HomeMy WebLinkAbout1025APPLICATION FOR BUILDING PERMIT
FOR, APPLICANT TO FILL IN (Print or type only)
BUI LDIN(
COUNTY OF LOS ANGELES
ADDRESS j
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY
NO, OF BL DGS]ner7l_"V_
BUILDING
SIZE OF LOT
NOW ON LOT
ADDRESS QZ
TRACT,- -311
BLOCK
LOT NO.
LOCALITY
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NEAREST
OWNER
NO,
CROSS ST.
v
ASSESSOR
ADDRESS
MAP BOOK LJ Ar
PAGE 1PARCEL
DISTRICT FIRE PROCESSED BY
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ENGINEER.STATISTICAL
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CLASSIFICATION S"ER MAP
ADDRESS
CLASS NO, Z2r)-DWELL.UNITS PG
CONTRACTOR
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USE 7-QNE MAP
NO,
ADDRESS
SPECIAL
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1
CONDITIONS
LIC-.'-
CITY
CLASS e
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO
CUC TION LENDER
'PVEAND BRANCH
BLDG. SETBACK FROM
FRONT PROP, LINE OF (STREET)
ADORES .. S
CITY
HIGHWAY + YARD ITOTAL SETBACK FROMI TYPE OF 1EXISTING
SQ. F NO. OF
%STORIES—
NO, CHECK,
FAMILIES ONE
FRONT PROP. LINE HIGHWAY WIDTH
SIZ
'4C 'g'L_
WORK DR 1 0-4191
NEW
+
1
ADD EjBLDG.
SETBACK FROM
SIDE PROP, LINE OF (STREET)
ALTER [:1
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
a4fZ
)7* A iEPAIR El
SIDE PROP. LINE HIGHWAY WIDTH
USE OF
❑
+
EXISTING BLDG,
DEMOL
APPLICANT
TEL
CORNER CUTOFF YES ❑ NO
(PRINT)
NO.
IN OPEN SPACE YES ❑ NO
BY (SIGNATURE)
0r__9wF_
—I
IN COASTAL PERMIT ZONE YES NO
VALUATION,$Z�
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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
HEREBYI WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE.S ATE
/INSUR
OF CALIFORNIA IN RELATING TO
WORKMEN'S COMIEAT ON CE.
SIGNATURE OF
PERMITTEE
ADDRESS
T E
FINAL BY
CITY
N a "_
VR.
DATE
MAKE CHECKS PAYABLE TO:
FEE $
HARVEY T. BRANDT, COUNTY ENGINEER
_* I --
PLAN CHECK VALIDATION CK�l M.O. CASH PERMIT VALIDATION �v M.O. CASH
Q
A co1025 5 1675 2 1 5 5.8 0 # co 1026 5 1675 1 186,000
76A638A CE:#003 5/74
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