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APPLICATION FOR COUNTY OF LOS ANGELES OF COUNTY BUILDING PERMIT DEPARTMENT BUILDING AND SAFETY DIVISION ENGINEER FOR APPLICANT TO FILL IN ADDRESS BUILDING BUILDING ADDRESS _2 LOCALITY A11//111z", 9,,, NEAREST CITY 0/ ZIP CROSS ST. NO OF BLDGS. ASSESSOR SIZE OF LOT _313 NOW ON LOT MAP BOOKi° PAGE PARCEL DISTRICT GROUP TYPE ON FIRE P _CESSE D BY BLOCK TRACT LOT NO. �(C S T, L _200E_ 1 . 17 - _JKL OWNER 20 1 - STATISTICAL CLASSIFICATION SE W,�R`MAP ADDRESS CLASS NO. 201 DWELL. UNITS 4K ------- PG-' CITY ZIP USE ZONE MAP NO, -3 V ARCHITECT OV'A TEL. ENGINEER NO, ry SPECIAL CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ No TEL.? CONTRACTOR NO. 9 5 5 f BLDG. SETBACK FROM LIC. FRONT PROP. LINE OF —(STREET) ADDRESS NO. TOTAL SETBACK FROM HIGHWAY + YARD TYPE )F 0 EXISTING LIC. FRONT PROP. LINE HIGHWAY' WIDTH CITY CLASS CONSTRUCTION LENDER i�7 NAME AND BRANCH BLDG. SETBACK FROM ADDRESS CITY 4, ,10' ,,2 SIDE PROP. LINE OF (STREET) -1 NO, F SQ. FT., NO. OF 0 CHECK A666, TOTAL SETBACK FROM HIGHWAY + YARD SIDE PROP. LINE TYPE OF ]EXISTING HIGHWAY] WIDTH S STORIES FAMILIES ONE — DESCRIP,PN OF WORK NEW El + .ADD a CORNER CUTOFF YES❑ NO ALTER F-1 IN OPEN SPACE YES ❑ NO REPAIR USE OF r-� IN COASTAL PERMIT ZONE YES ❑ NO EXISTING BLDG. DEMOL APPLICANT TEL (PRINT) NO. BY (SIGNATURE) I HEREBY ACKNOWLEDGE T14AT 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,v FINAL BY PERMITTEE __74� DATE ADDRESS TEL. P.C. Fee $ Permit Fee CITY NO. Issuance Fee VALUATION /,- eio J-- Total Fee _11111171111OU t A w 41// 5, 5 6 17,5 0 73 23 ©s 76A638A CE #803A 8/77 CK. M.O. CASH 8.0 L A co Z11156 PERMIT VALIDATION 6 -/ 0 7 8' 1 CK. M.O. CASH 1 7.0 0 -W-- PLAt +s TO APPLICANT INSPECTOR'S NOTES TC�� � DATE _ _ RETURNED APPROVED NO DALE _ - F '�rerh-F.�4 4, i� carfi,V 6,a 10111 bo rc oonsibl for tho I,,m4 cn bo.dono under, th ermii and 8iat in tbo I rurtn3uOf a c+k for iahlch ,Is Permit ar I;^u. I I .hall not en _loq N19 fU- ,Tl 'T sp :as to become l„�� „ti,y t t 11 during , c c c �t c,m and r this �^ I C II h the m qu d o ,nc�uie f In,.0 a c 7 3 ih t toifu.a �or APPROVALS _ WAIL! F.IdI ICATI I ILAL H DLPAl Ifi MT FIRE DrPaRTNMilT C". F2/\DING; YESOU1 � IRED NO — DATE RECEIVED OR APPROVED _....._ - rn o, h h,ww rid. c diions of ahi cor6Jczk2 and lizra read -. ,• t�, T, PEDESTRIAN PROTECT ION I rENCF1 ICANOPY1 SPECIAL I,I;P!"CIhN COI IC I wVsASNI l 1 i4V LDG,I LOT DRAIHAGE PAf11<I06 — AI PPO\/Al , ( DATE INbPLCIOR S SIGNATURE f LOCAIION SFlBAC, YE L I �FOUNDAT ONS W FRAME LA.TN/DFOV/AIL [Al 1-I-EXI I NIOR I I-I0Uo4 t IUPflBF(. CMPFC;T & POSTED FINAL EfvI I I 0N FROM L