HomeMy Public PortalAbout6035 CAMELLIA AVE_Building__ APPLICATION FOR-BUILDING , PERMIT
COUNTY OF LOS ANGELES BUILDING'AND SAFETY
WORKEWS COMPEN iATION DECLARATION POR APPLIqW TO FL1 W euaDtNG ADDFIM
I.herby affkm the I here■cwt'olb9 of ootieret to edf knife,
or■owdro.1.of wbrimn'eornperweb n Insunvce,or a oerttfled :j L
bopy tared p-3804,Lob.C.) 23P
Poicy No- ty IM OF Xr W.OF BLDW Mow ON LAT L
CmtHfed copy Is hereby h runlet d W.MVBT CF10w 8T.
Cs wwY copy.4 fbd with the County BLOp( LAT Na
USE ZONE MAP Na
APP rt NAP BOOK PA[iE PAFiCM SPBCLAL CONDI'KM
CiRT*7CATE OF FROM WOit R>t' TEL Na Y® NO
COi UMMTION PURR ANCE wtTtw 1000 FT ae ecrtooL r..
ADDRM
(This eedtion need not be gw0eled If the permit Is for one hundred AeroROIIP FwtE ZONE y .
dollars(S10D)or Lee.) 3
I oectlfy the'In the.perforTTl�nce o!the work for wtllotr lisle pemrFt tG /� a `
Is lepue�1 shell not employ wry'perva In any merner so se to APICH ECT OR B40MM TEL NO..
beoome eubieo to the VOiaerW Compwmdlcn Lt+we. uuuw KJ L CI_� Aar CONDO
Dai AppillCaflt_. ADOMBS CLAW Na T DWELL tftTB
NOTICE TO APPLICANT: tf, after makkV this CwHoste of PE06FIED TOTAL SETBACK FROU EXIST
Exemptlon, you. should become subject to the Workers' Co� OFl. SETBACK VM HWY PROP LINE w1DTH
Corn penettkm prWelorw d the Labor Code, you must*xttrwfth FRONT
oompty with such Rrovfelone or this permh shat be deemed 7evokacL14 Na PL .
Lbl: I aED CONTRACTORS DECLARATION >� PLE
I hereby i dM nn.the I wn.Fklerleed under provNionsor 9 eEwst AAP
.'(oorrtr6wwkrp wfth 8ecdori-AM of Division 3 d tta.E3Lr�reeaward No
Proleeeions Coda a(?d my icsrw M In fulIforce andgffecL NEW BK PO
PTION OF WORK �
)_Icww Nuriber Lia.CW" ADDq Mo
Corireolor Date ALTER ❑
El w exempt under sea I.REMR El
8.8P.C.for Mis reason DEMOL ❑ LbNA + .,
Do LSE OF E?QBTNO FA DG URM. ❑
1
sipneu ro (PHf f�
Ta-No. L13MA Penn�
- ACC 4T.T
D 4 se owner of the pix or my empfoyeee wkh vx*o ar
t wir sole oompen.atlorl,wnl do the work and.the mtuctLm V — 3347 858.91
ra
t hUnded or offered for sale (8ec5on 7044, Business and 4A. {
Pr'oleerOfle Code.) WLLTri APRXAHT OR RnUFW KA MOOMFO fT FWax3A HAZAFD 1L4WAn MAL _ � -- - L ITEMS
Ort A IIXnIw OONMUNM A FvzAFDoLA mAnFL4L nouAL To OR his THAN.
4 se.owner of the,propertX am exghretvey OOnUaodrig v fth TFE MKXKM 0e3aM ON THK+KZAFDOUe GUIDE? MpL n > T4lk- 35.8-91
kaved- oonhectors to =wbtat the Wood.(8eotlon 7044, w❑ rro❑
Bu*nw -and Pro$-Worw C-i&) CHECK 8%.91
wLL"srreoeD USE Of THE At•DM er YFE APNJO T OR RJMM OUL DRA
OCCLFMNT FEOIeC A P6efr FOR CON STR OT10N oR iKxJrwxcn0N micim TFE QOUTH
CONSTRUCTION COAQAFQUALM WNAMMONT DUTFOCT PaAMO 901 PM%frrM CFMOQ Fr - L7a ■0N
I hereby afttrm the tfrere Is a conebuadon leeft-V+Qeray for Tm❑ ko❑
the pMiormarae of the work for wtdd this permit In Ilaued(sec. I.F mw gtAD THw Fw.AFslous wn AL s sffohAu N auv!Aro TN eoAolo �yyy��y�y i J /[y y
3007,Ctv.C.). Fwaffrr rGF OF�O�i I uNowwwo W I�i/frl LpMw TFr Los AN�m VI.FL'yR�Jy 000} /3/27f 70
Op COU rrCCur.TfRLt,CW.PMlM@eOTK*el.alooTHFAD ilJnM00NC✓warre - 9720 1 I'71 9:14
d I-ends Lorne FW.AFEaA MAMMALS RMCK eNQ MQ FOR OEWeeA A POWT FROM Tri OW"Al. - ..
L.e Kk0i Address
owpM aR err
o' I cer"the I here reed tt-a oppkabon end state that the above P.G.FEE- Pyr ..
Infomwflon is oorrect. I Bares to con]pty with all OmE ty
ordrwloes end 8b to Wn reidft to bLdMV const uali r.and
hereby auttartae of this County to enlar upon t9SUANCE FEE
a
0?V®l7O/Q10N FEE TOTAL FEE= ,
�. NO
MR REVWM POR t'WLAMATORY LA,«oUAOC.