HomeMy Public PortalAbout9659 GARIBALDI AVE_Building__ 78A638A CE 1803 3-69 APPLICATION FOR BUILDIN PERMIT _
COUNTY OF LOS ANGELES BUILDING 4
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN D ICT NOG TYPE C ST. Y
(PRINT OR TYPE ONLY)
BUILDING STATISTICAL ICATION SEW ER MAP
ADDRESS lJ D
CLASS NO. DWELL.UNITS BK PG
1
LOT NO. q4� 01 /f J BLOCK USE ZONE MAP
NO.
TRACT SPECIAL
NO. OF BLDGS. """���•••
CONDTIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG. BLDG. SETBACK FROM
/y NOL FRONT PROP. LINE OF (STREET)
OWNER G�/P•1
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
L
ADDRESS HI HWAY WIDTH FROM C.L.
CITY
ARCHITECT OR TEL. BLDG.SETBACK (STREET)
ENGINEER N0. SIDE PROP. LINE OF
TYPE OF EX t5T lA SETBACK H Y + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
CONTFLA CTOR x'e0.EL.
+
ADDRESS. �/' IV RdJ+ra/.� NO d r� CORNER CUTOFF YES ❑ NO ❑ 0
- O
LICCITY U
�� � i cLAss SEE REVERSE SIDE FOR SPECIAL APPROVALS �
CONSTRUCTION LENDER FO
NAME AND BRANCH
ADDRESS
SQ. FT. NO. OF NO. OF ❑ Z
SIZE STORIES FAMILIES NEW
USE OF _ ADD ❑
STRUCTURE
ALTER ❑
'o— �1r 4- REPAIR ❑
SIGNATURE OF DEMOL E]APPLICANT
r.
VALUATION APPROVALS DATE IN2PXCT0X's SIGNATURE
IP.C. PMT. ,p�� FOUNDATION: TOCATION
FEE $ FEES V VUFiIA
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS,
DQLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC-
TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I GAS VENT, DUCT5
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT.
OF THE STATE OF CALIFORNI N R TING TO WORKMEN'S COM-
PENSATIONINSI FAN
SIGNATURE OF LATH, EXT.
PERMITTEE HOUSE NUMBER CORRECT
AND POSTED
ADDRESS FINAL
PLAN CHECK VALIDATION CK. L4.0. CASH _ JOHN F. LEWIS, PRI CIP LST URAL ENGINEER
PERMIT VALIDATION CN. M.0. CASH
��� � 0 4 5(� SEP29 1 D 9.00— c
RATION
ter`F'herel aff that I a cerlfflcateoff consent to self
Fnwre, or'a.certificate of Workers' Compensation Insurance, APPLICATION FOR• BUILDING PERMIT �J
or a certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFEJJ
Policy No. Company
n
Certified copy Is hereby fumisf»d. FOR APPLICANT TO FILL IN ADDRESS S
❑ Certified copy Is filed with the county bul]Jing'lnspec- BUILDING
Ilan deportment. ADDRESS
Date Appllconf crrr ^ C/T ZIP LOCAL"
CERTIFICATE OF EXEMPTION FROM WORKERS' tVO.,()F BLDC S
COMPENSATION INSURANCt SLZE OF LOT 1+ NOW L 5T
(This sgcdon need not be com leted if the psirmit Is for one * BLD« LOT NO. IT MAP BOOK PAGE PARCEL
hundred dollars(;900)or less
. TEL 115E
I certify that'In.the'performance of-the work for w1hich.thls 7
perm it i4 owed, I'shalI not employ any n In any manner jpN SPECIAL
so as to become siwblect to The Workerspensation Laws_ ADDRESS
y r f CITY CAS ZIP
o 0, b 8
Date Applicant I n R
NOTICE.TOAPPLICANT: If, after.braking this ificate of ARC�HITECT OR �. DISTRICT GROUP TYPE F!RE BY Q
Exemption, you. -should become subject•tor the Workers' CST'EN
Compensation provislbns of the labor Code,'yob must forth- ADDRESS v
with cpmply with suchprovhloru or this permit shall be TEL STATI.STIGIL CLASSIFICATION AFT
deemed revoked. CONTRACTOR - NO, r1•
LICB 45M CONTRACTORS DECLARATION LIC . CLASS 1,40-1a. DWELL UNITS
r I hereby affirm that I am licensed underprovisions of Chapter 9 ADDRESS NO. SEWER
(commercing'wtth Section 7000]of Qlvlslon 3 bf the Business and LICMAP
r Professions Cddp, and my Ikense Is In full force and-effect. CITY CLASS BK. PG. VALIDATION
SQ.'FT.LIINC.STO of NO.OF r HECK
License Number c lan � SItE # STORES ONE
Li
y . . CNEW
Q
Contractor Date DESC WORK
_
