HomeMy Public PortalAbout9002 GARIBALDI AVE_Building__ APPLICATION FOR BUILDING •PERMIT
COUNTY OF LOS ANGELES BUILDING ANd SAFETY
WORKER'S COMPENSATION DECLARATION FO '°`PPUCANIT- LLIN Buru3ihnADDRESS
I hereby affirm that I hare.e certifleate of consent to self V--r% i}
or a certfnbaie of Vlkxtcers' CorrCerna$t$Cn Insurance,or a cerHW
00"Y '
0"Y Lab C.)
SOY N C.frfpatrY 40.OF BLf NOW ON LOT
❑ Certffied copy b hereby futnwi9cL NEAREST CabSS ST.
BLOCK - LOT
CPtcerrrfied copy.la nfed with u,e �kgpectlon - USE IDtJE MAP NQ. '
ASSESSOR FMAE RAROI SPS CD1DfrKM
bete 4— �
CERTIFICATE OF EXEMPTION FROM WORKERS' _ h NO
COMPENSAPON INSURANCE C.V Hv V wlTAN 1000 Fr.OF SCHOOL? mss•
(This Section need not.be completed If the permit IS for one hprdred �i 4-7-a pSTRICT GROUP TYPE CONST F�tE axe .PFgCFSSFD BY
dollars (5100)or lean.) ��ZI • 1
I certffy that In the pertor-mArice of the wci-k for which this pwThlt
b teauad, 1 aha-11 not employ arry person In any manner so as to •!u lC' 3' r TAT
becorne subject to the VOorkam'Compenaation.Laws..
Date Applicant ..r C � WF1CONDO
UMTS . . �t
h40T10E 117 APALJG4MT.. ff,- after mak}np thfa Certfncate of REOLWED TOv1
ExerTptlorl, you should becorne' subject to the Ykxkera' M f y SET BACK, YAFO HWY
U21 !
Cpecmmt n provisions of the Labor Code, you Moet l0rth*th www
cony with Such provWona or thIs perrhtt Shell be deemed reroked. f
( �qs P FF<"r. i E1 4 1� 1��7
LICENSED CONTRACTORS DECLARATION �� p DE .VL)
I hereby attinn tttet I am Ilcerrsed underprovbbrra of Chapter. B 8EyyER MAP
(oommendnq with Sectlbrl 7000)of Division 3 of the Busines&and NO.O�ORES N0. FAMJES NEW BK
Pruteaaiaie Code, /{{���"��%pr�_b In fug force ' F¢70 �1
Lberrae tJu
LIC.Cfess OF ADD ❑ - Poo. 'Q'0 1 f�I
contiactor �Debs ALTER El ITEMS
ElI am exempt under Sec. REPAIR 11 $ - - TOT 10 92.
BAP.C.for thIa reason DEMOL ❑ LDAM.P�C# (CHECK 1�,`�
Date: USE NO BLDG - URM ❑ CHANGE .
Sipreture .• _ LDMA Perm I t:..
�..
❑ 1,
irir � t of ttpe property,I�o inns Work � " w2geee 6 re b � Eo
r7ot intended or offered for able (section 704-4, Bueheae and h"5 *oleo FWAL DATE Q 1312 1 AM11:32
Prdeealorre Code.) wrL THE APPLcANT ole Fururf eurLDW OCCUPANT FVMXE A FAAZARDCLO IMgFLAL
❑ 4 as owner of the property, dm "A;Wveh' ContractInG wf:h ca A haT B carp'++°A==eµvEf�E<xrN_TO as GWQER THAN n-e
lfcepeed cattredor8 t0 construct the rlrouN-ra oN THE µa�ws rr-or�vnaN oL�a FN,L BY
pro}ect (Section 7044, YES❑
BusJrieas and Prgfesaione Coda) vwL THE LSE of TE BUELNanPPL"Kt OR FUTUW suUONG
OCCUPANT FEWFE A PeMT FOR oR IA"ICR"FF"A THE Soon
CONSTRUCTION LENDING AQENCY �T An ounLnY'" e A�SEE NTNG°-EaareT FOR
GLUELFEa
I hereby afflrm that there is a conattvdion.fendlnp apehcy.for YEs❑ No
a the performanoe of the work for which tris perms Is leaued(Sea r.
m READ. ►NNasaA �oa►NAaaN euoE Aro THE eacao PER69TTM y ,
3087,Ctv.C.) MY REOL0Br17 THE Loa Aw3e Es couNrr cooE V
TILE 9ecTIONS 22a 1 W 7fIbLx1H 220.740 CONCEFra+a HAZARDOUS
Lenders Noone APE r FFICM TI-E aCINXO. 1
Lendera Address Ag�
I.Oertffy that I have read this appkaton and State under penalty
Of perjury that the above Morrnaflon Is correct.I agree to con#y / FERAfT FEE
with e!I ordinances and State Iewe relattrrp to Meng / T
6we?Y au7torfr0 reP T ee Of thfe COLrrty r881,Ar,CF FEE 5�
o rlvEsrtoAT10N FEE TOP,L FEE
a AlF.
SEE REVERSE FOR EXPLANATORY LANGUAGE