HomeMy Public PortalAbout5833ALESSANDRO AVE_Building PAC C lty
APPLICATION FOR COUNTY OF LOS ANGELES
-- DEPARTMENT OF COUNTY ENGINEER
BUILDING PERMIT BUILDING AND SAFETY DIVISION
BUILDING 3 !
FOR APPLICANT TO FILL IN ADDRESS
BUILDING _ ���
ADDRESS 7 LOCALITY
NEAREST
CITY C ZIPJ Q CROSS ST
X.jl,e NO OF SLOGS ASSESSOR
SIZE OF LOT47 J4PTbW ON LOT MAP BOOK PAGE PARCEL
DISTRICTUP ITYPE�_� FIRE PROC
TRACT BLOCKLOT NO `�Q' CONST�/Yd
TEL
OWNER Q NOal -C STATISTICAL CLASSIFICATION SEWER MAP.
ADDRESS CLASS NO-aI DWELL UNITS k- BKI� '
CITY ZIP USE ZONE MAO V l�P ifi!
N
ARCHITECT OR TEL —3 SPECIAL
ENGINEER NO CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONTRACTOR F TEL BLDG SETBACK FROM
LIC FRONT PROP LI NE OF (STREET)
L
ADDRESS NO HIGHWAY } YARD = TOT SETBACK FROM TYPE OF EXISTING
LIC
ONT PROP LINE HIGHWAY WIDTH
CITY CLASS
CONSTRUCTION LENDER C
NAME AND BRANCH l/ BLDG SETBAC ROM
a
ADDRESS CITY SIDE PROP L EOF (STREET)
SQ F NO OF NO OF CHECK HIGHWAY YARD = TOTAL SETBACK FROM TYPE OF EXISTING t=SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH
DESCRIPTION OF WORK NEW ❑ }
_ I/Y Ci✓ DD CORNER CUTOFF YES ❑ NO ❑ Z
LTER ❑
gy^ EPAIR❑ IN OPEN SPACE YES 11NO ❑
USE OF IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG G — DEMOL ❑
APPLICANT y� TEL y '
(PRINT) uLti
BY (SIGNATURE)
I HEREBY ACKN WLEDGE THAT I YFAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON
STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL HOT EMPLOY ANY PERSON IN VIOLATION OF TME
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURANCE
SIGNATURE OF FINAL BY
PERMITTEE DATE
ADDRESS
^ , TEL ,,�OyB,? PC Fee$ -` Permit Fee
CITY �i� c4f NO
/p ,q Issuance Fee
VALUATION$ / O O IJ� � �
!! Total Fee C�
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O _ CASH
3 0-FCB 24 1 U 1 � V U
a;.s
78A838A CE 0803B 12/75