HomeMy Public PortalAbout10233 GREEN ST_Relocation__ 76A698-CE 678",2-60-
, APPLICATION FOR RELOCATION B LDING PERMI
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS -
BUILDING AND SAFETY DIVISION LOCALITY �.
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN, SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN DIST.NO. ROUPI TYP SEWER MAP G S BY
PROPOSED �, T '�
/L�L33 7f &
BUILDING � ' MAP STATE
AD LI T NUMBER HWY. YE NO
LOCALITY r &nl �(� C.I USE ZONE SPECIAL
PRESENT / / CONDITIONS
BUILDING
ADDRESS I
LOCALITY 77; ," BUILDING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
OWNER Eh FRONT /j �� r
P. L. V
MAIL
ADDRESS SIDE
P. L.
CITY NO.
TEL-6NO. J SURETY DATE RECD
MOVING TEL. BOND $ FILED BY
CONTRACTOR NO.
CASH i— L U DATE iaC_ C D C i
ADDRESS DEPOSIT $ FILED BY
BUILDING TEL. APPROVALS DATE INSPECTO S SIGNATURE �..,
CONTRACTOR NO. FOUNDATION: LOCATION / O
FORMS, MATERIALS
ADDRESS FRAME: FIRE STOPS,
PRESENT - U
USE E BRACING, BOLTS a..,
BUILDING FURNACE: LOCATION O
PROPOSED GAS VENTS, DUCTS U
USE OF
BUILDING_
LATH, INT. ry
�j
SQ. FT. NO. OF LATH, EXT. a
SIZE ROOMS STORIES
WALL I ROOF LT HOUSE NUMBER COR-
COVERING !� COVERIN P RECT AND POSTED
LEGAL
DESCRIPTION LOT NO. BLOCK FINAL
TRACT WORK COMPLETED
NO. OF BLDGS. SURETY BOND v
,
SIZE OF LOT �' NOW ON LOT RELEASED
USE OF No. OF I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
EXISTING BLDG. FAMILIES APPLICATION AND STATE THAT THE ABOVE IS CORRECT
I HEREBY STATE THAT THE INF MATION GIVEN IS AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
CORRECT. i AND STATE LAWS REGULATING BUILDING CONSTRUC-
SIGNATURE OF TION.
APPLICANT �✓ i CERTIFY THAT IN DOING THE WOR UTHORIZED t
ADDRESSA0.23-3 - = � �� WILL NOT PLOY ANY PERSON IN V ATION OF THE
WORKMEN' COMPENSATION WS CALIFORNIA.
VALUATION 5 P. C. $ ----� SIGNAT
FEE PERMI T
FEE.$ l� ADDRES
VALIDATION � M•O. CASH ,Z74M CLYDE N. 6IRLAM, PRINCIPAL ST TURAL ENGINEER
PERMIT VALIDATION "'•D• CASH ®,
j 7 _ tF D �: