HomeMy WebLinkAboutN/A (1365)V l .n D30 o Elevation B PERMITI
BUILDING
APPLI I
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
OF COUNTY ENGINEER
BUILONG DiamondBUILDING
DEPARTMENT
AND SAFETY DIVISION
ADDRESS
ZIP
CITY
NO. OF BLDGS.
BUILDING
ADDRESS
SIZE OF LOT NOW ON LOT
TRACT 31062 BLOCK LOT NO.
CO � tion TN99-8491
LOCALITY
NEAREST
CROSS ST.
PARCEL
OWNER Anden
ASSESSOR PAGE
ADDRE529®V� na ®
MAP BOOK TYPE FIRE
DISTRICT GROUP CONST. ZONE
PROCESSED BY
ZIP 93.
-CITY TEL.
ARCHITECTO ®cN0.529 934
STATISTICALCLASSIFICATION
SEWER MAP
BK PG
ENGINEE�Q��
DWELL. UNITS
CLASS NMA
��� �® NO.
EZONE
O.
CONTRACTOR
NO. 31942�
SPECIAL
SPECIAL
CONDITIONS
YES
❑ NO ❑
ADDRESS LIC
n D] maS ® CA CLASS ��
ROAD DEPARTMENT APPROVAL REQUIRED
CITY
CONSTRUCTION LENDEbonti ental 'j111.nois
NAME AND BRANCH
6LDG' SETBACK F OFT
SETBACK FROM
(STREET)
TYPE OF EXISTING
9
S S 11o_ITY chica O
TOTAL
HIGHWAY + YARD = FRONT P. LINE
HIGHWAY WIDTH r
n
ADDRESS231 .La
NO. OF CHECK
SO FT. NO. OF FAMILIES ONE
SIZE 1794 STORIES
=
+
O
U
DESCRIPTION OF WORK NEW
❑
BLDG. SETBACK FROM
(STREETI p
ADD
:family maid nce ®
SIDE PROP. LINE OF
TOTALSETBACK FROM
= LINE
PEOF EXISTING w
HIGHWAY WIDTH z
Single ALTER
HIGHWAY + YARD SIDE PROP.
REPAIR ❑
+
USE OF DEMOL ❑
YES ®
NO ❑
EXISTING BLDG, N
CORNER CUTOFF
APPLICANT� COr orat:.OrINO.D9,7-849
YES ❑
NO ❑
(PRINT( �
IN OPEN SPACE
YES ❑
NO ❑
IN COASTAL PERMIT ZONE
BY (SIGN RE)
VALUATI N $ 32 92.00
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
ABVE IS CORRECT AND AGREE TO ITH ALL ORDINANCES
THAT IN DOING THE
E
THAT THE
AND LAWS REOGULATING BUILDING CONSTRUCTION. C RTIFY
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
IN RELATING TO WORKMEN'S COM-
WORK
THE LABOR CODE OF THE STATE OF CALIFORNIA
( /
PENSATI INSURANCE.
FSIGNATURE O
eERMIT r�tion,9 629 covin
nden CO FINAL BY
S
pD TEL, 599-849 DATE
}, S n :Lma p CA NO. PMT.
$
C
P.C. $ FEE
MAKE CHECKS PAYABLE TO:
HARVEY T. BRANDT, COUNTY ENGINEER
FEE
PERMIT VALIDATION CK.
M.O. GASH
CHECK VALIDATION CK. M.O. CASH
,,..V803 3-75
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