HomeMy Public PortalAbout9824 GARIBALDI AVE_Building__ APPLICATION FOR BUILDING PERMIT
t COUNTY OF LOS'.ANGELES BUILDING AND SAFETY
WORKERS.COMPENSATIODECLARATION. FOR APPUCANf F1L,L IN
}hNNby affirm that I Neve•a oaN rttkateyof consent to W k-eLue, BUL>x�ADD 39 r L A f
or a certlflcate of.lhbrkam' Compensathn kmurahce,br a oerftW ,p
copy ttered(sec 380p,Lap.C.)_ Cl ZIP Tri LOC"LFTv
Policy No. C«>�erry�f�8 FVhrD sg OF Na of row ON LOT
1:1tfM1ed CeFcopy Is hereby fvrnW-ed..
W-AFEST ST..
CertlA _copy b Mod with the coLloty bullding"pe TRACT BLOCK LOT NO.
USE a�rE ?4a
Det.•`74!�-q3 Appllcaht � a !,SSEssoa BeQ Z O OGE
sPEOu corornorrs
OWNER-CERTiFICATt OF EXEMPTION FROM WORKERS' J Z NO Yes 40
COMPENSATION INSURANCE -S WTHN,1000 Fr.OF SCHOOL?
(TI-d%&Ktipn need not be completed H the permk Is for one hundred ADDRESS 2 GtR t f UFRI T oROLm zone PROCESSED BY
dollars ($100) or leas)) ,
1 oerdfy that In the perfmTanoe of,the wont for whlch tido P-Tift 4 7 d Q —3 3
6.lamed, hal
ed, I sl not employ any person to arty ner manso as to ARCHTECT OR E%3f�R TEL N%
beoome aubled to the Workers'Compensation Laws- STATTSTK.AL�ION AFT. CONDO
Date, Appkant ADDRESS CUSS NO DWELL LKTS
MDTACE TO APP[�CANT.• H, efts making thle Certificate of REWIFED TOTAL SETBiCK FROM - E)QST
Exemption, You should become subled to the Vkrke CAH�R TEL NO. SET BACK )ARD WY PROP UNE WIDTH
Cornpensabon' pnrodelone-of the Labor Code, you must forthye th SKetS 2 V.,1. KFIDNi
comply wtth such prwbbae or this permtt ahall be deemed myc+, d. "ADDRESS LIC.NO. PL
LICENSED CONTRACTORS DECLARATION — Ass 3 O SDE
I hereby affirm that en
at I am Iloeed unerpr
dovbione d Chapter 9 ' C! "— PSEWER MAP
(commendng with Section 7000)of DHbbn 3 of the Business and sa FT
-as OF NC.OF FAAiEB
Profasaform Code,and my Ilcenee.Is In full force and effect 2 1 NEW ❑• BK pa
Uc _I to er � Q 29 3 Q L1o.Clew C--Zq DE of 4 ADD ❑ vtLu moN
etme
ContractorC�f L C- f�oaRS Date `?—l —`?3 $ G L 5 -
. t ALTER ❑. �
❑ 1 pm exeMpt under Sec ilitJp t1 REPAJR El
BAP.C.for this reeson DEMOL ❑ LDAW,P/C W
USE OF EXkMW BLDG U R M ❑ O r a
11l. r
Sl Ufa ! f APAUCAN-r r�v-rJ _ TEL No. LDt,,A Per,,;I •
❑ I, as of the'prop", or my employees w1th wages as � 1 -ITEM
CJ►�
thelr sole oompapo0on, will do the work and the sVuQWre to ADDRESS
not Intended o,,r,Lo,ffered for sale (Section 7044, Business and FNAL DJOZ' jU� 118 - 65
[C
. Profess"r-�7.'�•�
" ) .YLL THE APPUC.Wr OR FAURE BUILDING OOOUF►Jfr HMnLE A HAZARDOUS Wl4EFW. �{L►rf\ 11LI.CFJ
❑ I, as owner of.the property, am 'exoktra}vety contract v with oR A CONV.1 A HWAFO W MAERMIBfl�EQUAL To OR OFiF 9Fli THAN THE
AI/OINTD�EU ON THE.HWIRDOU.WUQH3YE rFOR►44gN OlI]E? ,F?lAl.BY
licensed contractors to cosintract the pro}eet (section 7044, res El
&xAneas and prb(esons Code.)
YL4 THE NTDcED usE dF THE aUOLNO By.THE Appuc w OR FUTURE D•DM .
