeted H the pernft le for one hundredXT aRC(p . 'loin douse 0100'or he p — � ,, / g" I certify that h the pariomirioa d the work for which this permit r (J.� t! K r ieaueCi, I siV -AN\ rdl nOt empioy any person in any manner o se b OR B GNEER Ta-NO. Tffl beoomd subject to the Wmiron'Compensation Laura. suKnw ICAL CLAM Fr.0-PON APT Deb Applicant APDRESS CLAM W. DWELL MTB NOTICE TO APPLICANT: if, -alter making this CartiHoste of REQUw® TOTAL SETBACK FROM EXISTExemption, you. should become subject to the Workers' CONTRACTOR �' SETBACK )%MHWY PROP LIE WIp7TH Cortrpersadbn provlsbrs d the Labor Code, you mut brthwfth 7 eFRONT compty with such provisions or th Is perm It shall be deemed Teroirod ADDREB9 LJQ NO. PL LICO r DECLARATION L SIDE PL I hereby aMr m that I am licensed under provisions d Chapter 9 tta� Na or sroREe No. FAYFALTME eta MAP oc (oommencft with S&cdm 7000)of Division 3 d the Bualnees and Protesslons Co*and my Dow"In In full force and effect Ucwaa Number LJa C$mn ❑ v , Contractor Date ❑ $❑ I am exempt under Sea ❑ EL P.C.for this reason LAM DEME ❑ OF oaenNo EM DG ,LDMA Pro. Data I .LIRM. ❑ ] . _ . sure APKJCANT(PRIMI) TEL NO. LDUA Perm ef T.A ❑ I, as owner of the propwty, or my employees wfth weges an - their sob compensation,MU do the work and the structure is ADORERS _.. 3307'. �■�1 not krisnded or offered for sale (Seaton 700A Business and "'A`DA 1 ITE? Pmommiors Code.) WLI THE APPLXANT OR PUTLFM HLADVQ OCCLF NT ri4DL.aA HAZAFIOUe VQaaAL . ❑ 1, as owner of the property. am T=k lv* contracting with O A�aP THE APIDOUS� sG0PamovAL a�a°Fm aulm THAN"" r7ML ay --TOTAL 858_$1 f awwd conbutors to oorstruot the projeot (Seotbon M", Yes❑ No❑ Business and Professions Code.) A I A CHECK &R■91 wLL TF&a1TED®UM OF TM BlLDNO BY M APRJGAblr OR KMW MADM . OCCU ONT ra'l]"A P6ifT FOR COMaTMUCTION OR PROP THR SOUTH a�/�y (Yt CONSTRUCTION LENDING ADENCY oOAaT An OUALTry uAra�rT DmrrmraT reonoM ho P +arn+o cracKLwT \.ca ., ■t-- FOn a Kx waw I hereby affirm that there Is a oorstructbn hndit egerwy for ys❑ No❑ the perkxnvuxe of the work for which this permit Is NwAd(Sea 3 3007,Ctv.C.). 'P,�rTm�E"'o°r,DOa�M„ �,S LOB� 0000-0001 ,�/ 7I90 HO Leeches Nene FAZACOUNPIwo)t a ms,R�oRTM AND rLID �Off"0ro AA PMFW rrROW 9717 1 AM 9:13 Lander.Address . o�OIArfT I cer"that I have reed thls eppkattim and state that the able P.C.FEE PER T FEE irrformarion Is correct I agree to oompfy with aA County ordinances and State laws reia&V buidtp com&uc fM and hereby represertattveo this Co"to enter upon UAX.L&ICE FEE O O the PmA�y - fP NVESTMATION Ftp TO-ML FEW D■■ SM REVEM POR EX LAAIATO"LAPOMWIN• i� 40 7eAe2eA Ct#.02.7-De APPLICATION FOR BUILDING PERMIT. 