HomeMy Public PortalAbout5738AGNES AVE_Building (2) • ' APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING -
ADDRESS `�'� DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS.SIZE OF LOT 50` I Jf LDING
NOW ON LOT � ADIDRESS '� ' yL2gJ
,� Ll
TRACT 5 l BLOCK LOT NO. 4 I LOCALITYTEL. NEAREST
OWNER (Wk' NO.'2p)'7 CROSS ST.
S��� ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
CITY `_iali ZIP DISTRICT GROUP CONST TYPE FIRE ROCES D BY
ARCHITECT
ER OR NO. 115-1, 620 IT-3ENGv -�
p4fqSTATISTICAL CLASSIFICATION SEWER MAP
�
ADDRESS 2 3- S LS' - CLASS NO. DWELL.UNITS BK/ �e-
TEL. �y
CONTRACTOR S NO. I�Z USE ZONE MAP
LIC. NO.
ADDRESS NO. SPECIAL
LIC CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE OF .L. y (STREET)
ADDRESS CITY TAL SETBACK FROM TYPE OF I EXISTING '
SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
SIZE S STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW ❑ + "4 10 - ' U a0
V
1 ADD BLDG.SETBACK FROM ze
SIDE PROP.LINE OF (STREET) O
Y
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w
HIGHWAY + YARD
REPAIR PROP.LINE HIGHWAY WIDTH
USE OF REPAIR ❑
EXISTING BLDG. (j DEMOL ❑ + Z
A(PRINT)NT F„ _ -. NOL �!pI-q2 CORNER CUTOFF YES ❑ NO ❑
8Y ISIGNATUREY � `'CJ IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 6
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-
PENSATION INSURANCE.
SIGNATURE OF.
PERMITTEE 'A'
ADDRESS
FINAL BY
�. ,� •� TEL. DATE
CITY NO.
MAKE CHECKS PAYABLE TO: FEE $ FEET $�7
HARVEY T.BRANDT,COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH a PERMIT VALIDA 1 d N, CK. M.O. CASH
0.9 8c'10APR e4 =1 (� 2 2.0 U e3
®s 76A638A CE#803 3-75