HomeMy WebLinkAbout2921 APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
FA>'4�,j
C? .� !` "✓� G r7�i COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
1t�1L•l''Y1' ZIP
BUILDING AND SAFETY DIVISION
NO.OF BLOGS. BUILDING
LOT NOW ON LOT ADDRESS '
r+�.vv°�� BLOCK LOT NO. LOCALITY 'Y 7 �'',,..._ ;!;l"•""�
JJNOS�.�^ ,W. NEARESTOWNERCRp55 ST. I
ASSESSOR
ADDRESS ( A^-O�e MAP BOOK PAGE PARCEL
DISTRICT GRO Ll P TYPE FIRE PROCESSED BY
CITY ZIP r%' CQNST. ZONE
ARCHITECT OR �// �+} TES,.: 1 /+,y {r^�- •.L` (
ENGINEER 1r. +CLC NOif+x e Y/ STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS ,�}
'I�140 / +� CLASS NO�DWELL.UNITS \„ BK,-P,/PG
CONTRACTLOyRr} 'yG J�¢fCR' L NAG.', Fr USE ZONE NOP
ADDRESS C'JG J/,tJ.`,33++ grip' NO Ems' �' �� ?�y SPECIAL
/ '` LIC. ¢ 11,, CONDITIONS
CITY ! Sa(// /.� CLASS ROAD ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO,E]
CONSTRUCTION LENDER
NAME AND BRANCH BLDG,SETBACK FROM,
FRONT PROP.LINE OF,- -`' ISTREET)
ADDRESS CITY NOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY } YARD
SQ. FTry NO.OF NO.OF CHECK FRONT PROP, LINE HIGHWAY WIDTH
SIZE rs STORIES FAMILIES 'ONE
„t _ U
DESCRIPTION OF WORK NEW ❑ } � f,,,_�,. U
ADD ❑ BLOG,S ETBACKFROM
FIN
,y l�dryT SIDE PROP.LINEOF (STREET)
1
-ALT ❑ _ TOTAL SETBgCH FROM TYPE OF EXISTING C
{' HIGHWAY } YARD HIGHWAY WIDTH
+-{sR '` d`sDEPROP. LINEREPAIR❑DEMOL } CD.BLDG.
NT¢`+ ,,q TEI[j +J GARNER CUTOFF YES ❑ NO) f '�POPEN SPACE YES❑ NO [:j
By
+�..... f
f IN COASTAL PERMIT ZONE YES❑ NO ❑
VALUATIONS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OP THF'"9YYi/TE PF CA��.LH�MIA IN RELATING TO
WORKMEN,
S COMPE0.TION'j1M ANCE.J
SIGNATURE OF
PERMITTEE
ADORES c/�(jr Jq
�/ Ty'®+`'S�� DATE
NAL CITY
BY
CITY �D L! ""'pI+'� NO
IIAKE CHECKS PAYABLE 7'O; $ ` JPMT';¢
FEE' �;,.�-"I"' FEE 'V """
HARVEY T. BRANDY, COUNTY ENGINEER ` -•p f..
PLAN'CHECK VALIDATION CASH PERMIT VALIDATION am
+ `) M.O. CASH
7SAS39A CE4P903 5/34
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