HomeMy Public PortalAbout6139 CAMELLIA AVE_Building__ 76A638A CE*803 8-63 APPLICATION FOR BUILDING PERMIT LJ
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS .-
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST _/ f
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTRICT N GROUP I TYPE ''�'" -CESSED BY
FOR APPLICANT TO FILL IN �7 IF- CONST::
ADORE
IN / /y, G�/�JELL STATISTICAL CLASSIFICATION SEWER MA G
CLASS. NO. DWELL. UNITS
LOT NO. BLOCK WATER
CERTIFICATE: NOT REQUIRED RECEIVED
TRACT �/3/ �J 'JA MAP ,(q HIGHWAY
CLE) STATE MAJOR SECOND. OCA
SIZE OF LOT SO X /��/ NOW ON LOGS'"�'SE NO.•
USE ZONE SPECIAL
USE OF t n _ CONDITIONS
EXISTING BLDG. tSiDL CC^
���� TEL.
OWNER ,..� NO. BLrILDING EXIST.
SETBACK YARD HWY STREET NA WIDTH
ADDRESS 6'1,3 G L /A FRONT /
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P. L.
ADDRESS / Q
TEL. �
CONTRACTOR dW//CA NO 7' 1,1 O
u
ADDRESS C/¢/rIELL vIm
DESCRIPTION OF WORK R
Lu
dr CL
NEW D ALTER REPAIR DEMOLISH / {� Z
SQ. FT. �4 y NO. OF NAMIOF
SIZE �7 STORIES Cr... ' ES
USE OF�IQ/
STRUCTURE
SIGNATURE OF 7t 92 -
APPLICANT 017
VALUATIONS -
APPROVALS DATE IN O I NATUR
P.C. PMT. p� @D FOUNDATION: LOCATI - +.
FEE $ FEE S`l^~ FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. .---•^^'-"""'-'^*^'--
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT. P
gt
SIGNATUREOF I HOUSE NUMBER COR- _
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL ST TURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION( cK. M.D. CASH
I
Liiuo 5 3 7 9 OCT 2 n 1 D 8.00-
r
i /
DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING AND SAFETQ •;
BUILDINGCOUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER APPLICATION
• CASSATT D. GRIFFIN, SUPT OF BUILDING
FORAPPLICANTTO FILL IN FOR OFFICE USE ONLY
ADDRESS ! � ? DISTRICT NO. PLAN CK.OR REC.No. PER
.1. Calif -7170 7 6 �
LOCALITY Temple Ci t yg alRECEIVED BY DA OF APDL. DAT ISSU
NEAREST Garabaldi - Z 0 26
CROSS ST. o
BUILDING
ADDRESS
� OWNER Tomlee, TInc.MA IL t�
ADDRESS 9170 ,,. Las Tu.na.s Dr LOCALITY ��i
NEAREST
CITY Temple Clty, NoAF 7_3759 CROSS ST.
ARCHITECT OR TEL. FIRE NO. OF TYP GROUP
_ENGINEER NO. ZONE PLANS Z
BLDG. � / R
ADDRESS SETBACK LINE G-
TEL• USE APPROVED
CONTRACTOR Tom�lee, TIncr.���� N7O�.,,At 7-3759 ZONE _/ BY DATE
ADDRESS 9170 -il• Las ureas Dr. T. C. HOUSE NUMBE G
,-. -a NO. ASSIGNED BY
LEGAL MAP NUMBER ,9 ice-^ x
DESCRIPTION I LOT NO. BLOCK
TRACT 193138CORRECTIONS
NO. OF BLDGS.
SIZE OF LOT KQ v �_1 K I NOW ON LOT :?
USE OF I NO. OF
EXISTING BLDG. FAMILIES
DESCRIPTION OF WORN o -
NEW 11 ALTERATION ADDITION
REPAIR -I DEMOLITION "� D
r•
SQ. FT. NO. OF i
SIZE 1-095 ROOMS STORIES
EXT. WALL ROOF t,,
COVERING Stucco I COVERING CO>hp0 Shgl
USE OF STRUCTURE
Residence
20 x 20 achd f4arage
APPROVALS,
INSPECT)6RJS SIGNATURE DATE _
FOUNDATION: LOCATION .'
FORMS, MATERIALS t/
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT.
I AGREE TO COMPLY I ALL COUNTY O INANCES FURNACE: LOCATION,
AND STATE LAWS REGU G BUIL CO SUCTION. GAS VENT, DUCTS {
SIGNATURE
LATH, INT. / r
PERMITTEn
ADDRESS
J170 E. I.;6s Tunas Dr., T. C. LATH. EXT.
PLASTER, INT.
AUTHORIZED AGT.
= ��
FEE PLASTER, EXT.
