HomeMy Public PortalAbout9050 GARIBALDI AVE_Building__i
APPLICATION FOR BUILDING PERMIT
_ COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLrANf TO FILL IN ss
I hereby affirm that I have a certifloate of coneent to self Inetue, EILIr ADDRESS
or a cerTtflcffi of WxRem' Compertaetbn tneurence,or a oerttfled
copy thereof(Sec.3600,Lab.C.) Crry ZIP
LOCAUTY
Polley No. Conpaw 817E NO. BLD33 NOW CAJ LOT a
❑ CertHied copy le NKaby fumW d. NEAREST GROSS ST.
❑ Carolled copy Is flied wRh the coLnty bulld rig Utspecibn TAT BLOCK LOT NO.
0opartnen- USE ZONE Mea Na
Data AppkarTt A88E880R MAP PAGE 1 Z9D/� _
sPecLu Corn+Tior,s
CERTIFICATE OF EXEMPTION FROM WORKERS' owNER TEL NO.
COMPENSATION INSURANCE wT m r000 FT.OF Scrioa YES 40
ADDRESS S
I BY
dcda median need Tat be conpfeted If the perTNt b for one hundred DteTwCT � iy� �W ZONE PRC�SSED
dotiars ($100)or lean) Crry Z11
I cerdfy that In the performance of the work for whloh this perrrdt v
is Issued, I shall nemploy
riot arty peraon In arty manner so as to '-_3
become a b)eot to the wbrkera'Compegmetbn Lswe a TEl Na
Date L4 4Sa ` 'AL Q1S8fACJ1TION APT CONDO
f>d�rn�.L WJ 1 c�/lirrt— ADD{ - CLAss NQ DWELL LHTS
N077CE TO APRJG4BT if, after mh ft
le Cbrtfficate of R S GA b e REou� TO GAL sErsAcx FRaM Dear
Exemptbn, you ehoL�d become eL>6Ject to the lhbricero' COtTfRACTOR TEl NO. SEr BACK yFm HWY PROP Lm VVIDTH
Compensation provfalom of the Labor Code,-you must for&wrtth G L
oorrpty.with much prowfabn:B or this permft shall be deemed revoked. ADDRESS LIC.Na PL LFFlDfJT
LICENSED CONTRACTORS DECLARATIONam
CITY LIC.CLASS PL _
I hereby affirm that I am Ilcenaed underpro b of Chapter 9 SEME19 MAP
(oommendrrg with Section 7000)of DMelon 3 of the 13Lx%Irx a and S4 9mR>Es Na OF FAMIJES NEW BK PO ,
Proiesalons Code,'and my Iloense l8 In fLdl force and effect
LJoenee Number Lk-Clew DE OF w,DRK ADD ❑ mu-uA,ON Q
CoDate ALTER El v
ntractor P (�
❑ 1 am exempt under Seaell REPAIR El
BAP.C.for this reason DEMOL ❑ $ P/C+
Date_ LOBE OF EXt8TNG BLDCL URM ❑
Sha ure APPUGANT(PFV T) TNO. LRAM Penn f 23 Z
❑ I, as owner of the property, or my errplvyeea with wagea as = ■T
their ado compenssftn will do the work and the sbuctrire Is ADDRESS 0
not Intended Dr offered for sale (Seotfon 7044, Bushiees and FlLU•DAFE / . 0.50
Profe"i"Code_) w._L THE APPUCANr OR R TLIFE MA DING O�NT HANDLE A HuzARab
oAVOBRW' —�(p/
❑ I as owner of the property, am ex kmNoty contracting wfth CA A AIXnJM CONou003 A HAZAFnoue LWERrAL L'a61 TO OR 3FW-NrER THAN THE
ALDUN78 APECF®ONTHC HAZAMOL16 LWERW-8I9-OFUC)ON GLIDE? FDU1L F3Y
B to Code.) the VoJed (Sed3on 7044, YE8 El No 11 ACCT.
