HomeMy Public PortalAbout6031 CAMELLIA AVE_Building__ APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKPITS COMPENSATION DECLARATION rOR APPLIGurr TO RL M BL VJ"4o ADOFtEBe y
I herby alarm that I have■certtitDate a consent to sen taus, OafM G�C L 1
or a cbrtiAcab a Workers'Compersedon Ineurams,or a owtHW 72
oopymereor(Seo.3800,Lab.C.) � - nP
� 19
P/ y c«np.n,rV k4r. SQE OF LOT NO.OF FA DOB MOW ON LOT Lv v 1
q1l G Sed ooPy is hereby fumYFwd TA"cT NEAA>�T CAoee ST.
�"Grttf ed copy Is filed With the county bukarg tupection BLOCK IAT NO. UBE ZONE YAP NO.
dWartment
ABeeBBOR YAP BOOK PAGE PARCEL
Date BPecv+L CONDfTIONS
CERTIFICATE Of FJIMMITION MOM WORKERS' Tri NO.
YEB
COMPENSATION va"XIIANCE va n4N 10M FT.OF SCHOOL?
(fhb section need not be complebd If the perm ft In for one hundred DCSTRICT GROUP CONST FitE ZOW EY
I certify that in the perkxTnance a the work,a v hloh this permit f � � //V� K
Is Issued, I shall not employ any person In any rtsnrsr so as tD oR ENOIr�i TEL_NO.
bsoome ard}ect to'the Y briaer'Compensation Law& S`Da3S n['.kL Cl_AaBIPICATION APT
DsW Applk7urt ADOrEBB CLA98 NO. OwB-L ukITL
NGMCa= TO APPLJCANT: If, after maldng this Cwttfioate of REOURED TOTAL SETBACK FROM EXIT
Exemption, you should beoome subject to the Workers' TE1- SETBACK 'MM HWY PROP LIE WIDTH
Compensation provisions of the Labor Code, you mut kx ttr*thFRONT
comply with suoh provisions or this permit shall be dsernedrerokod. A1513FUMOky
P L
LICENSED DECLARATION PDE S.
I hereby&Mrrn that I orn licensed under provisions a Chapter 8 Bre of M0. FAMILJES SEWERMAP S.
(convnertcft with Section 7000)a Division 3 a the Budneu and NEW SK PO c�p�y4
Profebiors Code,W)d my license Is In full lmcewA shoot ADD tlAa lu
LbKWW Number 1-1c.o.Clew
DEBCFdPTlON OF WORK Conbeotor Dab ALTER ❑ # 10
ElI am exempt under Sec. REPAIR El
B.&Ra for this reason DEMOL ❑ LDMA PIC e
Data UBE OF EXISTING BLDG URM
El-
f3lpna ur APPUCAW(PFWI) TEL.NO. L39A Perm e ACCT.❑ I. as owner a op
the property, or my ernployeee With wages as _._._
their sole oompensabor,Will do the work and the struchir Is 3M7
not Intended or offered for sale (Section 7044, Business andA,� i
PrOfeesiOrle Code.) T WLLT}EAPPUCAPrr OR Fund BOL M DOCUFMf FWCLEA FMZARDOLS WArEIVAL ."l. 1 lTu nr
❑ 1, m owner a the am Axd � OR A rornrs CONVJN+o A FMZArUOUe IMSDifAL EQUAL TO OR�0MR TFMM C
property, qty TFC AMOLWM ePEOlM ON TFE FMZARDOUS 4grO A 06CANAMIN cion t�tAL I > TOTAL 8F 5 8 .91
tkwsed oontaoton to Construct the pr*ect,(Section 7044, yes❑ Ho❑ r.r�
Butness and Prcfeseicns Code.) LrrL K- •
- WILL TF!MDG®U!OF THE real.r M R@YY THE APRJrJMr OR FUn1F!A.Tyra '0
OOCU ANT FROI WIr A PM41KT FOR OOHeTRLVION OR IrODMOC110M FRCM THE SOUTH �yy
CONSTRUCTION LENDMTiG AGENCY COWT Ali OIUALFY MAAMaB�rT DWrFACT PCAGAM4 ere Psarrr+o CFINCKUST ( � .. .00
FOR a IDE 24
I hereby dfirm that there Is a coneftixAlon lard ng agency for Yee❑ No❑
the perbrrr wm of the work for which this puxnti#t 18"Ad(sec
3087,CM.C.). I FW9WMn M �FM T,I UN s WA)Md sf'or+rAloM awAND rue eCano -
Qp �� al APT9h1°"e ' 'UNDER, ti LOANGELESB O�GD�OID1 3`/27/90
d Landers Name FMZARDOUS MKMRLALS REPORTING Aro FOR Off"MNq A P WOMT FROM TM sacro. � � 9718 1 AI I 9:14
Lenders Address
- 01�OIANfi
it
Inf lon is oorrctly�comply with ell county RC FEE Pt3RIG7 Ftp
ondlnrces and State lows relath to balldfnq cDnatruc5on,and I •�
Of this County to enter upon MANCE FI
hapection purposes-
F utvBSTraATroN FEE ro-oti.FEE
WE FEVMW POR OPLAMATORY L.SIOrsraa