HomeMy WebLinkAbout8874APPLICATION FOR COUNTY OF LOS ANGELES
DEPARTMENT• •
e
BUILDING PERMIT ! SAFETY DIVISION
FOR APPLICANT TO FILL IN
ADIDRESS
G
S
LOCALITY
lamlid Bar ZIP
NEAREST
CROSSST.
NO OF BLDGS.
LOT NOW ON LOT None
ASSESSOR
MAP BOOK
PAGE
PARCEL
33
F11E
DISTRICT GROUP
TYPE FIRE
PROCESSED BY
1152-A BLOCK LOT NO.
CONST. ZONE
PREST,Fv OF SO. CALIF. NO.540-0500
STATISTICAL CLASSIFICATION
SEWER MAP
S P.O. BOX 2200
CLASS NO.
DWELL. UNITS
BK PG
e rt Beach CA. ZIP 92663
USE ZONE MAP
CZzOR TEL
chltectural ConcernNO.979-0451
NO.
SPECIAL
E;
CONDITIONS
ADDRESS 77 Brookhollow Dr. Santa Ana I C2.
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONTRACTOR Same as Owner NO.
BLDG. SETBACK FROM
LIC.2H9274
FRONT PROP. LINE OF
(STREET)
ADDRESS NO.
HIGHWAY + YARD
= TOTAL SETBACK FROM
TYPE OF EXISTING
LIC.
FRONT PROP. LINE
HIGHWAY WIDTH
CITY CLASS B-1
CONSTRUCTION LENDER
+
_
NAME AND BRANCH Unknown
BLDG. SETBACK FROM
SIDE PROP. LINE OF
ISTREETI
ADDRESS CITY
SID FT NO OF NO OF CHECK
1351 2 1
HIGHWAY + YARD
= TOTAL SETBACK FROM
SIDE PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK Plan -B NEW
Single Family Dwelling ADD ❑
CORNER CUTOFF
YES ❑
NO ❑
Gar. - 508 sq. ft. ALTER ❑
❑
IN OPEN SPACE
YES ❑
NO ❑
REPAIR
USE
Ell
COASTAL PERMIT ZONE
YES ❑
NOEXI❑
OF BLDG. EMOL
APPLICANT Kenneth D. Stark TEL
540-0500
(PRINT) NO.
t
BY (SIGNATURE)`
A KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
1 HEREBY
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
.J
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
PERSON VIOLATION
4
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY IN OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATIONINSURANCE.^
SIGNATURE OFFINAL
BY
PERMITTEE
DATE
ADDRESS 4600 C us Drive
TEL.
Newport Beach, CA. 540-0500
P.C. Fee $
Permit Fee
7
CITY No
i ! :.✓
'` #"a '
Issuance Fee
/
VALUATION.,..,;,'-
Total Fee
t
PLAN CHECK VALIDATION
CK. M.O. CASH
156A0#
PERMIT VALIDATION CK. M.O. CASH