HomeMy Public PortalAbout5030ALESSANDRO AVE_Building (3) APPLICATION FOR BUILDING PERMIT
FOR 1"IPPLICANT TO FILL IN (Print or type only)
BLn(_CI NGCOUNTY OF LOS ANGELES
ADDRESS a I1/ DEPARTMENT OF COUNTY ENGINEER
CITY Ca - ZIP - BUILDING AND SAFETY DIVISION
NO OF BL ADDRBUILDNG�D3O
SIZE OF LOTIQ NOW ON LOTT ADDRESS
TRACT (176— BLOCK LOT NO .,� LOCALITY
TEL NEAREST
OWNER NO CROSS ST
ASSESSOR
ADDRESS c) MAP BOOK PAGE PARCEL
006— DISTRICT JGROUP �TYPE FIRE CESSED BY
CITY +- ZIP ��Ov CONST_ ZONE
ARCHITECT OR TEL .J��J— ]---3
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO DWELL UNITS BK PG
CONTRACTOR Qj, � TEL y VolLC - ti USE ZONE MAP �Q /
NO b
ADDRESS No
ySb 9 SPECIAL
LIC CONDITIONS
CITY CLASS
� ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUJtTION LENDER
NAME AND BRANCH BLD SETBACK FPOM d
FRO T PROP LINE OF (STREET) L
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
SO FT NO OF NO OF CHECK HIGH AY } YARD - HIGHWAY WIDTH
FRONT PROP LINE C
SIZE STORIES FAMILIES ONELL
} F
DESCRIPTION OF WORK NEW -❑ 4
ADD ❑ BLDG SET Z
SIDE PROP LINEOF (STREET)
ALTER TOTAL SETBACK FROM T OF EXISTING
HIGHWAY } YARD = SIDE PROP LINE HIG AY WIDTH
REPAIR❑ �
USE OF } -
EXISTING BLDG DEMOL ❑
APPLICAN TEL y CORNER CUTOFF YES ❑ NO ED(PRINT) NO - /
BY (SIGNATURE) IN OPEN SPACE YES E] NO ❑
jzs IN COASTAL ZONE YES ❑ NO ❑
\,ALUATION Q /yd- 0,0 ,>� 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)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR ODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURANCE
SIGNATURE OF E
PERMITTEE
AD1)RESS C
FINAL BY
CITY NOL3 ATE
P C $ PMT Q
MAKF CIIECKS PAYABLL 70 FEE P FEE D
HARVEY T BRANDT COUNTY ENGINEER
PLAN_CHECK VALIDATION CK M 0 CASH P MIT VALIDATION CK _ M 0 I� CASH
t
i
36 9C'Zr APR 3 D 2 1.7 5 ,&!38
76A638A CE#803 7/73 — - - 'r
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