HomeMy Public PortalAbout6236 CAMELLIA AVE_Building__ WORKERS'LOMPR4SA71QN_DECLARATION
hereby affirm ?hat I have a ce{tfflc6te.of conseni_tq_aeFf
f Warrs mruatlon Insurarice,
APPLICATION FOR' BUILDING PERMIT
Irnuro, or a certifl to oiceCop�
or a'cetttfled copy.thereof (Sec 3>�Ob, Lab.
. . COlfN7ti(�OF LOS ANGELES BULD1Na,AND.SAFETY
Po[Icy No. Company.' ia
- cerrifigd NG
Kopy li hereby fumlahed.,1. `. FOR APPLICA O FIl1 IN ADDRESS�ICiv' Lam• i
❑ ,C6rttfiad copy t filed With the cou�ity.bull�lnq{nspec-. A�olo
Hoo deportrneht:
Com:
Dater Appllcant�T�r r 1, - r ZIP LOGgi.ITY
CEiMR.C4TE QF D(ENWTION'fitGN4 woiaaRS' OF LOT •W Ota 'LOT
sA6notJ INSURANCE t ASSESSOR
,( is sect'ion need nQt 4�i torQt I.et�d if the prrm4 fi fof one f ACT BLOCK LOT Nb.'J gppt( P}1GE PARCC�1 '
hundred dbilars T$100)br-7esa� '1.
MAP
USE7�OfE
I certify that'lri the p6rforrtiance of the work for vAthlch this' O
permltis lasogd, I'iFpll nof-employ any,pe n Inany manner , �. - -- p - }
so as 1R.b.come tub ,to-thi}Workers,
Comp�jnsatlon l aws.-'
GQY - LP fab /� Q .
Itx
ITECT PR
NO .TO APPLICANT: If,. after-rna�nq`this C«ttflcgty of d NO. CrRQLIP -CONST RE.E. BY. O
Exemption,. you ihoyld become-.subject fo the ,Workdrs'
'Compensptlon provisions of'tha tpbor Code, you must forth - 5
A¢dth,comply;with ivah_pcovlstons 4r-this p•rrrllt_*-Iall be Cyd SfATISMALCASSIFOCAT10N APT. CptiDO.' Z
deemed revoked.- • -. ', . .ems . .. . - —
LICFN-SE�CONTPACTQRs,oEaA.j Ant �Gy 1 NO. F Cuss NK),s.� rrhQL Ute �
i hereby affirm thct I am Ilcerned under provIsibns-qf te,r9 `� g lillimilill -
(cpmmenaingwIth Seatlon 7900)of DlvliLon 3:6fthe$+r
; sinsei UG
f` ACCTV4PAnOP4 1
aid Profesalorn Gode,'army libprre is In full loruartd..Offer7. _ '. C BK Pd.
4 _ SQ. Fr NO. 0frNO. OF
T
Ucersse Number � tic 'class sig sroRt6 ' AAAIUEfi — , M . 140.510.
L y vuuAnoN
cor;rraaor � �i,PnON of woRx �r�. ►mow ; �D O' : 1-`ITEMS. N
�]I am ex•mpr'under Sec Al. - Tq. i , TOTM » 14Q.
A}T�R OEM 1TGUt 0.•J50
$.SRE' or.Htl�rdas6n I�.E. - R1�AIR ❑ ; {{
o.. . - Date: - -• D(15T1 NG -- -DEI�hOI ❑ ~ 1�77nL
Slgoatv7e APPLtcATrF a t O. RNAL .
OWNER LM �ECLARA�TfOtJ
-BW
d117H
0000-IM01 7f29 9b •
. I hereby affiQn that I am axempt from.tha CAntractoY*klcsrne -
Law for the-following reason (SectlDn 31.5, lkolriesr ahi� ADDRESS r- - T71 1 p+r �']4 .
1"FliAl" r r 11 �r��it
, _.professlona Co¢e): .'.., I .