CCC TFIE INTENDED ME OF TOg ry.+U 13YCT THE AFFLJCINT ORFIDWFUTURE BISDIq 171.93
71■93
OCClA�4rf FEOLiE A PEiff POR CC►IQTRICTYON OR Ir00P1fAgN FFC7Y THE BOIriH .
CONSTRUCTION LENDING AGENCY arnTa�rrY�••�.o;DEMICT MCAvo)e�P�TTMe CHECrOffiT FOR
GLADE,.jEA 2 ITERS AIR
I hereby afilrm Uret there to a corRatrLldbn ierRdtr>o agency for Yee❑ No❑
C4 the performance of the work for which thle perm It la l&a (Sec. RHA IEREADT EHAZARDoueA44E WADf3CFVA+rloNGLIDEAADTREeGDAoPE71697 D TBTAL 222 - 43
3097,Ctv.C.) O-EU<LW I L*CCF IAW W FEO�UNDER THE Los ANQB_EB couNTY cone ryr�
erTTL Z CHAPTER 220 SECT 2.20.,00 T-f 0 Z2 40 COND6i.NG FNZAADDIE DECK M.43
Lends Name LLVE RALS REPCFU143 AND FGR a MYNNG A PE;MT FRCIA THE SCACAD
L.endere Address
o GAGA CIM,rlrr .00
Q 1 certify that I have read Us application and state widw penafty
of pert that the above Information Is correct.I agree to comply Pr-FEE �D `jZ� PERMT FEF 1-144113
/? D000-0001 ]� � �
with all county brdIrwctat
ee and Se lawff„g s releto bLjWng 4o J
and hereby authortre reprseerdaOme of thb Canty ISSUANCE FEF
m
above-mentioned ove-mtioned property for tnmpection ��3 0 1456 1 AM 8:06
FNESTUC)ON FEE TOAL FEE / 0
►i /
SEE REVERSE FOR EXPLANATORY LANGUAGE
APPLICATI OR BUILDING PERMIT
y COUNTY OF Lgp,AN.QELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION 13ip� FOR APPUCANf TO FILL IN BULDNG ADDRESS
I bereby afro that I have a certificate of consent to see 11 re, n,., l-o — sd 6A&4n p I Av
or a certeicate of Workers' Con-peer
naabon Inaance,or a oerttffed 'T�/ `n LE Q.l
copy theme (Sea 3800,lab.c.) crry
�L E
Polley Na om
Cpany Loc1LnY
S 7 7�6 6 "a Biwa r ow ON LOT
ElCerttfled copy b hereby fuMW-,ed. NEAREST CR089 ST.
❑ Certtfied copy is flied weh the cm*buedlno Iriepectbn TRACT BLOCK LOT NO.
depart:rr rt USE 0DN1E MAP NO.
Date Apolaant AssEssoR !/A;
3PEClAL corntTlorls
CERTIFICATE OF EXEMPTION FROM WORKERS' TEL No.
+G
GOWPIENSATION INSURANCE MT WM N 1000 FL.OF S'Gila L? YES No
(1r,b eeotbn need not be corrQleted ff the permit Is for one Hundred 3,� gsfFtlCT GROUP TYPE CONST. FINE 7O+,E88ED By
ddlare (S 100)or Miss) ate+ r� `
PRO
I certtfy that In bw perform nce of the work for w�l, thle p.Tnft i 1 �o
b leaued, I shall not empty any p9roon In any manner eo ea to CT OR Er}GNE>;R TF1 Na �� -� L
become sub)ed to S11hT18T1('J+L APT CONDO
Date 9L IcarA ADORE CLASS Na- �DWE1L 1113
rand TO APPLrANT.• ft, carvficate of REGUIFED TOTAL SETBACK FROM EXIST
Exemption, you ahouid bject to the Y1brkEro'. CONTRACTOR - TEL Na SET BACK )%FdD ,HWY PROP LINE W.DTH
Corn-cwmafbn provisions of the you must fortith hw
cwn y with ouch"prabe deemed revoked. ADDRESS i.iC.Na PFR
ONT
covbbrb or th &hll IL
LICENSED CONTRACTORS DECLARATION SOE
CITY LiC.CLASS - P L
I hereby affirm that I am licensed urderprovbbn& of Chapter B 38WER NAP
mer
(ccmidng with Seddon 7000)of DtAsion 3 of the Budrxm and FT• Na NO. FA1,nFS
Professbrm Code,and my Ibanse b In full force and effect. NEW a( PG L}�.
