HomeMy Public PortalAbout9513 GARIBALDI AVE_Miscellaneous__ COUNTY OF LOS y4NQFLE$
DEPARTMENT OF'PUBLIC WORKS
BUILDING AND SAFM DIVISION .
OWNER-BUILDER VERIFICATION
Attention Property Owner.
An 'Owner Bul ' b Idl pe ft has been app(I for In your name and bearing your signature
at nI rl L IZ Please complete.
and return this Informabon In the anvefope pro.Wled at our ewliest opportunity to avoid unnecaesary
delay In processing and Issuing your building permit. No bullding permft.Vlll be Issued until this
verMcatlon Is received.
1. t personalty plan to provide the ma)ar labor and materials for con&tructton of the proposed
properly Improvement ( ym or no Vt.g
2. 1 (hev&bave not) 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 ��
Addrem C fty
Phone .Contractors License No.
4, 1 pleas to provide portions of the work-but I Dave hired the following penton to coordinate,
supervise,and PTvtiilde the majbr wor}c
Name
Address city
Phonb ContGv bxv LJoanse No,
6. t will provide some of the work but I have oonbvoted (fdred)the follow 'persorla•to provide the
work hdkatsd:
Nerve Addreas Phone . Type of Work .
Signed: lkstum Form to Address Below
ropbrty
Od/1 GN4