HomeMy Public PortalAbout9950 DAINES DR_Building__ ' f
QPS-76A638A
03(REV 6/78) -
APPLICATION F BUILDI; PE-RM,IT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Y BUILDING
FOR APPLICANT TO FILL IN ADDRESS
BUILDING �
ADDRESS LOCALITY ��s
NEAREST D1 �A/
CITY - ' ZIP CROSS ST /f'G�
NO OF BLD•GS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE, PARCEL
DISTRICT, - GROUP TYPE ^FIRE RO SSEDBY
TRACT tBLOCK LOT NO m CON
TEL
OWNER NO
STATISTICAL CLASS ICATION EWER
ADDRESS CLASS NO Q DWELL UNITS K L
CITY 4Q y. _ -ZIP
ARC
ENGI{NEERITECTOR J ' TEL NO VALUATION $ 3
ADDRESS BLDG SETBACK FROM,
TEL '11 FRONT PROP LINEOF (STREET)
CONTRACTOR NO 2'11 TOTAL SETBACK FROM TYPE OF EXISTING
1 LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH,'
ADDRES i J NO aM-
LIC +
CITY IL A — CLASS. BLDG'SETBACK FROM
CONSTRUCTION LENDER SIDE PROP LINE OF (STREET)
NAME AND BRANCH
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING �
ADDRESS CITY SIDE PROP LINE HIGHWAY-WIDTH O
SO FT NO OF NO OF CHECK + = V
SIZEl9b STORIES FAMILIES ONE 99
DESCRIPTION OF WORK NEW ElP ee$ Permit Fee CK /
W t ADD �v Issuance Fee �_ N
LTERL 4-1126
REPAIR ❑ Total Fee
USE OFl DEMOL ElEXISTING BLDG 7 5 2 7 A
APPLICANT TE
(PRINT) Imo' N0 �� Q
o # O oio'o 2 1'
BY(SIGNATURE( > #.o 010,0 2 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE, ` Y '
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE V .,2'0 O 1 512
WORK AUTHORIZED'HEREBY I'WILL*NOT EMPLOY ANY PERSON IN VIOLATION OF '
THE LABOR COD TE OF CALIFORNIA IN RELATI G TO WORKM S COM - - _ z !o O O 1 G 2 V-
PENSATION INS RANCE •A
79
SIGNATURE OF
PERMITTEE
ADDRESS Z ;275.28A
TEL O . t
P #.o o•o 0 0 1
CITY NO G • . , '
SZ NE NOP a 2:0 O 3 4 0.0
SPECIAL ' F .0 0 0 3 jJ 0 0
CONDITIONS
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BY ac
DATEL /��3/7
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