HomeMy Public PortalAbout5422 MCCULLOCH AVE_Building__ _ APPLICATION FOR BUILDING PERMIT -
FOR APPLICAI'JT TO FILL IN (Print or type only)
BUILDING "9# COUNTY OF LOS ANGELES
ADDRESS J4A_ _ j_L� DEPARTMENT OF COUNTY ENGINEER
_' BUILDING AND SAFETY DIVISIO��jl,�Q 4
CITY ZIP 14Ga('
NO.OF BLDGS. BUILDING
SIZE OF LOT NOW ON LOT ADDRESS
TRACT BLOCK LOT NO. LOCALITY
�/
TEL., NEAREST
OWNER (_- j//-� G NO. 1/ CROSS ST.
J � ASSESSOR
ADDRESS ` - v6 , MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE JA2RGqESSED BY
CITY ZIP471001 . e:50-101y fa CONST. Z3
ARCHITEGff"OR TEL <
ENGINEE sCi� C Gt�l STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS k" 40, p CLASS,NO. �WELL.UNITS JC BK,6 G
CONTRA CTOF !; ;its l�C? jOL . 0 USE ZONE MAP �1
N
O. V
ADDRES 7' NO. . r7 SPECIAL
LLIC. CONDITIONS
CITY ' _sN N 9//Q-7 CLASS
ROAD DEPARTMENT APPROVAL REQUIRED 1 YES❑ NO❑
CONSTRUCTION LEND •
NAME AND BRANCHJ� 14L U/S' / 6 BLDG.SETBACK FROM IL-- (STREET)
ADDRESS � '00' CITY ,�: /t . FRONT PROP.LINE OF C
�7' HIGHWAY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING c
SQ. FT y NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY, WIDTH
SIZE ZL�ra STORIES AC--, lFAMILIES ONE C
��- C
DESCRIPTION OF WORK NEW Ig + o t
ADD ❑ BLDG,SETBACK FROM C
SIDE PROP.LINE OF (STREET) G
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR
SIDE PROP. LINE HIGHWAY- WIDTH
❑
USE
EXISOT NG BLDG,SIhGLI �Llti 14 DEMOL [:] +
APPLICAN TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) f^ 1a7 LeGf..Lj NO. QV
BY (SIGNATU IN OPEN SPACE YES ❑ NO ❑
Q IN COASTAL ZONE YES ❑ NO ❑
VALUATION U CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLE GE 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. IC
THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL N 0 T EMPLOY ANY PERSON IN VIOLATION OF THE -
LABOR CODE OF THE STATE C ATING TO '
WORKMEN'S COMPE NSATI0
SIGNATURE OF
PERMITTEE
ADDRESS
FINAL BY `
TEL. DATE
CITY NO.
P.C. PMT.MAKE
MAKE CHE(:KS PAYABLE TO: FEE $ FEE $
HARVEY T. BRANDT. COUNTY ENGINEER , .,
f D, . o a
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT DATION CK. M.O. CASH
7 4 r FEB. 27 2 3 0 63 5.0 0 B98 '
76A638A CEMB03 12/72 0 2C*Z It l 9 1 o .2 2 5.0 0 A98