HomeMy WebLinkAboutN/AAPPLICATION 1LI PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
rjADDRESS
UILDING 7=7
DEPARTMENT OF COUNTY ENGINEER
T� r ��OLA
7iv BUILDING AND SAFETY DIVISION
NO. OF BLDGS.
BUILDING
x SIZE OF LOT q,nno F NOW ON LOT 0
ADDRESS
TRACT BLOCK LOT NO.
LOCALITY
OWNER M.J. Brock & Sons TEL.
NEAREST cNOSSST.
ADDRESS 6767 Forest Lawn Dr
ASSESSOR
MAPBOOK
PAGE
PARCEL
-CITY Les Angeles, Ca ZIP 90068
DISTRICT GROUP
TYPE FIRE
CONST. ZONE
PROCESSED BY
ARCHITECT OR Vito Cetta TEL. 828-4028
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
lADDRESS 1823 Stanford St Santa Monica C
CLASS NO.
DWELL. UNITS
BK PG
CONTRACTOR M.J. Brock & Sons No 851-6767
USE ZONE I MAP
DDRESS 6767 Forest Lawn Dr NO.54648
NO.
SPECIAL
Angeles, Ca
CONDITIONS
ITYLos LASSB
ROAD DEPARTMENT APPROVAL
REQUIRED
YES ❑ NOONSTRUCTION
LENDER noneAME AND BRANCHBLDG.
[ADDRESS
SETBACK FROM
FRONT PROP. LINE OF
(STREET)
CITY
HIGHWAY + YARD
= TOTAL SETBACK FROM
TYPE OF EXISTING
Q. FT. NO. OF NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
IZE STORIES FAMILIES ONE
'a DESCRIPTION OF WORK single family NEW X
+
ADD ❑
residence & attached garage
BLDG. SETBACK FROM
SIDE PROP, LINEOF
(STREET)
ALTER ❑
El
HIGHWAY + YARD
TOTAL SETBACK FROM
= SIDE PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
USE OF REPAIR
EXISTING BLDG. none DEMOL ❑
+
APPLICANT TEL
CORNER CUTOFF
YES ❑
NO ❑
(PRINT) M.J. Brock & Sons NO. 851_
NO ❑
IN OPEN SPACE
YES ®
BY (SIGNATURE(
IN COASTAL PERMIT ZONE
YES ®
NO
VALUATION d
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
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SIGNATURE OF
PERMITTEE
ADDREsS,6767 Forest
FINAL
BY
TEL.
DATE
CITY NO.
G�a
FEE'
FEET
_
in! bad he It be- sa
4.. L MAKE CHECKS PAYABLE TO:
HARVEY T. BRANDT, COUNTY ENGINEER
€t
CK. M.O. CASH
rr i
PERMIT VALIDATION CK. M.O. CASH
®s 76A63BA CE #803 3-75