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HomeMy Public PortalAbout9027 RANCHO REAL RD_Building_1974-04-22 ' APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS & Cl DEPARTMENT OF COUNTY ENGINEER CITY ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING. ' SIZE OF LOT NOW ON LOT ADDRESS _ TRACT` BLOCK LOT O. �� LOCALITY .: TEL NEAREST OWNER NO. CROSS ST. f t:✓ i' ASSESSOR ADDRESSMAP BOOK PAGE EL DISTRICT G P IT- PE FIRE PROC SED Y CITY ZIP NST. ZON ! ARCHITECT OR TEL. i(/� ENGINEER No- _ STATISTICAL CLASSIFICATIONSEWER MAP ADDRESS CLASS NO. �DWELL•UNITS BK CONTRALTO l NO. USE ZONE MAP LicADDRESS �_ i fjl�J NO�OJ7.9ca SPECIAL LIC. - �� CONDITIONS CITY y rL r. CLASS r:)~� ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM FRON PROP.LINE OF (STREET) C ADDRESS ( ITY - _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHW Y + YARD = C SQ. FT. NO. OF NO. OF CHECK FRONT HIGHWAY WIDTH • C SIZE STORIES FAMILIES ONE F DESCRIPTION OF WORK��� /J�� C�s NEW + C G.SETBACK FRO ADD ❑ SIDE PROP.LINEOF M ( TREET) ALTER ❑ HIGHWAY + YARD = TOTAL-SETBACK FROM TY OF EXISTING REPAIR❑ SID PROP. LINE HI HWAY WIDTH USE OF EXISTING BLDG. R_Ln�lyL.t� DEMOL ❑ + APPLICANT/ / TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) / NO BY (SIGNAT E IN OPEN SPACE YES E] NO El Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION•P��fSV♦;J CATEGORICAL EXEMPTION YES❑ 'NO ❑ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENPAL AND STATE.THAT THE ABOVE 15 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 CO F THE STATE OF CALIFORNIA IN RELATING TO �/ ♦ ,r: „r WORKMEN'S COM INSURANCE. %��� - /. — /0,6 I�Fi jC��e-IAII- O n A% I IJ SIGNATURE,& tJv+1 d✓7^/.l! 0`1. -'7�J .�r�� PERMITTEFr , ADDRESS �] CIT ��rJ�" / NO. FINAL BY / -7 DATE ��f .f• � f ��� �i:t.f�v !SiP-•s MAKE CHECKS PAYABLE TO':' FEE $ ` FEE •QP HARVEY T. BRANDT• COUNTY- (NEER PLAN CHECK VALIDATION CK. .O. CASH PERMIT VALIDATION CK. M.O. CASH 6 3 1r*-TAPR 22 21 D 1. 0.5 8 ©9 6 3 2LAPR 22' 1 D 3 5.2 5 a�R 7GA638A CE11803 7/73