HomeMy WebLinkAboutN/A (1356)APPLICATION I 1PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
DEPARTMENT OF COUNTY ENGINEER
- ADDRESS
BUILDING AND SAFETY DIVISION
CITY i ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT 8,000 S F NOW ON LOT O
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
TEL
OWNER M.J. Brock & Sons NO.851-6767
NEAREST
COSSST.
rv6767 Forest Lawn Dr
ASSESSOR
ADDRFCS
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY JOS Angelpq, Ca ZIP 90068
CONST. ZONE
ARCHITECT O TEL,
Tito Cetta 828-4028
ENGINEER NO.
1823 Stanford St Santa Monica C
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO. DWELL. UNITS
BK PG
TEL.
CONTRACTOR NO. -
USE ZONE MAP
NO.
ADDRESS 6767 Forest Lawn Dr No. 54648
o$ Angeles, Ca B
CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
"p CONSTRUCTION LENDER none
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
SQ. FT. NO. OF NO. OF CHECK
1
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
a
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
El
HIGHWAY + YARD = SIDE PROP. LINE
HIGHWAY WIDTH
USE OF REPAIR
EXISTING BLDG. none DEMOL ❑
Y
+ -
APPLICANT
P
Brock &Sons TEL
851-6767
CORNER CUTOFF YES ®
NO ❑
I PRNANTM.t1.
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES ®
NO
VALUATION_ ? ZZ3
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
IN RELATING TO WORKMEN'S COM-
THE LABOR CODE OF THE STATE OF CALIFORNIA
PENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
6767 Forest Lawn Dr
ADDRESS
AL BY
TEL,
DATE
CITY NO. -
MAKE CHECKS PAYABLE TO:
FEE FEE T
HARVEY T. BRANDT, COUNTY ENGINEER.®
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
r
n.
O
0
w
Z
®S 76A63BA CE #803 3-75