HomeMy WebLinkAboutN/A (1374)APPLICATION FOR BUILDING
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING777777= DEPARTMENT OF COUNTY ENGINEER
ADDRESS
CITY ZIP
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NO. OF BLDGS.
85000 SF O
SIZE OF LOT NOW ONLOT
ADIDRESS
TRACT BLOCK LOT NO,
LOCALITY
R M.J. Brock & Sons No. 851-6767
CROSSST.
ESS 6767 Forest Lawn Dr.
ASSESSOR
MAPBOOK
PAGE
PARCEL
DISTRICT GROUP
TYPE FIRE PROCESSED BY
Q$ An el es Ca ZIP 90068
CONST. ZTECT
ORV1tO Cetta TEL. 828=4028EER NO.
STATISTICAL CLASSIFICATION
SEWER MAP
ESS 1823 Stanford St Santa Monica C
kADDRESS
CLASS NO.
DWELL. UNITS BK PG
M.J. Brock & Sons No 851-6767USE
ZONE MAP
RACTOR
6767 Forest Lawn Dr No 54648
SPEECIAL
SS
CONDITIONS
LOS Angeles' Ca CLASS B
ROAD DEPARTMENT APPROVAL REQUIREDYES NORUCTION
LENDER
AND BRANCH none
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
SS CITY
HIGHWAY + YARD
-TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FT. _ NO. OF NO, OF CHECK
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 ❑
El
HIGHWAY + YARD
TOTAL SETBACK FROM TYPE OF EXISTING
= SIDE PROP. LINE HIGHWAY WIDTH
USE OF REPAIR
:. EXISTING BLDG. none DEMOL ❑
+
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
YES O
VALUATION $ ' o ,-:>
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-
PENSATIONINSURANCE.
r'�
SIGNATURE OF
6`
' PERMITTEE
ADDRESS 6767 Forest Lawn Dr
FINAL
BY
Los Angeles, Ca 90068 No. 851-6767
DATE
P CITY
MAKE CHECKS PAYABLE TO:
FEE'
FET
HARVEY T. BRANDT, COUNTY ENGINEER
CK. M.O. CASH r
E
PERMIT VALIDATION CK. M.O. CASH
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tS 76A638A CE 0803 3.75'