HomeMy Public PortalAbout8730 GARIBALDI AVE_Building__ APPLICATION FOR BUILDS G PERMIT
FOR API*ICANT TO FILL IN (Print or type only)
BUIL NG97 y COUNTY OF LOS ANGELES
ADDR DEPARTMENT OF COUNTY ENGINEER
CITY C�,z I P q 7 7 BUILDING AND SAFETY DrVISION
rrox NO OF BLDGS. BUILDING
SIZE OF LO TJNOW ON LOT ADDRESS
D
TR BLOCK LOT NO.�70 LOCALITY
OWNER NOLOgg CROSS ST.
47 ASSESSOR
ADDRESS I� MAP BOOK PAGE PA EL
DISTRICT GROUP TYPE FIRE ED BY
CITY ZIP l77 CONST ZON 't
ARCHITECT OR TEL
ENGINEER NO.
STATISTICAL CLASSIFIkTION EWER M6P
ADDRESS CLASS NO-1�214_OWELL•UNITS BVo G
TEL.
CONTRACTORNO, ZONE MAP 51
LIC. / NO.
ADDRESS NO, SPECIAL
CITY LIC. CONDITIONS
CLA35 ROAD DEPARTMENT APPROVAL REQUIRED YES[] NO ❑
CONSTRUCT, N LENDER411
NAME AND BRANCH BL .SETBACK FROM
ADDRESS CITY FR NT PROP,LINE OF (STREET)
TYPE
3Q. FT. NO. OF NO. OF CHECK HI AY } YARD = TOTAL SETBACK FROM HIGHWAY
EXISTING
rRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES •ONE
+4111 _
NEW
DES'C RIPTION OF WORK 8
DD BLD EfBFROM (STREET) CC
SIDE P LINE
E OF
CD
ALTER ❑ HIGHWAY } YARD - T CK FROM TYPE OF EXISTING t3
EPAIR SI E NE HIGHWAY WIDTH Iy
y CL
USE OF } - C/3
EXISTING BLDG. DEMOL Z
APPLICANT ..��� )` TEL 97NI CORNER CUTOFF YES ❑ NO
(PRINT) � 1►�1n NO.� 7
BY (SIGNA TUR EI IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION�$ Q
I HEREBY ACKNOWLEDGE THAT I KAY[ READ THIS APPLICATION
AMD STAT[ THAT THE ASOYE 15 CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING SUILDI NG CON-
STRUCTION. I CERTIFY THAT IN. DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE ■TOTE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMP YATION INSURANC[.
SIGNATURE OF
PERMITTE !,
ADDRESS
TEL
FINAL // 7� BY CIT N DATE
MAKE CHECKS PAYABLE TO: FEE $ FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION DATION CK. M CASH
1 7VAUG 8 .1 D 1 5.0 0 epi .
76AG3G.A CC*003 Gt7,k
WORKERS'COMPENSATION DECLARATION
I hereby Insure, r affirm
certificate of Worke�C mpe�sa��°ns��a Insurance, APPLICATION FOR �� . V�N G P E RM I T
or a certified copy thereof(Sec. 3800, Lnb. C-)
COUNTY OF LOS ANGELES WILDING AND SAFETY ,
Policy No. Company BUILDING
Certified copy Is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS r
Certified copy Is filed with the county building Inspec- BUILDING >
on department. ADORES J a 1 Y LOCALITY
NEAREST
Date Applicant CTIy etCdl LP 171775" GR=ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' `,� NO. OF B1D ASSESSOR
COMPHJSATION INSURANCE SLZE OF LOT (� X MOW ON _37 MAP BOOK PAGE PARda
(This section need not becorn leted If the permit Is for one USE ZOM Vhundred dollars ($100)or less. TRACT BLOCK 7 LOT NO.
I certify that In the performance of the work for which this OWNER V Ta B ��1 OCKDITK*6 IL
perV
mit Is Issued, I shall not employ any person In any manner g7 q �$j,i ( DISTRICT GRWP TYPE FIRE PROCESS®9Y O
as to become subject to the WorkerWorkers'Com tl n ADDRESS / C1 s �TZONECITY
cej
91
/Dcte -773
r ^9- Ilcan ARCHITECT ORZ1 6 r rZJP ATISTICAL CLASSTHCATION CONDO., 0OTICE TO APPLICANT making this _J t;
Codi of rl�t `o`. RZ
Exemption, you should become subject to the Workers' CLASS NO. DWELL'UN
a
Compensation provisions of the Labor Code, you.must forth- ADDS d a47 SEWER MAP
with comply with such provisions or this permit shall be
deemed revoked. AOR B� -. PG, VALIDADON
1110 NO.
LICENSED CONTRACTORS Dk ARATION C Ir UC
I hereby affirm*hot I am licensed under provisions of Chapter ADDRESS A ild NO. YALLIAITION
(commeocIng with Section 7000)of Dlvlston 3 of the Business and UC
Professions Code, and my license Is In full force and effect. Cfry CLASS i 7j LJ v
License Number Llc Clan' SIZE�J NO. p
FAMIUES4' O ,
_ 3438A
Contractor Date DESCRIPTION OF WORK NEW ❑ 0 0 o o 2 3
I am exempt under Sec. ek d
AM
ALTER . ❑ DA��Z 3294
B.BP.C. for this rbawn r REPAIR ❑ Zq
FINAL
0 0 0 ,294
Data: DDUUSTING BLDG. 12. DE+~AOL El
BY
Slgnatur i APPUCANPRItJTI L+1" S �+�► r o 7
OWNER43UILDER DECLARATION
I hereby affirm that I am exempt from the Contractors LLcenm -H 4 9 a 4 A
Law for the following reoson (Section 7031.5, Business and
Professloru Code): 0 0 o o 2 3
ILRESS
I, DING
a owner of the property,.or my employees with ApDRFSS 9 o o � 6.A 7wages as their sole compensatlon,will do thework and `
the structure Is not Intended or offered for sale(Section
LOCAL"
7044, Business and Professions Code). MOVING TEL 1
I, as owner of the property, am exclusively contracting
NO. 09, 05-83
with licQnsad contractors to tonstrict the project (Sec- ADDRESS
tion 70.44,Evsinese and Professions Code). ���� _P 4 9 rd 5 A
CONSTRUCTION LENDING AGENCY SET BfACK YARD HWY TOTALPS�UK SETBACK FROM TDT
I hereby affirm that there Is a construction lending agency for' FRONT , # o o . .•0
the perforance of the work for which this permit Is Issued .L
sec: 3097, Cly. C_} -SIDE 68..6 3
P.L.
Lenders Name
., o o
Lenders Address P.C. Fee$ Per .� 0.
.9, 05-83
I certify that I have read this applica*lon and state that the FM
above information Is correct. I ogres tis comply with.all County Invsan FM
ordinances and ,State laws relating to building construction, Total Fee •
and hereby authorize ntattves of this County to enter
u n the abov entlon operty for Inspection
/pKurrposes.
"lJ_.�j J
� fa•�!'O!DPLANATORY LANGUAGE
Slgrwhue of Applicant t Dais