HomeMy WebLinkAbout1013APPLICATION FOR BUILDINGPERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING- a
COUNTY OF LOS ANGELES
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
" CITY ZIP
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT Lm
BUILDING }
ADDRESS
( oI
' TRACiX
BLOCK
LOT NO.
LOCALITY �: J
TE
OWNER F ® NO G"
NEAREST
CROSS ST, l6S
ASSESSOR
ADDRESS
MAP BOOK j PAGE
PARCEL
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DISTRICT GROUP TYPE FIRE
CONST,_ ZONE
PROCESSED BY
CITY - elm.'" ... ZIP,. CC��
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ARCHITECT O _ � ,.,�. � NEOL.
ENGINEER -.
STATISTICAL CLASSIFICATION p
S/Eygy,E3R MAP
ADDRESS 01V_'
CLASS NO. L DWELL, UNITS d,,j
� �1C PG
TEL.
CONTRACTOR NO
USE ZONE MAP
1 NO.
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ADDRESS .a _ NO (sl.' _
p \ SPECIAL
LIC.
r o "- 9 CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ® NO
CONST CTION LENDER
NAME XND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
'
-' ADDRESS CITY
HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING
SQ. NO. OF NO, OF - CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
SIZ STORIES FAMILIES ONE
("D
RI NEW
DE SC T O O� WOR
101 ADD ❑
BLDG, SETBACK FROM
SIDE PROP. LINE OF
(STREET)'
a
CD
ALTER ❑
�' �
HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING
—
I- 1
�-�
_
SIDE PROP. LINE
HIGHWAY WIDTH
IjII
REPAIR❑
USE OF-
❑
+
�.w
EXISTING BLDG,.44 DEMOL
APPLICANT TEL
CORNER CUTOFF YES ®
NO
(PRINT) NO.
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
VALUATION w,af
IN COASTAL PERMIT ZONE YES ®
No
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 COMPENSATI INSURANCE.
SIGNATURE OF X•
PERMITTEE
ADDRESS -
FINAL BY
_ TE _- ^9
DATE
CITY N
QUAKE CHECKS PAYABLE TO:
FEE � FEE
HARVEY T. BRANDT, COUNTY ENGINEER
5
6, "
/ t
PLAN' CHECK VALIDATION ,6-K M.O. CASH
PERMIT VALIDATION CK.
M.o. CASH
LA
76A638A CE #003 5/74
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