HomeMy WebLinkAboutN/A (1370)APPLICATION [ [PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING
DEPARTMENT OF COUNTY ENGINEER
ADDRESS
"I
BUILDING AND SAFETY DIVISION
CITY ZIP
SIZE OF LOT 8,000 S F NOW ON LOT 0
ADDRESS
Y TRACT
BLOCK
LOT NO.
LOCALITY
TELNEAREST
OWNER M.J. Brock & Sons No. 851-6767
CROSS ST.
6/67
` ADDRESS Forest awn' r
ASSESSOR
MAP BOOK PAGE PARCEL
' -CITY Los Angeles, Ca ZIP 90068
TYPE FIRE
DISTRICT GROUP CONST. ZONE PROCESSED BY
ARCHITECT OR Vito Cetta TEL 828=4028
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
1823 Stanford St Santa Monica C
ADDRESS
CLASS NO. DWELL. UNITS BK PG
" CONTRACTOR M.J. Brock & Sons No. 851-6767
USE ZONE MAP
6767 Forest Lawn Dr No 5 648
SPECIAL
ADDRESS
CONDITIONS
e$
Los nge , Ca LASS
CITY
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH none
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
y ADDRESS CITY
TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD =
SQ, FT, NO. OF NO. OF 1 CHECK
FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK single family 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
USE OF REPAIR
EXISTING BLDG, none DEMOL ❑
APPLICANT TEL
CORNER CUTOFF YES ❑ NO ❑
)PRINT) M.J. Brock & Sons No. 851-6767
IN OPEN SPACE Y,ES ❑ NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE ' NO
VALUATION $
� ti
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
1
I
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
t
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATIONINSURANCE.
t` l
ry SIGNATURE OF
PERMITTEE
' ADDRESS 6767 Forest lawn Dr
FINAL BY
TEL.
DATE
CITY I QS AnQP1 PS , i d 9nn�� ' _NO. -
MAKE CHECKS PAYABLE TO:
P.C. TFE
FEE
HARVEYT. BRANDT, COUNTY ENGINEER
_ _
a_..
PLAN CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
es 76A638A CE N803 3-75"