HomeMy Public PortalAbout10612 ROSEGLEN ST_Building__ r� ;r PPLICATION FOR BUILDING PERMIT
,ft R,, mPLIC rNT 0 FILL IN (Print or type only)
BUILDINGCOUNTY OF LOS ANGELES
ADDRESS .LplDj = DEPARTMENT OF COUNTY ENGINEER _
E CITY��f r L C��Tz ZIP BUILDING AND SAFETY DIVISION
�^ NO.OF BLDGS. BUILDING
SIZE OF LO�J D NOW ON LOT ADDRESS /
TR C BLOCK I LOT NO. LOCALITY
TEL NEAREST
OWNER NO. im CROSS ST.
ASSESSOR
AJDDRESS fIJF MAP BOOK PAGE PARCEL
DISTRICT I GROUP ITYPEFIRE PROCESSED BY
CITY ZIP CONST ZONE
r
ARCHITECT OR TEL.
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS
11 CLASS NO.�-� DWELL,UNITS BK PG
CONTRACTOR , 'NO, �j bu USE ZONE MAP -
s J� N 0.
/AD ESS C• I'- NO �/ /1 �r SPE I .L
^ LIC. CONDITIONS
CITY /b��Liy C LA
Lip..
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENOER
NAME AND BRANCH ! BLDG.SETBACK FROM y.
FRONT PROP.LINE OF (STREET) h..
ADDRESS CITY HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING
Sq. FT. /I NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE bb STORIES FAMILIES ONE CD
} _
DES'C RIPTION OF WORK NEW ❑
DD LDG.SETBANq FROM (STREET) Z
T-- SIDE PROP.LI F
ALTER ❑ HIGHWAY } YARD - TOTAL SETBACK FROM TYPE OF EXISTING
EPAIR❑
SIDE PROP. LINE HIGHWAY WIDTH
USE OF ❑ t =
EXISTING BLDG. �t(_{' �(_ � � ENOL.
APPLICANT TE ++JJ// � CORNER CUTOFF YES NO ❑
(PRINT) , r�NO.
BY (SIGNATUR r� IN OPEN SPACE -YES El 11O
t IN COASTAL ZONE YES ❑ Nd• ❑
VALUATION $ CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THISAPPLICATION 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 MOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO if
WORKMEN'S COMPING TION INSURXNRte)
SIGNATURE 0 �•L(/ ��
PERMITTEE !'
ADDRESS etil Id 4"1
FINAL BY
TEL. J DATE -
CITY N0. G
%A KE CHECKR S'1 BLE TO: FEE $ FEE
HARVEY T. BRANDT, COUNTY ENGINEER d,D
PLAN CHECK VALIDATION CK. M.O. CASH PE31NM VALIDATIONQZh M,O. CASH
5 NDV y 1 4 2.0 0
70A838A CHN809 11/72
. DIVISION OF BUILDING AND SAFETY
COUNrr OF MARnemor LOS �.
` WH_JAM J. FOX C x xrr ImcumoR APPLICATION
CASSA1'r D. a1UFFIN, Sur. of SIIILmms
FOR APPLICANT FILL. IN � FOR OFFICE II88 ONLY
DISTRICT NO. APLAx CK.OR REa.NO. EMIT NO.
MU'LD=
ADDRLOCALITY 7_(vrn ,61c/ +
+ RECEIVm 1Y i DATE OF APDL_ TE LSQIIm
NEAREST
SUR-DING
ADDRIlSTVI
OWNKR
A DD RESS 7 S LOCALJT„
IaAltiST.
/ Tn- ��`. CROSS STQITY mo, .
ARCHITECT OR TQ TYL
FIRE NO. OF P _ GRO
IXG N ZONE PLANS
BLDG. -'
'� 7�6/O Ulm Alf�RONm
CO O A7,3
Z
Z /G HOUSE HIMAIERING
LEGAL Gi ilAr NU ■ �D � O. IQN®QY
DESCRIFTI I NSt
TRACT 8-SNM OF MLDQ&A�M
'
S DZ OF LAT
USE OF No. oR -
DESC81P77ON OF WORK o
KW Q
REPAIR D940OLITION
SQ. FT. 7 NO. OF
S= MS STO ES
QCT. WALL ROOF
COVEIUNG a
USE OF XTRUCTIIRE
APPROVAO
INSFECT 'S SIGNATURE
FOUNDATION+ LOCATION
FORMS MATERIALS /
1 HE.RXRY ACICHOWLEDGE THAT I NAVE READ THIS AP- FRAMEi FIRE STOM
PLICATION AND STATIM THAT THE INFORMATION GIVEN IS SPACIN MOLTS
CORRECT.
I gig TO OOM?LY WITH ALL COUNTY ORDINANCES FURNACES LOCATION.
AND STATE LAWS REGULATING MUMD,E" CONSTRUCTION. �A1 V>aIT DUCTI
��. ' / /I/� LATH, IM. L
rIGNATUR- . f l
Pew _
+ LATH. QCT.
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F. S� NOR]=AND nr STS
VALUAT16N FEE S O oTy
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