HomeMy Public PortalAbout5339ALESSANDRO AVE_Building (2) APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only( `fl
COUNTY OF LOS ANGELES
AbDRES DEPARTMENT OF COUNTY ENGINEER
CITY 2 ,e e ZIP /7,?0 BUILDING AND SAFETY DIVISION
O BUILDING
SIZE OF LOT NOW N�OWON LOTS p�� ADDRES553�
TRACT //y/Z BLOCCK - jLOT NO Op +7/ LOCALITY
NEAREST
OWNE ,6 /DO��' NOL,.Q86'Q /Lp CROSS ST
� ASSESSOR
ADDRES�Ja5p._r� qpT/� MAP BOOK PAGE EL
CITY ��/� rL-1r ZIP �1/ O DISTRICT GROUP TYPE /' FIRE PROCE SED BY
CONST Z
ARCHITECT OR TEL
ENGINEER NO
STATISTICAL CLASSIFICATION SEWER MA
ADDRESS CLASS NO� DWELL UNITS BK /jG
CONTRA CTO JSr ,VXM NOL O'pp Q.JJ7Z/ONE MAP r
ADDRESS „�� A'�fOe f NO /7O 6S' � �� SPECIAL I
LIC �}� ,
L CONDITIONS
CITY /^j,0,Vr0 CLASS .(!� �/ "
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH Q�Li BLDG SETBACK FROM G
FRONT PR P LINE OF (STREET) C
ADDRESS CITY - c'
HIGHWAY YARD = TOTAL SETBACK FROM TYPE OF EXISTING C
SO FT NO OF / NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH C
SIZE STORIES / FAMILIES / ONE C
+ 4
DESCRIPTION OF WORK o$ NEW
1 ❑ v
SIDE PROP LINE OF (STREET)
e. . ADD ❑ BLDG SETBACK FROM --
,C/.' Q/ie Z;A; IrM�/✓.ST ���
r ALTER _ TOTAL SETBACK OM TYPE OF EXISTING
iT� �V ee- Ai''w -N HIGHWAY + YARD -
T ,` �Y SIDE PROP LINE HIGHWAY WIDTH
REPAIR❑
USE EXISTING BLDG �',s'/( ��{/��' DEMOL [:] + _
APPLICANT �A/� TEL CORNER CUTOFF YES ❑ NO
(PRINT) u.Ss R/1 A.6 fq;r - NO -f/$0L,03/7
BY (SIGNATURE IN OPEN SPACE YES ❑ NO
ef
Q IN COASTAL ZONE YES ❑ NO ❑
V ALUATION$ 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 AL?L ORDINANCES AND LAWS REGULATING BUILDING CON
STRUCTIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODEOF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN SCOMPENSATION INSURANCE
SIGN-TURE O
PERMITTEE
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ADDRESSTEL FINAL
CITY [�CJfe�7f/ NO '� �/ DATE � ��p BY / 1
MAXI- CHECKS PAYABLE TO PEE ` FEE
HARVEY T BRANDT COUNTY ENGINEER L,
PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATIO Vm 0 r CASH ^
1
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