HomeMy Public PortalAbout5721 OAK AVE_Building_1/30/1976_APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDING
COUNTY OF LOS ANGELES
ADDRESS 7.2 a/ak Ave%
DEPARTMENT OF COUNTY ENGINEER
CITY 1e-AgP[c E I TV ZIP y/7ed
BUILD-IZNG ANDSA DIVISION
BUILDING
NO. OF S
S1ZE OF LOT J-4 X I / 6 NOW ON LOT
ADDRESS f_
TRACT AAt7 IBLOCK GOT NO.
LOCALITY
TEL. _
OWNER W •art. i V,�d%y v 7/y k�J NO. d FS -/t.r/Lf
NEAREST
CROSS ST.
ASSESSOR
ADDRESS %�% OAK A //
MAP BOOK PAGE PARCEL
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DISTRICT
GROUP YPE
FIRE
CESSED BY
CITY / e/YI /J< C rl 1'7 `/ ZIP /�/ /J a
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ENGINEER D Ul/Vi fZ NO.
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ADDRESS NO.
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CONDITIONS
CITY CLASS
R AD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH
DG. FROM
RONT PROP. LINE OF (STREET)
U NTPSETBACK PROP.
ADDRESS CITY
N HWAY } YARD Il`
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TOTAL SETBACK FROM TYPE OF
EXISTING
SO. FT.
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WIDTH
SIZE
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USE OF
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CORNER CUTOFF YES ❑ NO ❑
APPLICANTW Ilj. i aM -V ,L'eS TEL (%
(PRINT) / NO A/(0f
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YES E] NO ❑
BY (SIGNATURE)
IN OPEN SPACE
IN COASTAL PERMIT ZONE YES ❑ NO ❑
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VALUATION$ //(/d F C I
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1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
ABOVE i
ALL ORDINANCES AND LAWCORRECT AGREE COMPLY
WITH STATE THAT THE
REGULATING BUILDING CON
� /'V s/ O7//V �n
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STPTE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPEN TIO INSURANCE.
SIGNATURE OF(,(�
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FINAL
BY
CITY NO.
DATE
AIA KE CHECKS PAYABLE TO:
HARVEY T. BRANDT, COUNTY ENGINEER
P. C,
FEE $
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FEE •7 `ems
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PLAN' CHECK VALIDATION CK. M.O. CASH
PERMIT VALIDATION CK .0. CASH
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