HomeMy Public PortalAbout5432 MCCULLOCH AVE_Building__ .11 APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BU4LDINGCOUNTY OF LOS ANGELES
ADDRESS .5A:Ifl .r?C DEPARTMENT OF COUNTY ENGINEER
CITY LLr ZIP BUILDING AND SAFETY DIVISION
NO.OF BLOGS. BUILDING
Mo
SIZE OF LOT_ NOW ON LOT ADDRESS 3� (,/QN`C•
TL-A4- 2
TRACT �i BLOCK 3w 3 LOT O LOCALIT rJ
TEL. e� NEAREST - J
OWNER O. �YI/' CROSS ST. �✓✓
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE RO SSED Y
CITY ZIP Q� �•1D �� CONST,/' ZONE 1
ARCHITECT OR TEL. ✓'1
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NCI,02_�DWELL,UNITS`� K
CONTRACTOR TEL
OOZ US ZONE MAP
LIC. NO.
ADDRESS S. NO. `i� SPE AL
LIC, �+ CONDITIONS r
CITY CLASS J
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER /�
NAME AND BRANCH ✓L BLDG.SETBACK FROM
ADDRESS //_ZCITY �" FRONT PROP.LINE OF (STREET)
�� —_ TOTAL SETBACK FROM TYPE OF EXISTING C
HIGHWAY + YARD
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE (/17 STORIES FAMILIES ONE
'DESCRIPTION OF WORK NEW ❑ C
❑
ADD BLDG.SETBACK FROM
Y SIDE PROP.LINE OF (STREET)
v OF ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF + _
EXISTING BLDG. DEMOL
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) ` `.., 10.3S71-33
..0
BY (SIGNATU „y`� IN OPEN SPACE YES ❑ NO ❑
C^
Q IN COASTAL ZONE YES ❑ NO ❑
VALUATION P a !�
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 I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE S F CALIFORNIA IN RELATING TO
WORKMEN'S CO N-i'NryO NCE. � I
SIGNk
SIGMA
ADDRESS '
CITY „ 7 NO.
TELS,/ ?3 DATE
^ FINAL Y9 7� BY<�
' ' l-
MAKE (: ECKS I'AIIABLE TO: P.C. C PMT'
HARVEY T. BRANDT, COUNTY ENGINEEFEE 4' FEE
R
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
2 3 a.'LZ AR 26 1 1) 1 2.0 U Aga
76A638A CE9803 7/73 el
3-I,-- APPLICATION FOR BUILDING PERMIT
FOR AP LICAN'f'YT0`FRLL IN (Print or type only)
BUILDING �q / '' •. vCOUNTY OF LOS ANGELES
ADDRESS A �t„L�-t/� L- / `� TMENT OF COUNTY ENGINEER
CITY ZIP
" BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING /
SIZE OF LOT NOW ON LOT ADDRESS / le
c
TRACT Ale: Q1I�' LOCK LOT NO.TEL
c� ` LOCALITY
OWNER 7 a LL JC/Q NNEAREST U A/'
O./T T//p CROSS ST.
y ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE SSED BY
CITY (,�' ZIP GGA/ �.^0 CONST, ZONE
ARCHITECTOR TEL. q
ENGINEER +v LZ S NO. � Z7�� STATISTICAL CLASSIFICATION
c / / SEWER MAP
ADDRESS 1 S. ✓(�� ,(,y L' CLASS NO.-/2,DWELL.UNITS BK #7PG
CONTRACTOR /%G NOL �i.��lS' USE ZONE NO 0-5-DLIC.
ADDRESS
•� I7 NO. 2' 1�y
CITY LIC. CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER L'
NAME AND'BRANCH �.d(/L Ad. BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET) G
ADDRESS Z L' G A/ e.CITY TOTAL SETBACK FROM TYPE OF EXISTING C
HIGHWAY + YARD
SQ. FT. �r NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH C.
SIZE p47*b STORIES FAMILIES ONE
DESCRIPTION OF WOR NEW + JZ. u
ADD `❑ BLDG.SETBACK FROM (STREET) tai
SIDE PROP.LINE OF
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
USE OF TDEMOL
EPAIR❑
SIDE PROP. LINE HIGHWAY WIDTH
r
G BLDG. ❑ +
ANT EL�< � �+ CORNER CUTOFF YES ❑ NO ❑
T) �y �NO. ! LQ►d�
NATURE)Am"VA'zo L'1- / IN OPEN SPACE YES ❑ NO ❑
Q IN COASTAL ZONE YES ❑ NO ❑
ION sCATEGORICAL EXEMPTION YES NOEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT' EXEMPTION DECLARATION SIGNED (DATE)
L ORDINANCES AND LAWS REGULATING BUILDING CON-
ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZEDIMPACT REPORT PROCESSED (DATE)
I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIF NIA REL I 0
WORKMEN'S COMPE)ISATION I A
SIGNATURE OF
PERMITTEE
ADDRESS
F NAL
TE
CITY NOL. DATE f��7- 73"_
` BY Z < ✓O/ 1L-A_' 6-.)J
C.HEC KS PAYABLE TO. FEE $/ J FEE.$
HARVEY T. BRANDT, COUNTY ENGINEER V
PLAN CHECK VALIDATION M.O. CASH PERMIT VALIDATION
CK. CK: M.O. CASH
8 7 2 P FEB 27 2 3 D 41.40
904rXEM9 ' 9 1 D 6900 A98
76p638p CE#803 12/72 q/