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APPLICATIONI IPERMIT
FOR APPLICANT TO FILL IN (Print or type only( — -P
s. BUILDING
DEPARTMENT OF COUNTY ENGINEER
<' ADDRESS
'
BUILDING AND SAFETY DIVISION
CITY e ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT NOW ON LOT 0
8 OOO S F
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
OWNER M.J. Brock & Sons TEL 851-6767
NEAREST
.
N 6767 Forest Lawn Dr
ASSESSOR
ADDRESS
MAP BOOK
PAGE
PARCEL
-CITY Los Angeles, Ca ZIP 90068
DISTRICT GROUP TYPE FIRE
CONST. ZONE
PROCESSED BY
P ARCHITECT OR TEL' ENGINEER Vito Cetta No. 828-4028
STATISTICAL CLASSIFICATION
SEWER MAP
T
ADDRESS 1823 Stanford St Santa Monica Cz
CLASS NO. DWELL. UNITS
BK PG
' CONTRACTOR M.J. Brock & Sons TEL 851-6767
USE ZONE MAP
6767 Forest Lawn Dr LIC. 5
SPE
SPECIAL
ADDRESS NO.
CONDITIONS
LIC
CITY Los Angeles, Ca CLASS B
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUCTION LENDER none
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
L
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
SQ. FT. �e NO. OF NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE gam° STORIES FAMILIES 1 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 Py Son NO.8191-6767
IN OPEN SPACE YES
NO
BY (SIGNATURE)
IN COASTAL PERMIT ZONE YES
NO
VALUATION $ K ` wel
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.
SIGNATURE OF
UP
PERMITTEE
Y 6767 Forest Lawn Dr
ADDRESS
FINAL BY
DATEQ
" CITY Inc Angeles, Ca 90068 NO. -
PMT.
FEE' FEE
MAKE CHECKS PAYABLE TO:
HARVEYT. BRANDT, COUNTY ENGINEER
6
CK. M.O. CASH
17
PERMIT VALIDATION CK. M.O. CASH
®S 76A638A CE #803 3-75'