HomeMy Public PortalAbout5210AGNES AVE_Building (6) PLICATION FOR COUNTY OF LOS,ANGELES
DEPARTMENT OF COUNTY ENGINEER '
U I LD I N G PERMIT BUILDING AND SAFETY DIVISION
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING
ADDRESS LOCALITY
NEAREST '
CITY ZIP 6 CROSS ST
NO OF BLDGS // ASSESSOR
SIZE OF LOT ,S NOW ON LOT /" MAP BOOK PAGE PARCEL
TRACT 2 .16 a BLOCK LOT NO 7
DISTRICTGROUPG/R�OUP TYPE FIRE PR CESSED BY
CONSTTEL
Z�C�
OWNER rJ NO -
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS 1i s'� CLASS NO DWELL UNITS BK PG
CITY ZIP / d USE ZONE P
NO
yam/
ARCHITECT OR TEL �G 4
ENGINEER NO -J 72ar SPECIAL
CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑
TEL
CONTRACTORAla j QkjS4,4 N BLDG SETBACK FROM
LIC FRONT PROP LINE OF (STREET)
ADDRESS /�� rj NO G HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC �/J FRONT PROP LINE HIGHWAY WIDTH
CITY e G CLASS ESS�I
CONSTRUCTION ENDER a IqF, ",14t i •sa<<� +
NAME AND BRANCH O
BLDG SETBACK FROM
ADDRESS/Q ITY ��/� SIDE PROP LINE OF (STREET) V
SQ FT tNOOF NO OF HECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE EXISTING
SIZE IES FAMILIES SIDE PROP LINE HIGHWAA Y WIDTH O
J�
DESCRIPTION OF WORK �I�GI fj' NEW El0
ADD ❑ CORNER CUTOFF YES ❑ NO ❑ a
ALTER ❑ N
IN OPEN SPACE YES ❑ NO ❑ Z
REPAIR ❑
EXISTOING BLDG t d� DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT TEL
(PRINT) 4 NO Zee
BY(SIGNATURE)
I HEREBY AC OWLEDGE 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
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM F
PENSATION INSURANCE oo
SIGNATURE OF FINAL " BY '
L
DATE
NL � PC Fee$ Permlt FeeIssuance Fee�r f�
Total Fee d�
PLAN CHECK VALIDATION CK M ASH _ PERMIT VALIDATION CK M o CASH
V L0kKE°RS COMPENSAI 3 4 3 lrl--iA DO 1 n 9 7 0 0 et„
"OLICY HOLDPERA &"
76A638A CE 9803A 6/76
r
'OLICY NUMBER: s 7.f"1(/6/-77,