HomeMy Public PortalAbout4853 CLOVERLY AVE_Building__ Y APPLICATION'FOR BUILDING, PERMIT ,. , 1
FOR'APPLICANT TO FILL IN (Print o,type only) d - *' °. 1
BUILDING 4 COUNTY OF" 6S ANGELES
ADDRESS `i Or�� DEPARTMENT OF COUNTY ENGINEER
CITY - PZIP ' - BUILDING AND SAFETY'DIVISION-<
NO OF BLDGS BUILDING
SIZE OF LOT NOW ON LOT ADDRESS
TRACT//4:54, BLOCK ^ LOT NO / LOCALITY
TEle�nK-J NEAREST
OWNE _ N ff CROSS ST
ASSESSOR
ADDRESS i MAP BOOK PAGE, >'„ ° PARCEL
DISTRICT GROUP TYPE FIRE OC SED B
CITY i ZIP ^Gy Y CONST °ZONE { '
ARCH ECT TEL r '
ENGINEER NO `
STATISTICAL CLASSIFICATION r SEWER MAPt
ADDRESS
CLASS NO 'DWELL.UNITS BK �PGoo
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CONTRACT ELO US ZONE MAP�G
t
CLIC NO
ADDRESS ,, n ,� NO SPECIAL >: _
LIC CONDITIONS ^
'CITY iC LASS ` -
ROADLDEPARTMEN�T APPROVAL REQUIRED YES❑ NOr❑
CONSTRUCTION LENDER
NAME AND BRANCHBLD SETBACK FROM
- FR T PROP LINE OF * (STREET) ,
ADDRESS - CITY TOTAL SETBACK FROM TYPE OF EXISTING
SO FT - NO OF . NO OF CHECK HIG AY + YARD — FRONT PROP LINE,- rHIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW ❑ L r rU
BLDG SET
DD ROM (STREET)
f SIDE PROP LINE
L RHIGHWAY + _YARD TOTAL S 'K FROM TYPE OF EXISTING �'
REPAIR❑ SIDE PROP LI HIGHWAY t WIDTH W
CL
USE OF J(10 + = Z
EXISTING BLDG DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO J❑ _ °
(PR NT) _ NO
BY (SIGNATURE) IN OPEN SPACE + YESR❑ NO ❑oy Y
IN COASTAL PERMIT-ZONE, YES ❑ NO El `
VALUATION'PQQ
I HEREBY ACKNOWLEDGE THAT I HAVE,READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY, - i --.0or
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ' 'n r1 1 �' ��� �� w V
STRUC TION 1 CERTIFY THAT IN DOING THE`WORK AUTHORIZED ,
v
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RE LATIN6 TO +G"'�,6 a�` '� C-��
WORKMEN S COMPENSATION INSURANCE "
SIGNATURE O
PERMITTEE -
ADDRESS -AA' yyy
TY N__ TE
FINAL jO B Y,
CIO DATE
'IIAKE CHECKS P-1)ABLL 10 FEE`$ FEE'
HARVEY T BRANDT, COUNTY ENGINEER ^
PLAN CHECK VALIDATION ,r CK MO CASH _ PERMIT VALIDATION ck M CASH
12 1'.7 5 AJ
76A638A CE#803 6174
7 A63BACE8031 82 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUP T OF BUILDING CROSS ST
DI$TRI NO GROUP TYPE P OCES
FOR APPLICANT TO FILL IN coNsr
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS Tc- / 1 BK PG
CLASS NO a DWELL UNITS
LOT BLOCK WATER
CERTIFICATE NOT REQUIRED IY I RECEIVED
T - �� MAP HIGHWAY �I�///VVV
NO OF SLOGS NO p2Q (CIRCLE) STATE MAJOR SECOND OCAL
O L NOW ON LOT USE ZONE SPECIAL
USE OF p CONDITION
EXISTING BLDG i-- CA- /1 L q�
TEL o
OWNER LA,IAh6 N BUILDING YARD HWY STREET NA EXIST
SETBACK WIDTH
ADDRESS '1 I C, L FRONT
P L oG I
ARCHITECT O /? l TE \
ENGINEER C NO SIDE \ �,
ADDRESS
{� �.D S P L 0
JY
�J Q
{� Li p NEL r A /I U
CONTRACTOR (' J6 r �(� / �cg
ADDRESS Y V'Li Jogr r - v , \o
rui
DESCRIPTION OF WORK
/�. 7p e
EW ADD ALTER REPAIR DEMOLISH / ~•
SO FT NO OFNO OF
SIZE STORIES FAMILIES
A
/AlUSE OF
STRUCTURE
SIGNATURE O .Ntny1-l.B�rcf9
APPLICANT /-7.L,nt,A!' J 4 e //O�fi /0 1'"o
VALUATION $ J ��� �'�/ ,�! ,�y�
APPROVALS ATE INSPECTOR S AjTqIlE
P C PMT FOUNDATION LOCATION Q
FEE $ FEE $ �� FORMS MATERIALS `�� i tI QJ
FRAME FIRE STOPS a
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT$
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION O V �'
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK 1�
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA@ RELAT
ING TO WORKMEN S COMPENSATION INSURANCE o
\ �� LATH EXT
SIGNATURE OF -S-,�\Jt �\))) HOUSE NUMBER COR
PERMITTEE RECT AND POSTED 7 //
ADDRESS FINAL
PLAN CHECK VALIDATION 0 Mo cnsH _ JOHN F LEWIS PRINCIPAL STR URAL ENGINEER
PERMIT VALIDATION CK M o CASH
, iCo-4757 SEP 2523D 25.00A
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