HomeMy WebLinkAbout1121FOR
r�RAPPLIICANT TO-FILLAPPLICATION IN (Print or type only) E�UILDING PERMIT
BUILDING_"
'yey A COUNTY OF LOS ANGELES
ADDRESS 'et DEPARTMENT OF COUNTY ENGINEER
ZIP BUILDING AND SAFETY DIVISION
7=�, , FCIT7YA.7��v.�4d_ lfd4-IZL-
NO. OF BLDGS.
BUILDING- ) q iL-
el � , '17-
b,
SIZE OF LOT j'V&fCA;/WLAOW ON LOT
ADDRESS Z!?-i'),-1,1vI
TRACT
IBLOCK
LOT NO.
LOCALITY P�'1 141 "of 5 P
V TEL
OWNER NO, f
NEAREST
CROSS ST.
ASSESSOR
PY
IPAGE
ADDRESS
MAP BOOK
PARCEL
CITY &'�-r Ze/ Z I P
DISTRICTDISTRICT GROUP TYPE FIRE
S T. ZON
7-
-7
PROCESSED BY
ARCHITECT CAR -1 t 9 T E
O�ENGINEER N
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS 4B
2 NITS_
CLASS NO.___L/_)// DWELL.0
P 8�7ZPG
T EL.
CONTRACTOR NO,
'USE ZONE MAP
NO
LIC.
ADDRESS
SPECIAL
e NO.
LIC,
CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES NO
CONSTRUCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP, LINE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OFwEXISTING
SQ. F NO. OF NO. OF CHECK
TORIES FAMILIES 1'ONE
FRONT PROP. LINE HIGHWAYWIDTH
�
SIZE
+ iz
C3T
t- NEW 5n
S-1 RI PO
D ICN OF WORK
-
ADD
BLDG. SETBACK FROM
SIDE PROP. LINE OF
.(STREET)
ALTER ❑
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXII I . ING
REPAIR❑
SIDE PROP. LINE
HIGHWAY WIDTH
USE OF
+
DEMOL
EXISTING BLDG,❑
APPLICANT TEL
(PRINT) AN 0 Jlb�?,?14
CORNER CUTOFF YES
NO
BY (SIGNATURE)
IN OPEN SPACE YES ❑
NO ❑
666
IN COASTAL PERMIT ZONE YES
NO
VALUATION $ qj ij-wo I
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 CON-
STRUCTION . 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 COMPENSATIO INSURANCE
SIGNATURE OF
PERMITTEE-
ADDRESS
FINAL BY
TEL.
CITY NO,
DATE
MAKE CHECKS PAYABLE TO:
,C,�$
FPEE FEE PMT.:$
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN' CHECK VALIDATION (ct1
M.O. CASH —
PERMIT VALIDATION
(,rK CASH
-) M.O.
Col 0 .9 2 1
CIO
1 S) 4
76A638A CIE #803 5/74