HomeMy Public PortalAbout5623 1/2 WELLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING ,^ COUNTY OF LOS ANGELES
ADDRESS �SS-- Z 3 X- DEPARTMENT OF COUNTY ENGINEER
CITY <,e zIP v BUILDING AND SAFETY DIVISION
NO OF BLDGS BUIL IN
SIZE OF LOT ! NOW ON LOT ADDRESS 3 "I
TRACT/O Z..GC I BLOCK LOT NO. // LOCALITY
TELNEAREST
OWNER tl �(/!'"/' NO�!/433 CROSSSTASSESSOR.
ADDRESS MA BOOK PAGE I PARCEL
Af DISTRICT GROUP TYPE FIRE P CESSED BY
CITY ZIP eQ --73—
NST.
CONS ZONE
RCHIT ER ECT ORkC9. .73, Lj, �.L�� NO TEL Lam+ OR
STATISTICAL CLASSIFICATION SEVwtk MAP
r `
ADDRESS,�6 D I �, � ` CLASS NO. DWELL.UNITS BK PG
CONTRACTOR r/dQ►p NO.-75-?724? &5kZONE I MAP
�'�'���� NO. ~�
ADDRESS LfJs �� Q
LIC
ZJI-1440ZJ SPECIAL
CITY M}L CLA55 CONDITIONS
ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT P OP.LINE OF (STREET)
ADDRESS ro�Co 1~ µw0 CITYX. TOTAL SETBACK FROM TYPE OF EXISTING
SQ.FT. NO.OF NO.OF CK HIGHW Y + YARD = FRONT PROP.LINE HIGHWAY WIDTH
SIZE �d STORIES I FAMILIES ONE }
DESCRIPTION OF WORK �� NEW O
tom- ADD ❑ BLDG.SETBACK
SIDE PROP.LINE OF (STREET) O
ALTER ❑ TOTAL SETBACK FROM PE OF EXISTING w
HIGHWAY + YARD = SIDE PROP.LINE HIG WIDTH h
USE OF REPAIR ❑ Z
EXISTING BLDG. DEMOL ❑ +
AIPRINTNT 09 f l /pVrl- NO:20� 1 r3 CORNER CUTOFF YES C] NO ❑
r •G IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE(
IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$
IHEREBY 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 CONSTRUCTION.I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM.
PENSATION INSURANCE.
SIGNATURE OF C
PERMITTEE
ADDRE
SS ' `�r
NO FINAL��(, 3� DATE ' +�' BY 1�,e-j ..."Z
MAKE CHECKS PAYABLE TO: F E $ Q F'r FET
BRANDT,COUNTY ENGINEER J)
PLAN CHECK VALIDATION CK. M.O. CASH o PERMIT VALIDATION - M.O. C�AS/H`'
0 0 ����� .�0 1 D 2 8.5 0 az;3
®s 76A63BA CE#803 3.75'