HomeMy Public PortalAbout5817 CAMELLIA AVE_Building__r
s4/7 APPLICATION FOR BUILDING PERMIT
FOR APPICANT TO,rlLL IN (Print or type only) I a
COUNTY OF LOS ANGELES
BUIL DEPARTMENT OF COUNTY ENGINEER
CITY ZIP / - SI`] BUILDING AND SAFETY DIVISION
NO.OF BLDGS. -BUILDING,
SIZE OF LOT NOW ON LOT ADDRESS
TRACT / BLOCK LOT LOCAL TY
TEL.
NEAREST
OWNER CROSS ST.
ASSESSOR
ADDRESS ! T, MAP BOOK PAGE PAROL
DISTRICT GROUP [TYPE��s� � FRE ED BY
-0TY IJP , p 8 �— VZOJN
ARCH(TEC70R
ENGINEER STAT ISTICAL CLASSIFCAT ION SEWERMAP
ADDRESS ( /rl�\ CLASS NO. Z' DWELL.UNITS BK� �PTa $
CONTRACTO \ NO. USE USEZONE MAP
ADORESSIIC46."4Ador r3rpkw NO.UEm7111 /Q NO �0 0
uc CC NDMONS g v
CTTY� CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH kDG.SETBACK FROM
FRONT PROP.UNE OF (STREET)
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT. NO.OF NO.OF CHECK HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW + O
,ADP ❑ BLDG.SETBACK FROM oc
51DE PROP.LINE OF (STREET) O
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD SIDE PROP.LINE HIGHWAY WIDTH
USE OF REPAIR 1:12
EXISTING BLDG. DEMO) ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
1 PRl Nil
IN OPEN SPACE YES ❑ tio ❑
BY(SIGNATURE)
/y IN COASTAL PERMIT ZONE YES ❑ NO ❑,
VALUATION$ O O-- 3;r Z
1 HEREBY THAT I HAVE READ THLS APPL)CAdVCLATKO)IN
TE ,
THAT THE ABOVE IS AND AGREE TO COMPLY WITH CES � 1
AND LAWS REG11AT1NG BUILDING COfLSTRUCT10P1 I(BiT1FY THHE ��[� 7 t( r+ r �r
WORK AUTHORI�H .I HRLL NOT EMPLOY ANY PERT IOPTHE LABOR CODE OF OP IA RJ RELATING TO WA4SIGNATURE OF fIr✓7-AD DRESSRKA
Ta-
NO. DATE BY
DATEMA CHECKS PAYABLE TO. �g $ FEE
HARVEY T DT,COUNTY ENGI ��+ ✓► ��
PLAN CHECK VAUDATION CIK Wo. G"H PERMIT VALIDATION cIc �.a GADH
r-JAN 25 . 1 D3 5.? 5
Ss 76A63eA CE reo3 3-7s'