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APPLICATION BUILDING i
FOR APPLICANT TO FILL IN (Print or type only) — — — a
V�
tmOUN 1 i Or Luj ANUELCJ
BUILDING
ADDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
`+Vl.
CITY I ZIP
NO. OF BLDGS.
BUILDING
SIZE OF LOT 8 OOO S F NOW ON LOT 0
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
M.J. Brock& Sons No8,51-6767
cosssT.
OWNER
ADDRESS 6767 Forest Lawn Dr
ASSESSOR
MAPBOOK
PAGE
PARCEL
CITY Los 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
ADDRESS 1823 Stanford St Santa Monica Ca
CLASS NO. DWELL. UNITS
BK PG
TEL.
CONTRACTOR NO. -
USE ZONE MAP
ADDRESS 6767 Forest Lawn Dr No.54648
NO.
LIC.
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
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
SQ. FT. NO. OF NO. OF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE T STORIES FAMILIES 1 ONE
DESCRIPTION OF WORK single family NEW I
ADD ®
residence & attached garage
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
❑
SIDE PROP, LINE
HIGHWAY WIDTH
USE OF REPAIR
EXISTING BLDG. none DEMOL El
+
APPLICANT M.J. Brock & Sons TEL 851-6767
CORNER CUTOFF YES ®
NO
(PRINT) NO.
IN OPEN SPACE YES ®
NO
>' BY (SIGNATURE)
IN COASTAL PERMIT ZONE YE
NO
"- VALUATION $ 7
1 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-
PENSATIONINSURANCE.t
SIGNATURE OF
PERMITTEE
ADDRESS 6767 Forest Lawn D
FINAL BY
TEL.
DATE
' CITY NO.
=MAKE CHECKS PAYABLE TO:
F E F ET
HARVEYT. BRANDT, COUNTY ENGINEER
-
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CK. M.O. CASH
7
PERMIT VALIDATION CK. M.O. CASH
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W
0
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