HomeMy WebLinkAboutN/A (1371)APPLICATION
FOR APPLICANT TO FILL IN (Print or type only)
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0
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
CITY t Vb<� �� ZIP
BUILDING AND SAFETY DIVISION
NO, OF BLDGS.
?> SIZE OF LOT 8,000 S F NOW ON LOT 0
BUILDING
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
OWNER M.J. Brock & Sons No.851-6767
SST
cCOS .ASSESSOR
,. ADDRESS 6767 Forest Lawn Dr
MAPBOOK
PAGE
PARCEL
GROUP TYPE
DISTRICT FIRE
PROCESSED BY
-CITY Los Angeles, Ca ZIP 90068
CONST. ZONE
ENGINEER ARCHITECT OR Vito Cetta NQ.828-
STATISTICAL CLASSIFICATION
SEWER MAP
1823 Stanford St Santa Monica Ca
ADDRESS
CLASS NO. DWELL. UNITS
BK PG
CONTRACTORM.J. Brock & Sons N0.851-6767
USE ZONE MAP
6767 Forest Lawn Dr "c, 54648
NO
O.
SPEECIAL
ADDRESS
CONDITIONS
CITY Los Angeles, Ca CLASS B
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH none
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
SQ. FT. € _ NO. OF NO. OF 1 CHECK
TOTAL SETBACK FROM
HIGHWAY + YARD = FRONT PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
family ®
DESCRIPTION OF WORK single Y NEW
+
ADD ❑
residence & attached garage
BLDG. SETBACK FROM
SIDE PROP- LINE OF
(STREET)
ALTER ❑
TOTAL SETBACK FROM
TYPE OF EXISTING
❑
HIGHWAY + YARD = SIDE PROP. LINE
HIGHWAY WIDTH
REPAIR
= USE OF
EXISTING BLDG. none DEMOL ❑
+ _
APPLICANT M.J. Brock &Sons TELNo.851-6767
CORNER CUTOFF YES ®
NO ❑
(PRINT(
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑
NO ❑
VALUATION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION- 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 RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
f
SIGNATURE OF
PERMITTEE
ADDRESS 6767 Forest Lawn Dr
FINAL
BY
CITyLos Angel es Ca 90068 No -
DATE
MAKE CHECKS PAYABLE TO:
P.C.
FEE x
PMT.
FEE
HAIR EY T. BRANDT, COUNTY ENGINEER
r
CK. M.O. CASH
PERMIT VALIDATION CK, M.O. CASH
®S 76A63BA CE #803 3-75