HomeMy Public PortalAbout9565 GARIBALDI AVE_Building__ IVISION OF BUILDING AND SA
Department of County Engineer 3 B U ' L ® Iw Nr '
County-of Los Angeles - APPLICATION
J. FOX, COUNTY ENGINEER
FOR APPLICAIAT TO FI IN FOR OFFICE USE ONLY
DISTRICT NO. PLAN CK.OR RED.No. PERMIT NO.
BUILDING
R EIVED BY DATE OF ADPL. DATE ISSUED
LOCALITY
NEAREST •�N /
ROSS ST. BUILDING
ADDRESS /� C✓ /� (r�/Q/ �✓%aL D�
OWNER V. a' LOCALITY
MAIL / �, n
ADDRESS (@ EZ/ �s�'vc NrAREST /'f
TEL '� CROSS 8T. �Q !(
CITY .,, .. MO 4 03 FIRE NO.OF ZONE PLANS I TYPE GROUP
ARCH!1 OR TEL_
ENGINEE NO. BLDG. l C ORD. NO.
SETBACK LINE �C F 1 ^ y7 L"
ADDRESS
USE /Q APPROVED
CONTRACT NO ?u l ZON4�'j Z BY DATE
HOUSE NUMBERING
ADORES8 ` I MAP NUMBER �03 NO. ASSIGNED BY
LEGALCORRECTIONS
DESCRIPTION � BLOCK !'` :'
TRACT
81ZE OF LT ` J I R6.6r NOW ON L TOS'
USE OF �n/ NO. OF J
EXISTING BLDG. /I��M-MiC� FAMI LIE.
DE CRIPTION OF WORK 0
Q
NEW ALTERATION ADDITION Z
D
r
REPAIR DEMOLITION
Bc1.FT. [`' N O.OF 7 %
SIZE J ROQMB ,, STORIES
EXT.WALL RQDF �A/Ove
COVERING COVERING 4V
USE OF 8T CTU E•
INSPECTION FOR ,PS.•, APPROVALS
OCCUPANCYAS /� INSPECTOR'S SIGNATURE DATE
FOUNDATION: LOCATION T"
FORMS, MATERIALS `
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS AP-
PL
P- FRAME: FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS ✓Gs
CORRECT. BRACING, BOLTS
1AGREE TO COMPLY WITH ALL COIdNTY ORDINANCES FURNACE: LOCATION,
AND STATE LAWS REGULATJJN UILDI G CONSTRUCTION. GAS VENT,DUCTS
SIGNATURE OF LATH, INT.
PERMIT
S�
ADDRESSLATH. EXT.
�•�' I
PLASTER, INT.
AUTHORIZED AOT.
���///��� PLASTER, EXT.
,. �Y�O FEES; 0 3 S HOUSE NUMBER COR-
o pp���� PtTER,
POSTED
VALUATION FEE ,f't� ?�' FINAL r
76AS38A DBS 3 1-52
WOORK
I here, o afftrrr, � I have a Come of consent'to ce, APPLICATION FOR BUILDING -PERMIT
Insuro, or a certlfitate of Workers' Compensation Inwrance,
Copy eT°°f �) C6LIWY OF LOS ANGELES -BUILDING AND SAFETY
Com ny
Certified Copy b.hereby furnished: APPLICANT TO FILL IN ,.,ppm
"Certified copy is filed wffl-t ie•county building Irupec- BL1tLDItJG
do d I.
Dat Applicant rri
21P. s0Ty
NO. OF ELDG&CgZ
F[CATE Of� D(flWFTION fROM SU3-OF LOT'' NOW ON LOT N"JEST
COMPENSATION INSURANCE' tRbsS sT..
ASSESSOR
(This section need not be completed'If the permit-Is for-one. TRACT BLOC; LOT NO. MAp BOOK p:; pig
hundred dollar.($1W) or less. m USE
NO
I certify that In-theperformance .of.the work-.fbr.which this. ,
permit Is[loved, I skmall not employ any person In any,manner mbNS =
so as.to become.*ubhct.to,thb Workers Compegsafon Laws. �--s - Q
C� ZIP / r
Date Applicant. ARCHOR TEL GROUP TYPE .BY. O
NO.T1C7 T0'Af'PL1CAf, after, makJnfl�the Certificate of ENGINEER NO. CONST.
J xemptIon, you should become sublecf to, the Worker'
ompensofion provisions of the Labor Code,.you Must.forth- ADDRESS 4Kl- ✓
with comply with such provlslon; or.thb permit "ll" be TEL AT15T1CAL TION APT. CONDO.
_ Z
deemed revoked CLASS NO. UNITS
-
I
..CONTRACTORS.DEdARAT10f4
I hereby affirm that I am-llcer uhder ptovbions of Chapter 9 U SEWER P
(corrimenclap with Section 70D0)of-Divlsien 3 pf•the Business
. CLASS _3q
and Professiors and license b Imfull force nd `� - BK PG, r YAUDKMON -
8 S� Fi NO OF
OF CHEOC
Uoenrte Nurri ' c Cfas SLZE STORES FAti11LIES ONE
V TFOl1
Conttact /fAfi3A.ia}e D6CR1P1lUtJ OF NEW _E2 :
` ADD El ,
El1 am oixempt under Set .
❑n
BAPfthis ,
.C. or s reaso^�� _
- REPAI t
e: pG5OF
nWE BLDG - �[/ .❑
...
r., Signature- . TELFINAL '
OWNER-BUILDER DECLARATION �; Z �!
I I hereby affirm thta4 I am exempt from the Contractors Utense
`rm Law fbr thq;mfollowing reasonIfSedion 7031.3, Business and aFH,IAL
Profmslotis.Cod�: r _ ACCT1
El 1, as owner df the` BU MING•T 1,
�i property;.or my employees with ,:h�tr
'} Vy?ges as their sole compensation,will dq the work and
'' #9 the structure Is not Intended or offered for sale(Section LOCALITY - - - L 1 1' ITEh
70;14, Business and Professions Code.) Nq Ta
I, as owner of the property,amexclusively contracting � NO. TOTAL 70 3$
with Ilcedsed contractor'to constrgct.the prplect (SeC- - �
tion 7044, Busirmm.artd Pjofmslons Code.) ADDRESS CWC 0.,
CONSTRUCTION ELIDING m� • YARD HWY TOTAL FROM
I hereby affirm that there Is a contttuttl'on lending<KWcy for FRONT . l
the performance'of the work for-which this perrtmit It Issued P.L.
(Sec 3097, Ov. G). SIDE
OQO�— M I y�i 7 i Q{ 7`a
JI L 1
` Lenderr■ Name
P.C. F« dr
Pmft F« 1 LDAM Ref. f 6218 1 AM10:�.
Lenders Addrow ,
I certify"that I have read this apeeplication and state that the Is...FQ LDM>,PiC f
above Informbilorl is correct. I agree to comply with all County nvestlpaTlon Fes. ^
ordinances and State laws relating to bul ding cormsh'uctlon, Total Fee 0 LDMA Perm.
uthorize repress of the County to enter
upon th a mentlo for.iropecflon p
i WE RRVfZf♦t POR RICPLANATORY LANGUAGE
g of Applkant ar /