HomeMy WebLinkAbout1501 (440)'APPLICATION
FOR
COUNTY OF LOS ANGELES
BUILDING
PERMIT
DEPARTMENT OF COUNTY ENGINE
AIN FE DIVISI
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ZIP
CROSS ST.
NO. OF BLDGS.
ASSESSOR
SIZE OF LOT NOW
ON LOT
MAP BOOK
PAGE
PARCEL
1
BLOCK
NO
DISTRICT
GROUP
TCYOPE
FIRE
PROCESSED BY
TRACT
LOT
O
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OWNER i/ NO
STATISTICAL CLASSIFICATI N
SEWER MAP
ADDRESS
CLASS NO. DWELL. UNITS ^
8K�
CITY
ZIP
UV ZONE
MAP S
NO.
ARCHITECT OR
TEL.
/c "
t
ENGINEEP
NO.SPECIAL
D a�
CONDITIONS
ADDRE,
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO
TEL. a
CO T
�O�O%
BLDG. SETBACK FROM
a�
LIC
FRONT PROP. LINE OF 't ISTREETI
ADDR .
O. OI 7
HIGHWAY + YARD =
TOTAL SETBACK FROM
TYPE OF
EXISTING
LIC..�
CLASS e�
FRONTPROP.LINE
HIGHWAY
WIDTH
CITY
CONSTRUCTION
_
+
��
LENDER
NAME AND BRANCH
LL
U
BLDG. SETBACK FROM
t-�J
ADDRESS CITY
SIDE PROP. LINE OF (STREET)
SO. FT.
O
NO. OF N
OF
CHECK
HIGHWAY + YARD
TOTAL SETBACK FROM
SIDE PROP. INE
TYPE OF
HIGHWAY
EXISTING
WIDTH
SIZE
STORIES A
(LIES
ONE
O
+
DESCRIPTION WORK
NEW
U
ADD ❑
CORNER CUTOFF YES ❑ NO0
LLJ
IL
a�
ALTER ❑N
REPAIR [3
IN OPEN SPACE YES ❑ NO r17TZ
USE OF
❑
IN COASTAL PERMIT ZONE YES ❑ NO
EXISTING BLDG.
DEMOL
APPLICANT
TEL
(PRINT)
NO. NO.
BY (SIGNATURE)
I HEREBY ACKNOWLEDG AVE READ
S APPLICATION AND STATE
THAT THE ABOVE 15 CO T AND REE TO
M Y WITH ALL ORDINANCES
AND LAWS REGULATIN UILDING C STRUCTI N.
I ERTIFY THAT IN DOING THE
WORK AUTHORIZED YIYI Y OT EMPL
PERSON IN VIOLATION OF
THE LABOR CODE THE STATE ALIFORNIA
TING TO WORKMEN'S COM-
PENSATION INS E
TU
SIGNPERMIT
PERMIT � �
FINAL lk L /6(/
DATE �+ F
BY
/\ � ate•_
ADDR
TEL.
P.C. Fee $ 2.31 I-rZ
Permit Fee 412 • 0
CITY
NO.
O
Issuance Fee . ::p-0
i
VALUATION-
im
Total Fee 419,040
PLAN CHECK VALIDATION
cK. M.O. CASH
PERMIT VALIDATION CK. - CASH
1500 4 2 1 '78 2 1
23.52
ca 1501 4 2178 1 4 9,0 0#
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76AS38A CE N803A 6/76
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