HomeMy Public PortalAbout10246 GREEN ST_Building__ 76A688A CE#609-6-57 APPLICATION FOR BUILDING PERMJT I
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 414 ,t64f4g,2
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DIT NO. GROUP .TYPE SEWER MAP
FOR APPLICANT TO FILL IN BK PG
DIST
CONST.
BUILD'
.NG e STATISTICAL CLASSIFICATION
ADDRESS
l6� ()• CLASS.NO. DWELL.UNITS--j-1
LOT NO..R16 MAP STATE
NUMBER , 'WY YES NO
TRACT USEZ NE SPECIAL
NO.OF BLDGS. CONDITIONS `
SIZE OF LOT NOW ON LOT �/✓C
USE OF Dd0
EXISTING BLDG. BUILDING YARD HWY S EETNAME EXIST.
SETBACK WIDTH
OWNER (/
MA I ��// �,J FRONT
ADDRESS 7%Z (i'A��Q/J 8/Ca SA D/f P L
SIDE
CITY A' NO S BJZ� P.L.
ARCHITECT OR TEL. - INSPECTION RECORD
ENGINEER NO.
ADDRESS
.2 .
CONTRACTOR Kd O. -S L
elj
ADDRESS 6 " .V a . ,�'t- *V
DESCRIPTION OF WORK
EW ADD ALTER REPAIR DEMOLISH _
SQ. Z STORIES FT. NO.OF NO.OF
SIZE QFAMILIES
USE OF STRUCTURE
SIGNATURE OF APPROVALS
APPLICANT DATE INSPECTOR'S SIGNATURE
ADDRESS %1 d �' FOUNDATION: LOCATION
FORMS.MATERIALS �, v✓�-�'
P.C. $ FRAME: FIRE STOPS. 1
f FEE BRACING.BOLTS .../�
li VALUATION ; FURNACE LOCATION,
FEE GAS VENT,DUCTS - •�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- - LATH,INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT
AGREE TO COMPLY WITH ALL COUNTY ORDINANCE ND �•
STATE LAWS R TING 6U1 NG CONSTRU ON. LATH,EXT.
SIGNATURE HOUSE NUMBER COR-
PERMIT - RECT AND POSTED
ADDRESS v C �O FINAL
JOHN A. LAMBIE.COUNTY ENGINEER. CLYDE N.DIRLAM, PRINCIPAL STRUP.WRALENGINEER
PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION K. M.O. CASH
7 6.75 AT ®F
# ?. 0 0 7°a MAR 141 A 3 3.5 0 M
APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type Only)
BUILDINGCOUNTY OF LOS ANGELES
ADDRESS t C - DEPARTMENT OF COUNTY ENGINEER
CITYl ZIP BUILDING AND SAFETY DIVISION
NO.OF SLOGS. BUILDING If
SIZE OF LW
OT �x NOON LOT ADDRESS LJ
TRACT LOT NO LOCALITY L.
TEL. '� +�� NEAREST
OWNER, C1 NO. �� tX6/ CROSS ST. �sv✓
y� ASSESSOR
ADDRESS -eC• /j MAP BOOK PAGE PARCEL
f DISTRICT I GROU JTTPE FIRE ROC SED BY
CITY .� �/� �j/� ZIP Q CONST. ZONE
ARCHITECT OR TEL. •✓' 0
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO.__2/ __DWELL,UNITS BK PG
TEL,
CONTRACTOR. NO USE ZONE MAP ^ /�
LIC. / NO. V (O
ADDRESS �j J NO, �/ SPECIAL
;� LIC. - 1 CONDITIONS
CITY f CLASS —
ROAD DARTMENT APPROVAL REQUIRED YES❑ NO❑
CONS RUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM >.FRON PROP.LINEOF (STREET) a
ADDRESS CITY
SQ, FT. NO. OF NO. OF CHECK HIGHWAY } YARD = TOTAL SETBACK FROM HIGHWAY TYPE OF EXIST
THG 67
FRONT PROP. LINE
SIZE STORIES FAMILIES ONE O
} = U
DESCRIPTION OF WORKNEW ❑ W
ADD ❑ BLDG.SETBACKFROM N
e4l
•v ?) SIDE PROP. LINE OF STREET)42&5 ZZ
Z
ALTER ❑ HIGHWAY } YARD TOTAL SETBACK FROM TYPE 0 EXISTING
=
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE
EXISOT NG BLDG, DEMOL ❑ }
APPLICANT TEL •� ) CORNER CUTOFF YES ❑ NO ❑
(PRINT) �, �' NO.�jI V DO
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
Q IN COASTAL ZONE YES ❑ NO ❑
VALUATION$ m O � CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS 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 (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INSURANC
SIGNATURE OF
PERMITTEE
ADDRESS
/ FINAL BY
;�
CITY �/ NO. �`✓r• DATE ,�7�3
1I,IKL CIIL(.KS P.1T.113LFEE 1- 70: Q PMT,
FEE $ FEE $
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O. CASH _ PERMIT VALIDATION CK. M 0. CASH
=t 1 .1UL 25 1 0 1 2.0 u
76A638A CE 9803 12/72