HomeMy WebLinkAboutN/A (1073)0) S 76A638A
CE #803 (REV. 6/78)
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
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FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
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BUILD ING
B I D I N
ADDR (01
ADDRESS
A D D R E S S
LOCALITY
N' -1
NEAREST
CITY
I Y
CITY 6'
C
CROSS ST.
NO. OF BLDGS.
ASSESSOR
SIZE OF LOT NOW ON LOT
I LOT
S E 0 F
MAP BOOK
PAGE
PARCEL
I
DISTRICT GROUP
TYPE FIRE
PROCESSED BY
T LOT NO.
TRACT BLOCK
A
TRACT
EL. 0
T 0 W C N E R
OWNER C _0 0
F
(J
CONST. ZONE
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS
CLASS NO.
DWELL. UNITS
J
BK PG
" -on
CITY
ITY A ZIP
I C TEL.
ARCHITECT OR
NGINEER "J� NO. 0
ENGINEER
VALUATION $
ADDRESS 14
ADDRESS
FROM
TEL.
CO T C
CONTRACTOR NO,
FRONT PROP. LINE OF
(STREET)
HIGHWAY + YARD
TOTAL SETBACK FROM
TYPEOF EXISTING
C
6 ADDRESS 6/ 2 j L1N .
FRONT PROP. LINE
HIGHWAY WIDTH
LIC.
f CITY 1 1- (1) CLASS (' -�'
+
CONSTRUCTION LENDER
BLDG. SETBACK FROM
SIDE PROP. LINE OF
(STREET)
NAME AND BRANCH
HIGHWAY + YARD
= TOTAL SETBACK FROM
I TYPE OF 1EXISTING
ADDRESS CITY
SIDE PROP. LINE
IHIGHWAY I WIDTH
SQ. FT. NO. OF NO. OF CHECK
+
SIZE STORIES FAMILIES ONE
DESCRIPTION OF WORK NEW
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P.C.C. Fee
Permit Fee
A/ ADD
Issuance Fee
ALTER
REPAIR ❑
Total Fee
USE OF DEMOL 0
EXISTING BLDG.
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APPLICANT TEL
2
(PRINT) NO.
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
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AND LAWS REGULATING BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
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THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE.
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SIGNATURE OF
PERMITTEE
ADDRESS
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TEL.
0
CITY NO.
USE ZONE MAP
NO.
SPECIAL
CONDITIONS
FINAL BY
Lu
CL
DATE