HomeMy Public PortalAbout5544 GOLDEN WEST AVE_Building__ _ APPLICATION FOR' BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only) r
BUILDING COUNTY OF LOS ANGELES
ADDRESS / •�ji' • - DEPARTMENT OF COUNTY ENGINEER
CITY
ZI P BUILDING AND SAFETY DIVISION
�j•Y/ j .+'• '
J yy NO OF BLDGS- BUILDING ,�
SIZE OF LOT � / (,/ NOW ON LOT - ADDRESS
TRACT ' BLOCK J'SLOT NO LOCALITY L'
TEL NEAREST
OWNER p' l Q L,Se NO r CROSS ST.
ASSESSOR
ADDRESSj` {?d �/!/�,�,/ MAP BOOK PAGE PARCEL
J,�gf� ` DISTRICT GROUP TYPE FIRE PROCE SED BY
CITY .r?F'� •(� �: ZIP / �fF - ' CONST. ZONE + '
+ 3
ARCHITECT R TEL �FO 1, Y
ENGINEER NO STATISTICAL CLASSIFICATION /
SIQWER MAP
ADDRESS CLASS,NO DWELL UNITS BK PG
CONTRACTOR '' TEL. Li2L
,
NO ADDRESS- ' NCC.LICNS -
CITY0 VV CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES NO [] '
CONSTRUCTION LEKbER
NAME AND BRANCH BLDG SETBACK FROM '
FRONT PROP LINE OF (STREET)
ADDRESS CITY HIGHWAY } YARD TOTA SETBACK FROM TYPE OF' EXISTING
SQ FT NO OF NO. OF. CHECK F ONT PROP LINE HIGHWAY WIDTH
SIZE ,y7 D STORIES FAMILIES ONE
,
+ �-
a
DESCRIPTION OF WORK NEW•* ❑ BLDG.SETBACK FROM / ` V
ADDA
SIDE PROP, LI NE OF 00, (STREET)
LTE TO AL SE B FROM TYPE OF EXISTING
�' HIGHWAY } YARD = S DE R P LINE HIGHWAY WIDTH .W
EPAIR❑ a
USE
t/1
EXISOT NG BLDG. IDEMOL ❑ + Z
APPLICANT' TEL i _ CORNER.CUTOFF YES ❑ NO
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
I7 , 1
N COASTAL PERMIT ZON16 YES ❑, NO ,❑ ,
VALUATION�s a
� o
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION dC}tl'e
AND STATE THAT THE•ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING-CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT E LOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF T PTE OF CALIFORNIA- IN R ATIN TO
.WORKMEN'S COMP SAT N INSURANCE -
SIGNATURE OF y -
PERMITTE7E-
ADDRESS
FINgL BY
TEL. ppy/I�
CITYl-e" C; NO DATE / �� ?� 1/F
AIA KE CHECKSIPAYABLE TO FEE' FEE
HARVEY T. BRANDT, COUNTY ENGINEERzo
D
PLAN CHECK VALIDATION' cK M O CASH P VALIDATIO CK M Ci7 CASH
2`a•5JAW., 2.2 3, D, 7.2
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