HomeMy Public PortalAbout6101 CAMELLIA AVE_Building__ i COUNTY OF LOS ANGELES' Page 1 of 2
DEPARTMENT OF PUBLIC WORKS
"'°"""°W" BUILDING AND SAFETY DIVISION
NOTICE TO PROPERTY OWNER
Dear Property Odvner:.
An application for a building permit has been submitted in your-name listing yourself as the
builder of the property improvements specified at (vlot
P P
(Property Address or Assessor Parcel)
We are providing you with an Owner-Builder Acknowledgement and Infon-nation Verification
Form to make you aware of your responsibilities and possible risk you may incur-by having this
permit issued in your name as the Owner-Builder.
We will not issue a building permit until you have read, initialed your understanding of each
provision, signed, and returned this form to us. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statement below to signify yqu understand or verify this
information.
1. 1 understand a frequent practice of unlicensed persons Is to have tha property owner obtaln an
'Owner-Builder building permit that erroneously Implies that the property owner Is providing his or
her own labor and material personally. 1, as an Owner-Builder, may be held liable and subject to
serious financial risk for any Injuries sustained by an unlicensed person and his or her employees
while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner-Builder and am aware of the remits of my insurance
coverage for injuries to workers on my property.
2, 1 understand building permfts'are not required to be signed by property owners unless they are
responsible for the construction and are not hiring a California licansed Contractor to assume this
responslblifty.
Ci _3. 1 understand as an'Owner-Builder'I am the responsible party of record on the permit I understand
that I may protect myself from potential financial risk by hiring a licensed Contractor and having the
permit filed in his or her name Instead of my own.
4. 1 understand Contractors are required by lawto be licensed and bonded In California and to Ilsttheir
license numbers on permits and contracts.
5. 1 understand If I employ or otherwise engage any pemon(s), other than Califomla Jicensed
Contractor(s), and the total value of my construction Is more than five hundred dollars ($500),
Including labor and materials, I may be considered an 'employer' under State and Federal law.
6. 1 understand If I am considered an'employer'under State and Federal law, 1 must register wfth the
State and Federal government, withhold payroll taxes, provide workers' compensation disability
Insurance,and contribute to unemployment compensation for each'employee.' I also understand
my failure to abide by these laws may subject me to serious financial risk.
A ROAD DEPT. PERM►T IS R"UIRED
FOR ANY MATERIAL STORAGE OR WORK
DONE IN THE ROAD RIGHT OF
79ACNAaX1.=6-," APPLICATION - FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF .COUNTY ENGINEE& ADDRESS
BUE[MING AND SAFETY DIVISION LOCAL
JOHN A. LAMSIE, COUNTY ENa►NYER NEAREST
_=CASSATT D. GRIFFIN Sur-r oil Rut . CROSS ST.
DISTRICT NO. I GROUP TYPE! PR S88ffil BY
FOR APPLICANT TO FILL IN
BUIL DIjj�11G SrATFSTtCAP
L C�.A"IFICATION SEWER MA
.ADDRESS .. - BK
- CLASS,NOL UN
LOT NO. - lBLOC NUMBER _d d - SH"iyA7Y'E 'YES. NO
TRACT. q U ZOIH SPECIAL
NO.OF BLD _ Y EE
81ZE CSF LOT r NOW ON LOT I -
U61E Orr
EXISTING BLDG b U LL I F`t C BOLDING - Exl
8 BACK YARD 'HWY STREET NAME WIDTH"
OWNER - - - - FRONT -
_ _ P.L. SCJ
.DDRESH -SIDE
L
CITY`t E C O. — INSPECTION.RECORD
ARCHITECT O TE
]ENGINEERi. 1/
AD DRES-S t-. A i A A N i
TE
CONTRACTOR - v' NO '
ADDRESS C S f r
DESCEIPMON OF WORK
-r
NEW AD . ALTER REPAIR DEMOLISH
8q. FT.. - NO. OF _ NO. OF
-SIZE S 6RIEB FAMILIES r-
U8E OFUCT'
URE C
SIGNATURE O
APPLIDANT
APPROVALS DATE IN.SPECTOR'H SANATURE
ADDRESS- l FOUNDATION: LOCATION
FORMS MATERIALS
VALUATION ; FRAY E: FIRE STOPS,
BRACING BOLTS. t7
PMT. FURNACE:
FEE.- LOCATION,
FE E�. FE ' a b GAS VENT DUCTS.
