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Initial Screening Checklist
(Fields with an asterisk (*) are required)
Applicant or Property Owners Name
Contact Phone Number
Contact Email
Project Address
HPOZ Name *
Adams-Normandie
Angelino Heights
Balboa Highlands
Banning Park
Carthay Circle
Carthay Square
Country Club Park
El Sereno-Berkshire
Gregory Ain Mar Vista Tract
Hancock Park
Harvard Heights
Highland Park-Garvanza
Hollywood Grove
Jefferson Park
Lafayette Square
Lincoln Heights
Melrose Hill
Miracle Mile North
Miracle Mile
Oxford Square
Pico-Union
South Carthay
Spaulding Square
Stonehurst
Sunset Square
University Park
Van Nuys
Vinegar Hill
West Adams Terrace
Western Heights
Whitley Heights
Wilshire Park
Windsor Square
Windsor Village
North University Park (specific plan)
Existing Structure
(Please answer based on the current structure)
Building Type:
Single Family House
Duplex
Four-plex
Bungalow Court
Does your property have any Citations or Orders to Comply? *
Yes
No
Proposed Project
(Please answer based on your proposed project; complete what applies)
Type of Project:
*
Remodel
Addition
Change of Use
New Accessory Structure
Addition to Accessory Structure
Attached Garage
Freestanding Garage
Interior Only
Demolition
Paint
Window or Door Replacement/ Relocation
Roof Repair/ Reroof
Siding/Stucco Repair
Chimney Repair/ Reconstruction
Landscaping/ Hardscaping
Driveway Repair/ Replacement
Other
Size of Addition
New Building
Can you see the project from the street? *
Yes
No
Do you know of any non-original alterations/additions that have been added to your property?:
Doors
Windows
Water Features
Fences
Gates
Extensions or Additions
None are known
Other
