HomeMy Public PortalAbout5930 AGNES AVE_Building_1/24/1977_ _ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN` (Print or type only)
COUNTY OF LOS ANGELES
BUILDING 3" 3l>
ADDRESS !./_ , DEPARTMENT OF COUNTY ENGINEER
CITYzIP BUILDING AND SAFETY DIVISION
NO OF BLDGS BUILDING
SIZE OF LOT NOW ON LOT ADDRESS S Q
TRACT BLOCK LOTS - � LOCALITYH ~
s TEL7 NEAREST
OWNER NOG CROSS ST
ASSESSOR r
ADDRESS S U MAP BOOK - PAGE PARCEL
DISTRICT GROUP TYPE FIRE G�SSED BY
CITY G�f ZIP �.�+ D a CONS ZONE
ARCHITECT OR L_:_TEL
ENGINEER -- NO STATI,)TICALCLASSIFICATION SEWER KAP
� ' x a
ADDRESS CLASSNO DWELL UNITS B PG
TEL
CONTRALTO e(i^ NO z Z USE ZONE MAP
NOLIC z
O
ADDRESS Z� - �Ylt C NO �-2 SPECIAL - s
LIC CONDITIONS
CITY �� CLASS / ROAD DEPARTMENT APPROVAL REQUIRED s YES ❑ NO ❑
CONSTRUCT( LENDER _
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF (STREET) `
ADDRESS - CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT NO OF / NO OF CHECK HIGHWAY + VYARD = FRONT PROP LINE HIGHWAY WIDTH
SIZE Z STORIES ( FAMILIES - ONE }
IF + _ a
DESCRIPTION OF WORK NEW s0 ' 0
40
y ADD ❑ BLDG SETBACK FROM (STREET)
O
�zel , /l SIDE PROP LINE OF
Ova
� /� T f ALTER ❑ HIG AY + _YARD �= TOTAL SETBACK FROM TYPE OF EXISTING u
C= i C REPAIR ❑ SIDE PROP LINE HIGHWAY WIDTH
USE OF z
EXISTING BLDG DEMOL +
APPLICANT TEL — 9/ CORNER CUTOFF YES ❑ NO ❑
(PRj. r �?, NO �
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE(
� IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION Q s
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 LIFORNIA IN RELATING T WORK N 5 COM n " t
PENSATION INSURANCE
SIGNATURE OF
PERMITTEE
ADDRESS"W-24-7oinple AR ^
FINAL BY
CITY TEL
NO DATE
s
MAKE CHE S PAYABLE TO FEE F ET
HARVEY BRANDT COUNTY ENGINEER / L
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION cK o CASH
l 327r-'40V 7 i9 #° }� 1200 ��
JOS 76A638A CE#803 3 75