I am exempt under Sec, ' ALTER ,
6.41P.C. for this.reason V/ )Zoo
USE OF
Date: t XZMNG BLDG. IDEMOL
u APPLICANT TELIFINAL
5 ro OWNER-BUILDER DECLARATION (PRINO. DATI
I hereby affirm that I am exempt-from the-CgntractoBwr's,Llanse ADDRESS ^ AIL V)& #' g b
Law for the following redson.(Section 7031.3, 1, and
Professions.C-ode): 6UUDI41 - Wf '1 e 2 9 Q.2
I, as owner of the property, or my employees with ADDRESS FN `o ,e 2 9(12 5A
'Wooee as their sole cWnpensation,will do the work and
the structure Is not Intended or offered for sale(Section 1
70.44, Business acid Professions Cade}. MOVING ' Q 5 2 3 w 8
I, as owner of the property, am exclusively contracting CQtVVA47QR `
with licensed contractors to-construct the project ($ec- ADDRESS
-
tion 7044, Business and Professions Code}
CONSTRUCTION LENDING AGIE C Y FI1MY U
I hereby affirm that there Is a construction lending agency for FRONT
the performance,of the work-for which this permit is owed P
(Sec. 3097, Civ, C) SIDE
P.L:
Lender's Name
MRef. f
P. de 17
8 Permit e
'
Lender's Address .
L certify that I have read.this bppllcation and shote that the Issuance Fee 0 LDMA P/C#_
above Infornwtiorr Is correct. L agree to comp ly wtth all County lnvestlpaton Fee
ordinances and Skate lawrelating to bullding corxtru tbn, T01.1 Fae 67 0 w� 155LDMA Perm.#
alaws relating
and aythorize represrnhatives of thisCounty to enter
upon the above-mentioned prokbrty for Inspection purposes
o � "
f�lfV1111M PM EM ANAT4XY LAMOUAW
Atkpxsture of Appllomt or Daft
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLAMATION FOR APPLICANT TO FILL IN
I hereby affirm that I have a certl cafe of convert to self Insure t _
or a cerdkAde of V*x*z e'C«rpeneatlon lrourance,or a certRied 41
copy thereof(Sec-3800,Lab.C.) /7 O
Policy No. r y -�zf LOCALITYsrg of No.of BLDCiB.rx�w ON Lor
❑ Certffl d ocpy 19 hereby franiehed 0-x� NE cress
13Certteed copy Is filed with the op ity bulldhg Impeation TRACT BL" LOT No. 4/Y
DeYe� tA38EB90R MAP GOOF( PAGE RAACt3 USE ZONE MAP NO -5--a y
/l G
y1
�c -1 SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO, y
COMPENSATION INSURANCE
vvfTI-01 1000 FT.OF SCHOOL? YES NO
ADDRE
Cn*vection read not be completed H the perrrdt Is for ane hundred �
Dl9TRICi GROUP FTE ZOff PROCE,99ED BY
ddlare ($100) or lees-)
ZIP
I certify that In the performance of the work for wthfe porn* CTfY
mhich jr
b 'sued, I ehan not onpivy arty person In mW manner eo as Io 3
become subyect to the WO{kers'C4mpen5atlCn IBwe. ARCrfTECT OR ETJOfJEEA TEl NO.
m
svmsTFoti a.AssFFc.K-ION APT corpo
Date Applicant ADDFE89 CLASS Na. --V/ —.DWELL u,rTS
NOTr-E TO ARIJCW.- H, after making this Certlfict of REQUIRED' TOTAL SETBACK FROM EXIST
Exemption, you ahoLid become eub)ad tO the \hbrkere' / },,rqy SET BACK y>� HFWY PROP LFNE VFIUTH
Compensation provisions of the Labor Code, you must 4orthwHh Ih cz /Moo �m Z
corpfy with such provWorm or thb permH shall be deert»drevoled PAOtIf
_ 1iG. � P L
GG Z509'70 BIDE
LICENSED CONTRACTORS DECLARATK)Nf
hereby affYm that I am ficeneed ok.- }k � *- P L
I uTrderprovieiorr of Chapter 9 SEWER FAAP �
(oornnwx Tg with Section 7000)of DNfslon 3 of the B�and 9a Fr.Sig NO.OF STORES NO.OF FAMLMS
Prokxm ions Code,and my 6oerr�r Q Is h full force,a-ndd effect NEW BK PO
License 5-P!,17d`J Lb.Clave G_Y77 _ u J, ADD ❑ WLR + .d Q , o
C.tradOr C6 Date �' 30 r�T�" ALTER ❑ $ c�
_ W
❑ t am exempt under Sec. REPAIR El $ z_
BAP.C.for this reason DEMOL ❑ LDh1A P/C
bets et.oa U R1M El1
Suture Data:
APPLICANT(PFNVr) TEL NO. LDAM Pomn• JL ;.
