HomeMy Public PortalAbout5801 ENCINITA AVE_Miscellaneous__ pUBUC WORKS COUNTY OF LOS ANGELES
;Sr i DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY DIVISION
532 South Vermont, Los Angeles, CA 90020
(213) 738-2135
OWNER-BUILDER VERIFICATION
Attention Property Owner:
An "Owner-builder" building permit has been applied for in your name and
bearing your signature at EA!C Iti*lt7 �
Please complete and return this information in the envelope provided at
your earliest opportunity to avoid unnecessary delay in processing and
issuing your building permit. No building permit will be issued until
this verification is received.
1. I personally plan to provide the major labor and ,materials for construction
of the proposed propertyl improvement (yes or no) -(l i
2. 1 (have/have not) -��'r� signed an application for a building permit
for proposed work.
3. 1 have contracted with the following person (firth) to provide the proposed
construction:
Name
Address City
Phone Contractors License No.
4. I plan to provide portions of the work, but I have hired the following per-
son to coordinate, supervise, and provide the major work:
Name
Addressors ity
ct
Phone ContraLicense No.
5. I will provide some of the work but I have contracted (hired) the following
Spersons to provide the work indicated:
Name Address Phone Type of Work
1
Signed: Return Form to Address Below
Property Owner l �l �;�1 ���' �1 �f,c/(� ��I�° ( I�:ip-r� /lO(:;
Social Securi �6 I17 [)/A
Date: C 11 -
Reference: Sect t 1 �1 hapter o art
3 of division B of the State
Health and Safety Code.
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