HomeMy Public PortalAbout5218 MCCLINTOCK AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPL4-ItANTTO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
7ADDRERa"LD' c DEPARTMENT OF COUNTY ENGINEER
Q r ZIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING j7
SIZE OF LOT NOW ON LOT ' 12 ADDRESS �� OIV Me
TRACT 1338q BLOCK `LOT NO. 6 LOCALITY
TEL. NEAREST
OWNER NO-yy,41fj A CROSS ST.
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT UP TYPE FIRE PR E)4ED BY
-CITY ZIP ZONE
ARCHITECT OR TEL. ,
ENGINEER N STATISTICAL CLASSIFFIICA�TIO'N SEWER P
ADDRESS CLASS NO. _DWELL.UNITS OK /4
G
TEL.
CONTRACTOR NO. ,Id$E.ZQNE NMOP
LIC. IU/ll�J 1 SPECIAL
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ADDRESS NO.,
LIC. CONDITIONS
CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG SETBACK FROM
FRON PROP.LINE OF (STREET)
ADDRESS r CITY HIGH + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ.FT. NO.OF NO.OF CHECK - FRONT PROP.LINE HIGHWAY WIDTH
SIZE 3 STORIES FAMILIES W ONE }
DESC ON WORK NEW ❑ + O
ADD BLDG.SETBACK FROM (STREET) ad
O
✓✓✓��` SIDE PROP.LINE OF
ALTER = TOTAL SETBACK FROM TY OF EXISTING
HIGHWAY + YARD
USE OF REPAIR SIDE PROP.LINE HIGH Y WIDTH .
N
❑ Z
EXISTING BLDG. DEMOL ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO. 1A
IN OPEN SPACE YES ❑ NO ❑
BY)SIGNATURE) -
Q@ IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ U N6Kt> "6- L= eS • /IP-5-7
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES.
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
SIGNATURE OF
PERMITTEE— E r -,L
ADDRESS
FINAL
TEL. DATE [?
CITY NO.
KE CHECKS PAYABLE TO: FEE' FET
HARVEY T.BRANDT.COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH ERMIT VALIDATION CK. M. �CASH�
37 P-InT, 18 1 U 1 5.C) °!jd
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