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HomeMy Public PortalAbout6033 CAMELLIA AVE_Building__ n1 7BAD3EA CK fay IREV.e/7e) APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILD 0 3 3 FOR APPLICANT TO FILL IN 4.) BUILDING ADDRESS LOCALITY / NEAREST CITY ZIP Q2055 Sf. NO.OF BLDG5. ASSESSOR SIZE OF LOT' NOW ON LOT MAP BOOK PAGE PA DLSTF,+-7 GROUP TYPE FIRE TRACT EC L`6 Toy a CONST:, J E q;m�, OWNER C NO. - V y� STATISTKAL CLASSIFICATION ER MAP ADD /r' CLAM NO. DWELL UNITS as CITY L C zip ARCHITECT OR TEL VALUATION $ �'� ENGINEER NO. ADDRESS B.LDG.SMACY FROM TEL FRONT PROP.LINE OF (STREET) CONTRACTOR NO. TOTAL SETBACK FROM TYPE OF EXISTING LIC. HIGHWAY + YARD FRONT PROP.'LINE HIGHWAY WIDTH ADDRESS NO_ UC + CITY CLASS CONSTRUCTION LBJD6i BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP. TI UNE OF IST RE E HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.UNE HIGHWAY WIDTI+ C SO.FT. .OF NO.OF CHECK + V SIZE I STORIES FAMILIES ONE DESCRIPTION OF WORK NEW P.C-Fee$ Permfi Fee DD luuarxe Fee. ALTER s REPAIR Total Fee..USE Of EXISTING BLDG. APPLICANT TEL (PR]NT) ,' G BY)SIGNATURE] I HERBY AOQJOWLEDGE THAT I HAVE READ TIQN AND STATE THAT TH ABOVE IS OORREC7 AND AGREE TO Y WITH ALL ORDNNANCES AND LA RL-GiLATI NG BUILDWG CONSTRUCTION,I CERTIFY THAT IN DOING THE �{ WORK AUTHORIZED HERESY TE WILL NOT U4PLOY ANY PERSON WIO VIOLATION OF 31 QI 7 A THE LABOR CODE OF THE STAOF CAUFO-RN A IN RELATII,tG TO M'ORKMEN PB•SATK>N INSURANCE SIGNATURE OF 2 0•o'� �.O Q PERMITTEE ADDRESS 0 0 0 1 .Q-0 0 FI CITY O. ,03,09-79 E fAA NOP sC OO SPECIAL coN mONs H NAL BY DATE Cri — /S' 75 WORKERS' COMPENSATION DECLARATION hereby affirm that.I have a certificate of consent cane _ .APPLICAT_ ION. ,F. -,R BUILDING PERMIT Insure, or a certificate of Workers' Compensation Insurance,,, or a certified copy thereof (Sec. 3800, Lab. C.) - Pollty No �0 Company S ' COUNTY OF LOS ANGELES BUILDING AND SAFETY a Certified copy Is hereby furnished. FOR APPLICANT TO FILL INADD 1tvG 3 3 G TL lJt N �► l�F, Certified copy In filed with the county building Inspec- BUILDING tion department.11iI artmen. ADDRESS CAN �u • Date —1 0 — ?Applicant �_Z k p%uw It.\ f(w Ctrl HPLx ZIP LOCAIJTY 10 1, CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON L Sr. (This sectlon need not be completed If the permit Is for no TRACT BLOCK LAT NO ASSESSOR PAGE PA hundred dollars ($100)or leas.) �7/ I certify that In the performance of the work for ch this CMe� is (2 NO. J 6- 163 USE rE NO. Permit Is Issued, I shall not employ any�erson In an manner (�ZZ .S lap`( �A�Q�t' �,�.}} �I SPECIAL to as to become subject to the Worker C rn n on Laws. ADDwmCONDITIONS , Cm SAN C 1 ` ZIP q 1-77 4 Dat. Applicant ARCtf rIECT OR TEL-' NOTICE TO APPLICANT: If, after making thl Certificate of NO DISTRICT GROUP TYPE FI RE BY Exemption, you should become subject the Workers' CONST , Compensation provisions of the Labor you moat forth- ADDRESS y (/ with comply with such provisions or permit shall be 6 deemed revoked. CONTRACTOR Z(S�lis?LziP%nJ ��� S Z� STATTSTICAL a SSIFK710N APT. LICENSED CONTRACTORS TION CLASS NO. l DVAa_L UNITS 3Se Ul►U.�`� V NO. 5 O p a t SEWER MAPlw I hereby affirm that I am licensed u provisions of Chapter 9 ADDRESS.�1 O 1 (commendng with Section 7000)of bion 3 of the Busing and o / LIC PG. 1 3 VALIDATION Professions Code,and my Ipt.. In full force and effect. CITY rL M ti�T� 1 , /3 l CLASS 1 S b► 7 SIIZZE� 11 d STS NO. j License Number Llc.CI Contractor �+ ��U L sa► L �� ONE VALUATION DESCRIPTION of woRtc "H" /� A ; I am exempt under ��-!I D L f T� \ P, �"� 1 ALTER B.dP.C. for thls n o 6' 6 rib C R REPAIR = 2.0 5 Q 8 A USE OF Date: EXISTING BLDG. DEVOL • o o • os1 Signatu;ATEIR-BUILDER APPLH".s,Nr TEL ""'� — ---g� I •'� 6 0,5 0 DECLARATION PRI 40' DATE I herty afflI am exempt from the Contractor's License Law {ar the ollowing reason,(Sectlon 7031.5, Business and R • . o6Q5©6 Professions Code): RMI BUILDING I, as owner of the property, or my employees with ADDRESS 0 9,,0 2-'8 8 wages as thelr sole compensation,will do the work and the structure Is not Intended or offered for sale(Section LOCALITY 70644, Business and Professions