HomeMy Public PortalAbout5339 MCCULLOCH AVE_Building__ t ANT
1 IUN I-UR BU.ILUING PERMIT
FOR APPLICANT TO FILL IN (Print or type only) .
BUILDING COUNTY OF LOS ANGELES
ADDRESS �c_c DEPARTMENT OF COUNTY ENGINEER
i r ZIP 8 BUILDING AND SAFETY DIVISION
CITY`CtAR —Z C'
BUILDING
SIZE OF LOT �C NOW ON LOTS Q ADDRESS
TRACT I3(, BLOCK. il LOT NO. / LOCALITY
,, EL. NEAREST
OWNER {� O. CROSS ST. Q
'ASSESSOR I
ADDRESSS Qc-u MAP BOOK PAGE PARCEL
CITY �QL� C ZIP , DISTRICT GROUP TYPE FIRE PROCESSED BY
CONST. ZONE
ARCHITECT OR TEL.
ENGINEER NO.
STA TISTICAL.CLASSIFICA TION SEWER MAP
ADDRESS CILASS NO.-4:2 I DWELL-UNITSF SK/()IfiG
CONTRACTOR nA/.i NEOL. U E ZONE MAP
LIC. 1 NO. V V
ADDRESS NO, SPECIAL
LIC. 7a�7o COND TIONS
- I
CITY CLASS - ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ 1
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE'OF (STREET) C
ADDRESS CITY - TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD - 0
SQ. FT+� NO. OF NO. OF I CHECK FRONT PROP. LINE HIGHWAY WIDTH C
SIZE J STORIES FAMILIES ONE I CCCF
DESCRIPTION OF WORK NEW 1:1I + G
ADD BLDG.SETBACK FROM 1
AM
SIDE;PROP.LINE OF (STREET)
'1 ALTER ❑ _ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD - SIDE PROP. LINE HIGHWAY WIDTH
REPAIR❑
USE DEMOL ❑ +
EXISTING BLDG.
APPLICA T TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) � �N0. :�
BY (SIGNAT ) (�, IN OPEN SPACE YES'[] � NO ❑ '
' IN COASTAL ZONE YES ❑ NO ❑
VALUATION C / r 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)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. IC
THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE �L
LABOR
DE OF
THE STATE
CA
WOR MENDS COMPENSATION INSANCE IFOflN1A IN RELATIN TO e—.716/ yJc/-I
SIGNATURE O 112-2111
PERMITTEE
-
ADORESS: _ L U "flPeti
TE
CITY D
• ` ✓ C( 17 N O. '�� IA T E
MT
MAKE CHECKS PAYABLE TO:
P.
_C FEE $ ra
HARVEY T. BRANDT. COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.OCASH
F7i 9 AUG: 3.0 . 1 0 4 8.7 5 ASS
7BA638A CE#803 7/73
APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print:or type onlv) -
BUILDING ^' { `(� BUILDING
ADDRESS ` tl ADDRESS
,CITY o � ZIP �� LOCALITY �j(,� G of
�` � L' NO.OF BLDGS.
SIZE OF LOT �V K NOW ON LOT `31+1V NEAREST
^� l CROSS ST:
ASSESSOR 7
TRACT% e]�` BLOCK LOT NO � MAP BOOK PAGE PARCEL
•r. T L. DISTRICT. GROUP TYPE FIRE', PROCESSED BY
OWNER (, .,;. CONSTr � ZON r e
r Jr
ADDRESS d`LG
STATISTICAL CLASSIFICATION SEWER MAP
CITY ZIP CLASS NO. DWELL:UNITS BK PG
ARCHITECT OR TEL
ENGINEER N USE ZONEMAP "
r NO. d
ADDRESS' ® PSPECIAL
'TEL. CONDITIONS
' -
CONTRACTOR NO
LIC. ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ ,
ADDRESS
NO. BLDG.SETBACK FROM
CITY
LIC. FRONT PROP.LINEOF, (STREET.);
CLASS• _ TOTAL SETBACK FROM TYPE OF EXISTING
CONSTRUCTION• NDER - HIGHWAYS + YARD - HIGHWAY ,WIDTH
FRONT•PROP: LINE
NAME AND BRANCH _
ADDRESS CITY = +
SQ. FT• NO. OF NO. OF CHECK BLDG.SETBACK.FROM'
SIZE STORIES- FAMILIES; ONE SIDEPROP.•LINEOF (STREET) v
DES'CRIFTION OF WORK NEW ❑ HIGHWAY .:+ YARD. = TOTAL SETBACK FROM TYPE OF EXISTING CD
SIDE PROP. LINE HIGHWAY WROTH V
"'lO ADD + _
ALTER ❑ rn
CORNER CUTOFF YES ❑ NO ❑
EPAIR❑
USE OF
EXISTING BLDG. DEMOL ❑ IN OPEN SPACE YES ❑ NO ❑
AP PRINT) 7f. jf+..-1 ` Q$� kT
N01. JN. N
IN COASTAL ZONE YES ❑ NO ❑
BY (SIGNA TU• J ENVIRONMENTAL CATEGORICAL EXEMPTION YES[] NO ❑
• q IMPACT•'- '.EXEMPTION DECLARATION SIGNED (DATE)
VALUATION•Y too IMPACT REPORT PROCESSED (GATE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO •�• - a• '
WITH. ALL ORDINANCES AND LAWS REGULATING BUILDSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED -
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATIONLABOR CODE OF THE STATE OF CALIFORNIA IN R
ELWORKMEN'S COMPENSATION 1 UASIGNATURE O BPERMITTEE - A DATEADDRESS � � P.C!. $.,:
FEE FEEwo
.
CITY l f. Cl NO. ��•.p���
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT 4MATION CK.
6 9 1'tiAPR 3� U '6.0.0 A
76AB38•B C ERS03A 5/73.