HomeMy Public PortalAbout8848 GARIBALDI AVE_Building__ - APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS.ANGELES BUILDING AND SAFETY
DING
FOR APPLICANT TO FILL IN ADDD
BUILDING
ADDRESS LOCALITY
N EA REST ,
QTY QJ ZIP CROSS ST.
NO.Of BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
1ISTRICT GROUP' TYPE FIRE P ED BY
TRACT I BLOIX LOT NO. '^ .CONST ZONE r
TEL. d U
OWN Eat NO.
le
STAT I ST I CAC CLASSM CAT ION SEWER
ADDRESSgq'ff CLASS NO. � / DWELL11NFr5 BK///PG-
CITyj]5mfjA CJTX LP 7 O'
, ITECT OR TEL VALUATION
ENGIN R OWN NO:
ADDRESS BLbG.SEFBACK FROM +*
Tf� FRONT PROP.LINE OF (STREET)
CONTRACT C..O__. NO, r TOTAL SETBACK FROM TYPE OF EXISTING
�� [-I� LIC-. HIGHWAY + YARD FRONT PROP.UNE HIGHWAY WIDTH
ADDRESS NO
Go
QTY&Vwayq a-ASS BLDG.SETBACK FROM
CONSTRUCTION LENDER SIDE PROP.LINL OF (STREET)
NAME AND BRANCH f4O
HIGHWAY + YARD TOTAL SE7BAIX FROM TYPE OF EXISTING
ADDRESS QTY SIDE PROP.UNE HIGHWAY WIDTH
V
So.FT NO.of 1 NO.OF CHECK +
SRE vI STORIES 1 FAMILIES -ONE
ZONE MAP �' Q d
DfSCR1PTION OF WORK &nvtl ti -N EW NO:
it 77 SPEQAL
ADO d`�� CONDMONS
M �� H*TE. BY
REPAIR rE.
USE OF DFJJIOL ,
EXISTING-BLDG.. -
APPLICANT TEL Ztfi
IPRINTI NO.
BY LSIGNATURE • • e o o
IHB"Y AOQrOWUDG-E TH
AT I HAVE READ THIS APPLKCATKXd AND STATE
THAT THE A39VE IS OORR8_7 AND AGREE TO 09(&AY WITH All ORDINAW15
AND LAWS REGU.ATIj BU I CEkn FY THAT IN D04 NG THE
WORK AUTHORIZED WILL WILL T EMPLOY ANY PER50N IN VKOLATKDN Of -' z
THE LABOR ODOE OF ATE OF LA W RELATING TO WORKMEN'S COA4 Y'. � � '°:°�1 3 3-O O Uyy
.
PEIE#,TKON - I -
� ' 07,23-80
SIGNATURE of
PERMITTEE
ADDRESS i) I
QTY NO.
P.C. Fee$ P..fr Fee >
Issuance Fee
v - I
Total Fee
WORKERS'COMPENSATION DECLARATION 1
I 7�i,4� 4cer � ' brae a tComp of �r*ent to .elf APPLICATION FOR: BUILDING PERMIT
IiS"1 or d-certlfimte of Workers' Compensation Insurance,
or a fied opy thereof (Sr 3800 G) COUNTY OF LOS ANGELES SWLDING AND SAFETY
Po�ll�i`No 6Company
L�f Certified copy is hereby fumished. FOR APPLICANT TO FILL IN AMRESS
❑ certified Dopy h filed with the couhty.buildin Irmpec- B'Ar�� 1n d ' - -
flon department: /
ZJP �r
1iDateF� Ilgant. �" tOCALfTY
`
ND• _ NEARE;T OF
EX
CERTIFICATE O EMPTIQN FROM Sig OF LOT NOW ON LOT OROSS sr.
COMPEAISATION INSURANt� p
-(This'section.need-not be tom Mete¢,if the permit Is fqr one TRACT 4" BLOCK LO7 Z MAPASSEBOOK
' Q
hundred,dolidr* ($A1 0) or less MAP OOr< SAGE PARCEL
,s NO. h /9 MAP
I certtfy"that In the performance of the work for which this
permit t}{asued, I shsori In all not emplgy ahyperany manner ADDRESS - t0'i! �U f pr /G C
so.as to became subject to the Workers'Compensation Laws. O
- CITY. ( — ZJP� O f U ,
Dater�.ppllcant ARCHITECT.` TEL oC
NOTICE TO 4PPLICAto. If, After-maki thls Certtficote of ENGINIEEk T11- :DI GROUP TYPE- PROCESSED BY p `
Exemption, you should beCotne.-}ub Lertri
�.to the Wgrke ? CONST. /
Cornpensgtlon provWons of the.Labor Code, you must forth= AD15PEK ---
.with
_.with comply wfth"such-provlsloni or this permit.,ahall be ( �x STATISTICALgASSIACATION APT. COfDO..
wdeemed revoked:.-.., CONTRACTOR etwc� �)f 33(?>7.9 / —
ucaz D'.coMvACTORs DEaARATIOta ADbRESS ��'S lic zVJc �. CLASS NO. .UN.
I hereby affirm that I am licensed underprovisions of Chapter9 uC ! SEWER MAP
(commencln¢w th Section 7000)of Division 3 of the Bwlness .r�
and ProfeaIons.�,and my license Fi In full force-a effect. FCLAW PG. VAUDA.TK>N.
J/ SQ.T7. NO. OF
Llcense Nummbbw �7' t Hc. Clam SIZE STORIES'. FANO ONE
r O VALUATION
PT1bN OF WORK 7J NErN = FOO
X11 p ADD fl
01-Orn ekempt under'Scc 9LTER . 4�
BARO_ for this reason REPAIR =
4
EXIS„NG NLDG. D
reUSE Or-
O FINA
q
Si�^ ' OWNER-BUI ER DECLARATION I C+AhC�' ' dr. NO.
7. ��� DAT_i . w-*7 .
I hereby affirm that.I am exempt from the Contractors License - `e7l�
Law for the following recdon (Section 703L.�i.BusineU and ADORES FINAL -
Professloru'Code): N 1'
�. I, as owner of the 'property, NG
or my er�PloyeeK with pp •C(,
wages as their sole compensation,will do the work and
The structure Is not Intended or offered for safe.(Section LO�LrTY ' �}ii T[�[ .o]
7044,:Bvsirmss and Profetslgns Code.) MOVfNG TEL.
CONTRACTOR NO.
❑• I, as owner of the property,-am exclusively contracting
with Ilcepied contractors to cdrtstmgt the-prolect (Sec- ADDRESS _ TOTAL 32- 00
tion 7044, Buslne*and Profenlons Code.)
CONSTRUCTION LEIJDING.AGBNCY Y^RD HWI' AI FROM i $2.'L�CI
I hereby affirm that there Is a corrstniction-lending agency for FRONT
the performance of the.work for which this permit Is latued• ' P.L.
(Sec•3097, ay. G): SIpE .
P.L
Lenders Name f 1 •91r5/5/91
LDMA R :
PermIt
Lenders Addrew P.C. Fen Far LD 7334 1 Ay :iU
POO
I cbrflf� that I have redd thfs application and state that the tasuancf ' P'rU LDMA P/C
above nfomwllan is correct. I agree to com�,,ly with all County Ihvestlgptlon Fee
ordinances and State laws relatlrIg to building construction, To4al Fee or ' a� LDMA Perm. f
< and hereby authorlm.mp"mentatives of this County to enter
fYR upon the above-mentioned property.fot Inspectlon purposes.
Signature of.App Ikint or Agent Doti T
- f*RJ M=roR DGLANATOkY LVOGUAGA