HomeMy Public PortalAbout5329 ZADELL AVE_Building_1/16/1971_ APPLICATION FOR BUILDING PERMIT L�
FOR APPLICANT TO FILL IN (Print or type only)
BUI LCI NG COUNTY OF LOS ANGELES
ADDRESS 532f ZATRIL DEPARTMENT OF COUNTY ENGINEER
CITU - Z P BUILDIN AND SAFETY DIVISION
O
NO. F BLDGS. BUILDING
SIZE OF LOT '°SCJ Yt 'j ' NOW ON LOT ADDRESS !'
TRACT,/f(%�:_ : BLOCK LOT NO �'.•"G LOCALITY
TEL. NEAREST
OWNER NO. CROSS ST.
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT GROUP JTPE FIREPROC EO BY
CITY ZIP -- SGO NS T., ZONE )
ARCHITECT OR T Laft
.
ENGINEER TIMM CnMM NO.
STATISTICAL CLASSIFICATION S,EW R MAP
ADDRESS CLASS N�-DWELL.UNITS G
CONTRACTOR AQ t%= MIS NOL i4ji(oweW USE. ZONE NAOP � 'f
r
LIC. SPE CIAL
ADDRESS NO. 263M -�. CONDITIONS
LIC.
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES[_ NO CL
CONSTRUCTION LENDER v
NAME AND BRANCH BLDG,SETBACK FROM
FRONT PROP.LINE OF ISTREETI I
ADDRESS CITY
HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING L+..
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH >_
SIZE J STORIES FAMILIES ONE
CD
DESCRIPTION OF WORK NEW ❑
ADD BLDG.SETBAQ RpM -(STREET)
W
❑ SIDE PROP. LINO i " ' - F
Son= PwL
ALTER ❑ -HIGHWAY �}, -BARD TOTAL SEF'B CK �fb
- QM TYPE OF EXISTING
=
r
REPAIR[:] SIDE PROP. LINE •'41IGHWAY WIDTH
USE DEMOL ❑ d
EXISTING BLDG.
.APPLICANT TEL CORNER`6UTOFF YES ❑ NO ❑
y� (PRINT) NO.
IN OPEN SPACE YES ❑ NO
BY (SIGNATURE) ❑
IN COASTAL ZONE YES ❑ NO
VALUATION Y CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- '
STRUCTION. I 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 RELATING TO
WORKMEN'SCOMPENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
ADDRESS
FINAL BY
TEL. DATE
CITY NO.
S9A 10 t_HL KS PAYABLE 7 U; FEE $ PMT.Q
FEE FEE D
HARVEY T. BRANDT. COUNTY ENGINEER v
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK, M O CASH
76A638A CE#803 7/73 4. r` r w l 1 +� ��r ✓ "