- '�
•I HEREBY ACKNOWLEDGE TH�kTHAVE}BEAD THIS AP- LAT19. INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND ,
t?AEE'TO COMPLY WITH ALL COUNTY ROINANCES AND - _
TH LAWS R OU TNG B IN ,C.ONSTRUCTION. LATH EX• Z
.SIGNATUREH UqE NUMBER C.OR�
PERMITTE RECT AND POSTED
ADDREEIR
CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER
PJAN.0 = VALIDATION Y,a cwrH PE MMT VA MAMQN CX, Y.O. CASH
0 .4.0,45 ;,,IAYi s_ n " 3 .00 ;
COUNTY OF LOS ANQELFi9 TE34PL3 CITY 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTRRATION/REPAIR
BUILDING AND SAF= / LAND DEVEIARM TEMPLE CITY CA 91780 BL 0508 0705240009
PHONE: (626) 285-0488 EXT:
LEX]AL ID: NO. OF CONST BUILDING ADDRESS:
TR: 13277 LT: 10 UN: .002 SQ. FT STORIES TYPE 6101 CAMELLIA AV
STRUC-=: 25 VN TEMP CA 917801734
ASSESSOR INFORMATION NUMBER: REAR&ST CRASS STREET:
5385-015-017 THOMAS PAGE: 596 CIRID: J2 LOCALITY: TILE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: =T-2 ON:
EEI.ST OCC CRP: 05/24/07 SR 05/18/08
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: F CODE:
ANOUSH, TSKENDERIAN - 10,000 /
6101 CAMELLIA AV
TF24P 917801734 FEES PAID DE9CRIP'i'lON OF WORK
RENDVE SIDING APPROK 200 S.F. REPLACE WITH STUCCO. R124DVE 4
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: REPLACE ROOF WITH 30 YR COMP. PLYWOOD ROOF WITH 1/2. OSB
APPLICANT: TEL. NO: _
8 4 M CONSTRUCTION (626) 534-5209- AA BIAG PEld,= ISSTTANCE 27.75
13904 C:ORAK ST. AC STRONG MOTION RFS ID 10000.00 VAL 1.00 SPECIAL CONDITIONS:
BALDWIN PARK 91706 D2 PERMIT W/O FFV-HC 10000.00 VAL 216.60
- TOTAL 7fmS 245.35
CONTRACTOR: TEL. NO: - APPROVALS BATE INSPECTOR S IC$AT URE
S 4 M CONSTRUCTION (626) 534-5209-
13904 CORAK STREET LIC. NO LOCATION AND SE `BACX9
BALDWIN PARK, CA 91706 891070 B
90IIS ENGINEER APPROVAL
ARCHITECT OR ENlGIvR'wR: TEL. NO: F'OUNuTTTTON/TRENCH FORMES
LIC. NO: SLAB UNDER FLOOR
RAISED r SED FLOOR FRAMING
MAP NO: SEWER MAP BOOX: PAGE: FIRS ZONE: C le: UNI)ERFLAOR INSULATION
150H269 3 01
FLOOR SEEKATHING
190. OF FAM'[LIE.A: DMh'iLLING UNITS: APT/COPD: STAT CLASS:
NO 21 ROOF SHEA\THING
SCHOOL WITHIN HA.ZARDOU9 SHEAR PANELS
AIR QUALITY: 1000 FEET MATE R IAL0
NO 80 NO FRAME INSPECTION
REQUTAID TOTAL SETBACK FROM F= T FIRE SPRJ2rKLZR HANGERS
SET BACK YARD: HWY: PROP T. WIDTH:
FRONT PL- IFHDIATIOH WF.HTRTIR STRIP
SIDE PL-
INTERIOR LATH DRYWALL
rrr=OR LATH
RATED FLAG CEIL ASSEM.
RATED WALL AS9E30JBT-
RATED SHAFTS OPRNIN S
T-BAR CEILINGS
LOT rlcaINAGF
REPORT ID: DPR261 R.00TE TO: BS0508 � cmf
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