HomeMy Public PortalAbout5117 FARAGO AVE_Miscellaneous__ ti , 6••
pueuc WORKS COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY DIVISION
532 South Vermont, Los Angeles, CA 90020
(213) 736-2135
OWNER-BUILDER VERIFICATION
Attention Property Owner:
An "Owner-builder" building permit has been applied for in your name and
bearing your signature at 1 lO C,
Please complete and return this inf rmation in the envelope pr vided 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 property improvement (yes or no)
2. I (have/have not) signed an application for a building permit
for proposed work.
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name 1JMtouS S'Lt6cvAJ7RAA 6)2s WOO LA)Lt-L- 19ULL I'e!�H175' T;b2
Address City -7kMR oaW 72-Ats3
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
Address City
Phone Contractors License No.
5. I will provide some of the work but I have contracted (hired) th'e following
persons to provide the work indicated:
Name Address Phone Type of Work
Signed: Return Form to Address Below
Property Owner ;) AA(�'0„ ti
Social Security Number s� a -sig- Buz
Date: G' :3Ig2--
Reference: Section 19831 Chapter 9 o mart
3 of division B of the State
Health and Safety Code.
DISK1/AM30.13