HomeMy WebLinkAbout0 (14) APPLICATION FOR COUNTY OF LOS ANGELES
BUILDING PERMIT DEPARTMENT OF COUNTY BENGINEER
BUILDING AND SAFETY DIVISION
NG
FOR APPLICANT TO FILL IN ADDRIESS
I
DING Ili(;-
RESS (G` (• r7; �i;\ ,atm LOCALITY ✓:-r ,� �',/��� .
NEAREST
i )I IA:;.;�.�.1 ) i,1,f7 ZIP CROSS ST.
NO.OF BLDGS. A55ESSOR
OF LOT NOW ON LOT MAP BOOK - PAGE PARCEL
-DISTRICT GROUP TYPE FIRE PROCESSED BY
CT BLOCK LOT NO. - 'y CONST. _.ZONE.-'
, „�{'. f i• /
ER.\ISL Ir4{ 1•' 't`�A .�:7NLO°/ STATISTICAL CLASSIFICATION SEWER MAP
RESS'i, l l .•JT: I:!LI CLASS NO."m / DWELL.UNITS BK PG
,' IY --i L,.I ZIP USE ZONE MAPHITECT OR - TEL. NO.INEER NO. �i -� SPECIAL
-' CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO
[CTIACTOR I. I it'.F 'T :!•sI•N-OL t BLDG.SETBACK FROM
LIC. FRONT PROP.LINE OF ISTREET)
RESS• "I :+r. ~rl i. I NO. F: )•'}.1. TOTAL SETBACK FROM TYPEOF EXISTINLIC. HIGHWAY + YFRONT PROP.LINE HIGHWAY WIDTH
�iL I:,} CLASSSTRUCTION LENDER +,
E AND BRANCHBLDG.SETBACK FROM
RESS CITY SIDE PROP.LINE OF ISTREETI
T,,, . NO.OF NO.OF CHECK HIGHWAY .+ YARD TOTAL SETBACK FROM TYPE OFEXISTING
�-r-: STORIES FAMILIES ONE SIDE PROP.UNE HIGHWAY WIDTH
11 +
DESCRIPTION OF WORK ral ✓ NEW
ADD ❑ CORNER CUTOFF YES ❑ NO."❑
ALTER ❑ IN OPEN SPACE YES ❑ NO
USE OF REPAIR ❑ IN COASTAL PERMIT ZONE YES p NO ❑
[BY(SIGNATURE)
TING BLDG. DEMOL ❑
LICANT TEL - Y
(PRINT) - NO..
♦� i U
/(/G 'j. �.fqf'.HEREBY ACKNOWLEDGE THAI I HAVE READ THIS APPLICATION AND$TATET THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES LAWS REGULATNG BUILDING CONSTRUCTION,I CERTIFYTHAT IN DOINGTHEK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OFLABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM.
PENSATION INSURANCE.
SIGNATURE OF / -
PERMITTEE ,�... i''%�. L.. DATE L BY
ADDRESS
TEL. P.C.Fee 5 / %. I� <% Permit Fee -
CITY NO.
o VALUATION$ Issuance Fee
7Dt.1
PLAN CHECK VALIDATION CK M.o. CASH PERMIT VALIDATION CK. M.O. CASH
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®s ]eAd30ACI5l$03A8/77 „G Qi�' L ;? �;;. ,S 3, .0'u ' :
A Z Q J Y 14411-)D C7 Z.,,
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