HomeMy Public PortalAbout9008 GARIBALDI AVE_Building__ l
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING MD SAFETY
WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL tIULLDFIG W4
I hereby affirm th;Ed I have a certt(icate of ocneerd to sell hangs,
or a certtficafe of VrbrkeW Compensation Insurance,or a certlFled
Pol�No t a) C4ryIrl 7 LDCAuTY .
L�.� ' 1 fi0 OF fJOW ON LOT
❑ Cerdfled copy Is hereby furnished. —`� �^ ST CFS$T
py is filed wtth butkJfng Irepeotion lDT NO.
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ZONE � MAP N0.
Data AS8E880R — z 3 SF1EQjAL coNixnK
CERTIFICATE ADF EXEMPTION FROM WORKERS' 1 LYES No
COMPENSATION INSURANCE YATHIN 1000 FT.OF SQ-O ?
Fhls eectlon need not be oorrpieted If the permit Is for one hundred144-0
� �� DOTFOCT GFKXP TYPE CONST. FETE ZOPE PROCESSED BY
dollars (S1()0)ry lees)
I certify-that In the performance of the work for which this permit
Is issued, I shell not empty any person In any manner so as to W
become subject to the Yorkers'Compensation Laws- - ,�[ SXT011CAL CLASSFICJUION APT CONDO
Date Applicant ,ADDRESS 'I 'v /,,[_�� C1A98 Na DWE1L UMTS
NOTUE TO AWLC NT.• If, after maktr,g this Certificate of v 44 U "'� FEQURED TovL FROM D0.YT
Exemption, you should become &A)Oct to the V�brkere' SET BACK YARD HWY WIDTH
C rnpahsadon provision of the Labor Code, You meet brthwtth f Y' ��1�-' FRONT .r
corrpty with such prbvhbrs or thio permit shall be deemed revolted ADDRESS PL . I
DE 3303
LICENSED CONTRACTORS DECLARATION P L
CITY P L
I hereby affirm that I am licensed underprovblor>e of Chapter 9 SEWER MAP
(comnv)ndng with Section 7000)of Dlvfsbn 3 of the Bustrreaa and Na QF-Q tEB NO. FAMLES NEW BK Po 'b TOTAL 1V71.L fj
Protesalors Code Fa M full force end -C/� , �.t_�
Lbense N Llo.Cissa ADD ❑ WAwAI CW� 1092■04 IL
Contractor ALTER ❑ $ 011!!JD OWE 00
REPAIR ❑
❑ BSP. reason DEMOL ❑ LDMAPSC. 1 . 8/17/9
Dates TsnNO BLD. URM ❑ 1311 1 AM11: c
So-eure ( LDMA Perm+ '
-fes Z
❑ 4 as owner d the property, or my employees with wages as v v ZJL
their Bole oompeneetion, will do the wait and the structure is O ACCT.r
not htanded or offered for sale (Section 7044, Bush,ess and er FlIIAI DAT1
0 l]j 1X41.1?
Professions Code.) Y&L THE APPLXNrr OR FUTuE B•DNG 0catF0xT H6404DLE A HAZARDOUS uArEFLAL f l -q 1 ITET4J
❑ I, as-owner of the am exciuefvety oontraotlng with OR A hWrI COMDJ+IO A HAZARDOUS WUETWL EOUAL To OR OREArEA THAN THE
licensed oormactors to cornetruoi the project (section Toss,
AWOL"SPE oM„-E HAZACMus LWER6"�Crar,C"OME? FrNAL B' TOTAL 1941.1?
BAineaa and Professions Code.) Y& ❑ r+o —
,,,_L THE N-rE,oED ueE OF THE auoLNo HY 7FE AF4LICJd+-n o,FUTUFE aILfXA 4
,_ {{ �y
OCCLF T REOLWE A PEFMT FOR CONBTFUC,ION OR MOORGQpN FF"A THE SCUTH `>ECK 1941.17
CONSTRUCTION LENDING AGENCY COAST AS MAL"MMOaosrT n gnT t CAQM t sM PSiffTTM CF=pa W FOR 6
I hereby attlrm that there is a construction lending agency forYEe❑ C V �, •0J
C4 the performance of the work for which th!s permit Is Issued(Sec- rrAD MArERALS PFORWAWN GLIDE AND TFEeCAOADPERrTTM
3097, Civ.C.) Mr REOUFE3,exns LMCER THE Los ANOELEa Country CODS
Lender's Name
2 CTIOMa 2--a 100 TMOUGH 220.140 coMcsfa+o FHZAFDOLIe UL1�L1—VLA_►1 4f 3/94
. Tl-E ecAa►a
LendeWs Address �,,.. 4 - 1 AM11:34
0
I certify that I have reed this application and slate under Oenatty
with ordCancee and State PERMT FEE
taws relabrp Io bubJ p /�
hereby suthortra repreawtatlyee d /D 1^tp tBSUANC.E FEF /
toproperty for I
u PNESTKLkTION FEE TOTPL FEE /
SEE REVERSE FOR EXPLANATORY LANGUAGE