HomeMy WebLinkAbout0929FOR PERMIT
FOR APPLICANT TO FILL IN (PrAPPLICATIONint or type only) BUI,LDING
B U I L IN
BU I LDINCt�,
COUNTY OF LOS ANGELES
S S
ADORE SS &
C R E
DRESS
AD
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
Y
CITY
IT
NO,OF BLDGS.
BUILDING1
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SIZE OF LOT
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NOW ON LOT
ADDRESS
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BLOCK
BLOCK
LOT NO.
LOCALITY
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NEAREST
CROSS ST xi j (s) I_
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MAP BOOK
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DISTRICT GROUPTYPEFIRE PROCESSED BY
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ENGINEER e
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STATISTICAL CLASSIFICATION M/ AP
ADDRESS
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CLASS NO. (C_) DWELL.0 PG
CONTRACTOR
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No
USE 4ONE jMAP
ADDRESS
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SPECIAL
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NO a(
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CONDITIONS
CITY
CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES NOF
CONSTRUCTf'&4 LENDER
NAME AN RANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
ADDRESS
CITY
TOTAL SETBACK FROM TYPE OF EXISTING
YARD HIGHWAY + TING
SQ. I I NO. OF
NO, OF CHECK
FRONT PROP, LINE HIGHWAY WIDTH
SIZ&,Z
,S STORIES
FAMILIES ONE
AW�gM
DES I X
NEW
ADD
BLDG. SETBACK FROM
SIDE PROP. LINE OF (STREET)
ALTER ❑
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
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— REPAIR Ej
SIDE PROP. LINE HIGHWAY WIDTH
USE OF
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+
EXISTING BLC�G "14-1
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APPLICANT`-
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CORNER CUTOFF YES NO
(PRINT)
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NO.
IN OPEN SPACE YES NO El
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES NO
VALUATION
oL
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 COMPENSAT19,PCINSURANCE.
SIGNATURE OFF
PERMITTEE
ADDRESS
CITY �v
FINAL BY
DATE
MAKE CHECKS PAYABLE
,$ P.C.PMT.
FEE FEE ,$
HARVEY T. BRANDT, COUNTY ENGINEER
k 0
PLAN CHECK VALIDATION CK.) M.O. CASH
A
:_;oA 0929 5 15 75 21 5 5.8 0 ffi 'Go
76A638A CE#803 5/74
PERMIT VALIDATION'"`�:) M.O. CASH
0930 5 1575 1 18 6.0 0
CD