HomeMy WebLinkAbout0 APPLICATION FOR COUNTY OF LOS ANGELES
BUILDING PERMIT "DEPARTMENT OF COUNTY BENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ADDRIESS
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DING `OC,
RESS �' (• (7, �i;1 AJ,_ LOCALITY
NEAREST
i )I,A:;.;�.�.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
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ER.\lei lr....T 1•' "1^�A .�:7NL0"', 5TATISTICAL CLASSIFICATION SEWER MAP
RESS'i, i l .•JY: I:!LI CLASS NO."m / DWELL.UNITS ' BK PG
,' IY -.i L r.I ZIP USE ZONE MAPHITECT OR - TEL. - NO.INEER
-' CONDITIONS
ADDRESS TE ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO
CONTRACTOR( I. I it'.F ^T I'�`:I•NO.�t J-�! )-� BLDG.SETBACK FROM
LIC. FRONT PROP.LINEOF ISTREET)
ADDRESS• T"I :+I. ~r\ i. NO. F: )`'S.1. I TOTAL SETBACK FROM TYPEOF EXISTING
LIC.
HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH
CITY / �it J:,} CLASS -
CONSTRUCTION LENDER +.
NAME AND BRANCH BLDG.SETBACK FROM -
ADDRESS CITY SIDE PROP.LINE OF ISTREETI
50.Fj,7, NO.OF NO.OF CHECK HIGHWAY .+ YARD TOTAL SETBACK FROM TYPE OF EXISTING
$IZE,-r-: STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY1 WIDTH
DESCRIPTION OF WORK NEW
❑ +
ADD ❑ CORNER CUTOFF YES ❑ NO."❑
ALTER ❑ IN OPEN SPACE YES ❑ NO
USE OF REPAIR ❑ IN COASTAL PERMIT ZONE YES p NO ❑
EXISTING BLDG. DEMOL ❑
APPLICANT TEL - Y
(PRINT) - NO.:
♦� i U
BY(SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE a
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 4
AND LAWS REGULATING BUILDING CONSTRUCTION,I CERTIFY THAT IN DOING THE p
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF +y
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM.
PENSATION INSURANCE. -
SIGNATURE OF
PERMITTEE DATE L BY - -
ADDRESS
TEL. P.C.Fee 5 Permit Fee -
CITY NO.
VALUATION$ Issuance Fee
Total Fee %. e"..
PLAN CHECK VALIDATION CK M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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