HomeMy Public PortalAbout9000 GARIBALDI AVE_Building__ APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLJCANf TO FILL IN BtLDING ADDRE88
I hereby affl-m that I have a cerUfcata of corlaerd to seff irralrre, f
or a oerftkzte of Workers' Cornpermafion Insurance,or,a oertffied
copy thered (Sec 3800,Lab.C.) aP
FUk,y Na C-T"n>Y LOCALITY
817E OF LOT N0.OF BL.DQS.NOW ON LOT
❑'Certified copy IS hereby furrlletled. NEAREST MCSTV
❑ Certified copy is med with the o=-t y buknrQ Inepedlon TRACT BLOC7( LOT 40.
t USE ZONE MAP NO.
DateApplicarTt ASSE88OR MAP BOOK PAGE PAS
SPECIAL CONDITIONS O O
CERTIFICATE OF EXEMPTION FROM WORKERS' • '-1 YES No
COMPENSATION INSURANCE f O wm IN 1000 Fr.Cf 9CHOCC7
(rhea eectbn need not be oorrlpleted ft the permit b for one hundred AnDFE38 D19TFd T QAOIIP Tyw CONST. FIRE 3? ED B
rf PROCESSED
dollars($100)or leas.)
I cerlffy tha3 In the pwiarrnance of the work for whish this permft
Is feeued, I W-4 not employ any N eo as to
4
become Sub to the~kerB' ���frECT OR ENfiflEi3a TEL Na
8RTi8i1CAL CLA88F1C,QION AFT CONDO
Date AppfkTent AlewA,DCRESS 01188 Na DWELL Ut4M
h07rE TO APPLrAKf.• If, after this to Of REOUIFED TOTAL SETBACK FROM EXl8T
eu
Exenvdon, you shodd become b}e to the t SEr BACK lsM H%VY PROP uw WDI-H
Can>peneatlon provtalone of the Lebon Code% you must Torttlwfth 4 I►1,
FRONT
corrlpy wktT each provisions or this permit shall be deemed revoked. LNO. P L
LICENSED CONTRACTORS DECLARATIONP L
SDE
cll� Ar
LIC
hereby afitrm ttiat I licensed nTderprovlebrle of Chapter 8 }-r MAP
(commencing with Section 7000)of DNfelon 3 of the Buef wm end 9a FT.S= NO.OF STORES Na OF FAME FR NEW BK PG }
Prdesffione b In full farce Sff
Licerme Number43 Lk; WORK 1 ADD ❑
7Date
ALTER ❑
H 1 am exempt ender Seo. ' REPAIR ❑
BAP.a for this reason DEMOL. ❑
,
I LOMA P/C I _ W
USE of URM t�] 1 U
(PFNVT) LDMA Form• . .- C Z
❑ 1, as owner d the property, or my wages as { Z RC CI .r
their sole cornperleadon, will do the work end efruoture b
not Intended or offered for sale (Seddon 704-4, Buelnese and IM l FPIAL DAY 1
Prafesebne CAde.) wLL THE APPUCANT OR FUTURE BLXDM OCCIF"U HuvOLE A H41ZAH7OlJ8µvi r -�-� 1 I-r�
❑ I, as owner d the property, am exA* y owbactft with OR A r,On1.RE CONlYMM A HAZARDOUS WOEFML EOtAL To OFr c*EJUE7 TMW+TFE
licensed contractors to construct theASPECIFIED w_
D ON E HAROCUS MQGLIDE?i1LB lrrCFMACKN GLIDE?
D_c* ae and RVasal«Ya Code) pf° c (serftiDn 7044, MOrFrTe YES, E-1mo
WENDED
El TOTAL
TOTAL 137 - 40+�} lr
V TlEFDED UeE OF TFE BLIELM Bi TFE APPU .NT OR RrnFE MUN-DW C:1-EC•K 1J(.'KI
OCCUPANT FECIIFE A PEFUT FOR CONSTFDCTM OR 1/00F JT0N FROM TE WJTH
CONSTRUCTION LENDING AGENCY ODW All WAUTY raWdM6arr DmTF•cT MCAorvl eEE PB:SFMM CI-EMAT FOR
GUICE Fa CRAM. .07
I hereby affirm that there is a oonetruarlm
ticn Ieng agency for YES ElNo❑
a the pwbmlance of the work for which this pwTM Is is a (Seo.
o I HA£READ THE HAZJFDOIA L VERMLB PEOF164410N GLIDE AND THE ac.-cm PB%a TTNO
3087,Civ.a) OFEaCJffT.I LEDPAaa►D MY REOlAlRDAWM UNDER THE LOB M43ELES COLWTY CODE, y���v■ r,■^� [Y/ [�
Lenders Name TTM-E-E 2,IL RAPTE R 220 AM wKR oHrNgTA P�7,( �T-E H�CVS C--""rJ4 `1 1 7 f 14/7 4
Lerldere Address 6VUEb8'�] 1 Al110
cmdall OR Allow
Q I ow* that I have read this appfioalion and slate under penalty
d perON that the above Irdomretion is oorTect I aWee to oorTrpfy Pja FEE PEF� FEE ,///,
wfth a!I qty ordinanoee and State iawe retatfnp bD rQ
repnasentat}— d ISSUANCE FEE? z�
for I p b
m .HVESTKIATION FEE TO-G L FEE
d AppbnW IrAp* 7
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATION F UILDING PERMIT
COUNTY OF LOS ANGELES 1 BUILDIRG AND SAFETY rr
WORKER'S COMPENSATION DECLARATION FOR APPUCANT TO FILL IN ADDFtE
I hereby affirm that 1 have a oertfflcate Of consent to self I mm _
or a certfflcafe Of VkckDm' Compensation hnsurence,or a cerdfled _
COPY ( Lab.c) C --— L0CA1
PAY No.OF NOW CN LOTElCerUfled Copy Is hereby fumlehed. �[/G3/yr/� NEAREST cRoss .
