HomeMy Public PortalAbout5921 AVON AVE_Building_6/22/1978_pool FOR APPLICANT TO FILL IN .(Print ortype only)
COUNTY OF-LOS ANGELES
LDING
'ADDRESS / Q _ DEPARTMENT OF COUNTY ENGINEER "J
CITY &tllzIP 9 BUILDING AND..SAFETY DIVISI
N0: BLDGS. BUILDING
SIZE OF LOT NOW ON LOT ADDRESS
TRACT Q BLOCK LOT NO. LOCALITY ✓.�
TEL /NEAREST
OWNER• NO: 'CROSS ST. '
_ ASSESSOR
ADDRESS, � MAP.BOOK - PAGE PARCEL- -
�^ ` DISTRICT "GROUP TYPE FIRE PROCESSED BY
CITY y��/ ZIP ���7 CONST. ONE
ARCHITECT OR TEL,
ENGINEER - NO.. STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO. DWELL.UNITS BK PGG'
TEL
CONTRACTORj NO: 4 > USE ZONE NMA
OP
LIC.
ADDRESS NO. SPECIAL r .
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 TOTAL SETBACK FROM TYPE OF: EXISTING
SQrFT NO.OF _ NO.OF - CHECK HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH
SIZE,` STORIES FAMILIES ONECL
}
DESCRIPTION OF WORK NEW + O
ADD11BLDG.SETBACK FROM' (STREET) O
SIDE PROP.LINE OF H
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w
HIGHWAY + - YARD. = SIDE PROP.LINE HIGHWAY WIDTH. N
USE OF REPAIR ❑ Z
EXISTING BLDG. DEMOL ❑ +
APPLICANT, ' TEL / CORNER CUTOFF YES NO
(PRINT) j NO. p
1N OPEN SPACE YES NO ❑ "
BY(SIGNATURE)_
IN'COASTAL PERMIT'ZONE YES NO:[]
VALUATION'.Q{T � '
'IHEREBY ACKNOWLEDGE THAT I HAVE READ-THIS APPLICATION AND STATE - - -9
THAT THE ABOVE IS CORRECT•AND-AGREE'TO`COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING'SUILDING CONSTRUCTION.I CERTIFY THAT IN.DOING THE �`Z$,}j}. �. IVD7 6 P-W I- /�ezw
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. �h
PENSATION INSURANCE. ' - Y,,� V �/4„.•-+"'
SIGNATURE OF - I�
PERMITTEE
ADDRESS
FINAL BYA.
TEL., c DATE t
CITY - NO.
MAKE CHECKS.PAYABLE TO: FEE FEET
HARVEY T.BRANDY,COUNTY ENGINEER 1�• 6 S�0
J
PLAN CHECK VALIDATION CK. . M.O. CASH PERMIT VALIDATION CK. M.O. CASH
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