HomeMy Public PortalAbout5625 1/2 WELLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING �j COUNTY OF LOS ANGELES
ADDRESSpSeS_/ DEPARTMENT OF COUNTY ENGINEER
CITY ZIP p BUILDING AND SAFETY DIVISION
`
NO.OF BLDGS. BUILDING �j
SIZE OF LOT ! /J �,�7 NOW ON LOT S ADDRESS% ? 1f��
TRAC I6 V BLOCK LOT NO. LOCALITY
�/ LOCALITY
NEAREST
OWNER NO
d.O 7�L CROSS ST. L
y �y-� ASSESSOR
ADDRESS 7 0 ,S ! MAP BOOK PAGE PARCEL
0 DISTRICT GROUP TYPE ]ZIOR
E CESSED BY
CITY `q� ZIP 51 f-?
d f._^ CONST. N;NGARCHNER ITECT OR�. � T(. 7
STATISTICAL CLASSIFICATION SEW P
/
ADDRESS ( ` 'f `�`� i.� CLASS NO.�DWELL.UNITS BK PG
CONTRACTOR NO3�/a2_ 2 USE ZONE MAP
LIC. SPECIAL
NO. Q -!51)ADDRESS 513fled, Z/�(9 R+ 3 CONDITIONS
`_- LIC.
CITY C--. CLASS ROAD AARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH � di 14 BLDG. ETBACK FROM
ADDRESS ���3 L� �L, Y LIDS` FRON PRO .LINE OF (STREET)
HIGH AY + YARDTOTAL SETBACK FROM TYPE OF EXISTING
SQ.FT. NO
T6 NO.OF CHE - FRONT PROP.LINE HIGHWAY WIDTH
SIZE 7a0 STOK RIES FAMILIES ONE
DESCRIPTION OF WORK ))�LW— NEW + - O
ADD ❑ BLDG.SETBACK FROM oc
T p SIDE PROP.LINE OF (STREET) O
ALTER ❑ TOTAL SETBACK FRO YPE OF EXISTING b
HIGHWAY + YARD = SIDE PROP.LINE HI Y WIDTH h
USE OF ` REPAIR ❑ Z
EXISTING BLDG. , DEMOL ❑ +
APPLICANT TEL y�! CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO / p
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE)
IN COASTAL PERMIT ZONE YES ❑ NO'❑
VALUATION.p y 77�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAE�R
TATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHNCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY TTHE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON N OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO COM-
PENSATION INSURANCE.
SIGNATURE OF
PERMITTEE
ADDRESSFINA�sr ``
CITY TEL. 173 DATELMAKE CHECKS PAYABLE TO: F E w FEC. ET VHARVEY T.BRANDT,COUNTY ENGI `J
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION M.O. CASH
0 0 7 Nmaa 30 i D 2 8.5 0
Ss 76A638A CE#803 3.75'