HomeMy WebLinkAbout6861APPLICATION I 1PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING nCDADTAAFPIT nF Cf111NTV PhICIMSPI?
BUILDING AND SAFETY DIVISION
r° CITY"LVJ ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT NOW ON LOT
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY i`
TEL.
NEAREST
=m OWNER NO,
CROSS ST.
"
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
DISTRICT I GROUP TYPE
FIRE
PROCESSED BY
CITY ZIP
`®`, CONST.
ZONE
�®
mc��1��
ARCHITECT OR TEL.
1
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. 00 DWELL.
UNITS
BK PG
TEL.
CONTRACTOR NO.
USE ZONE MAP
LIC.
NO.
ADDRESS NO.
SPECIAL
LIC.
CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
Is CONSTRUCTION LENDER
NAME AND BRANCH
BLDG, SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
SQ. FTC NO. OF jj NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE STORIES 4-- FAMILIES ON
DESCRIPTION OF WORK NEW
+
- ADD
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
HIGHWAY + YARD =
SIDE PROP. LINE
HIGHWAY WIDTH
REPAIR
USE
EXISTTIING BLDG. DE(�OL ❑
+
APPLICA '' TEL'`-
CORNER CUTOFF
YES ❑
NO ❑
(PRINT)( NO• r
,
- _
IN OPEN SPACE
YES ❑
NO ❑
" BY (SIGNATURE( 4
•
IN COASTAL PERMIT ZONE
YES ®
NO
'°� -`� g�
VALUATION
1
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE
t
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
r
SIGNATURE OF
PERMITTEE
µ ADDRESS
FINAL BY
TEL.
DATE
CITY NO,
P.CMAKE �j
CHECKS PAYABLE TO:
FEE
FEE
FEE
FEE
HARVEY T. BRANDT, COUNTY ENGINEER
V �>�
PLAN CHECK VALIDATION CK.
n
es 76A638A CE #803 3-75'
M.O. CASH
I! 0,R 0 r
PERMIT VALIDATION CK. M.O. CASH