HomeMy Public PortalAbout9925 GARIBALDI AVE_Building__ APPLICATION FOR COUNTY OF LOS ANGELES
OF COUNTY
BUILDING PERMIT DEPARTMENT BUILDING AND SAFETY DIVISION ENGINEER
FOR APPLICANT TO FILL IN7,4A
ADDRESS Q i.l Ct
BUILDING?
ADDRESS i'..' i 'j /;4 e. 13,9LOCALITY Q
NEAREST
CITY b )/ t / 7 ZIPS CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICTGROUP I TYPE FIRE OCES BY
TRACT BLOCK LOT NO. v ) 40f E
J/
OWNER �~ 4 NO.
STATISTICAL CLASSIFICATION12 EWER MAP
ADDREiS'Syy.r (), � ��� /' CLASS NO. �`' DWELL.UNITS El L--PG
CITY f)P(P I/� ZIP q1 o Cl 6 USE ZONE NO.MAP a�0_?ARCHITECT OR TEL. SPECIAL
ENGINEER. NO. / GQNDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑
TEL.
CONTRACTOR . NO. BLDG.SETBACK FROM
LIC FRONT PROP.LINE OF (STREET)
ADDRESS / NO. TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
CITY CLASS ">'
CONSTRUCTION LENDER fF +
NAME AND BRANCH 1 BLDG.SETBACK FROM
ADDRESS CITY SIDE PROP.LINE OF (STREET)
SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
SIZE STORIES FAMILIES ONE SIDE PROP,LINE HIGHWAY WIDTH
DESCRIPTION OF WORK A/;!f J\r NEW +
{ A ADD CORNER CUTOFF YES ❑ NO ❑
ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
USE REPAIR ElEXISTTIING BLDG. DEMOL ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT TEL }
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(PRINT) NO. Q
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BY(SIGNATURE)
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IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES Q
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE 0
WORK AUTHORIZED HEREBY I WILL NOT.EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WrRKMEN'S COM
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PENSATION INSURANCE. �
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SIGNATURE OF / FINAL BY
PERMITTEE DATE
ADDRESS ''y`
TEL. P.C. Fee$ Permit Fee
CITY NO.
Q Issuance Fee
VALUATION$
Total Fee
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
n5 76A638A CE N803A 6/76
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' APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL I-N (Print ortype only) ,
COUNTY OF LOS ANGELS
BUILDING
ADDRESS ! DEPARTMEN T OF COUNTY ENGINEER
CITY ! ZIPBUILDING AND SAFETY DMSION
NO.OF BLDGS. ! BUILDING L7 e
SIZEOf LOT 104 306 NOW ON LOT / ADDRESS
T LOT NO. CA
LOLITY
TTi -NEA REST
OWNER CRoss ST.
ASSESSOR
ADDRESS .I .99. MAP BOOK PAGE PARCEL
Di5TR1C7 . GROUP TYPE FlRE P ED Y
ZIP S O D CONST. Z l `
ARCHFTECT OR TEL
ENGI N EER NO. STATIST I CAL CLASSI Fr-ATI ON, SEWER MAP
ADDRESS TEL CLASS NO. ,3-DWELL UNITS BK PC
CONTRACTORNO E MAP .
uc No.
ADDRESS NO. SPFCAL
U E CCIN DfT1 CM15
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
ooNSTRUCTFON LENDER
NAME AND BRANCH SEr&AtK FROM
PROP.LINE OF LSTREET)
ADDRESS CffY KkWAY + YARD TOTAL SETBACK FROM TYPE OF NG
MING
SQ.FT. NO.OF NO.OF CHECK FRONT PROP,UNE HIGHWAY WIDTH
SIZE STORIES- FALJES ONE
DESCRIPT OF WORK NEW ❑ +
.SETBACKo[
I-- ADD ❑ SIDE PROP.UNEOF ISTREETI
ALTS ❑ TOTAL SETBACK TYPE OF I EXISTING
HIGHWAY + YARD SIDE PROP.LINE 'MG4jWAYj WIDTH
USE OF REPAIR ❑
EXISTING BLDG. DEMOL +
APPUCANT CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
IN OPEN SPACE YES ❑ NO ❑
BY ISIGNATURD IN COASTAL PERMIT ZONE YES ❑ NO ❑.
VALUATION
I HE3Z»Y AOQ4DWLHXGf THAT I HAVE READ I M APPLICATION AND STATE
THAT THE ABOVE tS CORREL7 AND.ACRE TO COMPLY WRH ALL ORDINAWIS .
AND LAWS REGLAATING BUILDING OOWRLICT"L I CERTIFY THAT jN DOM THE ..
WCeK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PEZSON IN VFOLATTON Of
THE LABOR CODE OF THE STATE OF CALIFORN LA IN RELATING TO 3 COM-
PENSATION INSURANCE ol .
000l
SIGNATURE O
PERMTTTE�
ADD ^
CITYA �/!/�}'n ,Q�// TE .a ��r / BY
P.cEE
MAKE CHECKS PAYABLE TO, FEE 2 FEE
F �P FEE �P
HARVEYT.BRANDT,COUNTY ENGINEER
PLAN CHECK VAGDATION CK Wo. r-"H PERMIT VALIDATION c+c M.O. CAPI+.
?. 8 6�DEC 21 �. 9 .0 U AJo
(P, 76A63aA CE#9M 3-75