HomeMy Public PortalAbout5227AGNES AVE_Building (3) } 4
r COUNTY OF LOS ANGELES
a ` ��'P P L I CATION FOR K DEPARTMENT OF COUNTY ENGINEER
BUILDING PERMIT -, BUILDING AND SAFETY DIVISION_
BUILDING .-7
FOR APPLICANT TO FILL IN ADDRESS S� Z
BUILDING r �S
ADDRESS ci S LOCALITY
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NEAREST ,
CITY e J ZIP CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOT % NOW ON LOT 'Z MAP BOOK PAGE PARCEL
TRACT Z�-pU BLOCK LOT NO 3� DISTRICT GROUP TYPE FIRE SSED Y
CONST ZONE
OWNER
S TIL
NO 5, U
AA STATISTICAL CLASSIFICATION SEWER
ADDRESS >�27 IN CLASS NO DWELL UNITS BK G
CITY Q ZIPJE MA
OP /
ARCHIT CT OR TEL L
ENGINEEQ NO d SPECIAL
CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
TEL
CONTRACTOR NO BLDG SETBACK FROM
2 FRONT PROP LINE OF ISTREETI
ADDRESS , �( LIC NO / TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
CITY (4t5YL CLASS
CONSTRUCTIONLENDER /� + a
NAME AND BRANCH 1 O
BLDG,SETBACK FROM U
ADDRESS CITY SIDE PROP LINE OF (STREET) c
O
SQ FT NO OF NO OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING U
SIZE 3O STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH N
DESCRIPTION OF WORK r,0 NEW
E] + = Z
ADD CORNER CUTOFF YES ❑ NO v❑
ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
REPAIR ❑
USE
EXISTING BLDG /�/ DEMOL [:] IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT TEL
(PRINT) NO 6 - j /►
BY ISIGNAT v ( r
I HEPEBY AC OWLEDGE THAT I HAVE D THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES V -� i
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE //
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V j
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELA ING TO WORKMEN S COM v t
PENSATION INSURANCE V
SIGNATURE FINAL BY
PERMITTEE DATE
ADDRESS
CITYT l TEL NO G Q�� P C Fee$ � f�D Permit Fee �^
G2 � Issuance Fee
VALUATION$ co 3 �v
111 �"CCCJJJ r-
Total Fee
PLAN CHECK VALIDATIONS o CASH PERMIT VALIDATIO -(cK M o CASH
471�JUL 525 U 12960 �-�
281ra-)AU6 �L4 1 U 1 690U �
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