HomeMy Public PortalAbout9221 GARIBALDI AVE_Building__ T "
APPLICATION FOR BUILDING. PERMIT
GOUNTX OF.LCS ANGELES . BUILDINGFL
i
D$FA$TMENT OF'COUNTV'ENGINEER ADDRESS
BIIfI.DING'A�]D 3Ak'ETY DIVTsION LOCALITY.
JOP+N'�A.;LgMBISa COUNTY.ENGINEER p}EARE
WILLIAM A. JILNiaN, 8Ur'T.OF EpILDINa..., CROS$ST. +
P EBS
DIST RXt TYPE
FCR AFkLICANT TO, Kti IN. `S CONST.
,BUILDING. �.py -STA TJSTICA4CLAS$IFI'CATION SEWER MAP
ADDRESS �K . .
_ CLASS, NO,• ALL UNITJ� '
LOTilO. BLOCK ;WATER bT-REQLLIRED ' ,RE¢f,IVED
- SCE TIFICATE: N
-TRA I ". MAP �I HIGHWAY .STATE MAJd,R$ CQLu 'N.. -
.. 90.OF.BLgGS. . NO. 17�- - cclR�Ls) ,
SIZE OF•60T NOW ON'LOT - •USE ZONE SPECIAL
U E.OF _ - CONDITIONS.
EXISTING BL G.' +
fL
Owl ER � NO �!: J - '
SETBACK, •YARD HY" STREET NAME WI TM�
ADDRESS FRONT.,
A CHITEC7`OR , TEL-
ENGINEER
EL
ENGINEER .''NO. ° -SIDE •- �,,,
'P..L - - .D..
O
ADDRESS � . .
TE � � � V.
1L NO.
ADDRESS : � - .O
'DFScRuMQ-T4.bF woRk. Y4J�
NEW ADD ALTER xREPAIR DEMOLISH
.FT; - -NO.OF NO: OF - -
SIZE .STORIES RAMILIE3..
USE OF
STRUCTURE' -
Itul
§IGNATFJRE OF
APPLICANT ..
VALUATIONS
' ,APPROVAL DATE i48PXCTOn•r,SIdNATURI
P.C. P.MT.',' FOUNDATIOM UOCATION
FEE S. FEC - 'CORMS, MATER4AL -
', FRAME: FIRE STOPS,
-
I HfREDY ACKNOWL.�DG[ THAT i,I4AV[,RIAb THIS AlYLICATION� BRACI BOLTS
AND STAT)<.TH A'� THG'A�Cri[F le co RRECT AKb anS[ To cow"Ll( FU-RNACE: LOCAT16N
WITH
ALL''COUNTY bRDINANCtr AND'.'�TATI W RKOUL-A7ING GAS'VENT. DUCTS
.RU 1I_DING CONSTRUCTION.' I Cili'TI FY AT IN DOING-TWIE-WORK. _
AUTHORfFg H[RYEY 1 WILL NoT-KMPLOY ANY iIn IN VIOC,A- LATH. INT..,
TloN OF THE LAaOR COD[ OF TH[ IFTAT[ OF-CALIFORNIA A df-
ING TO WORKMEN' O N QN JNIFURANC£. L' T.
.- _ -LATH, EXT.
SIGNATURE"OF• _ HOUSE N #1BEFF��COR
PERMITTED AND PORTED
.. 'ADDRESS INAL /' r
OHN �. LEWIS. PRINCIPAL T\a! RAL:ENGINEER`
PLAN CHECg.V�LID.ATIOI� CK. ' :«.O. C BFB _ ' PEHNHT VALDATION cK w.o, cAirl
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN $�
1 hereby affirm that I have a certMoate of coneerrt to self Irmum, 02�
or a certificate of Workers' Compensation hWrarK>% or a cerHfled
copy thffe.
40 � .C.)�ny
1AG41 JTY
'�" saw of L7JT No.of N-DG.s Now ON LOT
Certlfled copy he hereby furnhhed. NEAREST C ST. dF
❑ certified copy he also with the bundl TRACT aLocx Lor No.
USE ZONEA4AA NO.
