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Home My Public Portal About9160 GARIBALDI AVE_Building__ 76A638A CE#803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEER noDREss BUILDING AND SAFETY DIVISION LOCALITY / JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE ESSED BY V FOR APPLICANT TO FILL IN CONS'-. y, BUILDING 0,K`_e STATISTICAL CLASSIFICATION WER MAP . ADDRESS �J Ll _-9K ' CLASS. NO. ._DWELL. UNITS_�j r LOT NO. BLOCK WATER NOT REQUIRED11RECEIVED ❑ .r CERTIFICATE: TR 'S MAP HIGHWAY NO. OF BLDGS. NO., - (CIRCLEI STATE MAJOR SECOND, (OCAL S17ffr OF LOTtgfXQft 6NOW ON LOT USE ZQNE SPECIAL USE OF t`C/rJ-'�„-' CONDITIONS EXISTING BLDG. TE / OWNER NO (J ILDING EXIST. SETBACK YARD HWY REETME WIDTH ADDRESS Q44 h FRONT I ARCHITECT OR TEL. P. L. U1�C ENGINEER &4leli& NO. SIDE P. ADDRESS / 1 CONTRACTOR / NWv L ADDRESS 0 DESCRIPTION OF WORKLu E ADD ALTER REPAIR DEMOLISH s Z SQ. FT. NO. OF NO. OF SIZE ` STORIES FAMILIES / USE OF O /1 1 STRUCTURE (9' SIGNATURE OF APPLICANT VALUATION APPROVALS jpATjE INSPEC 'S SIG E C' . FOUNDATION: LOCATION FEE $, U� FEE $ i C P.C. PMT ` FORMS, MATERIALS 4� FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS .' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. t WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION, i CERTIFY THAT IN DOING THE WORK AILATH, INT. UTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- TON OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S C MPENSATION INSURANCE. LATH. EXT. �� - COR- PERMITTEE , = SIGNATURE OF /. / D HOUSE NUMBER [� �� a'"�r RECT AND POSTED P. ADDRESS oer og4' FINAL t I M JOHN F. LEWIS, PRINCIPAL BS URAL ENGINEER PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION CK.1 M.O. CASH L�tv 3 2 3 ifJORKPRS COlV - ' ...tIQf,4.1 CJARATION y, r" '^7 1 •- L NRI?or a car that haW a certC6m e.of.consent to If �� NrFO k.-,B'.j L I N _PE�tT' Insurq, or a certNicate of Workeri Compensation I nce, of a cwilfled'dopy thereof (Sec. 38b0,.Lab.-C. - - -- r r.l.: COUNTY'OF LO; ANGEM _ BI�IONG-AN D SAFETY y. _ Polky No. Company - a Cwtfied.copyy Is hereby fU ed. Fp-R AP ICAf�TO FILL IN BLnLDufG ADD I�5$ Certified copy 1s-fi( th,tfie county bulldTri� lnapec BUILDING Pion deprrriment. ] --El ADDRESS pate Ap¢I lcant CITY ZIP LOCAL" - y&-DIMPTLON f'ROM WORKERS' - - NO:-O�BLDGS: - - NEAREST COMPBdSAtlOid'INSURAN( 1 SIZE- F LOT O / O NOW ON ST. . (Thli 6ctlon need'not be corn feted if the permit Is for one - - C Iwn�red dollars (1100)or.les Thr BLOCK- LOTiVO. MAi'�oOK PAGE PARCt3 TEL - OWNER: L, that th'the perfgr'majtce of,the' ",for wtrlch this . perm R:ii-Imued, I shall not empldy any'P8rwri IA any mohner _ ( ..