HomeMy Public PortalAbout9511 GIDLEY ST_Building__ f.
APPLICATION FOR BUILDING PERMIT
FOR, XCANT TO FILL fN (print or type vnl )
COUNTY OF LOS ANGELES
BUILDING
ADDRESS f� Lf TIP. DEPARTMENT OF COUNTY ENGINEER
QTY :j?Aelt .�1�' zip 5?11e0 BUILDING AND SAFETY DIVISION
Q NO.OF BLDGS. BUILDING
SI ZS OF LOT&-ig NOW ON LOT ADDRESS
TRACT BLOCK LOT NO. LOCALITY
y 1TEL NEAREST
OWNER /1c`TH �I1,l4lL NO. CROSS SASSESSOT
ADDRESS 1I (7/ (- JTp MAP 3"R
PAGE
QTY !�L C n�T zip l leo DISTRICT GRCIUP CONST FIRE P ED Y
ARCHI OR TEL C � ,
ENGIN EER NO.- STAT LS CAL CLASS I F I CAT ION SEWER
ADDRESS CRSS NO. DWELL UN
TEL
CONTRACTOR NO. USE ZONE
UG _ aAL
-
ADDRESS NO. /V_/
CTTY LIG CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTR}JQT DSI
NAME AND B CH SETBACK FROM
FRONT PROP.UNE OF (STRffTI
ADDRESS CITY TOTALS M TYPE OF EXISTING
SQ FT. NO.OF NO.OF CIECK HIGHWAY + .YARD FRONT PROP LINE HI AY WIDTH
SIZE STORIES F IJESONE
DESCRIPTION OF WORK �i9�� �- NEW + �..J 8
ADD E] BLDG.SETBACK FROM STR$T7 ce
O
T SIDE PROP.LINE OF 0
ALTER cl _ TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR ❑ HIGHWAY + YARD SIDE PROP.LINE HIGHWAY WIDTH N
USE jF Z
EXtS71NGBLDG. /�'DEMOL DAPP +
(PONT)LIIT j �LIfAf( No. 'K7T��/ CORN ERCUTOHF YES NO ❑
�Q� IN OPEN SPACE YES ❑ NO ❑
BY ISI GNATU RD `�
IN COASTAL PERMIT ZOI N E YES ❑ NO ❑
VALUATION
I HEREBY ACMOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE -
THAT THE AI�C)VE R OJRRECT AND AG;fE TO(SIMPLY WFrH Ki ORDINANCES
AND LAWS TING BUILDING OD16TRl1 7iCtF.I CERTIFY THAT IN DOING THE -
y�OR1C ALfTF10RIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VKJLATK)N OF
7`HE Ll CODE Of THE STATE OF G.L FORN IA IN RELATING TO WORKMEN'S ODW
PENSATKJN INSURANCE '
SIGNATURE OF
PERMM-EE
ADDRESS
HNAL BY
CITY �Yr4�Cr L 7'Y NO. DATE
✓� f�� � `�
MAKE G] ECKS PAYABLE TO. � $ �.
HARVEY T.CRANDT,COUNTY ZINGINQER a i
PLAN CHECK VALIDATION cr- m.o. c.Asm PERMIT VALIDATION CIL . Wo. (Ant+
1,6,AWP :14 *j b 3-5.2 Aw
es 76Ab3&A CE NOW 3-73'
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