// HOUSE NUMBER COR-
' ('// --Jt-� RECT AND POSTED
VALUATION OD FEE ----$----llll--Z-���-------�����, FINAL
L76A638A D893 9-52 ' o
WOkKERS'COMPENSATION'bECtARATTON
.hgreby affirm.that I have a,coOtflcate of consent tq self. 7 -_
Insure, br tertificate of Workers' Compensation Insuran4e, _- 'AP � l _ T• if ,�UIL�NC.• PERMIT ..
or a certified copy thbreof'(Sec'31M, Lab. C-)
4017NT�f of LQS'AMGF-mss �l!'LDI�Ia"i!►ND SAFEFY
PollcyNo. Company, -
'.Ceolried-eopy to hereby.furr4 hed. n'',�._ -. �' R i4P• ICAfQ. F LC ta- - ti•. Ao�RE�
W,
+ C.Wllfl`ed cdpy 1s�.1ed with tfie'counfy'bpllaltip•IrlsQec- BUILDING' _ f
Iron deP&4meiit".•
Appiladnt=' ' CITY ` IJP LOCALII Y
`{ CEI2TIFICATh OF EXEMPTION F1tG3M RS' �, BIEx,S N.EAREST._ ..___ _ . . .. . .. .
r 4 :!r.ti' COMOIEN5ATION I NSU '. i-'• - I Of LOT
Oli'secrtlon hW:-naT.'be'cotn'dleted if Th �pertnit1h for-
liars (iJ60)or fp :}} t ,' TZA0 BLOCK LOTi10. F PAGE PAPca
ta-f �er3tfy thot,Jn thi ah4g o Tf}° v+'4rk #gr wA, tKls ..�,�b_ Q MAP
Ug i
permIt li,hste� I aha,l hoTaJnooy any pbfsor In ally tnanndrr , y\ , -
ip as'to Eii'cotn6'iliblect to tha Woikers Comp�n 10,6'LaJw.' j ADDts55 ` mOr1s• t -
} +:' ",i+ :,, 77~p' 7 - <: it ?. '' 'T' •w .P\,t-,�'� �, \ •� 1 _ _ r VV
tJC>TtiCE`�O.'A 1 Vf after rhaklnQ this Certlft d•of- A'RO-1 rE ~ _ _, - t DI.S�CT GRQUP_ J,Yt?E - � : ._ FIRE, .By. i
E�eniptlbn"ryoU sh6w4d bticohie skfbfect to .I".�Wbrk"' JCI „�/ GofbT Zpt '
£ompensatFbn'pro'vhlons of the tabors Code, ydmus}#orth _ t r \_ SVA. — •i
with•coriiply.with-,inch-,provistbns.or '#hb.•permIt hall, be --1 - �. -
deemed revoked,• • STATISTICAL CLASSJF1 AWN' y- L.. AFF: 1 C0450-
IJCtNSEDCONTRACTORSDEaARATION-.,-" ,,,�,-' r n ti' CLASS
I affirnn,}wt J om Ilcgnsed;#uDder provlslorls of Chapter 9 NO:
(o rPeMing with Sectroh`71�00)'`(' 3 pf th' B)esl and ,. SEWER MAP � � :a• ,.
Ples�tbin bode and m� ilcgrd'Ts�lrl'tul)'Fbrtb and CTfY CLASS
11,,E -T•_ ..._ _ QF' 13K PG.
N4m--k. .. Llc.`�) SUE 5T 4AAlUES - °
'VALUATPN
1)ESC721FT1ON OF'WORtC - -•- • ,I ' L -'•'
ADQ
I am �xempl under Sec _ t s
,h,+•1`+- i .. •I � - � ALTE3t I -� y,r�-t ^ �}�l
6.t#P.C.1for thls reason .rr RF3tN1R i- - - -t ! -�- , Z rrr 1 4iG
USE OF i #.o',J`0 0. 0 1 I
EXISTI BLDG.
srflns -, . :r •. — �- Plrri►l r 1. o'd•5
9,27
OWNER-BUILQER DEgARATIOPI
--her*by dffirm,-thaf.ka(n exempt-frdm the-ContraatoCs'ucense- .• �' L� ~
Law for rth}re��fo�llorvl"p' idtiSectlOn 7031.5 Business and' ADDRESS _,j
0 3c 9i` f
3 ,.. .
0': 'was oLvnet of the_errop",_cr j:qy emprtryeeY with --
yvo#es qs ihelr sole compehxrtlgn,will dg the. o and
the structure ii not Intend4?d or offered for sale-(Section
70dfi-BU.}tness'pnd Professions CodeX _. - - _ .ANG _ -- - __ r T� r' _ -
' I, as owner of the'pr6p.", am exclusively contracting NO -
wltl:Cllceedibd
Can to-construct the girdle-tt-(Sgc- t
3Ion70", Business and Profesalons•Code). ADDRESS ;
- DUST-
CONSTRUCTION
CONSTRUCTION"L1 JQJNG 34CrENCy :' B.a YARD `IlYvv PROP. uta WIDTH
I hereby aff,7rrn thatthere is g construction lertding og*ncy for ,
the-performance of.the work for•which thls permit Is hsued
(Sec.3097, Cly. C.). SIDE w,v
t lender's Name
LDMA Rrf. f
-- P.C.-Fee i - - - i'ern1R-Fse -
Linder s Address -r`
' _( c.rtlfy that I haus res¢ tials appllcation.trn8 st4te--that-the - - - --- Fee V LDMA P'/C
- '�
above Infomtirtlon b correct. I agree to comply wfth all County.•. InveNTganon Fes : '•-�t
pidlnance♦ or>LShh_kM't.re,Wjlpfl_to_bylMing cgR}iTt+cfIon, - . - _ . _ _ t Total Fes, 'il5h1A Patrt,.f f 1. 1'r• -,- �`? '
• r}nd Here authorize representatives of this County to enter
• upon th_ - entlo pr -for Inspe4tlon purposes.
� fi RIf1rMIII!'O!wanAIiATO[Y LAIW'UAO! I .
-5lgrwture I00 of t ..fie.. .:- - -- - -- ---•- - -- -:- - - - .. ._ - - -- - ': -- - '
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