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HomeMy Public PortalAbout9006 GARIBALDI AVE_Building__ ` _. :xr. • APPLICATION FOR BUILDING, PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY- WORKER'S COMPENSATION DECLAPJMON "--'; ]FOR APPUCANf-TD F1F1 iN..._ I hereby affirm flat I have a certificate of consent to self Irlegre, or a certlHCale of Nbrkers' Compww9oa Insurance,or a oertffled copyf���� •C) LOCALfTY �loy compalry NO.OF NOW ON LOT ❑'CertffN d copy b hereby fumbhed. NEAf7E9T CR099 Is filed Arm fog inspection C.�y� BLOC!( LOT NO. ( USE ZONE MAP NO. Applkt A88E990fa MAP RAaE boscvL coNomoNs ,CERTIFICATE OF EXEMPTION FROM WORKERS' �� ��� wrr�i000 7. ICES No COMPENSATION INSURANCE Ka. 300 section need not be oorrrpieted If.the permft le for one hundred DISTRICT QAJ OUP TYPE CONST. FF � PHCCES�ED BY ddlars ($100) or lase,) I certify.that in the performance of the work for wNl this permit y le.tssued, 1 shall rlotemploy any person In any manner so ae to. T IA. a./ 3 J' `yr XT v becorne a1bjeGt to the Vlbrkere'Cornpensation Laws,. + a 1tST'OAL��E1L UNFSDate, Applcat CLAS8 NO +leu., / 2 OrA�AlN IvC�7i3 70 APPLIG4NT. H; after makklg. thio CertiM1oate of REQUIRED � TOVtL F'E10M D¢�', . E>rarYlpbo,, you aha,ld'of' subJect to the Workers' SET.eActc YARD HWY ���#i 17 Corrlpensarion prtivle!«n of the Labor Cade, ycil.must fordw ttti FFCW 194 17 oxnOy with sort-prwblorls or thle permit shall be deemed revoked. SS P ti 7I �1 �t?� _ SIDE LICENSED CONTRACTORS DECLARATION qn p L I hereby,affirm that i am 1"rAad uncierprovbiorm ot Chapter a SEWER IAV � / (ComrlerlCing with Sgction,7000)of Division,3 of the Business end NO.0!��S NO. FAMLES'+ SEW BK PO - {� �k� t�jJ 9�t Professions Code n full force G Q IJcerrae Nu cans °E 440"k ADD l •T CJ ,. � 1� A�11.,,,,., Contra' ���UL1ALTER ©' CCO f ITIM ❑ m Ian;exempt under sec: REPAIR ❑ TOTAL 10Ka00G BARC.for th}s reeaon DEMOL ❑. LDMA P/G Date: 1JSF KeBLDa URM ❑ i0rL.oc1IL IL ❑ I av tier.of-tile 'or f f V�v A Mil LDMA Perm f !` - i;,'_ �',, �,,4. .W Z property. my-arrployeea with wages as —AC l 1 y their'ede corrlpertsstlon, will do tire:work and the etwtWire b A�+E 00[�p—O[JQ1 $I17f9�+ rot Interl¢ed or oflered for sale (Section 7-044, Businees and ti+L7.)► FWAL DiME 3' Proteeslons Coda) KLL TIE AaFLrGrrr OR F1Jll. RJtL�lK3 CL FWDLE A FMZAF�dIJB �{AL - (�:A � � �y A}r ❑iv as owner of tfle property., Em e)7 bAlvafy Cortmcting with A AaTLFlE IFED C T A IAZAR OU9 u/SH1U_EQIy [71 moa oaE�4al �vJl Tl-E .[[ _ - - �� 1.?1U 1 -l'1111:37 Iloen6ocl contractors to corla>ruot the NAOl 1rT8 ePE CN T e HAZWDOl19 X15►FQgAq a+�E7 FINAL�V protect (Sectlon 7044, YEe Q No PC f3rmhness and Pro(eabbrla Code.) _ M� p 4LL THF USE OF TFe aY Tl-E'APPLK'JJrf Ori FUTUFE a■Z . CONSTRUCTION LENDING AGENCY aiprLwa ocar+wA�AEourlE A Pen*T NT In cC Toro on►tor "°FBou Tris IF111 rear ouAUTY uwAoosrr Iscao►o)sE� a-easter Foe �r I hereby affirm that there fe fl gxztu n lendhng agency for YES El 40I� a the perfomance of the world for�vhlch ties permIt b,baued(Seo. m � �FIVE a lFOF�rAIOf.!(iUDE AND THE or.n..,pEF�L1T�p 30137,,Ctv.C.) r ourF�lsr a uDE3a we MOELEs ttxiN�rr erg n m F z sa l oo l}gaJOH l40 CONC97H10 FKZAFDOIIa Ladder's Name A PE}ur Facet nl�ac-'o►a Lender's Address 5Qo I certify tat I hem reed this appl cadcn and stale mxW Penalty of perjury t tfle above information Is comsat I eRee fo comply PEFO T wfth ordlnalloes and $tate taws retaHrlg to buMng O hereby a rHloflze repreeentsHvee of County /D .+ l39UAN(,E FEE ' property for I (X(0 7/ m piVE9TnKnc)N FEF Tt7UU.FEF ,/ SEE REVERSE FOR EXPLANATORY i ANQUAGE