HomeMy WebLinkAbout0953I APPLICATION FOR BUILDING PERMIT LL
IL
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY ZIP
BUILDING AND SAFETY DIVISION
NO OF EILDGS."�h,,,..�
BUILDING
W SIZE OF LOT NO, ON LOT
ADDRESS
TRACT z
BLOCK
LOT NO.
LOCALITY
TEL----
OWNERzb, N t J C
NEAREST
CROSS ST
ASSESSOR
ADDRESS,
MAP BOOK
PAGE
PARCEL
4
A ';�e
CITY �AAI;z !A11 zip
DISTRICT GROUPTYPEFIRE
CONST ZONE
D By
PROCESSED
�
ARCHI1' tC TEL
71K
ENGINEER W
STATISTICAL CLASSIFICATION
E R MAP
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ADDRESS
CLASS NO DWELL.UNITS�
PC -PG
TEL.
CONTRACTOR NO
US
SEAqNE MAP
N0.
LIC
ADDRESS 4'ai'63
J15,
SPECIAL
� 0, CONDITIONS
LIC.
CITY
CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES NO
CONSTRUCTION LE
NAME AND BR"
BLDG, SETBACK FROM
A 0 0R5 `S C I TY
FRONT PROP, LINE OF
(STREET)
OM
TOTAL SETBACK FROM STING
HIGHWAY + YARD = AYPE OF EXISTING
St�F NO, OF . OF CHECK
ILI ONE
IZE STRIES FAMILIES
SIZE
FRONT PROP, LINE HIGHWAY WIDTH
_44j�L 2
.1S-t11_1fTAi.FW-00_4_R_K NEW
+
ADD ❑BLDG,
SETBACK FROM
SIDE PROP, LINE OF
.(STREET)
ALTER ❑
TOTAL FROM
SETBACK
HIGHWAY + YARD =
TYPE OF EXISTING
—
SIDE PROP, LINE
HIGHWAY WIDTH
REPAIR❑
USE
+
EXISTOFING BLDG.- DEMOL ❑
APPLICANT TEL
CORNER CUTOFF YES El
NO ❑
(PRINT) NO.
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑
NO ❑
VALUATION
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 CO �T EOF -CALIFORNIA IN RELATING TO
WORKMEN'S COMIE.SAT ON INSLRANCE
SIGNATURE OF-,/
PERMITTEE
ADDRESS
TE
FINAL BY
CITY))o N
DATE
MAKE CHECKS PAYABLE TO:
P �cg , s PMT,'
F FEE
$
HARVE Y T. BRANDT, COUNTY ENGINEER]
E
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5-""')_ V6
1 1.
�
PLAN' CHECK VALIDATION 'ieK.M.O. CASH PERMIT VALIDATION-r'�cik, M.O. ASH
)
55.80#
0953 5 1575 21 cfb 0954 515 75 1 1 8 6.0 0 #
76A638A CEE#803 5/74