HomeMy Public PortalAbout4931AGNES AVE_Building (4) APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL; IN (Print or type only)
BUILDING /�p�, COUNTY OF'LOS ANGELES.
ADDRESS 144!4DEPARTMENT OF COUNTY ENGINEER
CITY ZIP 17ZZ0 BUILDING AND SAFETY DIVISION
Y13-1
NO.OF SLOGS. BUILDING a'
SIZE OF LOT 16/�c 1� NOW ON LOT ADDRESS /
TRACT/3%r'6BLOCK I LOT NO. /6 LOCALITY
TEI� NEAREST.
OWNER f N0. V6-0 CROSS ST.
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT GROUP YPE FIRE ESSED BY
CITY L ZIP - ONST ZO `
ARCHITECT OR TEL.
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER AP
ADDRESS e� CLASS NO�DWELL.UNITS BK7�P
CONTRACTOR eir! NO C3- fjJ US )NEIMAP
/�/y/•+'� LIC. NO.
ADDRESS �S C4_r NO. I�%��� v� SPECIAL
�>j LIC. / z CONDITIONS
CITY �C.� CLASS , ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTIO LENDER
NAME AND BRANCH BLD .SETBACK FROM
FRO TPROP.LINEOF (STREET)
ADDRESS CITY
HIGH NOTAL SETBACK FROM TYPE OF EXISTING
AY } YARD
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. HIGHWAY WIDTH
LINE
SIZE STORIES FAMILIES ONE
d
DES'C RI PTI ON OF WORK NEW
BLDG.SETBACK FROM C.)
� pp ADD SIDE PROP.LINEOF (STREET). C=
f Z
ALTER ❑ TOTAL SETBACK FROM TY OF EXISTING U
HIGHWAY } YARD =
REPAIR❑ SIDE PROP. LINE HIGH Y WIDTH Lu
USE OF } = N
EXISTING BLDG. DEMOL ❑ �_
APPLICANT E - CORNER CUTOFF YES C:] NO ❑
(PRINT) �°is.�L L� ��✓ _
BY (SIGNATURE) rIN OPEN SPACE, YES ❑ NO. _
VALUATION, / 9 CIO IN COASTAL PERMIT ZONE YES ❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE .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 COMPE6STION INSURANCE.
SIGNATURE OFd.�._A� ��4
PERMITTEE y� W/"t/
ADDRESS CCG
� FINAL BY
CITY NO. GS DATE A�� �
i
WAKE CHECKS PAYABLE 70: P.C. $ PNIT.,Q
FEE' FEE D
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN'CHECK VALIDATION CK. M.O. CASH ' PERMIT VALIDATION K. M. . CASH '
s 'sF 5 1 0 2 1.75A98
76A638A CE#803 5/74