HomeMy Public PortalAbout4812 AGNES AVE_Building_9/6/1979_alum patio cover ®5 76AS38A a
CE#803(REV 6/78)
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING
ADDRESS LOCALITY
NEAREST
CITY M s ZIP CROSSST O�
NO OF BLDGS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
0 M f� tl DISTRICT GROUP TYPE FIRE PROCE ED BY
TRACT BLOCK LIT NO �JO Q CONST Z ��
TEL
OWNER NO
STATISTICAL CLASSIFICATION EWER MAP
ADDRESS S CLASS NO DWELL UNITS___A BK PG
CITY ZIP
ARCHITECT OR TEL VALUATION °
ENGINEER NO
M
ADDRESS BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
CONTRACTOR L NO HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING_
LICFRONT PROP LINE HIGHWAY WIDTH
ADDRESS NO _
LIC +
CITY CLASS C {
CONSTRUCTION ENDER r BLDG SETBACK FROM
NAME AND BRANCH SIDE PROP LINE OF (STREET(
t HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH o
SQ FTAIN NO OF NO OF CHECK +
SIZE STORIES FAMILIES ONE cc
DESCRIPTION OF WORK J2&Aj ALMAd NEW ❑ PC Fee$ �cJ �� Permit Fee &A
0
r -+
ADD to❑ Issuance Fee y Z
/ c zn ALTER
4 J REPAIR ❑ Total Fee e
USE OF
DEMOL
EXISTING BLDG � n�Y1 n- Zp A 6'517 A-
.APPLICANTTEL
(PRINT) NO C JG P V.5-3,5-4"'
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BY(SIGNATURE( > 2to a 1 51 2
1 HEREBY ACA OWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE beU
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES id o o o 1 Sl 25 t
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE _
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF {J 0 0'61_7 9
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM Z
PENSATION INSURANCE S
} d6 -46'518 A
SIGNATURE OF A
PERMITTEE 1 # 0 010 0 0 1
ADDRESS - C 2�o 0 3 Q,0 0
TEL �
CITY oat lkfio L NO < 1
0 oa ° 31005
USZOYE MAP
SPECIAL 0 8 0'6—7 9
CONDITIONS
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FINAL e.
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