- . _ _ J 1C'os fb me•'su'1ett to the Worker penicitlonl ADDRESS Al E COtDfIIONS �- D8t'p' IICnt -- CITY' - - -. .LP T}b if T�' Irnte of AaC I OR TEL DISTRICj. PROUP HYPE, _ . Rf BY. Exefn dh,' y .hould tori sub�ectLt •ihe VI/ofkeri' - _ !!ll - 4 Compensation-provisions of -ta4cW Code, yod_must Borth- AODM V� �./�• - - Itfr m wtthfsuch vIsIoni.or.this,: It shall be - l vy •40' RIy- -pro perm - , �' srA715T1G41 QASSIFI('ATION -d"Meditavoked: ' .- - coNTIiAc7oR " NO. - UCENS�D CoW ACTORS DKLAkATION •. 1' -- - -- . - -- - - - - LVG � -' Ct�S t 10 DWELL UNITS - I:hgreby affirntbat L m licbr2be ynder provwors 6f Cbaptw 9 NO. 1 (mmme ,on wtffr 7000 af`Dfyks�3 oflthe¢uslne�}and _ -.-- - . _ _ _-. -- -- • - s�MAP � j. Profe�i�o)ri C � Ilcer ti In full fdtce CITY. y —h VA AIMTIONPO T - h _ k C�� $$�q�ET ►•�4 Qf _ ►rQ• � f - L�cenj Numb& 'i^.•,• lig --+ SIS STO�fttES FAM1U i �}•r'=:`d1,YT VALUATK)M_r -4- -NEW 4- �T_ DatQ aY„ DESCl21FTION OF WORK- Contractor ORK - *- f �.i- - t, Contractor - (t F,I am exempt vnderALTER iy , �1Q�Inl/Itd.:- ��F� BED-.aC.pQ►�L`� . r g.BP.0 for reasoh a _� �� I{4 �- h/R REPAIR �� - f - _ _. ,•t U USE OF. Date: IX1511N6BLDG.• OWPER�UILbER DEG1 ARA710N a by 2 - _ Nd,_ _ --DATE ••-I heteby-ufBrrn thatd am-exempt fromthe Conhiktoes.Llderse" ' /� �?I N 'fit Lav for,the followlhg reason`(Section!031 6, guslness and I _ - BUILDING I, as owner of thgjxopgrty, or my empioxees with w6gei as-thefr soli compenjatlon,wjll do the work and LOCALITY the structure Is not Intended or offered for'sale(Secfloh , 704t,•BaslnewardProf 1 ' - �. MONtNG CONTRACTOR NO. - f, ai o o the prgperty, am ezc(uslvbly�controctln -with Ffoensed contvxtori�o construer*e'Prolett"(SqC la s tion 7044, Business afid Professions Code). -TOT -- - - -- -.o o .� . . { CONSTRUCTION LENDING_AGENCY. YARD FhNY PROP. utE WDTH I hereby affirm that there is a construction lending agency for WeSIT -the performarkw of ihe-work for'whlc'h-thls permit Is Issued - - -L - - (Sec 3097; Civ. C.). a j the $ Q� L4rid s Name Q ; C - i IDJW�Rat. f _ -- Lendi-s A¢drsss ' +l certl,fy.that L have read thA appllcatlon and state that tM _,:- - ,_r __ ._ __.... •-- Fruanc8 Fee - CDMA P/C above lnAd fomxfflon is correct. I agree to comply with all County I�tgotlon Fee prdjpaces 4nd Stall JqW- relating to huMIng_coq:#mrNon, _ _ Total Fee -- - 1DAAA Perm. n •�' -�- { '1` and'hereby authorize representatives of th unfy to enter - upon a an on property for I Ion pu 1 M RRVIIIMR POR EU LANATOIY LANGUAGN WORKERS'.COMPENSATION DVIARAno.N hereby affirm that I have a certificate of consent to self APPLICATION. FOR .BUILDING PERMIT . Insureora certificate of.Workeri Compo n Insurance, x'a L�erHfi))ed��cop��y,,th//e/roof (Sec b. ) + COUNTY OF 103 ANGELES BUILDING AND SAFETY Pollcy BU I IDI Certified copy Is hereby furnish FOR APPLICANT TO FILL IN Certifi ed copy is fi l ed with th e u my building Irispec- BUp ESS ING tion department. Date — ---<? ApplicantNO. ZIP LOCALITY CERTIFICATE OF B(EMPTK>N FROM WORKERS' OF LOT NOW ON LOT NEAREST