❑.I.,as owner of the property, or my employee with wages as =
their sole cornpenmdon, win do the work and the structure A ADDR:ESs o
not Intended or offered for sale (Section 7044, BuehTees and FINAL �Zb Roo,1
Pmfemions Code_} V LL THE APPUG NIT OR PUTUFM ra r rw,CCCLF T FIAADrE A HAZAFCCUe LLATMOL
0 1, as owner of the property, am exckm Tiy contrecting with CR A ID(TLIF COrrVMq A WZAFOOUB LWONAL EOU1L TO OR OrF-4ER THAN THE
licensed contractors to cone>ruot the p Doc t (Sectlon 7044, AN0LKT9 WECFED ON TFE FIAZMtDOLIe 16KSilALs WCFL49CN GLIDE? FMAL BY ACCT.r
Bm nees and Profeesione Code.) Ym❑ No❑ �L
wl.L THE FUEDED ..
Uee OF THE A G eY THE APPL1a*iT OR R,TURE MJLCb*l 111.1�
OCCUPANT FEOXtE A PMI&T FAIR CONffrmcTION OA AIOOmxrm mom THE 90UTH
CONSTRUCTION LENDING AGENCY COAST AamEip&QLWJTY uAx�EAarr oreTP#7(acme)sEE FE]:*AF ►q cR- a Foe S ��{�. 1 ��4 O f� 7 ITEM
I hereby affk,, that there Is a correhucdon larding agw-y for 4 /
oN the periormance of the worts for which this pemrtt is Issued(sec. 'Yee❑ ra❑ � TOTAL 215- 70
y 3097,Civ.C.) I WYE FEAR THE FVZA DOLIe WTEFLALB WCF"AT"GLIDE AND THE SCAQW 1PPEETTVATTNO r.�r r�1�.x
cV �E 2.Gil LTM 2-2w�DCTwgfF�ECUFE],6r19rFi z.LICER 0.140 4 ZAFC0 �T' f. I l�
1-enders Nacre IA4EFAAL9 1E}FEPCRTTIei /Nb FOR OBMfKi A PEFLET F FCU TFf eCXy,Q
larders Addreee •)
O CW*W OR AMBfT
I certify that I hake read thb apNication and state Fader peneHy c/�1 G mv�nM
of per)ury that the above Inforr afbn is correct I agree to comfy PC,FEE / /� PERMT FEE ! / 000C—(N1 f. 4IQ4
with all catty ordlnarK as and State law. refaf}rp to buildIng 7 Lr
Mori, and hereby authorize representetkee of dile Cwty FE / ,/r, ti }I]v 1 AM 10:Q
v10 I thePmS�ertY for kiepecoon prrPoeee.
m n !L_-�- / , ,, NVESTK ATION FFA U
TOL FEE
oSEE REVERSE FOR EXPLANATORY LANGUAGE
{ - APPLICATION FOR BUILDING PERMIT
�� COUNTY OF LOS ANGELES BUILDING AND SAFETY
woRkors cOYPENSAnoN DECLARAnoN POR APPLiGwr To PKI NBuuniNc�ADDRESS
I hereby afflnm dud I neve a certtflcate of consent to set! Inane, BLn-DM ADDRE8S
or a cprtiflm
nle of Workers'Compensation InsurerK^or a certified - /
copy thereof(sec.3900.Lab.C.) TWPLt crit C�T 23P ` U
Policy No. Company / �I(! LG
Eler
Carew copy is hereby fumished. SUE RAI
` I X Oa NO.DF�NOW NEAREST CROSS ST.
❑ 6Dfl
py In ed with the county buldng trspection TRACT BLOCK LOT USE ZOW
I1 a�
DeisAppitonrt BOASSESSOR"p j` �Z Z. �— epi COMMONS .
CERTIFICATE OF EXEMPTION FROM wORKEW 'No. Vp`� TEs NO
COMPENSATION W48URANCE U11 MO AMW lhwrn-m tODD FT.OF ScrroOL7ADDRESS
.
