HomeMy WebLinkAboutN/A (1358)APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
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DEPARTMENT OF COUNTY ENGINEER
ADDRESSSS
ADD
1 ZIP
BUILDING AND SAFETY DIVISION
CITY
NO. OF BLDGS,
SIZE OF LOT 8 OOO S F NOW ON LOT O
BUILDING
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
OWNER M.J. Brock & Sons TEL
NEAREST
CROSS ST.
ASSESSOR
ADDRESS 6767 Forest Lawn Dr
MAPBOOK
PAGE
PARCEL
Los Angeles, Ca 90068
DISTRICT GROUP TYPE FIRE
PROCESSED BY
-CITY ZIP
CONST. ZONE
I ARCHITECT OR TEL.
ENGINEER Vito C NO —4028
STATISTICAL CLASSIFICATION
SEWER MAP
1823 Stanford St Santa Monica Ca
ADDRESS
CLASS NO. DWELL. UNITS
BK PG
CONTRACTORM. J . Brock &Sons No.851-6767
USE ZONE MAP
6767 Forest Lawn Dr No 54648
NO
SPECIAL
ADDRESS
CONDITIONS
CITYLos 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
SQ. FT. NO, OF NO. OF CHECK
TOTAL SETBACK FROM
HIGHWAY + YARD = FRONT PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
u SIZE STORIES FAMILIES 1 ONE
�y
DESCRIPTION OF WORK single family NEW Ld
+
ADD ❑
residence & attached garage
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
❑
TOTAL SETBACK FROM
HIGHWAY + YARD = SIDE PROP. LINE
TYPE OF EXISTING
HIGHWAY WIDTH
REPAIR
USE OF
- EXISTING BLDG. none DEMOL ❑
+ _
APPLICANT M.J. Brock & Sons No851-6767
CORNER CUTOFF YES ❑
NO ❑
IPRINTI
IN OPEN SPACE YES P❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE Y
NO
VALUATION $ , 3 d>'3%
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
PERMITTEE
ADDRESS 6767 EQrest Lawn Dr -
FINAL
BY
TEL.
DATE
CITY NO.
Fg
FEE
T
FEE
MAKE CHECKS PAYABLE TO:
[:::H�ARVEY
T. BRANDT, COUNTY ENGINEER
r
CK. M.O. CASH
PERMIT VALI®AIIVN CK. M.O. CASH
®5 76A638A CE #803 3-75'