HomeMy Public PortalAbout4815ALESSANDRO AVE_Building (5) APPLICATION FOR COUNTY OF LOS ANGELES
COUNTY ENGIN
BUILDING PERMIT DEPARTMENT BUILDING OD SAFETY DIVISION
BUILDING IV
FOR APPLICANT TO FILL IN ADDRESS
BUILDING /
ADDRESS E.l LOCALITY
NEAREST
CITY ZIP CROSS ST
��/ O OF BLDGS ASSESSOR
SIZE OF LOT 0 NOW ON LOT MAP BOOK PAGE PARCEL
r Q� DISTRICT G UP T PE FIRE SSED BY
TRACT 7 BLOCK LOT NO a /�D Q ONS ZOt� 1
TELe;P (J �!
OWNER f /V NO "`�� STATISTICAL C S FICATION EWE MAP
ADDRESS CLASS NO DWELL UNITS BKPG
V�w
MAP
CITY IP 9 NO dARCHITECT OR TEL SPECIAL
ENGINEER NO CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
TEL BLDG S ROP LINE OF (STREET)TBACKFROM
CONTRACTOR S NO
LIC FRONT
ADDRESS NO HIGHWA } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
CITY ! LIC
FRONT PROP LINE HIGHWAY WIDTH
W CLASS _
CONSTRUCTION LENDER +
NAME AND BRANCH - BLDG SE CK FROM
ADDRESS CITY
SIDE PROP L OF (STREET) G7
SQ FT NO OF NO OF CHECK HIGHWAY } YARD = BACK FROM TYPE OF EXISTING
ET
SIZE STORIES FAMILIES ONE SIDE PR INE HIGHWAY WIDTH o
NEG.
DESCRIPTION OF WORK W +
V7
DD CORNER CUTOFF YES ❑ NO ❑ Z
LTER IN OPEN SPACE YES ❑ NO ❑
REPAIR❑
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG EMOL ❑
APPLICANT TE
(PRINT) j NO ��`
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON
STRUC TION 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 COMPEN ION INSURANCE Q /
SIGNATURE OF FINAL /f - 31 BY
PERMITTEE DATE V
ADDRESS '� ors _
T E L 71&_226
/ PC Fee$ S Permit Fee
CITY NO
Issuance Fee ... —
VALUATION z/ L�
Total Fee 7 0 �J
PLAN CHECK VALIDATION -CK M o CASH _ PERMIT VALIDATION CK M o CASH
77- 7,,rJUN - 2 21 'p_ 1 4.6 5 �
i r
71A838A CE#8038 12/75 " 7 8�JUN 2 ® 4 8.7 S`^-
1