HomeMy WebLinkAbout0 (17) APPLICATION FOR COUNTY OF LOS ANGELES
RTMENT OF COUNTY
BUILDING PERMIT °BUILDNGANDSAFETYDIVSIONR
FOR APPLICANT TO FILL IN noloaess f7` L' '�.�- Fr".' .!i
BUILDING / 1
ADDRESS 1 J77_7 C,� (,?,L+ r•(J LOCALITY I �:i rr ,•1 4'-4"
NEAREST
CITY i. ,A 11 ('' ZIP CROSS ST. '
NO.OF SLOGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT BLOCK LOT NO, CONST. ZONE
TEL
OWNER-{ rI4, STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS 1 J,7 1J: CLASS NO. I DWELL.UNITS BK,i PG
CITY 1S%. ,{rr 1fx, _ ZIP USE ZONE MAP
ARCHITECT OR TEL. NO. '
ENGINEEP NO. �, SPKIAL
CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REOUIRED YES❑ NOQ
CONTRACTOR + � {} 42,-, T o ! �' Ir
BLDG.SETBACK FROM
CO. FRONTPROP,LINEOF'
ISTREETI
ADDRESS LNI _
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
( LIC. FRONT PROP.LINE HIGHWAY WIDTH
CITY �� c,...=.1 CLASS _
CONSTRUCTION LENDER +
NAME AND BRANCH
BLDG.SETBACK FROM
ADDRESS CITY SIDE PROP,LINE OF ISTREETI
SO.FTS- NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SIZE � 'r. STORIES FAMILIES ONE SIDEPROP.LINE HIGHWAY WIDTH
❑ +
DESCRIPTION OF WORK r T <I ri NEW
ADD ❑ CORNERCUTOFF' YES ❑ NO
ALTER IN OPEN SPACE YES ❑ NO�❑
REPAIR ❑
EXSTTIING BLDG. DEMOL 1:1 IN COASTAL PERMIT ZONE YES ❑ NO ,❑
APPLICANT TEL >
IPRINTI NO. nD
V
BY ISIGNATUREI I, —
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA7\1pN AND STATE
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
THELABORCODE OF TH E STATE OF CALI TO RNIA IN RELA TI NG TO WO RKMENS COM
PENSATION INSURANCE. }/
SIGNATURE OF i f'7 Y f �i 1 ! FINAL BY
PERMITTEE DATE -
ADDRESS
T L. P.C.Fee b / "^� Permit Fee
CITY NO.
�^ Issuance Fee f
VALUATION
o Tocol Fee
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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ts 76A638A CE A803A O/]] �J
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