WCerttfied copy Is the Ing Irmapectbn41 BL" LOT N0.
113E ZONEIMP NO.
Dflte flied ASSESS-OR MAP E kJ �—
�- 9PEClAL CON!Df1lON8
CERTIFICATE OF EXEMPTION FROM WORKERS' R .t/+
COMPENSATION INSURANCE STI M 1000 FT.Of=yCA-pDL? . YES No
(fhb eecfion need not be completed ff the permit to for one hundred eMb Aft-*,2" DtBTFbGT GROUP TYPE CONST. FIE a)NE PROCESSED BY
dollars IS 10-0)Or lees) . 'r
I certify that In time performance of $me work for whirl this permit
b e ��► �I7�/ ��D 2
TamI shall not employ arry person In arty manner so as tOlad W/4 W, 1 ,1`.
become eub)ect.tO the Vmbrk&m'CornpenSatI n Lathe. / I' /� SW18TIC1L �y' CONDO ' t
Date Applicant Apq _8gq KJ Q�9 Na C�,e,7 DMIL UMEM i IT -:1
&CDCF TO APPLK_4NT.• H, after making th}a CerHfbate Cf REQUIRED TOTAL .17
Exemption, you should become a,bleci to the Workers' � p SET BACK vm HWY .17
Compensation prvvfalOrm of the Lebon Code, you must forttmwith r.[ AIL7rFR DNT
Comply wIth such.provisions or thio ha1
permit S1 be deemed revoked ` XDDRESS P L .1_1101
LICENSED CONTRACTORS DECLARATIONSEE
CITY L1C�LA3� P L
I hereby affirm that I am Ilceneed underprovtebrB of Chapter .9 8EWER MAP
(cornrnendng wIth Section 7000)Cf DMslon 3 Of the Business qnd S0 FT. ND.�4fO NO.pF F AL" NEW BK "� 3/Pe 74 }
Proreaelona Code,ucens,e Num ,b I70
n full force ect- (r l ��^� t7►i 1 1 r`l1(11:_ aQ
Con . i ! J p� �d 1 1` J ALTER ❑ADD El $u vtoN
❑ I am exempt under Sec. REPAIR
B.SP.C.fOr thla reason DEMOL ❑ LDhW Pic{ W
Date: LPbK117PGSTM M-Da URM ❑ d
S�rmature f TEL No. LD►tA Perm• ; `�
J;
❑ l as owner of the property, or rry emp+oyees with wages as ZO t'CCT,
Hieb Sole oornpeneffiion, will do the work and the Structure b ADOREsB C iti
not Yrtended Or offered for Sale (Secbw 7044B � olAe, alress and �Q 15.60
���
PIaf06si0ne Code.) Hu.TFE APRK.vrr OR FUTUFE BUI DM OCCUPANT FM:)LE A FIAZAFaOU8 uawAL
❑ t, as Owner of ths property, am exCkml vett' c orrtrwtnq wrch �A MIXTLRE COFf 004 TI A FIAZAFDOUB WEFMLSrEFIAL PFOBEQUAL To OF UDET A TI-NN TI-e
AF,rourrs ePeG�En oN rFe FiAzvnoUrS►wanAia rFoa�aTON OuoEt FW,L BY
flceneed contractors to conStruof the prcloat (Section 7044, YES❑ 40 r —15.60
Business and Profession Code.) JA
M-L TFE INTEAMD USE OF THE BUIXM BY TFE APPLIGkIlr OR R rrU E BJ rwra 2-7
OCCUPANT FRfl�'A PERYT FOR COIbTAJCTION OR mowic rm mom THE SOUTH
L
CONSTRUCTION LENDING AGENCY COAST AM ouALFrY wAm%EmmNT DmTFacT(8CAQ of ME PEFJAT M a-ECKUST FCCOUCIELPE /► -S 1
I hereby afflr rn that there b a corTsb'ucdon lending agency for
YES p V� �rIF--T+.r
S the performance of the work for which thio permit Is bared(Seo. IFE �
aoFµmGLEE
tiOPEff&9TTNO
[ !i
1 I
a 3097,Civ.C.) WUNDER THE Lob ANGELES COUNTY CODF
lll1E 1 „,y y 1 ITC.I
Lenders Name AND FOR Oe'VJNM A PET"T TFE r I I- -
Lender's Address
TOTAL I-W.U[I
QQ� 1 oerttfy ttrat I have read H1le aWbarion and state under penalty LifC1560.00
y Of pw).rry that ftInformationIs correct I agree to Coapfy P.C.FEE 60.0-0 PET7l ff FEF / ' ��r�1tL
Q wfth 0 and State laws r L&w to buidnp .00
hNreby authortrS repreaentethree Of I88UANCE FEE
`. Q
M/E3TlGAlION FEE TOTAL FEE/. / /. / 7 BOW—OWI 88117193
73
SEE REVERSE FOR EXPLANATORY LANGUAGE IM9 1 AM11:31