HomeMy Public PortalAbout6125 ROWLAND AVE_Building__ r APPLICATION FOR BUILDING PERMIT
BLIFQFC�RAk�PLICANTTO FILL IN (Prin or typeonl )
IZG COUNTY OF LOS ANGELES
ADDRESSDEPARTMENT OF COUNTY ENGINEER
CITY v�L
ZIP BUILDING. D SAFETY DIVISION
NO.OF BLDGS. BUILDING
SIZE OF LOT NOW ON LOT ADDRESS (�
TRAq BLOCK A LOT NO. LOCALITY
TEL. ',5� NEAREST
OWNER L1 NO .y/7 CROSS ST.
ASSESSOR
ADDRESS DA s-• MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE SSBY
-CITY IP Q� CONST. ZONE 1
ARCHITECT, / TD
ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS. / CLASS NO. FIDWELL.UNITS BK PG
CONTRACTOR L NO. ZONE NOP-
LIC.
ADDRESS NO. 62 SPECIAL
LIC. j` CONDITIONS
CITY CLASS t
CONSTRUCTION LENDER ROAD DEPARTMENT APPROVA UIRED YES ❑ NO ❑
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
ADDRESS CITYHIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
=
SO.FT:C NO.OF NO.OF CHECK FRONT PROP.LINE HIGHWAY WIDTH
SIZE STORIES 2, FAMILIES ONE >
_ a
DESCRIPTION OF WORK NEW - + O
ADD BLDG.SETBACK FROM Ix
SIDE PROP.LINE OF (STREET) O
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH , h
USE OF REPAIR ❑ �-., Z
EXISTING BLDG. [DEMOL ❑ +
APPLICANT TEL GORNERCUTOFF YES ❑ NO ❑
(PRINT( 0.
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ 5
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VI TION OF
THE LABOR CODE OFTHE STATE LIFORNIAINRELATINGTOWOR EN'SCOM- rLn��_7
PENSATION INSURANCE l /- 7 /
SIGNATURE OF /C%%�`GSL V �i' G,�� �: /�•• .
PERMITTEE /
9 2,- �/t 7b
ADDRESS ,
FINAL BY
TEL. DATE "7�
CITY NO.
MAKE CHECKS PAYABLE TO: F E $ 11
FEET,2 �.
HARVEY T.BRANDY,COUNTY ENGINEER 2 u / 3 ,3
� =7 6
PLAN CHECK VALIDATIONcr- M.O. CASH PERMIT VALIDATIr r cLc M.O. CASH
9291"DEC 15023 D 124..2 93
605RUB 9Li3 D •g ,3
®s 76A638ACE#8M-75' 6.0 6 rFtB 9 1 D 3 4 '7.6 3 Aa3