HomeMy Public PortalAbout4835AGNES AVE_Building (7) 4,9 76A638A'•
CE4803(REV.6/78)
APPLICATION FORBUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS
BUILDING
ADDRESS ' le& LOCALITY
NEA REST
CITY ZIP 7 d CROSS ST. LJ/Ule
NO,OF BLDG$. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICTv GROUP TYPE FIRE PROCESSED BY
TRACT BLOCK LOT NO. g kyr t5@ �J l CONS;! ZONE n L•
OWNER s— r' E -3 PbD1210
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS403,S-11,44,u CSArep. CLASS NO, 2-� DWELL.UNITS___JG` BKZSPG
CITY 1,eaZIP r
ARCHITECT OR TEL. VALUATION $ '—
ENGINEER NO. CJ
t
ADDRESS BLDG.SETBACK FROM
TEL FRONT PROP.LINE OF (STREET) .
CONTRACTOR NO. HIGHWAY t YARD __ TOTAL SETBACK FROM TYPE OF EXISTING
? LIC. - FRONT PROP.LINE HIGHWAY WIDTH
ADDRESS NO. ,::) �p + _
LIC. I CJ
CITY CLASS
BLDG.SETBACK FROM
CONSTRUCTION LENDER
NAME AND BRANCH SIDE PROP.LINE OF G (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF 1EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAYI WIDTH
SQ.FT ! NO.OF NO.OF CHECK + _
SIZEi'� V STORIES / FAMILIES ONE
DESC IPTION OF WORK NEW ❑ P.C. Fee$ Permit Fee /
rO et V ❑ p
ADD ❑ Issuance Fee 7� g
^ 7��./ va� ALTER
REPAIR ❑ Total Fee 0 0
USE OF/ DEMOL ElEXISTING BLDG. a 2
APPLICANT TEL C
(PRINT) NO. Q
D
BY(SIGNATURE) >
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - Y
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES uVi
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V
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 Z
PENSATION INSURANCE. ]
SIGNA RE r
PERM(
ADDRESS Ci Z .
TEL. _ 2 �
CITY N 0 Q 1
USE ZO M P y 0 NO
\"•` SPECIAL
CONDITIONS r 'Z
FINAL o BY ✓` 4 > u�i Q r .� D
DATE =' � Q Q
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