HomeMy Public PortalAbout8761 GARIBALDI AVE_Building__ 7EAE7AA Cl x#007 aez APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING r�6// L
DEPARTMENT OF COUNTY ENGINEER ADDRES6 /
B=ING AND SAFETY DIVISION LOCALITY L,
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST Civ
WILLIAM A.JENSEN, SUPT of BUILDING CROSS ST.IS .J
DISY NO. I GROUP I TYPE PRQCEBSED B
FOR APPLICANT TO FILL IN .1T- coNsr. SGL-/rte{
BUILDINGQ STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS DWELL UNITS BK PG
/e6
t!SIO CLASS. NO. /e6
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE, Ll Ll
TRACT O3 MAP GHWA
NO. Z;O O: He
NO.OF BLDGS. RCLE) STATE MAJOR SECOND LOCA
SIZE OF LOT SQ D NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. l
OWNER Q i�/OS 60 NO. BUILDING EXIST.
p 8ETBACK YARD HWY STREET NAME WIDTH
ADDRES 6 ,VJk B /- �( FRONT � /y/) Q r / D
ARCHITECT OR L,./� TEP. L- O /7/G 61y� b
ENGINEER ��t NO. SIDE
ADDRESWd( '/c+�4J.�0 P
7 4 � ,C{ O
TE V
CONTRACTOR
S dSew ` a,
ADDRESS ` O
DESCRIPTION OF WORK w P w 1da 4i
a
NEW ADD ALTER REPAIR DEMOLISH N
Z
. FT. NO. OF NO. O
SIZE STORIES FAMILIF
ES
USE OF
STRUCTURE Y / C r C
6,o iv
SIGNATURE OF
APPLICANT
VALUATION S /Oa0 Q
v APPROVALH DATE I OR'S SIGNATURE
FOUNDATION: LOCATION
FEE $3O Z S FEE $ FORMS, MATERIALS
HFRAME: FIRE STOPS,
I HKPJMY ACKNOWLEDGE THAT I HAVE ROAD THIS APPLICATION BRACING B S
AHD STAT[ THAT THE ABOVE 19 CORMCT AND AGREE TO COMPLY FURNACE, LOCATION,
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK
AUTHORfLED HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
T10N OP THS LABOR [ OP THE OP CALIFORNIA RELAT.
ING TO WORKM W'1 TIO NCL
LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
P E R M 111111
OR-PERMITTEE RECT AND POSTED 'y
ADDRE FINAL
JOHN F. LEWIS, PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION O M o. cASH _ PERMIT VALIDATION cK- M.O. CASH
LAC09 6 Q 1Lo JAN1 5 23 A 3 025A Q
b,00554to FEB 4 1 A 6050- �
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPUCANf TO FlIL IN BU 1M A70RE 5�
I hereby Situ,, that I have a certiflcate of consent to self lry um
or a certificate of Workers' Compensation Inerusnce,or a certified
copy thereat(Sec. aP -7 Y
I�Iky, 2 rN SVE OF LOT NO.OF S.DGS.NOW ON LfJT
❑ Certified copy Is hereby fumbhed. NEAREST CROSS ST.
4-.�d copy is filed wRh the collrty buOdbV I TRACT BLOCK LOT Na .
LrsE Dome. MAP No.
Date?f I AppoUcant
ASSESSOR MAP Boots PAGE PARCEL
I ePEaAL cororrbNs
CERTIFICATE OF EXEMPTION FROM WORKERS' 8
COMPENSATION INSURANCE WT N 1000 FT.OF SCaDDLp vas NO
(This secrion need completed ff the permit b for one hundred ADDRESS
Dt9TR}CT ONOUP TYPE CONST. FERE ZONE PROCESSED BY
dollars($
100)or lees
CITY zp —
I certify thh at the 0f the work for which fids permit 3
is tamed, I shell not arty person In flny manner so as to ARCH=OR ENG24ER TF1 Na
become eub)ed to the Campenaatlbn Lowe. APT APT CONDO
Date, ADCfESS - CLASS NO. DWELL LRJTB .
