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HomeMy Public PortalAbout5304 WELLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR;APPtICAN'T TO FILL IN (Print or rvae only) BUILDING COUNTY OF LOS ANGELES'- ADDRESS Sc30 j,�9N.. DEPARTMENT OF COUNTY ENGINEER CITY ( �. % ZIP BUILDING AND SAFETY DIVISION s �j NO OF BLDGS. 1 BUILDING `SI T ' W30 NO ON LOT �IQC. �J ADDRESS 130V' TRACT (7 13LOCK LOT NO. LOCALITY .� `g 0 r TELfa7p NEAREST OWNER f!i;)'; Ijyj/!�,! NO.' CROSS ST.. - C' 1•.j' _ ASSESSOR ADDRESS J ( jW% ���}/': (J MAP'BOOK PAGE PARCEL ZIP a DISTRICT GROUP TYPE FIRE SSED BY CITY bc.)AL �y /�/ CONST. ZONEE � ARCHITECT ORi 7�� TEL. - /(,�� . Y - S ENGINEER��yy a NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESSpr /y� /tI ,�� CL}(SS NO.D �DWELL•UNITS Z BK l/)-PG CONTRACTOR /rpy �7 NEOLf.M ;_ �C7� 'USE Z�!m 5'o p .� /ADDRESS Oo f vr/ �s{ NO.3C) . CIAL LIC. DITIONS CITY 16CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER - y / _ " NAME AND BRANCH a15 (-�" . -/ BLDG:SETBACK FROM ADDRESS"/ySS-m-9,0 CITY FRONT PROP.LINE OF (STREET) i� HIGHWAY + YARD' -_ 'TOTAL SETBACK FROM TYPE'OF EXISTING SQ• FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZ STORIES FAMILIES ONE } DESCRIPTION OF WORK NEW I + ❑ DD BLDG.SETBACK FROM' ASIDE PROP.LINE OF (STREET) C ALTER ❑2)6L = TOTAL SETBACK FROM TYPE OF EXISTING ~ �. HIGHWAY + YARD - HIGHWAY WIDTH a' �, REPA.IR❑ SIDE PROP. LINE USE U = z EXISTING BLDG, DEMOL ❑ + APPLICANT).,,,, ; TEL6�y` 1 ! CORNER CUTOFF YES ❑ NO ❑ (PRINT) N0: 1G , BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑, IN COASTAL PERMIT'ZONE VES. ❑ NO ❑ VALUATION;$ � I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 199—� 4001-/I'CAWJv ., `t' •'. !>!'^ �� li�`'�-c AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN D ING THE WORK AUTHORIZED" HEREBY 1 WILL NOT EMPLOY ANY RSOW IN VIOLATION OF THE - LABOR CODE OFE ATE OF ALIFQFNIA IN RELATING 'TO 'WORKMEN'S COMP ION INSURAN E. SIGNATURE OF .'PERMITTEE , ADDRESS CITY S NO. �l� 4a �TEL DATE it NAL BY MAKE CHECKS PAYABLE TO: P.C.,$ ���999 FEE, . HARVEY T. BRANDT, COUNTY ENGINEER /� �� _` �%/, •�1/�/s PLAN'CHECK VALIDATION CK. .0.• -CASH k PERMIT VALIDATIO cK} o. ' GASH 6 :9 .41-IJILL. '28 2 3 , 1 962 ©�g - 76AG38A CK*803 5/74 51 ^BSEP 5 1 D 327.00 -