HomeMy WebLinkAboutN/A (1372)O I APPLICATIONBUILDING l
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING DEPARTMENT OF COUNTY ENGINEER
ADDRESS
/A� 710 BUILDING AND SAFETY DIVISION
OF BLDGS.
$ DDD S F 0
BUILDING
SIZE OF LOT NOW ON LOT
ADDRESS
TRACT
BLOCK
LOT NO.
LOCALITY
T EL.
NEAREST
-_OWNER NO.
CROSS ST.
ADDRESS 6767 Forest Lawn Dr
ASSESSOR
MAP BOOK
PAGE
PARCEL
-CITY Los Angeles, Ca ZIP 90068
DISTRICT GROUP
TYPE F RE
CONST. ZONE
PROCESSED BY
ARCHITECT OR Vito Getta TEL.828-4028
ENGINEER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS 1823 Stanford St Santa Monica Ca
CLASS NO.
DWELL. UNITS
BK PG
M.J. Brock &Sons TEL 851-6767
USE ZONE I MAP
CONT ACTOR
NO.
IC.
ADDRESS 6767 Forest Lawn Dr LN2.5 6 8
SPECIAL
LIC
Los An el es5 Ca 6
g
CONDITIONS
CLASS
CITY CLASS
ROAD DEPARTMENT APPROVAL
REQUIRED
YES ❑ NO ❑
CONSTRUCTION LENDER none
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD
= TOTAL SETBACK FROM
TYPE OF EXISTING
F SQ. FT. NO. OF NO. OF CHECK
1
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK single family NEW ®
+
ADD ❑
residence & attached garage
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
ALTER ❑
❑
HIGHWAY + YARD
= TOTALSETBACK FROM
SIDE PROP. LINE
TYPEOF EXISTING
HIGHWAY WIDTH
REPAIR
USE OF
EXISTING BLDG. none DEMOL ❑
+
_
APPPLLICANT M.J. Brock &Sons No 851-6767
CORNER CUTOFF
YES ®
NO ❑
IN OPEN SPACE
YES ❑
NO ❑
M BY (SIGNATURE)
IN COASTAL PERMIT ZONE
YES
NO
VALUATION .
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-
PENSATION INSURANCE,
V
SIGNATURE OF
PERMITTEE
ADDRESS 6767 Forest Lawn D
FINAL
BY
CITY Los Angeles, Ca 90068 No 851-6767
DATE
FEE'
PMFEE
MAKE CHECKS PAYABLE TO:
WARVEY T. BRANDT, COUNTY ENGINEER
t
CK. M.O. CASH
PERMIT VALIDATION CK. M.O. CASH
®s 76A638A CE N803 3-75'