HomeMy WebLinkAbout0997APPLICATION FOR BUILDING PERMIT Id
FOR APPLICANT TO FILL IN (Pint or type only)
BUILDING
COUNTY OF LOS ANGELES
ADDRESS ,��
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY Z IP q, "1
NO. OF BLDGS,
SIZE OF LOT NOW ON LOT
BUILDING
ADDRESS uz
TRACTg?/
IBLOCK
LOT NO.
LOCALITY
OWNER
TE
NO
NEAREST
CROSS ST.
Dlj� ADDRESS - 11Z 7
ASSESSOR
MAP BOOK C t7
1PAGE 1PARCEL
�� 660
DISTRICT GROUPPROCESSED FIRE PROCESSED 8
CONST.. 70NE
ZIP
J 6
ARCHITECT OR
I TE
ENGINEER
4146K No
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS
CLASS NO. (2,) DWELL.UNITS
CONTRACTOR
NO, TEL..
USEZONE IMA P
ADDRESS
'C L J�__3
0
S OLCI
SPECIAL
LN
NO
C=
CONDITIONS
LI
CITY
C
CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO
CONSTRUCTLENDER
N
I`
NAME AND R
RANCH
BLDG, SETBACK FROM
FRONT PROP. LINE OF (STREET)
ADDRESS
CITY
HIGHWAY + YARD ITOTAL SETBACK FROM TYPE OF EXISTING
SQ. I NO. OF
Ff'd'
SIZE STORIES
N 0 OF CHECK
FAMILIES ONE
L
FRONT PROP, LINE HIGHWAY WIDTH
4_
Aga"
,5j --
+
IDISlRlr�
TION OF WORK
NEW D6
ADD -]
BLDG, SETBACK FROM SIDE PROP, LINEOF (STREET)
ALTER ❑
HIGHWAY + YARD = TOTAL SETBACK FROMI TYPE OF EXISTING
I
/I —REPAIR❑
SIDE PROP. LINE HIGHWAY1 WIDTH
USE OF
+
1
IN EXISTG BLDG,,/
OEMOLE]
-,-2
APPLICANT
TEL
CORNER CUTOFF YES N 0
(PRINT) Ak
NO.
..
IN OPEN SPACE YESO NO 1:1
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES NO
V L T
VALUATION
A A 1 0 N
I HEREBY ACKdOWLEAE THAT I
RE Y
HEREBY
H E
HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
E T
STATE
S T
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
W CON-
T A L L 0
WITH
STRUCTION. I CERTIFY THAT IN
U
STRUCTION. I
R N
DOING THE WORK AUTHORIZED
CT Y
HEREBY I WILL NOT EMPLOY ANY
HEREBY
HER L
PERSON IN VIOLATION OF THE
LABOR CODE OF THE ST�TE OF
C E
R CODE
-CALIFORNIA IN RELATING TO
E N S
WORKMEN'S COMPENSATIfl INS U AN-
M C
WORKMEN'S
SIGNATURE OF
TU
PERMITTEE
ADDRESS Z
TE
FINAL BY
DATE
CITY
N
MAKE CHECKS PAYABLE TO:
PMT,:
FEE FEE $
'$
V
HARVEY T. EIRANIDT, COUNTY ENGINEER]
56, 46
PLAN' CHECK VALIDATION c M.O. CASH PERMIT VALIDATION 6c._K.> M.O. CASH
0,9 9 7 5 t675 21 5 5.8 0 I -A 0998 5 1675 1 18 6,00
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76A638A CE*803 5/74