HomeMy WebLinkAbout1103, APPICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILLLIN (Print or type only)
BUILDING J1,
ADDRESS
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
CITY%/`�ZIP
BUILDING AND SAFETY DIVISION
NO. OF BLDGS,
SIZE OF LOT lell.;NOW ON LOT C
BUILDING
ADDRESS 3 E3 z z_'.1 41e V
TRACT 1t 'z�
'16 0 -1
d
BLOCK
1 LOT NO-
LOCALITY
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OWNER No
NEAREST
CROSS ST. 6-011u,7r, z-a""n)iN
ASSESSOR fr
IPARCEL
ADDRESS
MAP BOOK == 3
PAGE
DISTRICT GROUP TYPE FIRE PROCESSED BY
CITY '&�&j't72Lv-c1jzIP lod?,4,40
CONST X,
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ARCHITECT OR,,^' EL
T 0.
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ENGINEER
STATISTICAL CLASSIFICATION SEWER �-P
ADDRESS 415-
CLASS NO. DWELL.0 NITS/j:-) BK/'1AG
TEL.,
CONTRACTOR 'W� 17 7 No
USE ZONE MA. P ,
LIC,
NO.
SPECIAL
ADDRESS NO.,
CONDITIONS
LIC
CITY CLXSS
ROAD DEPARTMENT APPROVAL REQUIRED YES NO
CONSTRUCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LI NE OF (STREET)
- ADDRESS CITY
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FT NO. OF NO, CHECK
FRONT PROP. LINE HIGHWAY WIDTH
SIZE FAMILIES ONE
NEW
IrE:S'91X_110&N'1�1'0� WORK
ADD❑BLDG.
SETBACK FROM (STREET)
SIDE PROP, LINE OF
' ALTER ❑
41
5r f
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY WIDTH
REPAIR El
SIDE PROP. LINE
USE OF
DEMOL 01
+
EXISTING BLDG,
APPLICANT C. - TEL
IPR NT) 04t" iV
—
CORNER CUTOFF YES NO ❑
CORNER
IN OPEN SPACE YES ❑ NO
N EN SPACE
A " ❑
BY (SIGNATURE)
4" -C
-1
IN COASTAL PERMIT ZONE YES NO
I N COASTAL PERMIT
C
VALUATION,$ 41 00 0
A'
T 1 0 N
APPLICATION
P
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
P L Y
E To COMPLY
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
U L D N CO N_
BUILDING
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
JL
'Z .
AUTHORIZED
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
T HOR E VIOLATION
N 0 F T HE
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
CODE DE OF THE STATE OF -CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATIAN INSURANCE
SIGNATURE
PERMITTEE.
ADDRESS Au ZLL
FINAL BY
TE L.
Z'
CITY NO.
A T E
DATE
I
M,4KE CHECKS PAYABLE TO.,
P.C.,
FEE $ FPMT. i
FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN' CHECK VALIDATION
CK. M.O. CASH
c7"111
PERMIT VALIORTIU14 CK. M.O. CASH
zi,
76A638A CE#803 5/74