HomeMy Public PortalAbout9621 GIDLEY ST_Building__ r APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDINGCOUNTY OF LOS ANGELS
ADDRESS / DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING
SIZE OF LOT NOW ON LOT ADDRESS
TRACT BLOCK LOT NO. LOCALITY
TEL. NEAREST •T
OWNER NO. CROSS ST. l
_ ASSESSOR
ADDRESS I MAP BOOK P E PARCEL
DISTRICT GROUP TYPE FIRE P EO BY
CITY ZIP , IL CONST. ZONE. �C
ARCHITECT OTEL. vY
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO.2 3 DWELL,UNITS r 1--BKPG
CONTRACTOR GO�J O USE ZONE MAP rr��
LI NO. V
ADDRESS NOSPECIAL
z — _27 /14
LIC. CONDITIONS
CIT CLASS C-L ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTfON LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
ADDRESS CITY TOTAL SET19ACK FROM TYPE OF EXISTING
HIGHWAY } YARD 8
MFT NO. OF NO, OF - CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE O STORIES FAMILIES ONE 0
+ tom,
DESCRIPTION OF WORK NEW ❑ W
BLDG. ETBACK FROM
DD
SIDE PROP.LINE OF (STREET) Z
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
EPAIR❑
SIDE PROP. LINE HIGHWAY WIDTH
USE OF ENOL +
EXISTING BLDG. CORNER CUTOFF YES ❑ NO ❑
APPLICANT / EL
(PRINT) � LCD NO
IN OPEN SPACE YES ❑ NO
BY (SIGNATURE) ❑
t IN COASTAL ZONE YES ❑ NO ❑
VALUATION i CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACK WLEDGE THAT 1 HAVE READ THIS APPLICATION [NV IRONM[NTAL
ANO STATE THAT THE ABOVE Il CORRECT AND AGREE TO COMPLY IMPACT
EXEMPTION DECLARATION SIGNED-(DATE)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DAT£)
HER kBY I WILL NOT 'IAPLOY ANY PERSON IN VIOLATION OF TH[
LABOR CODE OF THE STATE OF CALIFORNIA IN R[LATI NG TO
WORKMEN'S CO MFE NI ON NDUIII,NCE.
SIGNATURE O
PERMITTIr
ADDRESS
FINAL BY
TEL DATE
CITY NO.
P.C. $
MAKE C:HEC; P.-1YABLE TO: FEE � FEE
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. 14.0. CASH PERMIT VALIDATION C M.O. CASH
a.433 2 1 U 12.00 •
.76A63BA CE 9803 12/72 .
APPLICATION FOR BUILDING PERMIT .
FOR APPLICANT TO FILL IN (Print 0r type only)
BUILDING COUNTY OF LOS ANGELES '
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
J
0.OF BLDGS. /� BUILDING
SIZE OF LOT /�ai oW ON LOT d t'. ADDRESS
TRACT BLOCK LOT NO.• LOCALI
/ TEL NEAREST
OWNER ((jj_ N0. CROSS ST.
ASSESS
ADDRESS e7 4L 440 7C MAP BOOK PAGE EL
DISTRICT GROUP TYPE FIRE Z:D_BY
CITY Z P ST Q O T. ZONE
ARCHITECT TEL �Q,
ENGINEER NO' 'O STATISTICAL CLASSIFICATIO /SEWER MAP
ADDRESS .1.. /l. CLASS N ; DWELL.UNITS====j �r BK9/PG
CONTRACTORCf0/s*,'1 a-do TEL. /l USE ZONEOP 0/�
ADDRESS ,Z j 1 ( /� 1Oa6 6 L �' CONDIITIONS
CITY LIC.
CC-ASSN ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH d L'` LDG.SETBACK FROM
RONT PROP.LINE OF (STREET)
ADDRESS CITY
(HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
�Q� FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH pC
SIZE STORIES FAMILIES ONE _ CD
DESCRIPTI N OF WORK NEW G�
DD ❑ BLDG.SETBACK FROM TREET) CO
CO
' L SIDE PROP.LINE OF _
LTER ❑ OTAL SETBACK FROM TYPE: EXISTING
L HIGHWAY } YARD = HIGHWAY WIDTH
IREPAIR❑ SIDE PROP. LINE
USE OF } _
EXISTING BLDG. DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT)
IN OPEN SPACE - YES ❑ NO ❑
BY (SIGNATURE)
IN COASTAL ZONE YES ❑ NO ❑
VALUATION
, CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLED THAT I HAVE READ THIS APPLICATION EXVIRONMENTAL
AND"STATE THAT THE ABOVE is CORRECT AMD AOR[E TO COMPLY IMPACT EXEMPTION DECLARATION EIONED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCEBBED (DATE)
HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE [TAT[ OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSA IXSURAN _
SIGNATURE OF
PERMITTEE
ADDRESS y-
FINAL BY
TEL DATE
CITY NO. {
.UAKE CHECKS PAYABLE 7*0: FEE + FEE
HARVEY T. BRANDY, COUNTY ENGINEER �+���}.�. �� Q
PLAN CHECK VALIDATION CK. M.O. CASH r}7ERMIAATI CK. M.O, c.
78A838A CESEOS IE/7: ..�� �� �• �.. �. 15L 0ss