HomeMy Public PortalAbout5248-5250 VILLAGE CIRCLE DR_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING S� �: _ COUNTY OF LOS ANGELES
ADDRESS t DEPARTMENT OF COUNTY ENGINEER
CITY ZIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING
SIZE OF LOT NOW ON LOT ADDRESS �
TRACT BLOCK LOT NO LOCALITY
P;
TEL. NEAREST /
OWNER NO. CROSS ST.
ASSESSOR
ADDRESS 2 MAP BOOK PAGE PARCEL
DISTRICT IGROUPITYPE FIRE ESSED BY
CITY ZIP Q CONST Z NE `
ARCHITECT OR TEL. �J V(� 7
ENGINEER NO. STATISTICAL CLASSIFICATION
SEWER M P
ADDRESS CLASS NO. DWELL.UNITS SK PG
CONTRACTOR' ` NO 4'Q USE ZONE MAP 7 h
LIC. NO. / v
ADDRESS p 1� NO� - C P SPECIAL
C1 LIC. 1 CONDITIONS
CITY CLASS (�� -� ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SQ. F NO OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE Q,)� STORIES 1� FAMILIES 'ONE
+ -
DESCRIPTION OF WORK NEW aa
ADD ❑ SDE PROP.L NE OF FROM (STREET)
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING V
REPAIR[-] SIDE PROP. LINE HIGHWAY WIDTH Iy
_ CL
USE OF EXISTING BLDG. DEMOL ❑ + Z
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL PERMIT ZONE YES C] Nd 1:1VALUATION
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 CON- 'J'i ' �—
STRUCTIO -�1�'CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 -
HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR ODtOF
T TATE OF •CALIFOR RELATI GTO I
WORKMENSA ON INBUR E.
SIGNATUR / � �— 75
PERMITTE
lo
ADDRESS-/C2
TEL. FINAL BY
CITY NO 3 DATE
.HAKE CHECKS Pr1YtIBL-: TO: FEE � FEE
HARVEY T. BRANDT. COUNTY ENGINEER ` -
PLAN'CHECK VALIDATION CK. M.O. CASH o PER A ATIONZ:��r7 CK. M.O. GASH
76AG38A CE 0803 5/74 0 G r F EB 1 5 8.8 5 AJC
AI-'F'LIC.H I IVN F'UK i�U1LUINC� t�'tKMI I I�
FOR APPLICANT TO FILL IN (Print Or type only)
EUr_cl''G COUNTY OF LOS ANGELES
ADDRESS5248-5250 DEPARTMENT OF COUNTY ENGINEER
CITY TOM— zip BUILDING AND SAFETY DIVISION
YPO.OF BLO99L I OV BUILDING
SIZE OF LOT NOW"QN,LOT ADDRESS
-TRACT ; �� LOT NO LOCALITY
AAAA TEL. NEAREST ,
OYVNERIA*d*32401 2 Ing,, NO. CROSS ST. _
ASSESSOR
ADDRESS akeS:toMAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
CITU sma ZIP ./ CONST. ZONE
ARCHITECT OR EL.
ENGINEER t t NO
STATISTICAL LASSIFICA TION SEWER MAP
ADDRESS ndC.LASS NO.._—..,rDWELL.UNITS EK PG
CONTRACTOR TEFL. USE ZONE MAP
N061 Betidwin LI48-3907 NO.
ADDRESS 10017 GreenSt. NO. 37 - s. SPECIAL.
LIC. 9 7 CONDITIONS
CITY
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ G
CONST N4t7 c:
NAME AND BRANCH I=perlftl BLDG.SETBACK FROM
FRONT PROP.LINE OF - (STREET) LL
a'
ADDRESSCITY
HIGHWAY } YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING LL
SQ. FT. O NO. O CK FRONY PROP. LINE HIGHWAY WIDTH >
SIZE 305 81 STORIES 2 1 FAMILIES ONE n ,y c
DESCRIPTION OF WORK NEW 1�-� } "' G
ADD BLDG.SETBACK FROM
PROP.LINEOF (STREET)ment
a
LL
ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING ~
HIGHWAY } YARD = HIGHWAY WIDTH
REPAIR❑ SIDE PROP. LINE
USE OF .y EMOL -1 }
EXISTING BLOG.Sinirle
APPLICANT TEL 448-390 CORNER CUTOFF YES ❑ NO ❑
(PRINT) _jjN0.
IN OPEN SPACE YES ❑ NO
BY (SIGNATURE) ❑
Q IN COASTAL ZONE YES ❑ NO ❑
VALUATION•V CATEGORICAL 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)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABO*-C.QD6-•-0F--j HE STATE OF CALIFORNIA IN RE}ATING TO
WORKMEN'S COMPENSAT ON INSURANCE
I
SIGNATURE OF/
PERMITTEE
ADDRESS10017 ureeft street
FINAL BY
TE L. DATE
CITY NO.
M,1Kl. I IILCKy JIA- :1hLl: 10: FEE I' FEE
HARVEY T. BRANOT. COUNTY ENGINEER
PLAN CHECK VALIDATION ZK 10 CASH PERMIT VALIDATION cK M o CASH
i� 'i .�!►t t
76A638A^CE#803 7/73