HomeMy Public PortalAbout9173 JAYLEE DR_Building_2/4/1973_fam rm a is
APPLICATION F®R' BUIL®ING PERMIT
FOR APPLICANT 4D FILL IN (Pilnt or type only
BUILDING �EE COUNTY OF LOS ANGELES
ADDREss DEPARTMENT OF COUNTY ENGINEER-
CITY ZIP - BUILDING AND SA TY DIVISION
NO.OF SLOGS, / BUILDING eq
SIZE OF LOT /� NOW ON LOT /I( ADDRESS 7_3 /Ci
TRACT BLOCK LOT.NO. /�+ LOCALITY _
r TEL.2 yrj/ &� NEAREST
CROSS ST. _
OWNER S —.�/�`�.s NO.rC�J.J
�
Y /
ADDRESS /,-7 '�/ �� MAP BOOK
ASSESSOR. PAGE IARCEL
CITYITYPE FIRE
+ ZIP DISTRICT GROUP CONST ZONE ROC SSE BY
ARCHITECT OR TEL. - - � --
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS - - CLASS NO.(=;2 _DWELL,UNITS B1q/ PG
CONTRACTOR //��'�/G/E� N0L,331J I/ USE ZONE MA NO.
Q Q�
ADDRESS 7 B� NO 7A60 _( SPECIAL
LIC. a CONDITIONS
CITY �.a'�/ ®d ' CLASS O. / ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH 7��- �✓�� BL .SETBACK•FROM
ADDRESS (/{/ �aOY,/_ Jar F ONTPROP.LINE OF (STREET) >-
IGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING O
SQ. fT NO. ( . NO,FAMILIES
K FRONT PROP. LINE HIGHWAY WIDTH U
SIZE STORIES FAMILIES ONE C
-_ CD
DESCRIPTION OF WORK NEW ❑ U
BLDG,SETBACK FROM w
ADD ❑ _SIDE PROP.LINE OF (STREET)
ALTE Z
HIGHWAY } YARD = TOTAL SETBACK FROMPE OF EXISTING
REPAIR❑ SIDE PROP. LINE Hf1kHWAY WIDTH
USE
EXISOT NG BLDG.J/i(J ,C_T/ DEMOL E] } -
APPLICANT /� '-TE CORNER CUTOFF - YES ❑ NO
(PRINT) fJ,/1� NO�.�J�-[y
BY (SIGNATURE) IN OPEN SPACE YES'❑ NO
S No
IN COASTAL ZONE CATEGORICAL EXEMPTION ON❑ YES NO ❑
VALUATION$ mlege,
,Q -
1 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)
WITHALL 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 �/ q� ^ •/
WORKMEN'S CO MPE NSA 71 NSU NCE. t/r��� % -/st�"�'/ LIN/.r L OI✓S�I'G9 � G/�
SIGNATURE O � ,(lll: A'-rd 4 �`7• AI�
PERMITTEE -
ADDRESS
CIT NOL - V NAL
TE
DATE -73 JB',�7,
JUKL' CHEC KS P:1YA13LE 'TO: P.C. $ /PM/TT.$
FEE )' FEE
HARVEY T. BRAN DT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH o PERMIT VALIDATION CK.' M.O. CASH
5''6 T 3:525,698
• 76 g638A CE#803 12/72. _ -