HomeMy WebLinkAbout9508L®I AT I N FOR COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
.:51WILDING PERMITBUILDING AND SAFETY DIVISION
BUILDING
ADDRESS
FOR APPLICANT TO FILL IN
ING >� ' „ _ �' ,. ..
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STATISTICAL CLASSIFICATION
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CLASS NO, N DWELL,UNITS
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/ ZIP
(�TEL..�),
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SPEC
CONDIITONS
ADDRESS % VCr-?
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO
CONTRACTOR TEL"�':"
��� ��!- NO „ �- ®
BLDG. SETBACK FROM
FRONT PROP, LINE OF
(STREET)
ADDRESS41 e' NO
HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
CITY ®,,. e9� LIC.
6 d1 CLASS
FRONT PROP. LINE
HIGHWAY WIDTH
CONSTRUC ION LENDER
} —
NAME AND BRANCH
BLDG, SETBACK FROM
ADDRESS CITY
SIDE PROP, LINE OF
(STREET)
SQ, FT, NO. OF NO, OF CHECK
_
HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
—
SIZE STORIES FAMILIES ONE
SIDE PROP. LINE
HIGHWAY WIDTH
DESCRIPTION OF WORK';< 76- C-a`.8 55 NEW
® / ADD ❑
f P1 �✓_
CORNER CUTOFF YES ❑
NO ❑
ALTER ❑
REPAIR ❑
IN OPEN SPACE YES ❑
NO ❑
USE OF
DEMOL ❑
IN COASTAL PERMIT ZONE YES ®
NO
EXISTING BLDG,
AP PRIN ANT �.. TELNO., ,q •, c�=��'s,
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d`=B
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE ISt#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 STATE OF CA IFORN IN RELATING TO
WORKMEN'S COMPE N INSURANC
SIGNATUROF °� _--
PERMITT ly
FINAL BY
ADDRESS d• p2
DATE
TELA :
P.C. Fee $ • Permit Fee
> : ,` \",,
CITY NO. ,.,.
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—'�. ��! Issuance Fee
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VALUATION Q
t
Total Fee-
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK
....CASH
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