HomeMy WebLinkAboutNo Permit Number (1509)APPLICATION FOR COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING PERMIT BUILDING AND SAFETY T)TUMTON fl
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
BUILDING
ADDRESS
LOCALITY > g/`� JrB �f M-a�✓ �.
CITY D' ZIP
NEAREST
CROSS ST,
ASSESSOR
NO. OF BLOGS.
SIZE OF LOT NOW ON LOT NONE
MAP BOOK PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
TRAC31151
BLOCK
LOT NO
CONST„�" ZONE
`�
Presley of So. CalifNo� 540-361`�
OWNER
STATISTICAL CLASSIFICATION
SEW - MAP
ADDRESS
CLASS NO. e DWELL. UNITS .�.... �
BK PG
CITY NeW O t Beach, Ca. ZIP 92663
USE ZONEIMA
NOP
ARCHITECT' TEL.
SPECIAL
_MMNO.
CONDITIONS
ADDRESS 17915 Sky ark Blvd.
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO
CONTRACTOR NO TEL.
BLDG. SETBACK FROM
LIC.
FRONT PROP. LINE OF
(STREET)
ADDRESS NO. 9,QQ97A
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC,
CITY
FRONT PROP, LINE
HIGHWAY WIDTH
CLASS e
CONSTRUCTION LENDER
+ -
NAME AND BRANCH
BLDG, SETBACK FROM
ADDRESS CITY
SIDE PROP. LINE OF
(STREET)
SQ. FT, " NO OF NO, OF CHECK
l
HIGHWAY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING
SIZE STORIES/+2 FAMILIES1 ONE
SIDE PROP. LINE
HIGHWAY WIDTH
DESCRIPTION OF WORK Gar. 570 sq.ft-NEW
+
ADD ❑
Single Family Dwelling
CORNER CUTOFF YES ❑
NO ❑
ALTER ❑
A e"
(,3 car) lz4j1 - REPAIR❑
IN OPEN SPACE YES ❑
NO ❑
USE OF
EXISTING BLDG. DEMOL ❑
IN COASTAL PERMIT ZONE YES ®
NO
APPLICANT TEL
(PRINT) NO.
BY (SIGNATURE)
I HEREBY AC 4OWLEDGE 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, I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RE TING TO
WORKMEN'S COMPENSA "0 SURAN
SIGNATURE OF
FINAL BY
PERMITTEE L`
DATE
I
C ADDRESS m $ O
Newport Beach, Ca. TEL. 540-3611
J ' h
CITY NO.
P.C. Fee $ Permit Fee
J, � ( Issuance Fee
p _
VALUATION � .� (� i,`/ �); Za
//.
.. Total Fee
PLAN CHECK VALIDATION CK. M.O. CASH ®
PERMIT VALIDATION CK.
M.O. CASH
•', 9 rl C)
76A638A CB#8038 12/75