HomeMy Public PortalAbout6002 BURTON AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Pd01 01 type only)
BUILDINGCOUNTY OF LOS_ DEPARTMENT OF COUNTY ELES
ADDRESS ENGINEER
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CITY < �A— ZIP BUILDING AND SAFETY DIVISION
O.OF BLDGS. BUILDING /
SIZE OF LOT'J ��IN/DAY
ON LOT,//+ ADDRESS ( 7O
T R A C T�? }-' J BBL ///7/�((.(i -LO jI g / { LOCALITY � �✓��/�G� _,b
OWNER (f G,(G d (NOS' { � CROSS ST.
- ��'^TIASSESSOR t
ADDRESS y-tJ � 4A---21--V— MAP BOOK r / .f�a PAGE '� ✓ ARCE
DISTRICT GROUP TYPE FIRE PRO ESSED BY
CONST
ARCHITECT
ZONE
CITY C1 i ZIP S _
ARCHITECT OR TEL.
ENGINEER NO. -
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO.�_DWELL,U ITS''� BI� PeI
CONTRACTOR TEL.
N NE MAP /
LIC, NO.
ADDRESS SPECIAL
LIC -
LIC. CONDI TIONS
CITY CLASS _
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH SETBACK
E FROM
FRONTPROP. _INEOF � •AP� (STREET) T
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING U
HIGHWAY } YARD
SO. FT/ �J NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE Z ,DO STORIES FAMILIES NEWNE �� �J1❑ 0 J } C
DESCRIPTION OF WORK
ADD [:] BLOG.SETBACK FROM w
SIDE PROP. LINEOF (STREET) Z
` ALTER ❑ HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
Y REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF + _
EXISTING BLDG. DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT). NO.
BY (SIGNATUR EI / j IN OPEN SPACE. - YES ❑ NO ❑
VALUATIONY
QQ Roe-) C/= / IN COASTAL ZONECATEGORICAL EXEMPTION YES❑ NO ❑
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING TIE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PER$ON IN VIOLATION - THE
LAB09 CODE OF THE STATE 0I CALIFORNIA IN RELATING TO
WORKMEN'S COMPENS TION INSURANCE _ t
SIGNATURE
PERMITTEE
L
ADDRES/STE
�J_ / �J L
CITY /'L/��f LtL -I /S�� ,N ��' G/LV y�ATE/C�7 IG` BY
PMT.
.q:1FE (.1/j_-(:KSP.0.4131-1' 'IO: F'E FEE
HARVEY T. BRANDY, COUNTY ENGINEER
PLAN CHECK VALIDATION cK. M.o. CASH _ PERMIT VALIDATIONGK. H.o. CASH
I , ( 3 0 7 573 SEP 5 1 A 1 0.0 0 d
76A638A CE N80312/72