HomeMy Public PortalAbout5625-31 GRACEWOOD AVE_Building__ APPLICATION FOR BUILING PER ,IT
FOR APPL CANT TO FILL IN (Print or type only) ;
BUILDINGCO OF LOS ANGELES
ADDRESS '— DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
OF BLDGS. BUILDING
SIZE OF LOT OW ON LOT ADDRESS -
TRACT BLOCK LOT NO. LOCA LIT -�
EL. NEAREST
OWNER To.. CROSS ST.
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT JGR TYPE FIRE R SSED BY
CITY ZIP -�.O
CONST. ZONE
ARCHITECT OR TEL
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP _
ADDRESS CLASS NO.L�77ZDWELL.UNITS BAIP46`
CONTRACTOR0.TEL. Lis E ONE MAP
21ZIC. NO. L
ADDRESS O SPECIAL
LIC. CONDITIONS
CITY CL�S3
D DEPARTMENT APPROVAL REQUIRED YES� NO❑
CONSTRUCTION LENDER rA
NAME AND BRANCH LDG.SETBACK FROM
ONT PROP.LINE OF -(STREET)
ADDRESS CITY - Q
SQ. FT NO. OF NO. OF CHECK HI Y } YARD - TOTAL SETBACK FROM TYPE OF H HIGHWAY EXISTING
`-'
FRONT PROP, LINE
SIZE STORIES FAMILIES ONE Ip-�
CD
DES'CLLI
IPTION OF WORK NEW ❑ + cj
r DD ❑ BLDG,SETBACK FROM
SIDE PROP. LINE OF (STREET) Z
•
ALTER HIGHWAY } YARD = TOTAL SETBACK FROM/ Of EXISTING
EPA IR❑
SIDE PROP. LINE HIO WIDTH
USE OF t =
EXISTING BLDG. EMOL
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL ZONE YES ❑ NO ❑
VALUATION i V� CATEGORICAL EXEMPTION YES NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE ID CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
_WITH ALL ORDINANCE/ AND LAWS REGULATING BUILDING CON-
STRUCTION, I CVRTI FY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT FROG k. (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'! CO COMPENSATION YFIANC
E.
SIGNATURE O
PERMITTEE
ADDRESS
FINAL D
CITY IY1 o„�Tx NOLlyrzAll
DATE 7
HAKE CHECKS PAI'ABLE TO: FEE FEE i
HARVEY T. BRANDY, COUNTY ENGINEER 3, 00
PLAN CHECK VALIDATION CK. M.O. CASH _ PE rvffT ATION CK- M.O. CASH
22627 JUL 1 D 3.00A
78A69BA CE#803 12/72