HomeMy Public PortalAbout5418 MCCULLOCH AVE_Building__ 5 ) APPLICATION FOR BUILDING PERMIT
FORA P2-ICANT-T0 FILL.IN (Friht or'tvpe only)
BUILDING 9 !/ COUNTY OF LOS ANGELES
ADDRE - old lll�I7 :��C PARTMENT OF COUNTY ENGINEER
CITY L? -L ZIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS.5 BUILDING
SIZE OF LOT NOW ON LOT 7 ADDRESS
w
TRACT •BLOCK LOT NO. LOCA LIT '
rj4. ;1TEL. NEAREST
[. - ;
OWNER / v r 0. CROSS ST.
ASSESSOR
ADDRESS �; MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE ESSED BY
CITY�/WfJ ZIP �'� •� CONS ZONE 9 w
ARCHITECT, TEL.
ENGINEER, t.eSOAL, e_Ltv;j5 NO,._
�J STATISTICAL CLASSIFICATION SEWER AP
ADDRESS �, 1 '� 1 ) /-/ CLASS NO.L�DWELL.UNITS �BK/a G
CONTRA CTO t C P' , '��NO, �� USE ZONE MAP
. LICNO. �
ADDRESS �� _ NO "2 - Q?_ SPECIAL
A LIC. CONDITIONS
CITY '� _� q11u CLASS •_
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDS
NAME AND BRANCH = -1 ' -• (A, BLDG.SETBACK FROM
FRONT PROP.LINE OFi-�ISTREET)
ADDRESS_ _12110 A/ L CITY -� C
HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. FTS NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH p
SIZE �L'��r STORIES f FAMILIES �/ ONE ( �yJ F
DES'C PTION OF W RK NEW �]{ +
O
ADD [:] BLDG.SETBACK FROM v
SIDE PROP.LINE OF (STREET)
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE EXISOT NG BLDG.`J( 1�+ [(,*vt I DEMOL [:1 +
APPLICANT L CORNER CUTOFF YES ❑ NO ❑
(PRINT) U/1/L_o T 4- - �` •�
BY (SIGNAT IRE) ----A IN OPEN SPACE YES ❑ NO ❑
IN COASTAL ZONE YES ❑ NO ❑
VALUATION$ 2-`rO
' CATEGORICAL EXEMPTION YES❑ NO ❑
1 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
LABOR CODE OF THE STATE OF CALIFORNIA IN R TING TO
WORKMEN'S COMPENSATION INSU
SIGNATURE OF
PERMITTEE
ADDRESS
FINAL BY
TEL.
CITY �_. NO. DATE /-�- - `4�
MAKE CH C KS PAYABLE TO. PEE � FEE
HARVEY T. BRANDT. COUNTY ENGINEER 1,31- 1,16 'S j
PLAN CHECK VALIDAT N CK. M.O. CASH PERMIT VALIDATION CK. M.O. /CASH
6 6 9 ti FEB 27 2 3 1 3 1.4. 0 ,&=�
76A638A CE*803 12/72 1 P I Ayd
8 6 r"'_7't1AY 9 n n A 4.4