HomeMy Public PortalAbout9015 ACASO DR_Building_6/11/1973_garage ceiling, partioning APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES
ADDRESS DO ��' DEPARTMENT OF COUNTY ENGINEER
C1TY��._�J7 / �i ZIP %�t�G� BUILDING AND SAFETY DIVISI
_ [[--��,,v NO.OF BLOGS. BUILDING
SIZE OF LOT�OX/vNOW ON LOT -` ADDRESS .
TRACT OCK LOT NO.JC LOCALITY `
NEAREST
OWNE� CROSS ST.
ASSESSOR '
ADDR SS �I/ / /� MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE R ESSED BY
CITY 'f�. ZIP CONST. ZONE
ARCHITECT OR TEL.
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS - CLASS NO. �_OWELL,UNITS BK PG
CONTRACTOR No. USE ZONE MAP
LIC. NO.
ADDRESS NO, ,/�SPECIAL
LIC. ✓� CONDITIONS
CITY CLASS
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 c
SQ, FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY. WIDTH
SIZE STORIES FAMILIES ONE
❑ + = C
~
DESCRIPTION OF WORK NEW V
W
BLDG.SETBACK FROM
�et GFS j ADD ❑ SIDEPROP. LINEOF (STREET) Z
/ ALTER TOTAL SETBACK FROM TYPE OF EXISTING
7TJO�Gr/fjJGj �C• '/,0 HIGHWAY + YARD = HIGHWAY WIDTH
/��� REPAIR❑ SIDE PROP. LINE
USE OF I� U + _
EXISTING BLDG. DEMOL_❑ ,
APPLICA T CORNER CUTOFF YES ElNO ❑
(PRINT .�'� / cif. OJG_5��/���`7♦wf
BY (SIGNA TUR
IN OPEN SPACE YES ❑ NO ❑
IN COASTAL ZONE - YES ❑ NO ❑
VALUATION$ ee, ----------- '�"'•
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 ATE OF CALIFORNIA IN RELATING TO
W ORN MEN'S COMP�TNANCE.
SIGNATURE OF
PERMITTEE
ADDRESS ,,t
FINALU�r rI y[BA
YTEL. DATE jj�� (CITY - NO. 1 F/616- ti
e �
1IA KE CHECKS PA YA L3LE 7 0: FEE C � gyp' �� FEE
HARVEY T. BRANDY, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMITVAL ION CK. M.O. CASH
} �s
1 a 6to�N
76 g638A CE#803 12/72