HomeMy WebLinkAbout5569APPLICATION FOR COUNTY OF LOS ANGELES
OF COUNTY ENGINEER
BUILDING PERMIT DEPARTMENT
BUILDING AND SAFETY DIVSION
FOR APPLICANT TO FILL IN
ADDRESS%
BUILDING e i/7 y �j�
ADDRESS / (j
LOCALITY
N EA REST
CITY /1 i� ZIP
CROSSST.
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT
ASSESSOR
MAP BOOK
PAGE
PARCEL
/
DISTRICT
GROUP
TYPE
FIRE
PROCESSED BY
TRACT
BLOCK
LOT NO.
CONST.
ZON
�S
TEL
OWNER "", NO.
STATISTICAL CLASSIFICATION
CLASS NO. �� DWELL. UNITS
SEWER MAP
PG
ADDRESS
CITY ZIP /
USE ZONE
,
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NO.
ARCHITECT R . e j�
ENGINEER. �f�P� 6 0Oj• �
5fGelgsl
SPECIAL
CONDITIONS
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ADDRESS !� .` d �( ��F f�
ROAD DEPARTMENT APPROVAL REQ15KRED YES ❑ NO
TEL.
CONTRACTOR C _ ONO. ��
BLDG. SETBACK FROM
(STREET)
LIC.
FRONTP OP_-LINEOF
HIGHWAY t YARD"- b.
TOTAL SETBACK FROM
FRONT PROP. LINE
TYPE OF
HIGHWAY
EXISTING
WIDTH
ADDRESS � NO
y LIC
CITY CLASS
_
+ —
CONSTRUCTION LENDER
fZlr-9�
BLDG. SETBACK FROM
SIDE PROP. LINE OF "'•- (STREET)
NAME AND BRANCH U vL -'
ADDRESS CITY
HIGHWAY + YARD
TOTAL SETBACK FROM
SIDE PROP. LINE
TYPE OF
HIGHWAY
EXISTING
.
SQ. FT.
NO. OF
NO. OF
CHECK
SIZE
STORIES
FAMILIES
ONE
t
DESCRIPTION OF WORK GCS-=
NEW ❑
❑
CORNER CUTOFF YES ❑ NO
ADD
ALTER ❑
❑
IN OPEN SPACE YES ❑ NO
IN COASTAL PERMIT ZONE YES ❑ NO
USE OF
REPAIR
❑
EXISTING BLDG.
DEMOL
y'
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 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE. ►-
SIGNATURE OF/
FINAL
BY
PERMITTEE '`
DATE
ADDRESS � 4'r�
� V f � 3 NO. P.C. Fee $ '
Permit Fee
Issuance Fee �Td
CITY
t. VALUATION
1
Total Fee
CK. M.O. CASH
^V pq^ r^cu
, AM rucrV %/Al inATinni PERMIT VALIDATION
57 2578 2
6A638A CE N803A 8/77
G, -7 0 co 5570 7 2573
J
Ln
N
Z
PLANS TO APPLICANT
INS ECTOR'S l"1
TO:
RETUP,NED
APPROVED
NO
DATE
NO.
DATE
APPROVALS
REQUIRED
DATE RECEIVED
OR APPROVED
YES
NO
WATER CERTIFICATE
HEALTH DEPARTMENT
FIRE DEPARTMENT
GRADING
G[OLOG.ICAL_ '
PEDESTRIAN PROTECTION
(PENCE) ICANOPYI
SPECIAL INSPECTION
(GONG) IMASNP.Y.) IWEWCA
LOT DRAINAGE
PARKING .
APPROVAL5
DATE
INSPECTOR
5 SIGNATURE
LOCATION. '
,SETBACK & YARDS)
FOUNDATIONS
FRAME
LATH/DRYWALL
INTERIOR
LATH -EXTERIOR
HOUSE NUMBER
CORRECT $ POSTED
FINAL
ENTER ON FRONT