HomeMy WebLinkAbout0 (22) APPLICATION FOR COUNTY OF LOS ANGELES [cam
RTMENT OF COUNTY
BUILDING PERMIT °BU DNGANDSAFETYDIVSIONR N�
BUI RESS r---'
FOR APPLICANT TO FILL IN ADDRESS 1 r� >1 1.
BUILDING - // ,i !
ADDRESS lit" !1 �``• . l... ;7 ./..:� LOCALITY i1
NEAREST
CITU I�•- M.,: ti'!^: ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT BLOCK LOT NO. �� CONST. ZONE
TEL.
OWNER 1011 i NO.I1\(-: i).. .
STATISTICAL CLASSIFICATION SEWER MAP
ADD\RESS IJ 1. +I': I`;% ,'_I CLASS NO.`" DWELL.UNITS BK PG
CITY \ I ,�+T,.� ZIP USE 20NE MAP V _
ARCHITECT OR 4 - TEL. NO. i
ENGINEER NO. SPECIAL '
CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL RE?UIRED YES❑ NO❑
TEL.
CONTRACTOR. I> /.. r..�.i-'.,NO: /(!=~'4Y•L!: I BLDG.SET BACK FROM
(( 1 LIC` FRONT PROP.LINE OF 1STREET)
ADDRESS) :', hili- 4 n..'^�� NO. I`I Z. TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD FRONT PRO P.LINE HIGHWAY WIDTH
CITY I .?i'; CLASS L-
CONSTRUCTION LENDER +
NAME AND BRANCH BLDG.SETBACK FROM
ADDRESS i CITY SIDE PROP,LINE OF LSTREETI
SO.FT, NO.OF NO.OF JANAT
HECK HIGHWAY + YARD TOTAL SETBACK L FROM TYPE Of EXISTING
SIZE STOR/IE-S FAMILIE5 ( ONE SIDE PROP,LINE HIGHWAY WIDTH
DESCRIPTION OF WORK\, I�. PW ❑ +
D ❑ CORNERCUTOFF YES ❑ NO ',❑
ER IN OPEN SPACE YES ❑ NO.I]
AIR
USE OF - IN COASTAL PERMIT ZONE YES ❑ NO Q
EXISTING BLDG. - OL
APPLICANT TEL >-
LPRINTI NO. p
rte„ r
V
BY ISIGNATUREI I f li i-•, —
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLID STATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY TING THE p
WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSONTION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO 'S COM-
PENSATION INSURANCE.SIGNATURE OFFINAL BY
ERMITTEE I' ` ' ` DATEADDRESSTEL. P.C.Fee S ,�%- Permit Fee
CITY NO.
Is—rice Fee
VALUATION
1. Total Fee
PLAN CHECK VALIDATION C. M.O. CASH PERMIT VALIDATION CK. M.O.' CASH
24-1 X;
r f X)0
t$ 76Al38A GE A803A B/]7 L-• r{L� �'- Y�I ^`• k`
a
9Q y 't-1j:,:1 f 1
r',7
71
13�Ay
yi,
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