HomeMy Public PortalAbout5120 FARAGO AVE_Miscellaneous__ PtlBUC 'N0FkKS; COUNTY OF LOS ANGELS
DEPARTMENT OF PUBLIC 'WORKS
�1►' BUILDING AND SAFETY DIVISION
:M South Vermont, Los Angeles, CA 90020
(213) 73B-2135
OWNER-BUILDER VERIFICATION
Attention Property Owner:
An "owner-builder" building permit has been applied for in your name and
bearing your signature at e/j><
Please complete and return this infom atiol� 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 proposea property improvement (yes or no)
2. I (have/have not) && signed an application for a building permit
for proposed work.
have contracted with the. following person (firm) 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
Address City
Phone Contractors License No.
S. 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
„igneo: Return Form to Adoress Below
Property Owner ii i ,�8 C ,
Social Security Number ,gd igrz/�r�
Date: q
Reference: Section 19831 Chapter 9 of Part
3 of division B of the State
Health and Safety Code.
DISK11AM30. 13