HomeMy Public PortalAbout4930 ALESSANDRO AVE_Building__ • •- APPLICATION FOR BUILDING PERMIT -
FORS ANT TO FILL IN (Print or type only)
BUILDING - COUNTY OF LOS ANGELES
ADDRESS SSI$A)10 R a - 4Vt DEPARTMENT OF COUNTY ENGINEER
CITY BUILDING AND SAFETY DIVISION /es.5.,,,
fi O OF BLDGS BUILDING _
SIZE OF LOT &-00 FT NOW ON LOT / ADDRESS �Q / /{
TRACT BLOCK �^ LOT NO �1 LOCALITY
NEAREST
OWNER � A( I.Nr`Y NEL ?- 117} CROSS ST
C� ASSESS
ADDRESS /.�4 s /v.0IRo Y� MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIREaSISED�EY
CITY ZIP y� 7pB CONST ZONE
ARCHITECT OR . /.� TEL
ENGINEER A' //�C NO /►7 STATISTICAL CLASSIFICATION
_ SEWER MA
ADDRESS CLASS NO-2/ DWELL UNITS BKjP3
CONTRACTOR NOL E ZONE MAP �/
LIC NO
ADDRESS NO 1 SPECIAL
LIC J CONDITIONS
CITY CLASS
RO D DEPARTMENT APPROVAL REQUIRED YESCj NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT ROP LINEOF (STREET) }..
ADDRESS CITY
HIGHW Y + YARD TOTAL SETBACK FROM TYPE OF EXISTING �
SO FTS NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE Q STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW ❑ U
oo BLDG SFTBACK TBACKFROM- a
ADD SIDE PRO LINE OF (STREET) Z
ALTER ❑ HIGHWAY } Y FROM TYPE OF EXISTING
REPAIR❑
D PROP LINE HIGHWAY WIDTH
USE
EXIISOT NG BLDG �' /�/rCT� DEMOL ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO El
RINT) hopOeVT NO
BY (SIGNATUREIN OPEN SPACE YES ❑ NO ❑
)
Q IN COASTAL ZONE YES ❑ NO ❑
-VALUATION�Y CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNO LEDGE THAT 1 HAVE READ THIS APPLICA ION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT z R EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON
STRUCTION _1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATIN TO
WORKMEN S COMPENSATION INSUR E
SIGNATURE OF
PERMITTEE
ADDRESS
- FINAL BY
T E L
CITY NO DATE
N l
1\1 ( M ( KS P 1) 1131 L 10 PEE $v FEE
HARVEY T BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION- CK M 0 CASH _ PERM ALIDATION CK M 0 CASH
y� 1 0 6 9"3 MAY 11 -1 D 1 5 0 0- r
76A638A CE 9803 12/72 _ a