HomeMy WebLinkAbout1019I I APPLICATION FOR BUILDING PERMIT Id,
FOR APPLICANT TO FILL IN (Print or, type only)
BU'LD'NG2
COUNTY OF LOS ANGELES
ADDRESS J!
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DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY
Z I P �176-6,
SIZE OF LOT
NO,OF BLDGS.j),,,__,,,
NOW ON LOT
BUILDING
ADDRESS ts
ill&j 9
TRACT' /1
IBLOCK
LOT NO. 7
LOCALITY
T! X
NEAREST
OWNER
NO
ZI
CROSS ST.
ASSESSOR
VU
1PARCEL
ADDRESS"
MAP BOOK
PAGE
TYPE FIRE
DISTRICT I GROUP IC
PROCESSED BY
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CITY
Z,P�9
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ONST, —7- ZONE
EL
tFIA, [
ARCHItIECT
ENGINEER
NO
STATIST ICAL CLASSIFICATION
S EWE R MA P
ADDRESS
CLASS NO,, DWELL,UNITS
7 G
CONTRACTOR
NO
US E E I MA P
3 1k;
ADDRESS
LIC
SPECIAL
NO
9 CONDITIONS
CITY
CC CxSS
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 OF EXISTING
SQ. NO, OFt�
SIZEY&i,V STORIES
NO OF CHECK
FAMILIES ONE
FRONT PROP. LINE HIGHWAY WIDTH
IL
r,
DE S * C P01`O__`N of WORK
NEW
—ADD
BLDG, SETBACK FROM
A
SIDE PROP, LINE OF
.(STREET)
fog
ALTER El
.
TOTAL SETBACK FROM
HIGHWAY + YARD
TYPE OF EXISTING
10 dd
[:1
SIDE PROP. LINE
HIGHWAY WIDTH
REP A I R
us� OF
0
+
EXISTING BLDG.
DEMOL
APPLICANT
TEL
CORNER CUTOFF YES
NO E]
(PRINT)
NO,
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES
No
VALUATION,
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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 E IT 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
S THE T TE
LABOR CODE OF "
OF -CALIFORNIA IN RELATING TO
WORKMEN'SCOMPEVNSATIOIVIN U RAN CE
SIGNATURE OF
Me_lax,�
PERMITTEE-
ADDRESS
TE�'
FINAL BY
CITY
N 2
DATE
MAKE CHECKS PAYABLE T
P.C.PMT,
FEE.$ FEE'
QQ
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN' CHECK VALIDATION M.0
'-'I' . [0 / 9 5 1,679 21
'0 76A638A CE#803 5/74
CASH PERMIT VALIDATIONCK I �;' M.O. CASH
55.80 CoCo 1020 5 1675 1 1 8 6.00
CD
CD