NOT?Q- TO AP fL ..- ff. after mWdrQ thle Certificate of REQUIRM TOTAL SEfBAC,K FROM EXIST
Exemption, you a"-Jd become wb)eat to the Vrbrkere' SET BACK )%M HWY PROP LIE Wm
m
Copensation pmvWona of the Labor Code, you meet fordmfth TZTc-. ?T—aa
(00 oornpty wfth each vbbr�n proor ti-da permlt shall be deemed revoked. PFRONT
LICENSED CONTRACTORS DECLARATION o0� S "—O�Z SIDE
CIS P L
I hereby afflrm that I am Ibensed underprwbbns of Chapter 8 J SSR MAP
(=nmendng with Section 7000)of Division 3 of the&;&Irx ae and Sa FT.SIZE NO.OF STORES NO.OF 111Attt1ES
Professions Code,and my 1 b h full force act- NEW ❑ BK PO , d
Ucenee rL tuber " Lb.Clasa DESCRPTION OF WOK ADD El W-�� h Q
Won
Contractor Date ALTER ❑ $ `' 8
` ❑ I am exempt under Seo- REPAIR
/ BARC-for thl. DEMOL ❑
�
USE of URM El
P/C
Date--
Sgr�re 1 z
Z
❑ I, as owner of the property, or rry employees with wages as z ACCT.T
their &ole conpensatlon, wd➢ do the work and the stnicfure is
not lntarded or offered for sale (Section 7044, Butalnees and "� FWAL DATE Q J0} 7 117.?0
Rofe&&l«,a Code.) wLL„FE ARQ,".NT OR Fx trr.W 91-9 0=,n,H-r F A , I�-�
& L - �_ _ 1 ITEM
El as owner of the Property, am ezckufve►y contractfrp with CR A L07UFIE A HAZA DOUS►wERxL EOwL TO oR OFEATM THAN THE
Auax sH-ZAFccus mArBwLB rFoRw -K)N GLIDE? - ffNAL BY
lD sed,contractors to construot the project (Saobw 7044, YES ElTOTAL 117 _ 90
BjMro a and Pra(eeabn& Code.)
wai TTF� R LFtF USE OF TO A ry.n ev Tf ArQu r�rr OR r�rruRE E SOUTH [�E i 117.91
OCCUR4tr FEOURE A PE}tiLi FOR CON&TF0.ICTION OR FTIOM Tf 90lrrH �j
CONSTRUCTION LENDING AGENCY COAST�QUALFY•••".rr�T(8CJCo1�Ta��T FOR -/1 S.D� 1�L1lS
rr.,w.c a �'.�-r1I'I1L .00
I hereby afflrrn'that there Is a constr Kion lerdlnp agency for YEA❑ Poo
wthe of the work for wf�lcb this permit to faa (Sec.
30C Civ.C) awe U►Da xEa EVEN a UNDER THE tae ANGE ES COUNTY
00001--"l
Len(we Name lTl'LE 2,a-uaT31 z?o 9ECTo►t8 z2o.loo T+louorl CONCH?-R"TFE a-+O WIZAFLoi�e I /7.7
Landes Address F` �V SA 1 AM 10:4S
p C*MQAOR
I certtfy that I have reed this appBmtfon and state under penatty P.
kuy
of perthat the abare Ydomiatbb re
n corct.I agree to corpfy C FEF PERMfT FEE
with 11 county c llry ncee and State taws relating lo bul,"
constn- n, and hereby authortre representetiree of thio County tBSLN,NCE FEE
to err6er LvpnJrerthe abo+e Ttbr property for I
\^ ry��
m r 'fl, l/-' .may—), _ NVE8TI(3ATION FEE TOp,L FEE
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