Ucerme NumtiQr Uc.cissa 5Eq4aRsncN OFy_r7'7 g F12 lnj ADD ❑ , i S
Contractor Data ALTER El _$/
A
.
ElI am exempt under Sec. RE PAIR ❑ .+yam. �O.
BhP.C.for this DE
$ 1103 1._`4,5.6[g
ree&on MOL ❑ LDMA PSC• .1 ITEMS
Dates BLoa y+�
URM ❑
S4-& re 1f fIjAL 1�.5C_
' rP*�T� No. LDIM Fbm,� tton
❑ I, as owner d the property, or rry enooyees with wages a& O= ` c-4= p,J
their sole ccmpernafti, yd do the work and the st ix:ture b 1-_k7..+.�p
not - or offered for eale (Section 7044, Bovines& and FN/1L DAME + - �� )
C'°cia.) wu T-E Aartxsvrt OR FUTUFE BuI-DNG ODDJW47 rwofE A FVSNDOUe LWHIAL i i j +
I, Ba ownerla�r of the property, am e�uh+ely conn-ac with OR A WnM 0WPMNG A FMZNFDOUa MJ46i1hL EOUAL TO OR OFEAER THAN THE!
fbermed C«,t7act rs t0 cone uct the pro} (Section 7044, YE8 El a eR ON TFE HAZAFDOIJB M s.FOFMQrQI 0LL1OEs7 RIAL ar AM-M 1 8/?4/94
Business and Profeeabne Code.) vEe❑ No❑
VLL TFE WENDED UeE CF THE BUULNG BY THE APPLICAIIT OR PUTlI'E eLiDNo1"Qtl.�.gZJ-
OCGL�REDID A Parr FOR GaaF OCTION OR FROM TFE&OUTH A
CONSTRUCTION LENDING AGENCY � �rT�'wAAaE1�T DoTT�T(°r�W 8� SMT 7 ITPI1
I hereby affirm that there Is a oormthictbn iending aglwxy for vEs❑ No❑ 7 / TI]TL iii . ,
the perbnrrcrce of the work for which this permk Is baled(Sea Yj
rD I HAM READ TFE HAZAROOM hWEFiALe IFOFOAMON GLIDE AND THE aCACAU PE F#A r N0 -
3087,Ctv.('..) _ _/ nTLECHEGMJ9TCl-.I urDEFISwa F.(r�O za 100 IT$K)UGH THE LOB ANOE1®CCC*"HAZA co0�
—�`�-1r..VlTd� 9EctFORE t C#� ?,:;,.�y.:rF
I_erKws Name MWrEFI LS EPORTM AND FOR 00WANo An ELT R"TFE .
(Landers Address •ISI]
QQ I certffy ffvd I have read this application and state under penalty
y of perOy that the above hTformatlon b correct.I agree to Canty P.C.FEE �O PERMT FEE n— / �r� LrJ+_R1—Coll 11301T,R with all county ordlnancee and State lave relating to bullv.J +� 07f O
and hereby authortre repreawrtatfve& of this county 02 08UANCE FEE n / . p� 319 1 f1112:21
the property for I �c14 G
o F VEST}GATION FEE TORL FEE
n d
SEE REVERSE FOR EXPLANATORY LANQUA13E