HomeMy WebLinkAboutN/A (1360)jAPPLICATION FOR BUILDINGPERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING DEPARTMENT OF COUNTY ENGINEER
ADDRESS ==7
`I ^ r„ '-N P 0.� o BUILDING AND SAFETY DIVISION
- NO OF BLDGS.
SIZE OF LOT 8 , 000 S F NOW ON LOT 0
BUILDING
ADDRESS
g TRACT BLOCK LOT NO.
LOCALITY
NEAREST
TEL,
OWNER M.J. Brock & Sons NO. 851-6 6
CROSS ST.
ADDRESS 6767 Forest Lawn Dr
ASSESSOR
MAPBOOK
PAGETYPE
PARCEL
-CITY Los Angeles , Ca ZIP 90068
FIRE
DISTRICT GROUP CONST. ZONE
PROCESSED BY
ARCHITECTOR Vito Cetta TEL. 828-4028
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS 1823 Stanford St Santa Monica C
CLASS NO.
DWELL. UNITS
BK PG
M.J. Brock & Sons No 851-6767
MAAP
CONTRACTOR
USE ZONE NO.
ADDRESS 6767 Forest Lawn Dr No. 54648
SPECIAL
LIC.
Los Angeles, Ca CLASS B
CONDITIONS
❑ ❑
CITY
ROAD DEPARTMENT APPROVAL
REQUIRED
YES NO
CONSTRUCTION LENDER
NAME AND BRANCH none
BLDG. SETBACK FROM
FRONT PROP, LINE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD =
TOTAL SETBACK FROM
TYPE OF EXISTING
SQ. FL ° NO. OF NO. OF CHECK
1
FRONT PROP, LINE
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK single fami 1 y NEW ®
+
ADD ❑
residence & attached garage
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
®
HIGHWAY + YARD =
TOTAL SETBACK FROM
SIDE PROP, LINE
TYPE OF EXISTING
HIGHWAY WIDTH
REPAIR
USE OF
EXISTING BLDG. none DEMOL ❑
+ _
APPLICANT TEL
CORNER CUTOFF
YES ®
NO ❑
(PRINT) M. J Brock & Sons NO. 851-676
.
IN OPEN SPACE
YES ❑
NO ❑
BY (SIGNATURE)
IN COASTAL PERMIT ZONE
YE ®
NO
VALUATION $
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 Eorest Lawn Dr
FINAL
BY
., TEL.
DATE
CITY NO.
FEE' ,,
yo
FEET
MAKE CHECKS PAYABLE TO:
MARVEYT. BRANDT, COUNTY ENGINEER
F`
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
®5 76A63BA CE t1803 3-75