HomeMy WebLinkAbout853APPLICATION U ILa IN MIT
FOR APPLICANT TO FILL IN (Print or type only) I'
COUNTY OF LOS ANGELES
BUILDING -
ADDRESS , ,: '' DEPARTMENT OF COUNTY ENGINEER
I - CITY //lrr.;r..` ,'- 71P BUILDING AND SAFETY DIVISION
NO. OF BLDGS.
t SIZE OFLOT NOW ONLOT
BUILDING
ADDRESS��✓t,
TRACT 306
BLOCK
LOT NO.
LOCALITY
e / TEL.
OWNER L C3.�, �s N✓. NO-933-
NEAREST
CROSSST. E / 1
ADDRESS A/ * 4,PO UC• .
ASSESSOR
MAP BOOK 0 PAGE
PARCEL
CITY ZIP
DISTRICT GROUP TYPE FIRE
P90CESSED BY
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ARCHITECTOR TEL.
r' CONST-,- ZONE
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ENGINEER WjAj NO.
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STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS Vivo sr. G • �•
CLASS NO. ''` DWELL. UNITS
BK PG
CONTRACTOR i NO.
USE ZONE IMQAP
LIC.
ADDRESS NO.
SPFCIAL
,
CITY j°' CLASS
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CONDITIONS
ROAD DEPARTMENT APPROVAL REQUIRED
YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH
BLDG. SETBACK FROM
FRONT PROP. LINE OF
(STREET)
ADDRESS CITY
HIGHWAY + YARD - TOTAL SETBACK FROM
TYPE OF EXISTING
SQ. FT. NO.OF NO. bF CHECK
FRONT PROP. LINE
HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK may' NEW ❑
+
e)r sevi".0smvet ADD ❑
BLDG. SETBCK FROM
SIDE PROP, LINE OFF
ISTRFET)
ALTER ❑
.GL_ P•
TOTAL SETBACK FROM
HIGHWAY + YARD -
TYPE OF EXISTING
REPAIR ❑
SIDE PROP. LINE
HIGHWAY WIDTH
USE OF
EXISTING BLDG. DEMOL El+
APPLICAN'L,,TEL.
CORNER CUTOFF YES ❑
NO ❑
(PRINT) 1,J �, NO
IN OPEN SPACE YES ❑
NO ❑
BY (SIGNATUREL
IN COASTAL PERMIT ZONE YES ❑
NO ❑
VALUATION $ l
f:a
i m >7
- '
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
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17e Z-1
WORK AUTHORIZED HERE I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODEOFTH T TEOFCALIFORNIAINRELATINGTOWORKMEN'SCOM-
c�
PENSATION INSURANC
.
S€GNATUREOF
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PERMITTEE
ADDRESS
TEL. w (//�
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FINAL BY
DATE
7
CITY NO. T�
MAKE CHECKS PAYABLE TO:
HARVEYT. BRANDT, COUNTY ENGINEER
FEE' FEET'
/ ``j�
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N
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PLAN CHECK VALIDATION
CK. M.P. CASH
PERMIT VALIDATION r' CK ' M.O. CASH
Os 76A638ACFH8033.75'