Code}. MOVING TEL I, as owner of the property, am exclusively controcting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Cede) CONSTRUCTION LENDING AGENCY YARD HWY TCTA� . UP WI T}i I hereby affirm that there Is a construction lending agency for FRONT the performance of the work for which this permit Is Issued P.L. (Sec- 3097, Ov. C.). SIDE P.L. Lender's Name LDlr4A Ref. tT Lenders.Addren P.C. Fee>< Perm It rye /� I certify that I have.read this licatlon and state that the Issuance Fee v P/C 1 g above Information Is correct. I to comply with all County InWatlgatlon Fee t-�} ordinan and State laws lati to building construction, T�1 F>. l J(J LDAM perm � R and her by authorize repr nt vases of this County to enter upon boo entl rty Inspection purposes5.A,"U 4--77 3t�+� M W1,11111115111P01111D�LANATO"LANG %� _ nature of Appikant or,#Ipnt Dote ►�n n /� /r '* �� /+ 1 AL APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKEITS COMPEMSATtON DECLARATION FOR APPLr—#lf r TO 1RLL N BuXDM Awe I hereby attlml that I have a certHfcels of oonwd to sett Mire, or a oertfffcste of Workers'Compenaarion Insurance,or a oertI led copy thereof(Sam 3900.Lab.C.) nz aP comS�OF LOT NO.OF Ell NOW ON LOT p Dopy Is hereby NEAREST MOSS ST. copy Is fled with the county lxj* ng hupectlon BLOCK LOT NO USE ZONE YAP NO. A1AP BOOK P0,13E PAACa SPECIAL COMDr7TON8 CERTIFICATE OF FROM WORIEREr /y — TTS No. YES No COMPEPMATION DiSURANCE WrM N loco PT.OF ecrlooL? �ssese onneedor M be oompie6ed N the permit Is for one hundred ze T arta F�zorF BY I cert fy that In to peefOrmonce of the work for which this pwmtt 5-Or �3 r � /-F Is I..Ded, I shall not wnPbY any person.In Ery manner so as to [TBO�T OR Tu-NO. / , becoi I =A*ct io the Work"Compensntlon Laws. 1SPl-Un r i-CLAS&F)C40'ON APT Dale APPS ADDFdM CLAW NO DWELL UNITS NOTICE TO APAJQ" . H, after mekhq this Cwtffioate of FtEQUFtE) TOTAL SETBACK FFIOM EXrST Exemption, you should become subject to the Workers' TEL NO. !J SET BACK 1bwD I IVw PPODP UNE wnm}I Compensation provisions of the Labor Code,you must forthwRh 7 FRONT oornpty wtth such provWons or this perm It stsl be deemed TewAVad. P L LICENSED DECLARATION PPL S I hereby affirm that I em Ilcensed under provisions of Ch&ptsr 9 STORES No. FAItJ 8L�YAP oc (commencing with Section 7000)of Mislon 3 of the Buskiess andP40NEW BK PG Professions Code,and my Ilam Is In Tull force and aflsot- , tis LJcwnss Number Lb.Ctass of WORK ADD Contractor Delle ALTER 7❑ # �� Z ❑ I am exempt under Svc. REPAIR ❑ R&RC.for this reason DEMOL ElLDYA P/C 0 Dab& USE Of EXOTM BLDG uRM ❑ ..3307 853-91 Signature APPLICANT ffd T) T13 NO. LDYA Form 0 1 ITEMS ❑ I, as owner of the propertX or my employees with wages. thatr sole oorrpansation,w9l do the work and the Struohue is ADOREBS —TOTAL -- 858 .9 1 not Intended or offered for axle (Secdon 7044, Business and mm+ �vNIS 91 CHECK F-1 I, d owner Of the property, am exdlsFveiy conttracttng wtth Protessions Code.) ws.L T FEAPM"Nr OR FUTURE MEDM D�Frr FMXN A wvAraOLe Ii4EiAL OctORA LECrU E OONMUM 10 A HAZAFEOUB MAMUL EQUAL TO OR OFEIQ�1 THAN LR THE AWIGuNTs aeorCD ON THE HAZAFKOUe W07R/LLd af'OFOACION GUIDE? MAL > �# ■ ketwed corrtnoton to construct the Wood.(Seotion 7044, w❑ Ho❑ Bustriess and Professions Code.) OUILDPQ ywYLs��hE O &=r.rrX EA 01 FORS■00 TMUCTIOTM Y0Dr10AaXN I APPLJCAKr 01q�TFCSCUM L/ '�J CONSTRUCTION LENDM AGENCY GOAU AM QUALM WaQ15rr DFnTtaoT MONOL"SER malar Tr1 3/'3/'-)7/%R 9:14 FBF,a�� I 9715' f AL1 hereby dlfrm that there Is a corat uation lending agency for yes El Fp❑ the performs ce of the work for which tris penult Is Issued(Sea i Hqffl FEAD TFN FAMFOOLIe MATMALS 9V0F%Wn0 F artoe AND Tse SDACM 3087,Ctv C). ou0Q1T.i uroussTafo W rEawsvrrs ulama THO LOS ANOaLaa Lenders Name HAZARDD01A W a.LS FFOR'T i0A D FOR COWUN Ja A PeraT Landers Address C W an Arra I certffy that I have reed this spp6catbon and state that the above P FSE P F� Information Is correct- I &gree to compty with al county r and StRW lame nkat tp bukHrQ corsLvction,and tris County to ant4r upon I89U N(,E FEE Irapection Pu .ee r R5%%07,91VI .- Ir,vEBTtc10a-I0N r$ T'O"W_FEE AMW Dr AE FIEVISIM FOR EXPLANATORY LAltG"=.