HomeMy Public PortalAbout5627 WELLAND AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
COUNTY OF LOS ANGELES
BUILDING
ADDRESS �5 G I Y)).4 ad AdE DEPARTMENT OF COUNTY ENGINEER
CITY zIP ��a,p BUILDING AND SAF TY DIVISION
NO.OF BLDGS. BUILDING
SIZE OF LOT �,.j 1 7 NOW ON LOT 3// ADDRESS �(%G�
TRACT /s� �,(3 BLOCK LOT NO. CP LOCALITY 4
Z�l t TEL.. .y NEAREST
OWNER s t C.wa. NOr/3' lU S_7� CROSS ST.
A' �� ASSESSOR
ADDRESS �j d,5�.5 ��.� � D � � MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE CESSE Y
CITY /�'/+y �% ZIP Ii1��0 d CONST.- ZONE—
ARCHITECT
^
ARCHITECT OR TEL. 1
ENGINEER NO. STATISTICAL CLASSIFICATION SEWER4fAP
ADDRESS 7 CLASS NO. 'DWELL.UNITS BK/� PG
CONTRACTOR t9� ,4 jX pp ' NL? d 6 aI% USE ZONE NO. ��-�
ADDRESSZ?r- �lJ• OQJ� p NO.rZZ/ZIP(; a-3 SPECIAL
LIC. CONDITIONS
CITY &0 amt. vla 1, Cal CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER /7
NAME AND BRANCH /f} G� /rE- BLDG.SETBAjtk FROM
�� �-- FRONT PRO LINE OF (STREET)
ADDRESS 67f / O�Ljr£yTY }�.ss �i ;
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
S ZEFT.G.Z�/ NO.OF NO.OF C ECK - FRONT PROP.LINE HIGHWAY WIDTH
a STORIES FAMILIES I ONE
DESCRIPTION OF WORK NEW ❑ - O
f + ADD ❑ BLDG.SETBACK F (STREET) Ix
O
{p- SIDE PROP.LINE OF
ALTER 135
_ ETBACK M TYPE OF EXISTING
HIGHWAY + YARD = HIGHWAY WIDTH N
USEOF REPAIR ❑ Z
EXISTING BLDG f� DEMTEL /OL 9 + ^
A(PRINTNT ` J^'r N62e2 2p.31? CORNER CUTOFF YES ❑ NO ❑
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑
VALUATION$ 5-,90
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 I 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 ^
PERMITTEE
ADDRESS WI T
' r FINAL BY
CITY / rr�.
TEL L &'� �+� DATE 1 "/ �y�`ue
MAKE CHECKS PAYABLE TO: P.C.EFET
HARVEY T.BRANDT,COUNTY ENGINEER L
PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATION CcK. M.O. GASH
6 3 4 i'x±na 10 1 U 1 2.0 0
es 76A63BA CE#803 3.75'
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