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Home My Public Portal About5424 MCCULLOCH AVE_Building__ S`f'I APPLICATION FOR BUILDING PERMIT FOR APP'LICAX-4r TO FILL IN (Print or type only) BUILDING ? ALL '' ;� COUNTY OF LOS ANGELES - PARTMENT OF COUNTY ENGINEER . CITY �E �� ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING yyu��G /J SIZE OF LOT , NOW ON LOT ADDRESS rAl oL6&(< 1—; TRACT � BLOCK LOT NO. , LOCALITY C TEL NEAREST OWNER �/ C O. CROSS ST. ASSESSOR ADDRESS.Jai&2 MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE P CESSED BY CITY ZIP /� ,1{/ CONST. /' ZONE ARCHITECT-ORTEL. L�/1 v `6 ENGINEER Af S NOt99 STATISTICAL CLASSIFICATION SEWER XkP ADDRESS J, j&_& 49!4/VO IJ4, CLASS NO. ,�qq nn DWELL,UNITS -/ F BK a7PG CONTRACTOR �f�ljpL /1 USE ZONEg3 Fcs AP LIC.r�� O. CJ ADDRESS ' NO,�T,�c, PECIAL LIC. ON DI TI ONS CITY CLASS, ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDS NAME AND BRANCH : •Q IBL J D jay/ BLDG.SETBACK FROM . c FRONT PROP.LINE OF � / 9 (STREET) ADDRESS, - CITY S HIGHWAY + YARD _ TOTAL SETBACK FROM TYPE OF EXISTING SQ.IZ FT.f'jpV STORIES FAMILIES CHOCK FRONT PROP. LINE HIGHWAY WIDTH C SIZE (((Ul �/j' F� DESCRIPTION OF WORK ' NEW + `� 0 Ll BLDG,SETBACK FROM a ADD ❑ SIDE PROP.LINE OF (STREET) ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING rD EPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OF EXIST NG BLDG. Q EMOL 11 + APPLICAN J EL CORNER CUTOFF YES ❑ NO ❑ (PRINT) _ 0. BY (SIGNATOR IN OPEN SPACE YES ❑ NO ❑ Q J/�y/lam�J-� IN COASTAL ZONE YES ❑ NO ❑ VALUATION�F' /(J W 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. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE A TING TO WORKMEN'S COMPENSATION SIGNATURE OF - PERMITTEE ADDRESS FINAL -BY CITY NOL DATE MAKE CHECKSPAYABLE7'U: FEE FEE 4 HARVEY T. BRANDT. COUNTY ENGINEER Q PLAN CHECK VALIDATION cIi M.O. CASH - PERMIT VALIDATION CK. M,O. CASH 07 5 P FEB 27 2 3 0 81.90 198 _ 901MR 9 1 D ` 136.50e98 7GA838A CE#80912/72 -- APPLICATION FOR BUILDING PERMIT FOR A.PF'LICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS cl y= DEPARTMENT OF COUNTY ENGINEER CITYfJ(4r1 ZIP BUILDING AND SAFETY DIVISION "0.OF BLOGS. n BUILDING SIZE OF COT NOW ON LOT ADDRESS, ✓ C 3 TRACT �rj BLOCK� LOT NO LOCALITY TEL. NEAREST OWNER 51 NO. CROSS ST. ------ JIF .ASSESSOR ADDRESS 2� G I MAP BOOK PAGE PARCEL _ DISTRICT GROUP TYPE FIRE PR ESSED BY CITY ZIP Q CONST. ZON '\ ARCHITECT OR TEL. ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS N�DWELL.UNITS __4 B ' TEL. CONTRACTOR NO USE ZONE NMA OP ADDRESS , O � �_ NO � SPECIAL LIC. r CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF STREET) C ADDRESS � Tf� CITY � TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = C SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH C SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK J � NEW ❑ + ADD ❑ BLDG.SETBACK FROM SIDE PROP.LINE OF (STREET) ALTER ❑ - TOTAL SETBACK FROM TYPE OF EXISTING EPAIR❑ _ HIGHWAY + YARD - SIDE PROP. LINE HIGHWAY WIDTH rDEMOL USE OF + EXISTING BLDG. • APPLICANTrTEL CORNER CUTOFF YES ❑ NO ❑ _ (PRINT) /J� ® BY (SIGNATOR .�� IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ 490 CATEGORICAL EXEMPTION YESO- 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. 1 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 COMPE NSATIO CE. SIGNATURE - PERMITTEE 2ar /�` ' ADDRESS— L3° FINAL BY CITYe ,0e NOJDATE 7"23 // �✓ /i G.e�I✓ MA KF. CHLACKS PAY BLE TO: FEE FEE $� HARVEY T. BRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 2. 4 1 C--MAR 26 1 D 1 2.0 0 ,&9d 76A638A CE9803.7/73 .