HomeMy Public PortalAbout6004 BURTON AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (PH�t Gr rYP� IX1IYI
Bu1LDwG COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITYiP BUILDING AND SA TY DIVISION
O.OF BLOCS. BUILDING -
SIZEE OF LOT ®O NOW ON LO/T�J/(J(�' ADDRESS [l�Pi Z'
T A + BLOCK OFf Z LOCALITY
TE / NEARES
OWNER ,N .r '� (y CROSS ST. .G--
ASS
ADDRESS / MAPEBOOK lJ 'B�b PAGE PARCEL -31
DISTRICT GROUP TYPE FIRE SED BY
CITY 21P CONST. ZONE
ARCHITEC OR TEL.
ENGINEER NO. -
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASSNO./)/ / SK6PG
CONTRACTOR NEOL. USZONE MAP
LIC. NO. O
ADDRESS NO. �I SPECIAL
LIC. CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROMLBI >
FRONT PROP.LINE OF (STREET) CO
ADDRESS CITY
HIGHWAY + YARD c TOTAL SETBACK FROM TYPEOF EXISTING U
SO. FT NO. OF NO. LI CHECK FRONT PROP. LINE HIGHWAY WIDTH CC
512E (/ STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW J WCL.
L DD ❑ BLDG.SETBACK FROM rn
SIDE PROP.LINEOF (STREET) Z
®vLTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
-REPAIR[-] SIDE PROP. LINE HIGHWAY WIDTH
USE OF +
DEMOL
EXISTING BLDG, ❑
APPLICANT ( TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT)
BY (SIGNATURE) / IN OPEN SPACE YESMez� ❑ NO 1:1
C IN COASTAL ZONE YES ❑ NO ❑
VALUATIONS
CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNO EDGE THAT I HAVE READ THIS APPLICATIONENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRVCTIC N. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OI THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO •
WORKMEN'S COMPE TION INSURANCE.
SIGNATURE
PERMITTEE
7 OF
ADDRESS
y�� FINAL BY
CITY ` NO. 6L''�' OA TEf�����
>IAKL ( IIECKS PAYABLE 7'0: FEES FEE
HARVEY T. BRANDT. COUNTY ENGINEER
.57. 30 /
-PLAN CHECK VALIDATION cK. M.o. CASH PERMIT VALIDATION cK. V-13 CASH
z 7 3 07; AUG 15 2 a 5 7.30i
JP, 3 0 ; 873 SEP 5 a 9 5 .50a
76A638A CEP803 12/72