HomeMy WebLinkAbout1135APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDII
ADDRESS-
DEPARTMENT OF COUNTY ENGINEER
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da
BUILDING AND SAFETY DIVISION
CITY
NO. OF BLOGS.
BUILDING
SIZE OF LOT NOW
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ON LOT
ADDRESS
TRACT"
BLO CH
NO.
LOCALITY A
OWNER��_ �,,—
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NEAREST
CROSS ST,
ASSESSOR Y",
ADDRESS
MAP BOOK - _F
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
CITY
ZIPS
CONST ZONE,
ARCHITECT
TEL. _
NO ��VZ
ENGINEER
STATISTICAL CLASSIFICATION SEWER'MAP P
ADDRESS
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CLASS NO. DWELL.0 N I TS B /JP G
CONTRACTOR
NO
TEL.
USE ZONE MA
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ADDRESS
,
SPECIAL
jl'` CONDITIONS
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CITY
CLASS —
ROAD DEPARTMENT APPROVAL REQUIRED YES NO
CONSTFWCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
ADDRESS —
_FN
CITY
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. 07 OF
NO. OF C HECK
FRONT PROP. LINE HIGHWAY WIDTH
SIZE �, STORIES
FA LIES ONE
r.
+
NEW
go
DIICRIPCTI��N OF WORZ
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ADD
BLDG. SETBACK FROM
SIDE PROP. LINE OF (STREET)
ra
__
- ALTER ❑
TOTAL SETBACK FROM EXISTING
HIGHWAY + YARD
;qYPE OF
C)
s 0
—REPAIR Ej
SIDE ROP. L IGHWAY WIDTH
P
USE OF
DE MOL ❑APPL�CANI)
+
EXISTING BLDG,
CORNER CUTOFF YES NO ❑
TEL
NO.
(PRINT)
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE)
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ld
IN COASTAL PERMIT ZONE YES NO ❑
VALUATION,$ 0
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 STF �CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATI.KN.URAN
SIGNATURE OF
PERMITTEE.
.ADDRESS
FINAL
BY
TEL.
DATE
CITY NO.
TO
P.C.
$
PMT,:
$
MAKE CHECKS PAYABLE
HARVEY T. BRANDT, COUNTY ENGINEER
FEE
FEE
PLAN' CHECK VALIDATION 6.--) M.O. CASH
PERMIT VALIDATION
�17
CK M.O. CASH
Ad, i 1-3-11 2 1
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76A638A Ca#803 5/74
