HomeMy Public PortalAbout5028AGNES AVE_Building 76A638A CE4803 3 68 , I
APPLICATION FOR BUILD G PE IT lul
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS D
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING NEAREST
CROSS ST
DIST�ICT N GROUP YPE O BY
FOR APPLICANT TO FILL IN coNST d
Print or type only)
BUILDING
O ` STATISTICAL C AIIFICATION SEWER MAP
ADDRESS 249-66490-lave
�i� 4 f I CLASS NO DWELL UNITS BK �PG
` 0-1
LOT NO BLOCK USE ZONE MAP
NO
TRACT SPECCONDIT ONS
AL
NO OF BLDGS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
OWNER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESSO HIGHWAY WIDTH FROM G L
CITY
ARCHIT CT OR TEL BLDG SET K FROM- (STREET)
ENGINEER NO SIDE PROP LI
TYPE OF EXISTING SETBAC Y + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
TEL
+
CONTRACTOR NO a
LIC O
ADDRESS NO CORNER CUTOFF YES ❑ NO ❑ U
LIC C=
CITY CLASS ` SEE REVERSE SIDE FOR SPECIAL APPROVALS o
U
DESCRIPTION OF WORKLu
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NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION $ O®s
APPROVALS DATE INSPECTOR S SIGNATURE
P C PMT FOUNDATION LOCATION
FEE$ FEE $ 0-0 FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF TME LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S C NSA ION INSURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED G
ADDRESS NAL r /
JOHN F LEWIS PRINCIPAL STDCK
PLAN CHECK VALIDATION CK M o CASHURAL ENGINEER
_�nI p PERMIT {VALIDATION MO CASH
ujrr, V mAR 17 1 D
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