HomeMy Public PortalAbout9703 VAL ST_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (PfIDI D.+YPR GDIY)
Bu1LryNc/ _ v L 7. COUNTY OF LOS ANGELES
ADDQESS DEPARTMENT OF COUNTY ENGINEER
CITY GAJ ZIP BUILDING AND SA DIVISION
NO OF BLDGS BUILDING
SIZE OF LOT �O NsO NOV ON LOT ADDRESS Q _
TRACT L7 BLOCK LOT NO / LOCAL(
TEL NEAREST
OWNER NO CROSS ST
_ ASSESSOR
ADDRESS ,�J MAP BOOK PAGE PARCEL
n 015TRICT GROUP PE FIRE SED BY
CITY 'T ZIP �DQ T ZONE
ARCHITECT OR TEL
ENGINEER NO
STATISTICAL CLASSIFICATION SEWEf[' 7
ADDRESS CLASS NO.2oUNITS /- ElNj (PG
CONTRACTOR hew TNo
EL �Y}(/Q '"OHNE -C
NOP 2 a Q
ADDRE5n5J(� ]. �. / tS NO 'Ir CSP ONCIAL0NS/
CITY t/�/ZI�T
CLASS
CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES C] NO❑
NAME AND BRANCH BG SETBACK FROM
F ONTPROP LINEOF (STREET)
hEG
S CITY TOTAL SETBACK FROM TYPE OF "ISTING
NI HWAY } YARD
NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH
STORIES FAMILIES ONE
\11 } -
TION OF WORK NEW
O
BLDG S U
A DD SIDE PROP LINIEOF (STREET) C
LTER ❑ _ TOTAL SET ACK FR YPE OF C%ISTING 1O-
HIGHWAY } YARD - 9 U
907 EPAIR❑ } SIDE PROP LINE WAY WIDTHG BLDG jo3 97 ENOL11
ANT /' TEL CORNER CUTOFF YES) bO !i(. � NOATURE) IN OPEN SPACE YESIN COASTAL PERMIT ZONE YES NO ❑
IONS O L)
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �T ` /" Q U -r 'Q Z0.7f
AMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL 0MDINAICES AND LAWS REGULATING BUILDING CON-
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORISED
HEREBY COWILL MOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CDE 01 TX[ STAT[ OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION INSURA"
SIGNATURE OF tel(/\)
PERMITTEE
ADDRESS
FINAL BY
TEL DATE Zr-76
CITY NO
, PIAT
VARE CHECKS PAIAHLE !O FEE $ FEE $
HARVEY T BRANDY, COUNTY ENGINEER S�
PLAN CHECK VALIDATION CK Al 0 CASH PERMIT VALIDATION cK H O C,B
1 8 7-OMT 17 1 1 '5.0 0 Ls
TNAGG[A CB0852•/CIM o
APPLICATION FOR BUILDING PERMIT '/V
FOR APPLICANT TO FILL IN (P,ID,o, ,YDB only)
BUILDING .� COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY — C17-1iZIP BUILDING AND SAFETY DMSION
NO OF BLDGS BUILDING /y
SIZE OFJ.LO •� NOW ON LOT ADDRESS (/
TRACT V� / BLOCK LOGLNd
LOCALITNEAREST
OWNEROSS ST
ASSESSOR
ADDRESS MAP BOOK PAGE PARCEL
�SDISTRICT GROUP TYPE FIRE ESSED BY
CITY ZIP y A�•N+,� CONST 7/�,` Z p,
ARCH'TEC
OR L V•Q �+� .i'�
ENGINEER NO
STATISTICAL CLASSIFICATION
S//EWER(�j1/AQP
ADDRESS CLASS NO Q / DWELL UNITS /MBK Q WG
COTRACTOR G TEL ZONE MAP OO
L LIC NO
ADDRESS N ,�+ SPECIAL
CITY LIC CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑
CON &RUCTION LENDER 12
NAME AND BRANCH '� SLOG SETBACK FROM
FRONT PROP LI NE OF ISTREETI
ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING Lr
SO FT NO OF NO OF CHECK FRONT PROP LINE NIGHWAY WIDTH
SIZE �, Z STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW
❑ BLDG SETBACKFROM =
OD SLOG
LINEOF (STREET)
acs .
ALTER ❑ HIGHWAY + YARD - TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP LINE HIGHWAY WIDTH
USE OF + _
EXISTING BLDG EMOL ❑
AP,P LICA TEL CORNER CUTOFF YES ❑ NO
PRINT) ND
BY lSIGNA IR IN OPEN SPACE YES ❑ NO
l IN COASTAL ZONE YES NO
VALUATION 32LATE OO RI CAL 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)
WIT HALL ORDINANCES AND LAWS REGULATING BUILDING CON
STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED DATE)
HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF STATE OF C L IN RELATING TO ����-�\ (.�' /7T
WORKMEN S PENS ION I PAN J
SIGNATU E
PERMIT& �Y
ADDRESS v /�
FINAL IDS/5�S BY
TEL Y' /
CITY �+✓ NO DATE t
MAKE CHECKS PAYABLC TO FEE b FEE Y
HARVEY T BRANDT COUNTY_ NGINEER /+{ �• ZO 8 80 2.2.5700
PLAN CHECK VALIDATION cH o CASH V PERMIT NATION cN M CAS.a 2 o::r>Ar ae a 1) , 1 0 6.20 .zIo
9B� O(}gEDA fie' 2 8.8 0 A!3d
6 3 V JUN 24 1 0 2 2 °,5.0 0 A�W