HomeMy Public PortalAbout4849AGNES AVE_Building (2) APPLICA'i`I0 FOR BCU IL®ING PERMIT
FOR APPLICANT TO FILL IN )(Print or type only)
COUNTY OF LOS ANGELES
BUILDII1`1,
ADDRESS !1919 AdN915 VE DEPARTMENT OF COUNTY ENGINEER+
CITY r�tt ZIP BUILDING AND SAFETY DIVISION
�DIjVIISIION
NO OF BLDGS
SIZE OF LOT ? , X J OW t NOW ON LOT AUDDRESS ILDING 4t' f %'��/� _4
ly
TRACT BLOCK LOT NO c LOCALITYNEAREST
OWNER p /v/ClLS NO SG`7 CROSSSTAS EOR
ADDRESS % MAP BOOK a PAGE ARC
1DISTRICT t GROUP TYPE t I FIRE t P SSED BY
CITY L - ZIP CON Z J
ARCHITECT OR TEL v �p
ENGINEER NO STATISTICAL CLASSIFICATION ` WER MAP
TEL
ADDRESS CLASS NO DWELL UNITS i BKE PG
/y,�j
CONTRACTOR NO US ZONE NOP (1/
LIC
ADDRESS NO SPECIAL
r LIC CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NOE]
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
ADDRESS - CITY __ TOTAL SETBACK FROM -TYPE OF EXISTING
SQ FT NO OF NO OF � O EK HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
SIZE A� STORIES FAMILIES _
_ a
DESCRIPTION OF WORK NEW ❑ + OV
ADD BLDG SETBACK FROM (STREET( O
SIDE PROP LINE OF F
ALTER TOTAL SETBACK FROM I TYPE OF I EXISTING w
HIGHWAY + YARD = SIDE PROP LINE I HIGHWAYI WIDTH H
USE OF .- REPAIR^❑ Z
EXISTING BLDG DEMOLJI +
APPLICANT w TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) /Yf NO '
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$Ca 00 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE M' '
T
SIGNATURE O
PERMITTEE
E I
ADDRESS SKS �` �'
s FINAL BY t
CITY %Zc7rl/��E L lT%
TEL L 7 DATE t w
-^ MAKE CHECKS PAYABLE TO FEE F ET
HARVEYJT BRANDT COUNTYiENGINEER
PLAN CHECK VALIDATION E CK t ff o CASH — PERMIT VALIDATION cK ff o� CASH
3 S 6 r--JAN 1 1 ® 2 1 V..5 °_
18f 76A638A CE#803 3 75 t S' i
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