HomeMy Public PortalAbout4906AGNES AVE_Building (5) - APPLICATION FOR BUILDING PERMIT
FOR4PPLICANT TO FILL IN -(P,rnt or type on(v) `
BUILDING - r - COUNTYIOF LOS ANGELES
ADDRESS 'WOZ 1111f DEPARTMENT OF COUNTY ENGINEER
CITY e - , Z �6T BUILDING AND SAFETY DIVISION
NO OF SLOGS _ BUILDING
SIZE OF LO �� Al
T ot w ADDRESS
NOW ON-LOT
TRACT O L K LOT NO LOCALITYNEAREST
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OWNER �^ NOL - - CRO /- �SS ST V V
ASSESSOR r
ADDRESS ,6 N MAP BOOK S� PAGE CEL v
/y� ��// �� �/"' DISTRICT TYPE FI PROC SSED BY
CITY �_/�/ (�. ZIP r O'{�7� ��J ZO E
ARCHITECT R TEL (�/G
ENGINEER F✓ NO,�y��J1Lt
_ _ STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS ��
CLASS NO��/�DWELL UNITS B �PG
CONTRACTOR S - NOL USE ZON�LIC qFN
PDI
ADD S '� NO �IJ� ECIAL
LIC !/ NDITIONS
CITY ��3� t_CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES C] NO❑
CONSTRUCTION LENDER
NAME AND BRANCH B OG SETBACK FROM - f
- - ` F NT PROP LI NE OF (STREET) n-
ADDRESS CITY HIGH AY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
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-SQ FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH CG
SIZE STORIES FAMILIES ONE r CD
DESCRIPTION OF WORK /Ui NEW ® + _
ADD -❑ BLDG SETBACK ti
SIDE PROP LINE OF (STREET) Z
LTER ❑ HIGHWAY + YARD _ TOTAL SETBACK FROMFrW4 OF EXISTING
USE
J0REPAIR
SIDE PROP LINE HIGH YWIDTH
EXISOTNG BLDG ES/a( EMOL ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑r NO ❑
(PRINT) NO
IN OPEN SPACE YES ❑ _ NO ❑
BY (SIGNATURE) - _
Q IN COASTAL ZONE YES ❑ NO ❑
VALUATION Q- - - CATEGORICAL EXEMPTION YES❑ NO ❑
I HERE BY�ACK NOWLEDGE THAT'I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE�THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL 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 r
WORKMEN S COMPENSATION INSUR NCE _
SIGNATURE OF
PERMITTEE
ADDRESS
� �``�� ) FINAL BY/� -
CITY/"./� fd7t, Z ���NOL / /7v DATE ��� -
1 hb C FIC( hS !s 1}�1 F3L! 10 P C a - - PMT
FEE I+ FEE ��
FHARVE7T BRANDT COUNTY ENGINEER _ - _ 2/.
PLAN CHECK VALIDATION CK M o CASH- PERMIT VALIDATION - CK M 0 ASN
- - --- -- - -'a 6 7 7 AUG 9 _1 '0 2 1.7 5 •
76A638A CE#803 12/72
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