OCCUPWT Fjr i A PE3:4fr FOR LCNBrFUCTCN OR L*0 FlGKRON FROM THE.SOUTH
CONSTRUCtiON LENDING AGENCY �T AP QUALiTv��EIo brarF57,sGACh"SET=PER3KF NO CHEaaiBT FOR OODD—"1 7/19/93
I hereby affirm that tt ere Is a =vt> action lerding agency for rEe❑ No❑ 2 0779 1. 0 W
N the perforr R nce of the work for which this permit Is laaled(Sec. HyryE READ THE HAZAFDOI$W k-EFl" c,LOE Ann THE eGan PeFLLTTING '
m 3097,Ctv.C.) a EM-11 MY u�T THE L0e Ar%a=CCUNTr CODE,
TfTLE 2, 220�CCpCY�B 2 100 7Ha000f-I 22c,14o CONCERNNG HA AFDOUa .
Lander. Name W4SEFLAL9L�NOw D POR oFfPl•!Ki A PEFW FF"A TME OQAO A:. .
Lerdere Address
o. o+rw"❑A Aart .
I certIy that 14m reed this application and state LLrx& penalty PG FEE FF}TAAfT FEE G�
Pf i a*(y�a the above inforn atbn Ls correct I agree to comply
wt(h all oounrty ordinances and Stele laws rdatbV to bulid r-c O►
cocotruction, and hereby authorLe repres.rdati ea of this G=Tty 149�FEE
to upon above- proper{y for hN)aC bn purpoeeq
NVEM)aCION FEE TOTAL FEE / ? /
SEE REVERSE FOR EXPLANATORY LANGUAGE
I
T°AW° APPLICATION FOR BUILDING PERMIT ],
„mss
DIVISION OF BUILDING AND SAFELY S 81W IIaNsAD, 1
Deparw- t of Co=tr EnabLow
Cmntr of Lds Anw1M LOCALITY
JOHN A. LAMBIE. COUNTY ENAINmt NEAR EBT
CASSATT D.GRIFFIN, SUPT OF CUILDIN• O88 BT
FOR APPLICANT TO FILL IN DI 1 NO. GR U TYPI SEWER YAP
CONST.
fZ
ILDING MAP
DR[Ba NU BR D D �HWY YK$ O
NO. f >♦ 17
U NE SPECIAL
CONDITIONS
t'T �/ 'NO. OF BLDGS.E OF LOT -o ^ O NOWONLOT BUILDING YARD HWY STREET NAME KX16T.
HETBACK WIDTH
E OF19TING BLDG. FRONT / �•
P. L. V
OWNKR .BIDE /
L
MAIL
ADDRESS 1 O 15 riO 6'YLR4;Q— D TRACT DWELL 1 UNIT
T!� S INDUSTRIAL
CITY E O NO. I DWELL 1 UNIT
6 PueLtc BLDG.
ARCHITECT OR TEL 2 DUPLEX 2 UNITE
INGINEHR NO. 7 ADDN.,ALT., ETC
8 APT. UNiTD 8 MISCEL
ADDRESS n 4 COMMERCIAL
CONTRACTOR NO.. ENSPECTION RECORD
I
I ADDRESS
D9SCRIPTION OF WO -
I KW ADD ALTER REPAIR - D OLISH
NO. OF N OF
aIZI STORIED F ILIEB
U
1J�i
6
Zia TURK OF {
APPLICANT APPROVALS D(J�'T`'Y �ry 6r
r,
ID DATE INSPECTOR'S SIGNATURE
_ FOUNDATION: LOCATION
�^ {
Vw'' P. C. S FORMS,YATIRIALS
FRAME: FIRK STOPS. _
VA-LUATI N rH q RACING, BOLTS
FE FURNACE: LOCATION,
1 HEREBY ACKNOWLEDGE THAT 1 HAVI EAD\.THIS OAS VENT, DUCTSAPPLICATION AND STATE THAT THK 18 CO?tFtXCT
'
AND-AGREE TO COMPLY ALL C UBOVE NTY ORDINANCES LATH, INT.
AND STA% LAWS REGUL.AT G BUILDING CONSTRUE
TION.. LATH. EXT.
SIGNATURE OF RECT AND POG
HOUSE NUMBER COR-
PIRYITTKK "i®
oxtADDRESS FINAL
JOHN A.LAMBIE.COUNTY ENGINKER VALIDATION CLYDE N. DIRLAM. CHI@' BLDG. INBP[cTOR
O!( MO CATH
LACb" CCT 416 14.00l � -
1077N WT 5 i 280
�p � m
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