HomeMy WebLinkAbout6851115APPLICATION FOR BUILDINGI
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
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BUILDING AND SAFETY DIVISION
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SIZE OF LOTwh
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BUILDING
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TRACT
BLOCK
LOT NO.
LOCALITY
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NEAREST
OWNER NO. &„
CROSS ST.
ADDRESS!
ASSESSOR
MAP BOOK PAGE
PARCEL
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AWAt
DISTRICT GROUP TYPE FIRE
CONST. ZONE
PROCESSED BY
-CITY ) v ZIP
ARCHITECT OR T L,
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x ENGINEER NO�f
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STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS �` �� ��� ��
CLASS NO. DWELL. UNITS
BK PG
TEL
USE MAP
CONTRACTOR NO.
LIC.
ADDRESS Na - ' NO.
ZONE
NO.
SPECIAL
} LIC.
CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRU TON LENDER
NAME AND BRANCH t; y�
/V/ iV 4_
BLDG. SETBACK FROM
p
ADDRESS" ( CITY
FRONT PROP. LINE OF
(STREET)
I:
SQ. FT NO. OF NO. OF CHECK
TOTAL SETBACK FROM
HIGHWAY t YARD = FRONT PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
-
I SIZE,,, STORIES FAMILIES ONE
DESCRIPTIQN 61" WORKF °'^
f
ADD ❑
a.�
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
a
+ = TOTAL SETBACK FROM
TYPE OF EXISTING
El
HIGHWAY YARD SIDE PROP. LINE
HIGHWAY WIDTH
USE OF REPAIR
EXISTING BLDG. DEMOL ❑
+
APPLICANT TEL -
CORNERCUTOFF YES ®
NO ❑
IPRINTI ' NO. 17
�
411
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE
IN COASTAL PERMIT ZONE YES ®
NO
VALUATION $ .� "/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
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THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION. 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 CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
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I
-� SIGNATUREOF 'r
PERMITTEE
ADDRESS
- 47 ''
TEL.
-FINAL BY
-� %
DATE
CITY NO.
MAKE CHECKS PAYABLE TO:
:]
T
FEE' $ FEE
HARVEYT. BRANDT, COUNTY ENGINEER
;2 � ff
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
®S 76A63BA CE #803 3-75'