COMPENSATION INSURANCE �7 CROSS ST. ASSESSOR -- (This sectlon need not be completed if,the permit Is for one TRACT Q BLOCK LOT Y hundred dollah (;100) or less.) o N4�BOO� PAGE PARCEL OWtEK NO.. USE ZONE MAP I certify that In;the performance of.the work for whlch thisl _ r�. NO. permit Is Issued, I shall not employ arty fmrson In arty manner Lia CONDMC*4S so as to.become subject;to the Work" Compensation Laws. ,�/-• O CITY r✓l�1 [/ ZIP U. Date Applicant. AKU1ITECT(K2 . TEL DI GROUP TYPE F O NOTICE,TO APPLICANT: If; after making this Certificate of T?JGIN�t NO. � O E Exemption,• you should become subject to the Workers' / Compensation provislotms of the Lobar Code, you must forth- ADDRESS LJ with comply with such ovisions or this It shall be. /7 Tli z P Y Pr P l' ATIST1C.41 d�6il)i[ATFOfJ O COf IDO. Z deemed revoked: !JO ,J(yLJ J� UCENSED CONTRACF(JRS.DECIARATION uG CLASS NO. DWEIL UNITS I hereby affirm that I am licensed under proyWons of Chapter 9 °D NO'� (commgnctng Section 7000)of Dlvlsjon 3 of the Business -�7-� UG MAP and F4ofeasIons C,odIe,and my ligense is In full for nd effect. c1! �`�NO. CHECK BK. pG. VALIDATION Ucense Num �'{�1 U� Clams c SQ STONo.RfES FAANU6 ONE OF VAWATION ContractoLDafezlzt> DESCRIPTION OF WORK TEN' El _ ❑I am exempt under Set t / ADC.) ° ALTER ❑ . . - B.BP.C..fpr this reason D REPAIR ❑ $ OF r)r,tq: SUSTiNG DE WN.❑ Signature APPU CANT /``ler t O.�t� •3� FINAL OWNER-BUILDEIZ DECLARATION FATE I hereby affirm that I am exempt from the Contractors License ADDRESS � �! ��e., Law for the following reason (Section 7031.5, Business and �" M FINAL Professions Codb): er (.�T.T ❑ I, as owner of Thd property, or my employees with BUILDINGA .IX] 3307 wages as their sole cpmpensatlon,wlll'do the work and the structure is not Intended cr offered for salt(Sedlori LOCALITY pop-, /' 1 ITEC 704x,'Business and Professions Code.) MOVING TEL T�T ❑ I, as owner of.The property, am exclusively contractIng CONTRACTOR NO. tit 00 with licensed contractors to construct-the project (Sec- tion 7(144, Business and Professions Code.) ADDRESS CW�i V" Oct CONSTRUCTION LENDING AGENCY YARD HWY FRom I hereby affirm that there is a construction lending agency for FRONT" the perforrimance of the work for which this permit Is Issued P.L .. (Set 3097,-Civ..C-).. SIDE P.L. . �6.,o�S�i-o�aoi i 3f WWI Lenders.Name LDMA Ref, 1 421 1 AM 8:22 �. P.C- Fes Permit Fee -D Lenders Address �.{ o I certify that'I h¢ve rood this application arx}state that the Issuance Fee -/•0 LDMA P/C i Poo above Information Is correct. I agree tc comply with all County Investigation Fee ordinances and State laws relating to building cgnstruction, Total Fee LDMA Perm. and h mut represen Ives of this County to enter ' u bo rime tlo rty for Irupetylon purposes. _ o vy M REVEMB FOR UPLANATORY LANGUA04 SI CalfApplkant or A1.nt Date