HomeMy Public PortalAbout5728AGNES AVE_Building (2) APPLICATION FO R COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING PERMIT BUILDING AND SAFETY DIVISION
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING72X /
ADDRESS / LOCALITY
> NEAREST
CITY ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT J V "� NOW ON LOT MAP BOOK PAGE PARCEL
a / DISTRICT UP" TY E FIRE FROG SED BY
TRACT BLOCK NO.
-y _ TEL. NST. ZONE-
OWNER Z NO.
r_ STATISTICAL CLASSIF�CA/TI'ON SEWER MAP
ADDRESS �� G CLASS NO.�// .DWELL.UNITS BK PG
CITYZIP (� USE ZO%E MAAP s --J
ARCHITECT OR TEL.
ENGINEER NO. SPECIA
'J7,-4 ' CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑
TEL.
CONTRACTOR NO 5o ( BLDG.SETBACK FROM
7 yl/,/ FRONT PROP.LINE OF (STREET)
ADDRESS 7I •> e NO. / TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD
LIC. = FRONT PROP.LINE HIGHWAY WIDTH
CITY �� CLASS '�� j
CONS R CTION L DER �� + _ }
NAME AND BRANCH C
BLDG.SETBAGI4FROM. .._.._._
IL
ADDRESS CITY SIDE PROP.LINE OF (STREET)
SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD _ TOTAL SETBACK FROM "TY.PE OF EXISTING
SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHN7A� WIDTH C
DESCRIPTION OF WORK NEW +
11 �� ADD 1:1 CORNER CUTOFF YES 1:1NO ❑ s a
.�+ ALTER ❑ �
NMIIN N OPEN SPACE YES ❑ NO ❑ Z
USE OF REPAIR 1:1 IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG. DEMOL ❑
APPLICANTS TEL
(PR
T(INU. NO.
BY(SIGNATURE(
I HEREBY ACKNOWLEDGE THAT I HAVE READ APPLICATION AND STATE ,_Ji �/� �'a.� (%�"
THAT THE ABOVE IS CORRECT AND AGREE TO Y WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCT( CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLO ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE TE OF A FORM RELATING TO RKMEN'S COM-
. PENSATION INSURAN
SIGNATURE OF FINAL ,'' .. BY '
PERMITTEE
DATE ,
ADDRESS XUP
TEL P.C. Fee$ ���C Permit Fee �7
CITY NO
VALUATION,p
Q t
Issuance Fee
Total Fee "1
PLAN CHECK VALIDATION K. O. CASH _ \ J PERMIT VALIDATION K. M. CASH
1 1 QrAPR ;--"4 2 1 3 62 S �«►
1 APR 24 0 7 L).0 c) Au
76A638A CE N6o3A 6/76 -
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