HomeMy WebLinkAbout0137,APPLICATION FO
BUILDING PERWI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDIVG-AAW:M��.r fiu--
FOR APPLICANT TO FILL IN
BUILDING
ADDRE SS
BUILDING
ADDRESS
LOCALITY
I
Ar
CITY ZIP
NEAREST
CROSS ST.
90 jrc=
3
NO, OF BLDGS.
SIZE OFLOT NOW ON LOT
ASSESSOR
MAP BOOK
PAGE
PARCEL
TRACTZZ�4&i IBLOCK I LOT NO.
DISTRICT GROUP
TYPE FIRE
I
NST.
ROCESSED BY
TEL
OWNER /
I
CANP%4A
NO.
ADDRESS
STATISTICAL CLASSIFICATION
CLASS NO. C2 DWELL. UNITS
S MAP
BKV PG
CITY
US ZONE MAP 7 C�
-RGI19-E�R
A TEL
ENGINEER _kEl Z� 13,�I'
_ / NO.
SPECIAL
114 CONDITIONS
ADDRESS
ROAD DEPARTMENT APPROVAL REQUIRED
YES
TEL
CONTRACTOR
BLDG. SETBACK FROM
LIC.
FRONT PROP. LINE OF
(STREET)
ADDRESS ADDRESS NO.
HIGHWAY + YARD
TOTAL SETBACK FROM
TYPE 01 1 EXISTING
LIC.
FRONT PROP. LINE
HIGHWAY WIDTH
g CITY
ITY CLASS
*N
CONS CONST TION LENDER
+
15-A
, o NAME AND BRANCH
BLDG. SETBACK FROM
ADDRESS CITY
SIDE PROP. LINE OF
(STREET)
SQ. FT. NO. OF NO. OF CHECK
HIGHWAY + YARD
TOTAL SETBACK FROM
TYPE OF EXISTING
SIZESIZE ONE
FAMILIES
SIDE PROP. LINE
HIGHWAY WIDTH
I- DESCRIPTI N OF WCRK,
NEW
'ADD El
CORNER CUTOFF
YES ❑
NO
ALTER F
El
IN OPEN SPACE
YES ❑
NO 0�
REPAIR
USE OF
EXISTING BLDG. DEMOL ❑
IN COASTAL PERMIT ZONE
YES ❑
NO
APPLICANT TEL
(PRINT) NO.
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I W" NOTEMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE _ STATE A IFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
FINAL
BY
DATE
ADDRESS
TEL.
P.C. Fee $
11C IT Y —NO.
Permit Fee
Issuance Fee
VALUATION $
Total Feet
%.Ilrlr%sIllk CK. M.O. CASH
0 / 3 6 3 -778 23 1 4.4 0
76A638A CE #803A 6/76
PERMIT VALIDATION
co 0 13 7 3- 7 78
M.O. CASH
M
0
0
CK
0
F
0
PLANS TO APPLICANT
INSPECTOR'S NOTES
TO
RETURNED
APPROVED
0
DATE
NO
DATE
APPROVALS
REQUIRED
DATE RECEIVED
OR APPROVED
YES
NO
WATER CERTIFICATE
HEALTH DEPARTMENT
FIRE DEPARTMENT
GRADING
GEOLOGICAL
PEDESTRIAN PROTECTION
(FENCE) tCANOPY)
SPECIAL INSPECTION
(CONC.) (MASNRY.), (WELDG 1
LOf DRAINAGE
PARKING ...
-
. .... x '. ...:
APPROVALS
DATE
INSPECTORS
SIGNATURE
LOCATION
SETBACK & YARDS,
FOUNDATIONS
_...
FRAME -....... ..
.. . ..
,. '....:,
LATH/DRYWALL
INTERIOR
LATH -EXTERIOR
HOUSE NUMBER
CORRECT & POSTED
'...
ENERGY INSULATION,
ENTERON FROM