HomeMy Public PortalAbout6433 TRELAWNEY AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (P,,Ht Gr typo MIY)
BUILDING/ COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
clrvT //LE e IT zIP SII 7 g� BUILDING?AND SAFETY DIVISION
BUILDING
SIZE OF L^OTT4 ti X I!0 NOW ONNO OF LOTI ADDRESS ��,_,J /�{ 1L%v ��/✓`�
TRACT 1.1704D 04D BLOCK I LOT NO �� LOCALITY ! of
OWNER `N
No
_701
0 CROSS ST Q
ASSESSOR
ADDRESS 6' MAP BOOK PAGE PARCEL
-.( qy /� DISTRICT GROUP TYPE FIRE SSED BY
CITY 1 CLE CLT ZIP Q CONST/ ZONE //777
ARCHITECT OR TEL 1��/1 %L�( ,/t-NM
ENGINEER NO
STATISTICAL CLASSIFICATION��JJ�� SEWER AP
ADDRESS CLASS NOS DWELL UNITS BK PG
CONTRACTOR 5 V/ C EL U E i ONE MAOP O
C N
ADDRESS ZU NI jeD SPECIAL
.` 1' CONDITIONS
CITY L MO CLASS
CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
NAME AND BRANCH BLDG ETBACKFROM
FRONT ROP LINEOF (STREET)
ADDRESS CITY HIGHWAY } YARD TOTAL SETBACK FROM TYPEOF EXISTING
SO FT NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE ISI
DESCRIPTION OF WORN NEW 23 } C
/ DD W BLDG SETBACK FROM E.a
SIDE PROP LINE OF (STREET(_ o
ALTER ❑ HIGHWAY } YARD _ TOTAL SETBACK PROM VPE OF EXISTING
o3lockL Q ' REPAIR SIDE PROP LINE H HWAV WIDTH
EXISOTING BLDG EMOL 1:1 }
USE Z
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATIONS 8l'DED0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON
STRUCTION IC
THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LASOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN 3 COMPEMB IOM INSURANCE
SIGNATURE O
PERMITTEE
ADDRESSFINAL/J
CITY C•L- `IC/NOL DATE Y G`
MAKE CHECKS P,i)ABLE 70 FEE $ FEE $
HARVEY T BRANDT. COUNTY ENGINEER !�
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M/0 CABH
�./nu7 3•'lcfp 17 J 1 0_ 1. 5.0 0 A�
ITaweA cs♦ a ./Ta '
1
,'APPLICATION FOR T Il
�' BUILDING PERMIT
biDFOR APPLICANT TO FILL IN ADOR IESS C 3-3 / NV L ! 1 R
BUILDING
DDRESS 33 LRe LOCALITY '—
AI NEAREST
CITY ZIP CROSSST
NO OF BLDGS ASSESSOR
SIZE OF LOT f 0 NOW ON LOT MAP BOOK PAGE PARCEL
�y DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT L ��__//V BLOCK LOT NO TEL �y� .7.C) CONST ZONE
OWNER L,�7DVA ,talc NO 1Of'I7O� Sr0
ADDRESS 6y,� %RC�//w,►-4� STATISTICAL CLASSIFICATION SEWER MAP
CLASS NO DWELL UNITS CZ:BK
CITY r ZIP USE_ZONE
( P
ARCHITECT OR TEL / SPECIAL L
ENGINEER NO CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
TEL
CONTRACTOR NO BLDG SETBACK FROM
LIC FRONTPROP LINEOF ISTREETI
ADDRESS NO I TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
CITY CLASS
CONSTRUCTION LENDER + a
NAME AND BRANCH O
BLDG SETBACK FROM U
ADDRESS CITY SIDE PROP LINE OF ISTREETI p
50 FT NO OF NO OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM iY PE OF EXISTING
SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH a
+ Z
DESCRIPTION OF WORK Xl17H L/ NEW
,41&T' � / App CORNER CUTOFF YES ❑ NO ❑
C ALTER IN OPEN SPACE YES ❑ NO ❑
REPAIR El
USEOF _ IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG DEMOL
APPLICTEL
ANT
NO
BY ISIGNATUREI
I HEREBY ACK E E THAT I HAVE READ THIS AMICATION AND STATE
THAT ME ABOVE CORRECT AND AGREE TO COMPLY WIN ALL ORDINANCES
AND LAWS REGLIATING BUILDING CONSTRU CN I CERTIFY THAT IN DOING ME
WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VKXATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S DDM
PENSATION INSURANCE
SIGNATURE O FINAL 2- / BY /
PERMITTEE DATE
ADDRESS �S77 ,,....��••�E
TEL PC Fee$ / 7• w Permit Fee �-p•-w
CITY a NO
VALUATION$ '2— %Z C) V Issuance Fee
81'�•
Total Fee
PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK w o CAIN
5"23.1 17.10 • , 292�or s 1D 2850eyD ,
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