HomeMy WebLinkAbout1029APPLICATION FOR BUILDING PERMIT
FOR, APPLICANT TO FILL IN (Print .,,type only) rf-
BUI LIDIN COUNTY OF LOS ANGELES
J,�3 1
ADDRESS DEPARTMENT OF COUNTY ENGINEER
r-ITY A )k_ AIJ17 7 1 P BUILDING AND SAFETY DIVISION
NO. OF BL!bGs.
BUILDING
SIZE OF LOT NOW ON LOT
ADDRESS 0107Y&
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IBLOCK
I LOT NO'-Q'J,
LOCALITY
T
N E E
0 WNER N
C R A SRSS.S T
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ASSESSOR
1PAGE
1PARCEL
ADDRESS
MAP BOOKy Ci
b-, 60
da&
DISTRICT GROUP TYPE FIRE
IONST ZONE
PROCESSED BY
CITY ZIP
ARCHITLCT T
"T'
ENGINEER N
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. DWELL. UNITS
JiE0
N PG
TEL.
CONTRACTOR 0.
N
USE_3QNE MA
0
L'C
ADDRESS
LN7
SPECIAL
NO,
CO D TI,ONS
LIC,
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES NO
CONSTRUCTION LENDER
NAME AND BRANCH
BLDG, SETBACK FROM
FRONT PROP. LI NE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. F h*piNO. OF 6,) NO OF CHECK
YISTORIES
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE FAMILIES ONE
NEW IV
+
DESCRIPTION OF WORK
fi ADD
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER El
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
REPAIREJ
SIDE PROP. LINE
HIGHWAY WIDTH
USE OF
EXISTING BLDG. LDEMOL El
+
APPLICANT TEL
CORNER CUTOFF YES
NO
(PRINT) NO.
BY (SIGNATURE)
IN OPEN SPACE YES ❑
NO ❑
IN COASTAL PERMIT ZONE YES
NO
VALUATION
I HERE PY-KKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
-
A ORI
H L DINANCES
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
T
STRUCTION. UC TION . I CERTIFY THAT IN DOING THE WORK AUTHORIZED
R U 1 N C
ST' C T
HERE
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
By 0
E BY I L
LABOR E 0 THE
0 R 0
CODE
LABOR CO DE OF THE STAT OF -CALIFORNIA IN RELATING TO
W ORKMEN'S COMPIEVN.ATNSURANCV
S '0'
SIGNATURE
IGNATURE OF
I G T URE 0 F
PERMITTEE
ADDRESS 40
D 0 SS
TE
FINA,L BY
CITY NO
DATE
MAKE CHECKS PAYABLE TO.
P. C.
FEE'FEE
V Y I
HARVEY T. BRANDT, COUNTY ENGINEER]
a
PLAN* CHECK VALIDATION M.O. CASH PERMIT VALIDATION fcK M.O. CASH
f-A
_10 10?9 5,1679 21 5 5080 4 CO I030 5 1675 1 186,000
76A638A CE#803 5/74