HomeMy WebLinkAbout0947APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
COUNTY OF LOS ANGELES
SS ADDRE
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
CITY
ZIP
SIZE OF LOT
NO, OF BLDGS,��
W
NOON LOT
BUILDING
ADDRESS
TRACT
IBLOCK
I LOT NO.
�*6_2
LOCALITY
OWNER
TEL
NO. 1
NEAREST
CROSS ST
ASSESSOR
IPAGE
1PARCEL
ADDRESS//�')/
MAP BOOK c
DISTRICT GROUPTYPEFIRE I PRqCESSE�D BY
CONST.0
CITY
ZIP
,
ARCHITEC 1360�'
ENGINEER
TEL
N
STATISTICAL CLASSIFICATION SFWER MA K
ADDRESS �3�
0-
CLASS NO.0 DWELL. UNITS YIQPG
CONTRACTOR
NO, TEL.
USA ZONE MAP r
NO.
LIC
ADDRESS
NO.
SPECIAL
C_'C)NDITInN
CITY
c_1
CLASSROAD
DEPARTMENT APPROVAL REQUIRED YES NO
CONSTRUCTION LENDEI�
NAME AND BRAN
j tC44_
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
ADD
CITY
HIGHWAY + YARD ITOTAL SETBACK FROM TYPE OF EXISTING
SQ. NO. OF
NO, CHECK
FRONT PROP. LINE HIGHWAY WIDTH
SIZ STORIES t;&N
FAMILIES ONE
e
NEW
DES'CRIPTION OF WORK
ADD ❑
BLDG, SETBACK FROM
SIDE PROP, LINE OF (STREET)
ALTER
I❑TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD
CD
,1A
SIDE PROP. LINE HIGHWAY WIDTH
USE
REPAIR
+ =
I
of
EXI
DEMOL ❑
ZPPLI&NT
TEL
CORNER CUTOFF YES NO
(PRINT)
NO.
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES NO
VALUATION =/y
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-
STR UC TION CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBYI WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR
OR CODE OF THE STATE OF �CALIFORNIA IN RELATING TO
NSAV ON INSURANCE
WORKMEN'S COMPE U NCV
SIGNATURE i
V
PERMITTEE-
ADDRESS„
FINAL
BY
CITY N
DATE
MAKE CHECKS PAYABLE TO:
P.
FEEC.
FEE $
HARVEY T. BRANDT, COUNTY ENGINEER
Z) D,
PLAN* CHECK VALIDATION (��CK. M.O. CASH
PERMIT VALIDATIO
C K,� M.O. CASH
0947 5 1575 21 55.80
co
0 914 8 5 1575 1
18 6,0 0
:A
co
76A638A CE#803 5/74