HomeMy Public PortalAbout5233ALESSANDRO AVE_Building (4) APPLICATION FOR BU DING PpgylT '
rOR APPLICANT TO FILL IN (Print or type only) -
BUILDING .523<3 AlA� �S UNTY`OF L ANGELES
ADDRESS _ DEPARTMENT OF C LINTY ENGINEER
clry = ! ZIP BUILDING-AND SAFETY DIVISION
�., NO OF BLDGS BUILDING
SIZE OF LOTQ�)(/yam NOW ON LOT -�Q ADDRESS
TRACTIO�Z6�J BLOCK LOT NO �O LOCALIT
TEL NEAREST
OWNER - F I NO CROSS ST Al
ASSESSOR
ADDRESS /i16-AJ MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE OC ED BY
CITY C7YJ �E ( ZIP CONST ZONE
ARCHITECT OR _r N
NGINEER EOL�3 302
ESTATISTICAL CLASSIFICATION
SEWER MAP
ADDRESSIZ,fLV LU/n A7�/�/ CLASS NO,2/-- DWELL UNITS BK PG
CONTRACTOR USE ZONE LIC No
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ADDRESS f / Cf,& C t NO �'���/ l SPECIAL v
LIC / / CONDITIONS
CITY CLASS _ y -
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER _
NAME AND BRANCH LDG SETBACK FROM
RONT PROP LINE OF (STREET) a
ADDRESS CITY GHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING CC=
I
SQ FT 1 NO OF- NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE S FAMILIES ONE G
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DESCRIPTION OF WORK NEW 1 ❑ LL
CoUe,'-__ ADD L�I BIDEGPROP LINE OF (STREET)lbZ
_ ALTER ❑ HIGHWAY - + YARD _- TOTAL SETBACK ROM TYPE OF EXISTING
G REPAIR[] SIDE PROP LINE H1,GHWAY WIDTH
USE OF
EXISTING BLDG DEMOL ❑
APPLICANT TE� CORNER CUTOFF YES ❑ NO ❑
(PRINT)
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BY (SIGNATURE) _ IN OPEN SPACE_ _ YES ❑ NO ❑
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QQ�� ,530IN COASTAL ZONE YES E] NO ❑
VALUATION CATEGORICAL- _ 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)
C
HEREBY II WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LTA
LABOR ODE OF THE STATE OF CALIFORNIA IN RELA
WORKMEN S'COMPENSATION SURANCE_ TING T / _
SIGNATURE OF
PERMITTE_E _
ADDRESS �O
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(� (, y/ FINAL �Q f
CITY M / NOL �O_/ 7 DATE e v� �Qg7) y
11 11vE C HL C KS P 1) 1131 E 10 AEE � ���"� - FEE
HARVEY T BRANDT COUNTY ENGINEER
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,PLAN CHECK VALIDATION CK M O CASH " - PERMIT VALIDATION cK O CASH
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