HomeMy Public PortalAbout9941 GARIBALDI AVE_Building__ WORKERS'COMPENIO
SATN DECVIRATION r
hereby affirm that I have r Com certa of consent selfInsure, or a certificate of Workers' Compensation-Insurance, APPLICATION F Oi B U I L D I N G P E RM I T
or ace II co� thereof (Sec. 3WO0, Lab. C.)
MoT�l��mpany COUNTY OF LOS ANGELES BUILDING AND SAFETY7&4 -
Cffl
erted copy Is hereby furnished. FOR APPLICANT T FILL IN ,c,�� i
Certified copy Is filed with the county.building Inspec- BIJILNNG
tlon deportment.. AM41ESS LOCALITY•
NF1,l2E5T
Dote — Applicant CJTY Z1P' CROSS ST.
CERTIFICATE OF E)SWTI FROM WORKE ' t4Q. OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARM
(This sdctIon nedcl not be cam leted if the permit Is for one USE ZONE O GI
hundred dollars (;100)or len. BLOCX LOT NO. NO
TEL /1 SPECLAL
I certify that-in the performance of the work for which this OWNIER NO. CONDITIONS 4.
permit Is.issued, I shall not employ any�erson In any manner AD[755 D GROUP CST TYPE Z� BY 0
so as to become sublgct to the Workers Compensation Laws.
3 (/ 0
Iicant CITYzIP..: STAT15TK•.AL ICATiON O
NOTICE TO APPLICANT: If aft*.r making tills Ce0gIcate';of 'T� =" G
Exemption, you should be,;or-6e su6ject-to- The Workers' aA*NO. DWELL NITS_ d
Compensation provisions of fh4k Labor Code', you must fortkr gyypt MAP an
Z
with comply with such provisions or this permit.shaII.be G
deemed revoked. OONTRpCTOR Tfl BK L PG,d y. VALIDATION
LICENSED CONTRACTORS DECLARATION LK-
I hereby affirm that I am licensed under provI&Ians of Chapter 9qCf� NO VALUATION
(commenting with Section 7000)of DtvWon 3 of the Busmen and L
Professloro Code, and my license is In full force andr. C1TY 1 ,
SQ.FT NO.OF tJO.OF Ci IE
License Numbe LIc Cl.- 517E STORIESor
.�,r y DESCRIP ION OF WORK NEW ❑
Cantract0 r-'��� Date - -
ADD
I am exempt under Sec ALTER ❑ FJNAL / -8 0 7 S A
1 B.BP.C. for this reasonE] DATE (0USE
Ri�AI R
Date: - D&Aa
El FINAL G J O G O 1
TEL llity
SignatureAPP -
OWNER-BUILDER DECLARATION PRI
I hereby affirm that I am exempt from the Contractors License
I_aw for the following reason (Section 7031.5, Business and
Professlons.Code): PRESENT
F-1 1,I, as owner of the pro , or my employees with �A DRREI SS
wages as their sole compensation,will do the work and
the structure Is not Intended or offered for sale(Section LOCALITY
7044, Business and Professlons Code). A"NG TEL
I, as owner of,the property, am exclusively contracting Q2baR6gOR NO.
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions CodedRED SETBACK
R�pl1
CONSTRUCTION LENDING AGENCY MUCK
K YARD HWY TOTALYARDu FROM XTH
I hereby affirm that there is a construction lending agency for FRONT ,
the performance of the work for which this permit is Issued P.
tSec 3097, Clv. C.X SIDE
CP.L
Lenders Name
Lenders Address P.C. Fee Permit Fee C12 S'
I certtfy that I have read this application and state that the issuance Foe d a
above Information is correct. I agree to comply wtthall County lnvestlgation Fee /�
ordinances and State laws relating to building construction, Total Fee Oj .1
and hereby authorize representatives of this County to enter
the above mon n o foon purposes
re W W� POR ECKANATOCY LANGUA04
��SrKfttrW of I Agent r I Dais
COUNTY OF LOS ANGE=S TED?SPLE CITY 4 0508 BU_=ING PERMIT
DEPART ENT OF PUBLIC WORKS 9701 LAS TIINAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT T&31PLE CITY CA 91780 BL 0508 1101100003
PHONE: (626) 285-0488 ETT:
LEGAL ID: NO. OF CONST BUTI,DING ADDRESS:
TR: 32644 LT: 8 SQ. FT STORIES TYPE 9941 GARTB.ALDl AV
STRUCTURE: V-B TEMP CA 917801716
ASSESSOR INFORMATION NUMBER: NRAREST CROSS STREET:
5385-024-049 THO14A.S PAGE: 597 GRID: A2 LOCALITY: T131PT.R. CITY, C
TELNANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCF99ID BY:
EXIST OCC GRP: 01/10/11 SR
091NER: TEL. NO: BLDGS. NOW ON LOT: VAL[SATION: FIPAL DATE FINAL BY: CODE:
SMITH ARMEN AIEI.AENE (626) 285-5680- 4,000 .
9941 GARTzurI1I AV
TE?@ 917801716 FEES PAID D CRS QN OF ►ARIL
CHANGE OUT 11 NIB DOWS LIKE R LIKE SAME TYPE-SAM19 SIZE-SAME
FEE DESCRIPTION: QUANTITY: UOK: AMOUNT: STYLE
APPLICANT: TEL. NO:
HAYES, JOHN R (714) 745-7987- AA BLDG PERMIT TSSIDBNCE 27.80
20891 CATAMARAN IN. AB STATE GREEN BLJDG FEE 4000.00 VAL 1.00 SPECIAL CONDITT ONS:
HUNPINCTTON BEACH AC STRONG W=ON RRSII) 4000.09 VAL 0.50
D2 PERMIT W/O EN-HC 4000.00 VAL 116.00
TOTAL FE49 145.30
CO R: TEL. NO: APPROVALS DATE INSPECTOR SIGNASVRE
J RANIVU7 COA4T'RQCTTON (714) 745-7987-
20891 CATAMARAN LANE LIC. NO LOCATION AIND SETBACKS
HUNGTINGT'OH BEACH, CA 92646 704087 B
SOILS ENGI:M= APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS
LIC. NO: SLAB UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOL: PAGE: FIRE ZONE: CMP: UNDER17"R INSULATION
153H269 3 00
FLOOR SHEATHING
190. OF FAKE=: DWEJr i NG UNITS: APT GOND: SIXT C ASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATER31g
NO NO NO FRAME INSPECTION
FIRE SPR12VKLER HANGERS
INSULATION/WS.&THER STRIP
INTERIOR LATH/DRYKALL
EXTERIOR LATH
RATED FLOOR/CEIL AS9EM.
RATED WAIL ASSEMBL]7'i9
RATED 9RAFT9 OPENTNGS
T-BAR CEILINGS
LOT T7RAINAGE
REPORT ID: DPP-261 ROUTE TO: BS0508