HomeMy WebLinkAbout1131APPLICATION FOR BUILDINGI
FOR APPLICANT TO FILL IN (Print or type only)"9
BUILDIN
COUNTY OF LOS ANGELES
ADDRESS R ' :�
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY z I P
NO, OF BLDGS.
SIZE OF LOT G �� , NOW ON LOT
BUILDING
ADDRESS
BLOCK
TRAC,06
T/
LOT NO.
LOCALITY
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OWNER -` — ,Cl NO `
NEAREST
CROSS ST. /!i % L <' f� r !' kk
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ASSESSOR
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MAP BOOKS
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PAGE PARCEL
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DISTRICT GROUP TYPE FIRE I PROCESSED BY
CITY , ZIP t)
CONST, ZONE
ARCHITECT OR ti TEL
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ENGINEER r, ENO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS �_Imo✓
CLASS NO, t OWELL,UNITS BKI;f% PPG
P
CONTRACTOR NoL
USE ZONE MAP _
ADDRESS NO
SPECIAL
LIC.
!a' CONDITIONS
CITY yj. CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES ® NO
CONSTRUatM LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
- ADDRESS CITY
HIGHWAY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING
SQ, F NO. OF a NO. OF CHECK
FRONT PROP, LINE HIGHWAY WIDTH
SIZ STO IES FAMILIES ONE
J
CD
f
A �!. 01 `5( 1k NEW ( +
�"
DES'CR PT�ON CTF W0bR k 1J4.1
ADD (L—JI
BLDG, SETBACK FROM
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SIDE LINE OF (STREET)
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ALTER El
HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTINGf
HIGHWAY
4
SIDE PROP. LINE HIGHWAY WIDTH
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REPAIR❑
USE
+ _
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EXISTING BLDG, DEMOL ❑
.-.
APPL1cANT' TEL
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CORNER CUTOFF YES NO
(PRINT) No
BY (SIGNATURE) /{�"
G
IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES ® NO
VALUATIONS,$ z" f
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 ST E OF -CALIFORNIA IN RELATING TO
WORKMEN'S CO MPE NSA T) INS URAN
SIGNATURE OF
PERMITTEE
ADDRESS '�':_i i
FINAL BY
_ TEL.
CITY NO.
DATE
MAKE CHECKS PAYABLE TO:
FEE $ PMT.,S
FEE' FEE D
HARVEY T. BRANDY, COUNTY ENGINEER
f / f
y Y Y
/wyy �y VALIDATION
PLAN+ CHECK Y ALa1DAjTI-j®N CASH
PERMIT VALIDATION �K.� M.O. CASH
3
76A638A CE#803 5/74