,❑ - '
BUILD
I, as owjer.of the �rgperty;..or my empIoyed� with
-
woge+at-their sole co,mperNatlon,Y+III do th.wor-k and LOCAl1TY
thsstructgre Is minter ed'opaffetedfpriale(Sectlgn _
=' 7044, Biuinq-and prpfbssldns Qcle:} Nc p -
Q : . NO.
4, thePefh. .r:m bxdLslw Ncgnbctng.
.y✓Ith IlcenWi con"CWa to Wn#tuct the proLeci.(Sec. AIDDRESS
tion X04*, Business and NbfmVQns Cbde.).
. CON$T QTFON LFNbiNG 4OfNCY ti YARp Flv✓(
I hereby affirm tW there is.a cp6irtrocHb 0 1andIng agency for FRONT ( I .
the,performance of.;thq work for whichhla permit Is Issued. P t
(Set. 3097;Clv_C).` S E .
RC
Lindens Name 7'
- - iDNA Ref.
D PG Tie Prmlt'Fe•
110.
o I.certify that I Fxfw read thin application and state that}the hsuancs Fee CDMA PlC I
above'Infomwtlon is correct..i,agiee tocomply with all Cgynty
o{dlnances'cnd State laws.relating td bulfding,construction, To" FM LDMA P06. it }
and-hweby autFiorfze representatl.vsi of this.County.to enter _
upon the above-rrlentipnpd property for,lnspectron purposes_ .
fi nN1111IM111 ME E04,A iATO[Y LANOUAOH I
Sienna»of-Appikant or ApsnT Da» n
COUNTY OF LOS ANGELES TEMPLE CITY f 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS ILIUS NEW RESIDENTIAL
BUILpING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9608200053
PHONE: (818) 285-0488 EXT:
'U-GAL ID: NO. OF COINST NEW ADDRE
TR: 50836 LT: 0007 SG., STORIES TYPE OCC1P GROUP 6236 CAMELLIA AVS:
STRUCTLRE: 27011 2 V R3 TEMP CA
ASSESSOR IWFMMTION NUMBER: GNME: 754 2 NFARESY CROSS STREET:
OTHER: THOMAS PAGE: GRID: LOCALITY: TEMPLE.CITY
PR07� EXPIRES ON:
USE ZONE-• - - C 08/20/97
TT� FINAL
CAMELLIA HOMES L P (714) 93 -0433- 240,100 - -
2100 ORANGEUnM
ORANGE, CA 9ZEbt3 NEW SINt�LE FAMILY RESIDENCE
FEE DESCRIPTION; QUANTITY: UOM: AMOLIIIT:
APPLICANT: TEL. NO:
ALEXANDER/* {714) 937-0433- AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESIQ40100.U0 VAL 24.01 L1
B2 PERM 11 WENp OOCES VAi 2,441.51 i
• ` N ES® 2,443.27
DONTRAZTOR- Lor-ATION AND SETBACKS
MO
DEV. INC. (714) 937-0433 l
2100 W. ORANGEWOOD #116 LIC. NO CbD
ORANGE, CA 92868 NOME ��
ARCHITECT OR-EWGINEER: TEL. MO:
LIC. NO: trttttl
$LAB7005ER FLOOR
RAISED
TLDOR FRAMING
p (� f
153H26: SEWM MAP K 83 3 01 PUBLIC WOR���
LEVEL FLbM SHEATH
NO 80
n _
AIR QLIALI•TY: 1000 FEET MATERIALS \��-� r-=f—
NNoO NO _ I/1 �t � ' FIRE� DEPT.TOTAL SE79M FROM EXIST BLDG DEPT. FRAME lNbFLLI d it
( _
SET BACK YARD: HWY: PROP LINE: WIDTH: p., _ic
FRONT PL, I SH R PANELS
SIDE PL-
940C DETFffTTN-nTrMF
REPORT ID: DPR261 ROUTE TO: BS0508