HomeMy Public PortalAbout9034 RANCHO REAL RD_Building_6/13/1975_block wall APPLICATION FOR BUILDING PERMIT
FOR�Af�PLICANT TO FILL IN (Print or type only) LJ
BUIL#bINGCOUNTY OF LOS ANGELES
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ADDRESS 3 — DEPARTMENT OF COUNTY ENGINEER
CITY em fet. ZIP 1 BUILDING AND TY DIVISION
NO.OF BLDGS. 41 BUILDING
SIZE OF LOT NOW ON LOT 4
7; ADDRESS
TRACT,j BLOCK LOT NO LOCALIT
- /A
CROSS ST.
ASSESSOR
ADDRESS Z.- ay1L Vdi MAP BOOK PAGE PARCEL
1 DISTRICT
IGROUPJTYPE FIRE SSED BY
CITY ZIP CONST ZONE
ARCHITECT 04tt TEL. O
ENGINEER 140•
STATISTICAL CLASSIFICATION SEWER P
ADDRESS CLASS NO(21-0 _DWELL•UNITS ' BK PG
CONTRACTOR/ No.�7 ,US ONE MAP /
LIC. NO. /
ADDRESS NO, 4 SPECIAL
LIC. CONDITIONS
CITY CLASS :�
ROAD DEPARTMENT APPROVAL REQUIRED YES NO
CONSTRUCTIONA ENDER I
NAME AND BRANCH 'd�4 b BLDG.SETBACK FROM C
FRONT PROP.LINE OF (STREET) C
ADDRESS _ CITY _ TOTAL SETBACK FROM TYPE OF EXISTING L
HIG AY + YARD' -
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH L
SIZE STORIES FAMILIES ONE F
DES'C N O WORK NEW +
ADD ❑ BLDG.SETBACK FROM
SIDE PROP. 'LINE OF (STREET)
00, ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑
SIDE PROP. LINE HIGHWAY WIDTH
USE'OFEXISTING BLDG. DEMOL ❑ +
EXISTI
APPLICANT TEL �j
CORNER CUTOFF YES ❑ NO ❑
(PRINT) f e NO.
BY (SIGNATURE) rIN OPEN SPACE YES ❑ NO ❑
Q 77 INICOASTAL ZONE YES ❑ NO
A ❑
VALUATION �G/ 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 (GATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE ORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERS N IN IOLATION OF THE tae
LABOR CODE OF WORKMEN'S COMPENHE STATE OFA CELT ORN IN RELATI G TO T d �R®�m
I 4 ` }
SIGNATURE OF �� /'LJA
PERMITTEE
ADDRESS / l9 {/�
CITY /� NOL [is�Q� DATE' 1�q-7J
BY
MAKE CNEC S PAYABLE- TO: FEE $ FEE P
HARVEY T. BRANDY, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK/ O. CASH
75 8 Lu-"jut, 4 2.0 U aJs
76AS38A CE#803 7/73