HomeMy Public PortalAbout9520 GARIBALDI AVE_Miscellaneous__ COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY DIVISION
OWNER-BUILDER VERIFICATION
Attention Prosy Owner.
An 'Owner BuIW bullding rmlt has been applied for In your name and bearing your slgnature
at v2 f Please complete
and ratum this Information In the envelope provi at your lest opportunity to avoid unnecessary
delay In processing and Issuing your bullding p6rmlt. No buikding permit will be Issued until this
vertflcation Is received.
1. 1 personally plan to provide the major labor and materials for constructlon of the proposed
property Improvement (yes or no)
2. 1 (hav&bave not) signed an application for a bullding permit for proposed work.
3. 1 have contracted with the following person (firm)to provide the proposed constuction:
Name
Address City
Phone Contractors License No.
4. 1 pian to provide portions of the work but I have hired time following person to coordinate,
supervise, and provide the major work
Name
Address City
Phone Contractors Lkense No.
6. 1 will provide some of the work but I have contracted (hlned) the following persons to provide ft
work Indicated:
Name Address Phone Type of Work
Signed: Return Form to Address Below
Property Owner l CJ
Social Seourtty Number
Date
04/19104
r
,pUBuc WORKsi COUNTY OF LOS ANGELES +
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY DIVISION
532 South Vermont, Los Angeles, CA 90020
i
(213) 738-2135
OWNER-BUILDER VERIFICATION
Attention Property Owner:
An "Owner-builder" building permit has boen a ied for in your name and
bearing your signature at
Please complete and return th s inf t on the nve ope provided at
your earliest opportunity to avoid necessary 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)
2. I (have/have 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 G�
Address /e) . &= o Al city
Phone -s — ontractors cense No. Vo d
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
Address y
Phone Contractors License R5.
5. I will provide some of the work but 1 have contracted (hired) th'e following
persons to provide the work indicated:
Name Address Phone Type of Work
Signed: Return Form to Address Below
Property Owner
Social Security er
Date: — —
Reference: Sectfbn 19831 Chapter 9 of Part
3 of division B of the State
Health and Safety Code.
DISK1/AM30.13