HomeMy Public PortalAbout5218AGNES AVE_Building (2) A`PPLICATION FOR BUILDING PERMIT
FOR APkLICANT TO FILL IN (Print or type only)
BUIL-01"G
ADDCOUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY - L� I P j r- BUILDING SAFETY DIVISION
NO OF BLDGS BUILDING Aw F
SIZE OF LOT NOW ON LOT ADDRESS16
A
-TZ
TRACT ' BLOCK LOT NO LOCALITY
/ TEL NEAREST
OWNER (�.� NO CROSS ST
ASSESSOR
ADDRESS 15 MAP BOOK PAGE CEL
DISTRICT IGMI PE FIRE PROC SSED BY
CITY ZIP CO ZON _
ARCHITECT OR A1j" EL �0
LNGINEER �/� O STATISTICAL CLASSIFICATION `
SEWER M P
ADDRESS CLASS NO L DWEL_UNI i o`�V� BK PG
CONTRACT O �0 USE ZONE MAP
O NO
ADDRESS �wl_�p /(J PECIA!�
Z� ONJR`TI ONS t
CIT poele �.� LIC
!�Q`� CLAS ROAL u�"PARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LE DER r
NAME AND BRANCHN, ULDG ETBACKFROM a
FRON PROP LINEOF (STREET)
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHW Y t YARD - �
SO FT NO OF NO OF - CHECK FRONT PROP LINE HIGHWAY WIDTH C
SIZE STORIES FAMILIES ONE 1
} - ) LL
DESCRIPTION OF WORF� NEW t co,
BLDG SETB ROM
r— ADD SIDE PROP LINE (STREET)
ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACK FRO 'TYP F EXISTING
SIDE PROPLINE HIGHWA WIDTH
REPAIR❑
USE OF /DLZ ❑ t =
EXISTING BLDG DEMOL
APPLICANT EL� r CORNER CUTOFF YES ❑ NO ❑
(PRINT) 0
BY (SIGNA TU
IN OPEN SPACE YES ElNO ❑
)
IN COASTAL ZONE YES ❑ NO ❑
�.AL U A T 10NL�Mp 6) - CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE 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 THE E OF CALIFORNIA IN RELATING TO yy ,q �,L� �b p ,��,t�
WORKMEN S MP INSURANCE II Y ]71 / e-Nn 4 J'I'B fC/Id
SIGNA'U Az'4ye 5b ;7�! 14,j
PERMIT E
ADDRESS
FINAL BY
� TEL
CITY NOF
O DATE/te,/Gn '' � � I
Q .
MAKI CIIFCKS PAYABLF TO FEE $ FEE
HARVEY T BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION CK OSCASH _ P RMIT VALIDATION CK, M o CASH
0.
76A638A CE9803 7/73 6 0 8L4�NOV 4 1 D 3 52 5 ♦90