HomeMy Public PortalAbout4918 FIESTA AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF LOS ANGELES
ADDRESS /--, 1 $ -�i DEPARTMENT OF COUNTY ENGINEER
CITY zIP BUILDING D SAFETY DIVISION
NO OF BLDGS - BUILDING ^
SIZE OF LOT /Z_�- NOW ON LOT ADDRESS A 9
TRACT I Aw BLOCK I LOT NO I 0TEL2r LOCALITY Te j e C1 T
NEAREST
OWNER UA N 13t (HCA N62CROSS ST
ASSESSOR
ADDRESS q�) r IEj f MAP BOOK 11GE PARCEL
DISTRICT TYPE FIRE SSED BY
CITY -rE.'n P1 E C,[`t' ZIP / �/ CO T ZoNf—
ENGINE R ITECT OR TEL✓1S - NO�3(X2-)u `
Q,.,� Ap STATISTICAL CLASSIFICATION SEWER AP
ADDRESS Z [ o�Cf�IUIC51 �1NArtrtCLASS NO I DWELL UNITS BK PG
CONTRACTOR V,.1S t' PCSJS NO331a°i USE ONELIC
NOP
ADDRESS Idl N �ZG /�/�NO 17 p SPECIAL
LIC / Z� CONDITIONS
CITY _ CLASS G 53 ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO
CONSTRLYCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRONT PROP LINE OF ISTREETI
ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING
SQ FT r'1 NO OF NO OF CHECK HIGHWAY t YARD = FRONT PROP LINE HIGHWAY WIDTH
SIZE V STORIES FAMILIES ONE _ y
DESCRIPTION OF WORK NEW + OU
ACK FROM
(� J ADD ❑ SIDE PROP BLDG BLINE OFF (STREET) O
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING
Z� HIGHWAY + YARD = SIDE PROP LINE HIGHWAY WIDTH N
USE OF REPAIR ❑ Z
EXISTING BLDG DEMOL ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO�
(PRINT) NO
- - IN OPEN SPACE YES ❑ NO
BY L30)i
(SIGNATURE) I IN COASTAL PERMIT ZONE YES ❑ NO
VALUATION $ -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE O
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE F CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE
SIGNATURE OF '
PERMITTEE d
ADDRESS I�"�,
FINAL BY
TEL-4V:�, ri) DATE
CITY N
! MAKE CHECKS PAYABLE TO FEE $ FET $
HARVEY BRANDT COUNTY ENGINEER /���� ZZ 1
PLAN CHECK VALIDATION cK o' CASH PERMIT VALIDATION cK mo CASH
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