(this eecfton need not be mn*ted tf the panrdt Is for one hraldtvd '44R/ DUMUCT GFCLrP TYPE FlFtE ZOlETH
BY
ddlsn 0100)or fess) Cm tip ` ' rJ 31 certtfy tint In the performance of the work for whIch thls.permit LG D (J� J
Is Issued, I shall not ernploy wiy perms In arty nwvv r so se to ARCHI Ta-?4p.
beoome eubjeot to the Workers'Compensation Lww 84SiBTlCAL CLASS Fr.KnON APT
DstM AppkwA A DREHB CLASS NO DWELL UPYTS
NOTICE TO APPLICANT• If, atter making this Ceriffloefe ofREOUIR® TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONTRACTOR TEL.Na SET BACK YARD HWY PROP LPJE WIDTH
Cortrpeneehbn provbiors of the Labor Cods, you mud f xtT*tth FRONT
with such prwhions or rile permit shad be deerrred-revoked_ ADDREBB Na PL
LICENSED CONTRACTORS DECLARATION My LKI CLASS SIDE $
I hereby affhm that I am licensed under provialons of Chopler B so SUE Na of 9TOREs Na of FAAIIIJ� /�Aa
(comm ndng with secdon 7000)of Dtvlsion 3 Of the Butneu and NEW ❑ BK C po
Professions Code,and my Ikxrse Is In tuN force ernd effect Z11-1 ,
Llc n Number Lia Cissa DEBCFDPTFON OF WORK ADD vALW► � t
Contractor Date ALTER 0❑ $ t D z
ElI am exempt under sec. ❑ $
B.BP.C.for oris reaso �EMOL n LDMA P/C s
Da*K LA1ffof DGBTM BI DG URIM ❑ � -7c
ftnature APKrF ( PWO T13 Na LDWAPerm F 7 t�.l,J
El as owner of the property, or my empbyeee with wages as 1 ITE] S
their vote oompersation,will do thwr
e ork and the structure V w►n
not Intended or offered for Bele (seodw 7044, BusYsss and -C III,
PFoteeelole Code.) w71THE AAPLKS�NT OR PUT Fe BULDM OCCUPANT FM 4 LE A HAZAPK"A Y4asAL -- � �/ T,}�TAI. 5, - 75
OR A IDRLFW 00f(DkA0 O A FW.AFOOLIS YQII;N_eQML TO OR GF19T R THAN
❑ I, r owner.of the property, em exdtrahrety contredtng wail OR
AMOUNTS OPWlsED ON TFE FWARDCUS uasaALB saKXftKr ar QUIM PeiAL >
boersed contractors to oonstruct the pro}eot.(section 7044. rm❑ No❑ CKCK
a tntes and Protesslons Code.) aW4GE .Cu
WILL TFE FrraD®USE Or TFE RF.DM BY THE APPL".NT OR RfnUFE SULDno
OCOLFMrIT ReDLW A PHME'r FOR OONSTRU MON OR YOOPIdVION FFICU T}y MOUTH
CONSTRUCTION LENDING AGENCY 055 AR QUALM Uwaass"DWFWT pMwow am Pffw res a-eaaaT
SDR Q IDE MS
I hereby aft, that there Is a construction Wx ing wawY for Ys❑' No❑ 000a-DWI 8/3119[]
the perfornv nce of the work for which this permit Is bvLled(Bea i H&T WAD THN HACAfi"rr001esALA nroRrwFON eume Ano Tse acAOD 7[[� T,
ov 3097,Ctv.C.). PUFAETTM On�la.�T.I UMERM M W MIXO l` 9M LRDER TFC LOS Ar030-m 2 63 1 AM 7:33
d. OOl M OCM TMA 1,CFVPTM LV S 7rIONS LMM TFHOIXMi 1.211ti 00H0SfMq
d Lenders Nanne HAZAM"WaMI LF FHPORT AND FOR 06L15pl0 A PEFUNT RION TFe 90ACMD,
Lenders Address
- a�OIAdwIfT
,o 1 owdfy thcd I Ice reed thle appilcadon and state that the above
information Is correct I agree to comply with ail county P.C.FEE PERKUT FEE C
ordinances and stale laws relattng to buBdng convtrlldlon,and
hereby aut xxtna representatives of this County to enter Leon K*ILLANCE FEE 3.O O
the for Inspection pu poves �J
g�(t/�p
R1VEB,l(3ATK7N FEE FEED.
WE REVM:tSE FOR EXPLANATORY LMDDUAGE.