HomeMy Public PortalAbout9441 GARIBALDI AVE_Miscellaneous__ ,PUE1UC wORKSI COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
N4W BUILDING AND SAFETY DIVISION
532 South Vermont, Los Angeles, CA 90020
(213) 738-2135
OWNER-BUILDER VERIFICATION
Attention Property Owner:
An "Owner-builder" building pe�i# ihas been appliedfor 1 your name and
P
bearing your signature at `� C&V-k I C
Please complete and returns informs n in the envelope provi ed at.
your earliest opportunity to avoid unnecessary delay in processing and
issuing your building permit. No building permit will be issued until
this verification is received.
1. I personally plan to provide the major labor and materials for construction
of the proposed property improvement (yes or no) kA�_—S
2. I (have/have not) tkAV�-- signed an application for a building permit
for proposed work.
3. I have contracted with the following person (firm) to provide the proposed
construction:
Name k
Address City
Phone contractorz7Tcense No.
4. I plan to provide portions of the work, but I have hired the following per-
son to coordinate, supervise, and provide the major work:
Name I ►J [A
Address — City
Phone contractors L cense No.
5. 1 will provide some of the work but I have contracted (hired) th`e following
persons to provide the work indicated:
Name Address Phone Type of Work
gned: Return Form to Address Below
Property Owner 'fit 4 .4�L„tx►�
Social Secur t Number 7- & d3
Date: -711
Reference: Section 19831 Chapter 9 of Part
3 of division B of the State
Health and Safety Code.
DISK1/AM30.13