HomeMy Public PortalAbout5717 PRIMROSE AVE_Building_7/22/1976_CONVERT GARAGE TO FAM ROOM APPLICATION FOR BUILDING PER(M)IT
FOR APPLICANT TO FILL IN (Print or type only) • '
COUNTY OF LOS ANGELESEU'LD '
ADDRESS DEPARTMENT OF COUNTY ENGINEER
.57/7 r�mras
CITY�i� G `¢- ZIP nj/730 BUILDING D SAFETY DIVISION
NO.OF BLDGS.- BUILDINGV t�
SIZEOFLOT $'Jr r NOW ON LOT ADDRESS 6`7 7 Y•Im r a S`e
TRACT�,Fj BLOCK LOT NO. SCS LOCALITY ) k�_ C;+o
TEL. NEAREST •
OWNER 40,tn. Qn C e vr_ NO� CROSS ST. C>Q
ASSESSOR
ADDRESS _C�Q{Y)� L�ry Q p v�V_ MA BOOK PAGE
3 yx PARCEL
' RICT GROUP ITYPE - FIRE CESSED Y
CITY ZIP CONST.�j Z
ARCHITECT OR TEL.' „
ENGINEER NO. STATISTICAL CLASSIFICATION SEWER
ADDRESS CLASS NO.�,2� DWELL.UNITS BK PG
TEL.
CONTRACTOR NO. ONE -7•NOP Ly
LIC. / SPECIAL
ADDRESS NO.. / CONDITIONS
LIC.
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRON7fROP.LINE OF (STREET)
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ.FT. ' NO OF NO.OF CHECK HIG AY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
SIZE ��x�� STORIES FAMILIES ONE }
DESCRIPTION OF WORK NEW ❑ + O
BLDG.S K FROM
DY1 V�°1-+ Qy,��,� a O ADD �❑y SIDE-PROP.LI TOTAL SETBALT"494 TYPEOFETEXISTING G
V 1 ALTER �I
' C O 1'yn HIGHWAY + YARD = SIDE PROP.LINE IGHWAY WIDTH . N
USE OF REPAIR El Z
EXISTING BLDG. DEMOL ❑ +
'APPLICANT TEL CORNER CUTOFF '. YES ❑ NO ❑
IPRINTI NO. - •
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE). . ,,d4ULG`y�, IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE Z;-6
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 COM-
PENSATION INSURANCE. Z 7 _ COV If—?Z.- PJ131-rj3
SIGNATURE OF
PERMITTEE
ADDRESS
FINAL BY
TEL. DATE /t .-'.7
CITY 'NO.
MAKE CHECKS PAYABLE TO: FEE $ FET
HARVEY T.BRANDT,COUNTY ENGINEER Aa_
PLAN CHECK-VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. �cASH
r :1. 5.:0:0 AGs
®s 76A638A•CE#8033.75'