HomeMy Public PortalAbout5012 FIESTA AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES
OF COUNTY
BUILDING PERMIT DEPARTMENT BUILDING AND SAFETY DIVISION ENGINEER
BUILDING /0/ 1
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FOR APPLICANT TO FILL IN ADDRESS J
BUILDING
ADDRESS X40/ LOCALITY
CITY ZIP lro NEAREST
CROSS ST
;ANO OF SLOGS ASSESSOR
SIZE OF LOT a1/1 �K NOW ON LOT MAP BOOK PAGE PARCEL
//�� _ DISTRICT GROUP TYPE FIRE P SED BY
TRACT 33Z BLOCK T t . 2— CONS ZON
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OWNER .(,(1 NOL2g,
STATISTICAL CLASSIFICATION
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ADDRESS o • CLASS NODWELL UNITS BK PG
CITY ZIP E;ONE 8DNO
ARCH ECT R TEL SPECIAL (�
ENGINEER NO
ICONDITIONS
ADDRESS AD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONTRACTOR TEL �y9-4 LDG SETBACK FROM
NO ttJJ FRONTPROP LINEOF (STREET)
� LIC r
ADDRESS [� '� LI lJ IGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
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FRONT PROP LINE HIGHWAY WIDTH
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CONSTRUCT N LENDEKI }
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NAME AND BRANCH
BLDG SETBACK FROM
ADDRESS �_ CITY SIDE PROP LINE OF (STREET) V
SQ FT NO OF NO OF CHECK HIGHWAY } YARD = TOTAL SETBACK FRO YPE OF EXISTING O
SIZE �Q7 STORIES FAMILIES / ONE SIDE PROP LINE H WAY WIDTH t3
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DESCRIPTION OF WORK NEW ❑ y
ADD CORNER CUTOFF YES ❑ NO ❑
ALTER ❑
e IN OPEN SPACE YES ❑ NOUSE ❑
REPAIR❑
EXISTING NG BLDG * EMOL ❑ IN COASTAL PERMIT ZONE IYES ❑ NO ❑
AP PRIN ANT 0ATENOL�g5-3
BY (SIGNATUREjf�j 446e(�
I HEREBY ACKN LEDGE THAT I HAVE REA T S APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AN REE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON }
STRUC TI ON I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURANCE
SIGNATURE OF -4.410 :FN T 7 27-72 BY rs
PERMITTEE ADDRESSee$ 3-�� Permit Fee ,�, �
CITY NOL
? b Issuance Fee
VALUATION Total Fee 14 3,
PLAN CHECK VALIDATIO CK M o CASH PERMIT VALIDATION CK M o CASH
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7GA638A CE*803B 12/75
TMPD �T}6OUNTY OF LOS ANGELES
APPLICATION FOR DEPARTMENT OF COUNTY ENGINEER
BUILDING PERMIT BUILDING AND SAFETY DIVISION
BUILDING
FOR APPLICANT TO FILL IIN// ADDRESS
BUILDING /
ADDRESS rO ✓ LOCALITY
p INEAREST
CITY f.� P CROSS ST
' OF BLDGS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP I TYPE FIRE PR CESSED BY
TRACT BLOCK LOT NO
CONST Z�
TEL
OWNER Uj
NO 29;4 j STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO / DWELL UNITS BK PG
CITY `' ZIP USE ZONE MAP/J /�
,f NO 6
ARCHITECT OR TEL PC /�p� SPECIAL
ENGINEER NO f CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES NO
TEL BLDG SETBACK FROM
CONTRACTOR L y NO
LIC FRONT PROP LINE OF (STREET)
ADDRESS NO HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
LIC FRONT PROP LINE HIGHWAY WIDTH
CITY _ CLASS
CONSTRUCTION LENDER +
NAME AND BRANCH 7 w "% a
BLDG SETBACK FROM
ADDRESS CITY SIOEPROP LINEOF (STREET)
TOTAL SETBACK FROM TYPE OF EXISTING C=
SQ FT NO OF NO OF CHECK HIGHWAY + YARD = HIGHWAY WIDTH C=)SIZE STORIES FAMILIES / ONE SIDE PROP LINE
DESCRIPTION OF WORK NEW ❑ +
r ADD ® CORNER CUTOFF YES ❑ NO Z
ALTER ❑
REPAIR❑ IN OPEN SPACE YES ❑ NO ❑
USE OF IN COASTAL PERMIT ZONE YES NO
EXISTING BLDG r EMOL ❑
APPLICANT TEL
(PRINT) 0
BY (SIGNATURE) ,� MX14w,
1 HEREBY ACKNOWLED I HAVE READ T S APP TION
ANO STATE THAT THE ABOVE IS CORRECT AND A44E TO COMPLY
WITHALL ORDINANCES AND LAWS REGUI ATINr, BUILDING CON
STRUC TI ON I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURANCE
SIGNATURE OF FINAL �i BY
PERMITTEE _ DATE
ADDRESS
TEL114 -24 P C Fee$ Permit Fee
CITY NO
QIssuance Fee
VALUATION$ / a� ��A '�J�
VV Total Fee
PLAN CHEC-K VALIDATION CK M o CASH PERMIT VALIDATION CK MO CASH
5 9 8 OCT 8 1 0 2 1.75 ®yo
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76A638A CE08038 12/75