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HomeMy Public PortalAbout5349 VILLAGE CIRCLE DR_Building__ APPLICATION FOR BUILDING PERMIT G5 FOR APPLICANT TO FILL IN (Print or type only) FRE1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER , -�- �....= zIP J'i�' '-�'� BUILDING AND SA TY DIVISION fl NO.OF BLDGS. BUILDING NOW ON LOT ADDRESS ✓ �Qr i� t e;.^ a( TRACT, BLOCK LOT LOCALITY-°7• _ �—y—d, -�"G-f (✓" ' TELeW n NEAREST OWNER !.,:Ia I.. 'n'4 ". NO.54<-- CROSS ST. y ASSESSOR ADDRESS �' "��` t h MAP BOOK PAGE CEL DISTRICT GROUP TYPE FIREPROWSED BY CITY 71 - - T ZIP ONST ZONE ARCHITECT„OR TEL.,. 1 - eNr3INEER t r.,.{..Y? NO. 'r 77 p- STATISTICAL CLASSIFICATION SEWER MAP G ADDRESS 17 7Z l• '+ �. L%1P, T .1 GLASS NO. DWELL.UNITS BK PG CONTRACTOR`..a`.•'Qk` C nda, NOL a 'C i t USE ZONEFc P _ 9 fid 10. =� `Y✓ ADDRESS 4 '+�T1j 464 ?',. L„ Q NO � tr"e E'` t �JPECIAL CITY 'f.j„{ '�4s F y LIC. .f ONDITIONS !i jai 'f CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES Cj 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. FT, NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH a SIZE STORIES FAMILIES ONE + C� DESCRIPTION OF WORK NEW IC--I W ADD ❑ SFROM IDE PROP.L NEOF �` (STREET) ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = Q HIGHWAY WIDTH REPAIR❑ SIDE PROP. LINE USE OF + = a EXISTING BLDG. OEMOL ❑ APPLICANJ- CORNER CUTOFF YES ❑ NO ❑ IW— (PRINT) i"f.,,,iRs� �„ -J;a„�"N'rZ TEL f BY (SIGNATOR IN OPEN SPACE YES ❑ NO ❑ �?'' - IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION 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. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON ll�.-VIOLATION OF THE LABOR CODE OF TSATATE OF {ALIF IN RELATING TO WORKMEN'S COMPE{15AilIIION INSURANE[. �!,. SIGNATURE PERMITTEE 1, ADDRESS FINAL BY ,mow' TE Lr;';f fi CITY A^ F-: r a NO. tl: � Ot DATE 71A KE CHECKS P:17'AHLE 70: FEE FEE HARVEY T. BRANDT, COUNTY ENGINEER PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 76A638A CE#803 5/74 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) FSIZE ING ,- - ,°. `�5`t _ �� COUNTY OF LOS ANGELES ESS ��7 DEPARTMENT OF COUNTY ENGINEER . BUILDING int P/-k 22L(TY zip j7 k d BUILDING AND SAFETY DIVISION OF LOT717X/ 7r NOW ON LOTNO.OF S ADDRESS _'05 X 37 4 ') TRACT BLOCK LOT NO LOCALITY TEL, NEAREST OWNER 191Pfl=IAq--.5Ad �`y Gai4�✓ NO. CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL 1 DISTRICT Ioup TYPE FIRE ESSED BY CITY )P/,i��{{Ha12 fu 4 ZIP T.0 CONSZON ARCHITECT OR TEL.�• ENGINEER `-0 F-E.&S�L. NO. /6d0/ti/ _ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS Cly dt- r1jpUs(dz 'rCLASS NOo8 DWELL.UNITS BK PG TEL CONTRACTOR &64L LOW/w N0. 0 39d7 USE ZONE MAP D Z�� (� NO. ADDRESS S.J�Z �fJ�-mow�� Np�3] df 7 �J SPECIAL LIC. CONDITIONS CITY .lpmloLk C (74, CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) c ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD - L SQ. FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH [ SIZES STORIES FAMILIES ONE DESCRIPTION OF WORK NEW s + ADD ❑ BLDG.SETBACK FROM CV'U —2 12ee-Xbl7F JV MC/L/7>' SIDE PROP.LINE OF (STREET) ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING REPAIR[:] SIDE PROP. LINE HIGHWAY WIDTH USE EXISOT NG BLDG. DEMOL ❑ + APPLICANT �/ Cq�,,�'� CORNER CUTOFF YES ❑ NO ❑ (PRINT) �uO J. 13k LDw 1�I NOLYce-2�/" BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION pL CiO 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 THEWORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) H B f WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LA THE STATE OF CAL( NIA IN R TING TO - WORKMEN'S COMP NSATION SUR NC 4113 SIGNATURE PERMITTEE ADORESS FINAL CITY O. DATE Q MAKE- CHECKS PAYABLE TO: FEE I' / FEE / HARVEY T. BRANDT, COUNTY ENGINEER 1p a �� •�v ` PLAN CHECK VALIDATION CK. .O. CASH PERMIT ALIDAT CK.' M.O. CASH 1 8 �4�OCT , 2 2;:35 0 ©Ud --'� 4 1.4 aeA�ada EW034i 32-::5 1 6.2 U a8 8��E0 1ti 1 D 9 (7:J 0 Ab