HomeMy WebLinkAbout0 (22) APPLICATION FOR COUNTY OF LOS ANGELES
RTMENT OF COUNTY
BUILDING PERMIT °BUILDNGANDSAFETYDIVSIONR
FOR APPLICANT TO FILL IN noloaess f7` L' '�.'- Fr
BUILDING / 1
ADDRESS 1 J7 7_7 (,^,L+ r•(J LOCALITY I �:i rr ,•1 4'-4"
NEAREST
CITY I ,A 1! ('' ZIP CROSS ST. '
NO.OF SLOGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT BLO[K LOT NO. r�' CONST. ZONE
11/ _ TEL _�
OWNER—{ rla, i- ) -.I,l r,,.. N0.O.'1 � y STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS 1 J,7 1J: � ��.. ry CLASS NO. � DWELL.UNITS BK, �PG
CITY 1S%. ,{rr 1fx, _ ZIP USE ZONE MAP
ARCHITECT OR TEL. NO. '
ENGINEEP NO. SPECIAL
CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NOQ
J . TEL, Ir
CONTRACTOR - {)1,. NO.1I LI�,'JrL'Y P, BLDG.SETBACK FROM
!'.+ ! LIC FRONT PROP,LINE OF' ISTREETI
ADDRESS {U�� J.M1I r NO. !s��/C/-2_. HIGHWAY + YARD TOTAL SETSA[K FROM TYPEOF EXISTING
( LIC. FRONT PROP.LINE HIGHWAY WIDTH
CITY ��� c,...=.1 CLASS _
CONSTRUCTION LENDER +
NAME AND BRANCH
BLDG.SETBACK FROM
ADDRESS CITY SIDE PROP,LINE OF ISTREETI
SQ.FTS- NO.OF NO,OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
SIZE � 'r. STORIES FAMILIES ONE SIDE PROP.LINE 1HIGHWAY1 WIDTH
❑ +
DESCRIPTION OF WORK r L, 0 ri NEW
ADD ❑ CORNERCUTOFF' YES ❑ NO
ALTER IN OPEN SPACE YES ❑ NO�❑
REPAIR ❑
USEISOF
BLDG. DEMOL 1:1 IN COASTAL PERMIT ZONE YES ❑ NOEXTIN ,❑
APPLICANT TEL >
IPRINTI NO. nD
V
BY ISIGNATUREI —
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT\IpN AND STATE
THAT
THE ABOVE I$CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.1 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. 7
SIGNATURE OF S 17 Y f �i 1 ! FINAL BY
PERMITTEE DATE -
ADDRESS
T L. P.C.Fee S / "^� Permit Fee
CITY NO.
�^ Issuance Fee f
VALUATION
Tocol Fee
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION CK. M.O. CASH
I ,
ts 76A639A CE A803A O/]] �J
I
41,
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