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HomeMy Public PortalAbout4901AGNES AVE_Building (6) ©S 76A638A CE#803(REV.6/78) r f APPLICATION FOR BUILDING PERM/IT COUNTY OF LOS ANGELES BUILDING AND SAFETY uLDING FOR APPLICANT TO FILL IN ADIDRESS AlS BUILDING �� ADDRESS LOCALITY NEAREST CITY f ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK AGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED BY TRACT BLOCK LOT NO. p . CONST ZONE TEL. `Jv OWNER d NO. qpn(- l_ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS G p CLASS NO. - DWELL..Ul,ITS BK PG CITY `j ZIP �O O ARCHIT CT OR TEL. VALUATION $ r, a ENGINEER NO. ��- d/ V V ADDRESS BLDG.SETBACK FROM TEL FRONT PROP.LINE OF 5 1-461' (STREET) CONTRACTOR NO. TOTAL SkTBACK FROM TYPE OF EXISTING LIC HIGHWAY + YARD = FRONT PROP,LINE lHiGHWAY1 WIDTH ADDRESS NO. LIC. + CITY CLASS CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP:LINE OF (STREET) HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SO.FT/ NO.OF NO.OF CHECK + _ SIZE(� .S' STORIES FAMILIES ONE DESCRIPTION OF WORK "� NEW P.C. Fee$ © Permit Fee ADD a Issuance Fee - b/9�Zet�i� ALTER 4v'l Qr -J8a REPAIR ❑ 1 Total Fee USE OF DEMOL El EXISTING BLDG. 2 APPLICANT TEL I O (PRINT) NO. 1\W}p, 3 2 1.3 A BY(SIGNATURE) n I a IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE c V # o 0 0 0 2 3 THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES VUA AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V 2-1 51.20 THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-' Y 2 PENSATION INSURANCE. \ 9 o o 1 31.2 0 U SIGNATURE OF o -31, 31-79 PERMITTEE ADDRESS - Z TEL. 2 CITY LQ NO. USEZ(NE MAP Q IC SP > / SPECIAL r CONDITIONS FINAL BY DATE I