HomeMy WebLinkAbout4484APPLICATION FOR COUNTY OF LOS ANGELES
®BUILD
OF COUNTY ENGINEER
BUILDING PERMIT BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
BUILDING
ADDRESS
LOCALITY
NEAREST
ZIP
CROSS ST.
NO. OF BLDGS.
ASSESSOR S:z
IPAGE
SIZE OF LOT 6 NOW ON LOT
MAP BOOK
PARCEL
BLOCK
TRACT,.3 aij LOT NO.
DISTRICT FIRE
2pN
7QCESSED BY
TEL.'2_jj
S T.
OWNER&�_/d A aes'!"'v NO.
STATISTICAL CLASSI (CATION
SEWEI�MAP
ADDRESS ,�_
:Z;e,,4 hk-
CLASS NO. 6)
D_ DWELL. UNITS
BK PG
CITY _-/< 0�, f� C1,'.-_A,1 ZIP 90
PLONI MAP
ARCHITECT
'r TEL. 1;'
ENGINEER /
2R,. ,yAZ�jl NO.4,21 1
SPECIAL
-2 f,; r) 'CONDITIONS
ADDRESS 62/ W, ° 114
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
TEL.
CONTRACTOR NO.
BLDG. SETBACK FROM
LIC
ADDRESS X</#y N6.
FRONT PROP, LINE OF
—(STREET)
HIGHWAY + YARD =
TOTAL SETBACK FROM
TYPE OF I EXISTING
1HIGHWAY
LIC.
FRONT PROP. LINE
1 WIDTH
CITY CLASS
CONSTRUCTION
+
r OW-7-
NAME AND BRANCH04
l
—
'
BLDG. SETBACK FROM
ZLENDER�/
'
ADDRESSW/J41�_<ITY 4 4,
SIDE PROP. LINE OF
(STREET)
'Q FT. NO. OF CHECK
HIGHWAY + YARD
TOTAL SETBACK FROM
TYPEOF EXISTING
JNO.OF
SEE STORIES FAMILIES ONE
I
SIDE PROP. LINE
HIGHWAY WIDTH
DESCR PTION OF WORK NEW
ADD ❑
CORNER CUTOFF
YES ❑
NO ❑
ALTER El
El
IN OPEN SPACE
YES ❑
NO ❑
REPAIR
USE OF
[:]
IN COASTAL PERMIT ZONE
YES ❑
NO ❑
EXISTING BLDG. DEMOL
APPLICANT TEL
(PRINT( 41) A S d NO.2,1j"?,
INT�'6 1
(SI NATURD
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMiLlY 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 TATE OF CALIFORNIA IJ4,RELATING TO WORKMEN'S COM-
PENSATION INSt J�C �E J)
SIGNATURE
FINAL
BY
PERMITTEE
DATE
ADDRESS
TELL
EO.
P.C. Fee $
Permit Fee
CITY N
VALUATION
Issuance Fee
Total FeeAye
ram
M w w-m-, a a] w 1 q41 :Jkvff_'j q I 9j_'j I Lq 0 1
L-A
'pDS 76A638ACE#803A8/77
CK, M.O. CASH
4 3.2
PERMIT VALIDATION CK. M.O. CASH
z/8 5 0 _iC)
1 6 1.0 0
6