ASSE83Cfl MAP BOOK PAGE PARCEL
SPECTRE CO�DfTlOH.9
CERTIFICATE OF EXEMP N FROM WORKERS' TEL1� O/
COMPENSATION INSURANCE lu wlTfW 1OX FT.OF SCHOOL? YES NO
(This aection need not be completed If the permft is for one hundred
W,;.v / DHh4CT GROUP FIRE ZONE PROCESSW BY
donate ($100) or leas) _
1 certlfy that In the performance of the work for which this permft fy O J
b leaned, I shall not employ any person In arty manner ac es ki V f J
become subjaot to the Wor'kefs'COmpen8atiOm Lswn CT OR ENG&= TH..NQ
STRT"CALCl1�fl(AiON APDO
T CON
Date APPf)Cent ADDRESS CLASS NO. [ _ MSL UNITS
NOTUE TO APPLK'.WT. H, after makkc this Certfnoate Of
REQUIRED
rrption, you ahould become subject. to the Workers' �9 B,ACI( yA,gD l-ryyy - F PFgP LF1`EwD1lT
Fxr
Comp&iaaibn proyWorm of the Labor Code, you moat fo thwIth -v�
comply with arch provfalons or this permR shall be deemed revoked. ADDRESS LIC. �� P
IO
LICENSED CONTRACTORS DECLARATN 0 7 SrDE
I hereby affirm that I am l lceneed uxlw provblorta of Chapter 0 LIC CLA88 G,'� P L
(commerorAV wfth Section 7000)of Division 3 of the Business and OF STORIES NO.OF FAMUEs SEWER MAP
Profession Co(* lbarim Is In full force and p NEW ❑ B}( PG , a}
License Nd Llo.Ciera OF WORK ADD ❑• YILUATION
Contractor &Z2un22W Date AL"T"ER ❑ s
❑ I am exempt under Sec C L REPAIR
BARC.for this reeson DEMOL ❑
LDASA P/C f
use NG Brnli URM ❑sl�u1
ro APP CAKT(PRIVr) TEL No. _
El 1. as owner o( property, or my errpbyeee wlfh wages as LDr�A Ppm� = ANT.i
ti-"r so-19 wfll do.the work and the etruc is ADDRESS 3303
not Intended or offered for sale (Section 7044, Buslneeo and FINAL DAE 1J!.
Code.) A' 1 ITERS
1hLL ll-E APPLIGAIrr OR FRJrIEE RA-M43 OCCIPIJrr Fi4OLE A Fi1ZAFDOUE►L4EFVL .S'��T--'
❑ 1, as owner of the property, am OR A MUTE o0WP A HAZAFUoLm vArs ML EQUAL TCS OR LYE,4FA TWW THE
exo proely trtion with AMOJWM WEC ON THE HIAZARDOUS MQFRALB IYOFiL1Ti0N GLEDE7 FI
licensed contractors to construct the project (section 7044, YES❑ Fa❑ TOTAL 137 - 40
Bu&hbm and Protessbm Code.) 1-37.}[I
w71 THE NTQD® USE OF THE euDLNG 6Y TFE APK".hrr OR FURJFE w■DM 4fL4f1
="wT FEQFE A PEAU FOROR FTIOM THsol
E rni
CONSTRUCTION LENDING AGENCY COAST Are QLW_rY ILMY.(EWENT sc<W 8EM F rM G1EaaeT FOR
Q r,F,SE&
I hereby affirm that tiers b a conetruotbn 4iding agency for YEs❑ No❑
the performance of the work for which tib permit Is Issued(Sec.
o I W VE FEAR THE HAZAROCLIe WrEFLALB lPOFI kC'ION GLIDE AND THE WACAO PEANOATT
3087, CtV.C..) CJ-EM ST�PlT16D7� WY REOLIFEI@rT8 ENDER Tl-E LDB ANGELES GXKFY QPCF_
LOCKWS Name 64CEF LB F£PUT9HG�,a FOR 08W&JG AAP W FF"A TITI-E ZUM
Lders Addreea 6#$3 1 AM 9:5l
an
I mtfy that I have read tib appllration and elate Fader penalty PG FEE PE33A1Ir FEE
of perjury that the above Im
rtfoetlon le correct I agree to cony
wtth all county ordl and State laws relating to buldnp
end hereby a of ti h County FEE �� �p
to the for I
m NVEST%IA,ON FEE TOUR FEE
r
SEE REVERSE FOR EXPLANATORY LANGUAGE