HomeMy WebLinkAbout8872COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN
ADIDRRESS
BUILDING
ADDRESS
LOCALITY
NEAREST
CITY Diamond Bar ZIP
CROSS ST.
NO. OF BLDGS.
ASSESSOR
SIZE OF LOT NOW ON LOT None
MAP BOOK
PAGE
PARCEL
I
DISTRICT GROUP TYPE FIRE
PROCESSED BY
TRACT 31152-A BLOCK LOT NO. 42
CONST. ZONE
OWNER PPFSLBY OF SO. CALIF.No. 540-0500
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS P.O. Box 2200
CLASS NO. DWELL. UNITS:::::::::::j
BK PG
CITY Newport Beach CA. ZIP 92663
USE ZONE MAP
ARCHITECT OR TEL.
ConcernNO.979-0451
NO.
SPECIAL
ENGINEERArchltectUral
CONDITIONS
ADDRESS 77 Brookhollow Dr., Santa Ana, CA.
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
TEL.
CONTRACTOR Same as OWller NO.
BLDG. SETBACK FROM
LIc 289274
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
+
U_
NAME AND BRANCH nknOWn
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ADDRESS CITY
SQ. FT. NO OF NO OF CHECK
1262 1 1 1
HIGHWAY + YARD = TOTAL SETBACK FROM
SIDE PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK Plan 81-2-B NEW
Single Family Dwelling ADD ❑
CORNER CUTOFF YES ❑
NO ❑
❑
Gar. - 453 sq. ft. ALTER ❑
IN OPEN SPACE YES ❑
NO ❑
REPAIR
USE$Prch - 94 sq. ft.
❑
IN COASTAL PERMIT ZONE YES ❑
NO ❑
EXISTING BLDG. DEMOL
APPLICANT TEL
Kenneth D. Stark 540-0500
(PRINT)
BY (SIGNATURE)
I HEREBY AC 4 OWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
ff
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
EMPLOY ANY PERSON IN VIOLATION OF
`�!�-
WORK AUTHORIZED HEREBY WILL NOT
THE LABOR CODE OF THE STATE OF CALIFORNIA IN IFELATING TO WORKMEN S COM.
;-IT
PENSATION INSURANCE ,,.f✓' `°
ii
SIGNATURE OF �`=% t `" �" ��"
FINAL BY
PERMITTEE
DATE
ADDRESS4600 ampUS Drive
Newport Beach, CA.
P.C. Fee $
Permit Fee
L- a`
CITY NO.540-0500
f
Issuance Fee
7
VALUATION
p/
Total Fee
_ <.
II1t7_AIll Lei k'i
818 7'2 12 29 77 2 3
CK. M.O. CASH
14 8.80
PERMIT VALIDATION CK. M.O. CASH
(i�S 76A638A CE #803A 6/76