HomeMy Public PortalAbout5043ALESSANDRO AVE_Building (2) wr -7k APPLICATION FOR BUILDING PERMIT q
FOR APPLICANT TO FILL IN (Print or type only)
BUILCItiG U d�O COUNTY OF LOS ANGELES ,
ADDRESS AlDEPARTMENT OF COUNTY ENGINEER
CITY /gym I6 ZIP - BUILDING AID SAFETY DIVISION
NOFOF BLDGS BUILDING `�� / p^
SIZE OF LOT NOW ON LOT ADDRESS 0 A� J�-o ,
TRACT BLOCK- LOT NO ` LOCALITY ��1717V
TELNEAREST tr
OWNER vv NO �p� CROSS ST O�
U � Y /�n ASSESSOR
ADDRESS ! o MAP BOOK PAGE PARCEL
J/--//��,,,, DISTRICT GROUP TYPE FIRE S�SED Y
CITY G//1 ZIP /�j�(j CONS _ ZOl�E
ARCHITECT O - TEL X408
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER M4
ADDRESS n A CLASS NOj�_2/ DWELL UNITS BK PG
CONTRACTOR //
ADDRESS /Q _V USE ZONE MAP
/C/-//1L 0All r�YCIX v IAL
IT ONS
CITY— LIC CONDI
(1 A CLASS _ROAD DEPARTMENT APPROVAL REQUIRED YES[:] J NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM n'
FRONT PROP LI NE OF (STREET) C
C:
ADDRESS CITY
HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING C
SO FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
fi ,� E] } = 4
DESCRIPTION OF WORK A--r G NEW a
BLDG SETBACK FROM ?
MO C �� �n ^D,y ADD ❑ SIDE PROP LINE OF (STREET)
-51
o4bove �t ch l (-f/C� ALTER = TOTAL SETBACK FROM TYPE OF EXISTING
/ HIGHWAY } YARD
REPAIR❑
SIDE PROP LINE HIGHWAY WIDTH
USE OF }
EXISTING BLDG DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
QJ ,+� IN COASTAL ZONE YES ❑ NO ❑
♦ALUATION$ f/ (,7 VQ r p�(J _
CATEGORICAL EXEMPTION - YES❑ ,. NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WIT HALL ORDINANCES AND LAWS REGULATING BUILDING CON
STR UC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE -
LABOR BODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN 5 COMPENSA ON SURA/dC�
SIGNATURE OFA //�/5�/
PERMITTEE
ADDRESS
FINAL BY
TEL ��
CITY NO DATE `4 I
MAKF CHECKS PAYABLE TO FEE $ J FEE
HARVEY T BRANDT COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION ( CK/
K M O CASH
-- U 1A l i 1 u 2 1 7 5 ®!J�
76A 630A CE#803 7/73
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