HomeMy Public PortalAbout6028 CLOVERLY AVE_Miscellaneous__ •il
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COUNTY OF LOS ANGELES
PUBLIC WORKS DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY DIVISION
SeNICB'n`a\ 1
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OWNER-BUILDER VERIFICATION
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Attention Property Owner:
An "Qivner Builder" building permit has been applied for in your name and bearing your signature
at l i p Please complete
and return 'this informa n in the envelo e provid at your earliest opportunity to avoid unnecessary 'I
delay in processing and issuing your building permit. No building permit will be issued until this I
verification is received.
1. 1 personally plan to provi the major labor and materials for construction of the proposed I
property improvement yes r no )
2. 1 hay;have not) signed an application for a building permit for proposed work.
3. 1 have contracted with the fol owing person (firm) to provide the proposed construction:
Name b--yVL - S
Address afwvp_yv-e— City ��w _ _ / Z� I
Phone �v_ Cofitractors License No.
4. 1 plan to provide portions of the work but I have hired the following person to coordinate,
supervise, and provide the major work:
Name
Address City
Phone Contractors License No.
5. 1 will provide some of the work but I have contracted (hired) the following persons to provide the
work indicated: .
Name Address Phone Type of Work
Signed: _ Return Form to Address Below
Property Owner
rate — - v
04/19/04