1 BUILDING AND SAFETY DWMION BUILDING 1Lt Of Ca—t7 ADDRESSD*parw CO>mty of IAS AngelM LOCALITY . JOHN A. LAMBIE. COUNTY ENGINxm NEAREST CAEQATT b. GRIFFIN, +ur'T OR BUILnims CROSS ST. APPISCANT O •T• DISTRICT NO. O TYPE rK MAPFOR COIN NST1 BUILDING ADDRESS O STATISTICAL CLASSIFICATION /V. D / BLOCK CLASS. NO DWL ELUNFTS-4e!)J LOT NO, MAPSTATE NUMBER Q © HWY YES NO TRACT S SE ZQNE SPECIAL - Q� NO.OF BLDGS. (! CONDITIONS SIZk OF LOTS (J NOW ON LOT USE OF EXISTING BLDG BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER FRONT MAIL' P. L ADDREM 4 SIRE r TEL P. L. NO INSPFrGTION RECORD ARCHITECT 16R TEL_ Q9GINEER NO. - ADDRESS T CONTRACTOR ADD "WA HO � - DESCM PTION OF WOSk NEW ADD TER REPAIR DEMOLISH SQ. FT. NO. OF NO.OF SIZE STORIES FAMiLIMS USM SiRUCTU APPROVALS B I G NATU APPLI �E j INSPECTOR'S516KATURE ADDR OFOUNDATION:LOCATION FORME MATERIALS s'.'e,yQO �—� P. C. s FRAME: FIRE SrOPQ. ' —BRACING. BOLTS VALUATION S FURNACE: LOCATION. FEE -17r Pd GAS VENT. DUCTS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINAN E8 AND LATH. EXT STATE LAWT��� D} qM. SIGNATURE4l� `Irr HOUSE NUMBER COR- PERMITT RECT AND POSTED ADDRESS— FINAL JOHN A.LAMBIE, COUNTY ENGINE>ERCLYDt N. DIRLAM P INCIFAL CT RAL ENGIN PLl1 a93= VAT.W TK'flt q(, Y.O. CAAH PEEICT VALIDATI OK. Y.O. CA1H TACO 41 6 5 MAR 27 1 A 1 2.0 0 m DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES BUILDING WM. J. FOX, cHtnr ENGINEER FOR APPLICANT TO FILL IN FOE FFICE USE ONLY :71 DI9TR�f NO. PLAN CK. NO. PERMIT NO. BUILDING ADDRESS REAR[VED BY DATY OF APPL. DATE ISSUED LOCALITY NEAREST CROSS ST, BUILDING / ADDRE" OWNER ngs MAIL LOCALITY ADDRESS 6QZ9 CAMAl I i A NICA REDT I TEL CROSS ST. d V F'c- CITYle City NO. FIR[ NO. OF TYPE ARCHITECT OR TEL ZONE FLANS �I✓/7"�.. ENGINEER NO. BLDG, ORD. NO. SETBACK LINE ADDRESS APPROVKD T' BY DAT[ CONTRACTOR NO, AT 6 1137 US[ APPROVED ZONE BY DATE ADDRp1 B HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. BLOCK MAP NUMBER (t _RI`_v" n CHECK BY TRACT NO. ASSIGNED BYE J �A NO. OF BLDG§. CORRECTIONS SIZE OF LOT NOW ON LOT UBE OF NO. OF U(ISTING ELDG. FAM I Uffs 1 DESCRIPTION OF WORK NEW ALTaRATION ADDITION 0 REPAIR DEMOLITION _A SQ. FT. NO. OF SIZE ROOMS 13TORIES Z EXT. WALL ROOF f I COVERING I COVERING USE OF STRUCTURE 1 APPROVALS INSPECTOR'S SIGNATURE DAT[ I HERESY ACKNOWLEDGE THAT 1 HAV[ READ THIS AP- FOUNDATION LOCATION FLICATION AND STAT= THAT THE INFORMATION GIVKN IS FORMS, MATERIALS CORK ECT, 1 AGREE TO COMPLY WITH TW CORRECTIONS USTED F'RAMEi FIRE STOPS, HKREON AND WITH ALL COUNTY ORDINANCES D STATS BRACING, SOLTQ LAW! REGULATING UILD G R rON. FURNACE. LOCATION, SIGNATURE OF nj .� GAS VENT, DUCTS 0. 'vr''� F[RMITT LATH, INT. ADDRESS- LATH, DDRpuTrl, ocT. AUTHORI7sn Aril. PLASTER, INT, 7awssaA• ossa 10-90 s P. C. S FRE �,� PLASTER, EXT. A VLUATION FEE FINAL f