HomeMy WebLinkAbout0 (19) APPLICATION FOR COUNTY OF LOS ANGELES
RTMENT OF COUNTY
BUILDING PERMIT °BU DNGANDSAFETYDIVSIONR
BURDLNG r---'
FOR APPLICANT TO FILL IN ADDRESS 1 r� �-'>1 1.
BUILDING
ADDRESS l Ll !T r``• . 1,.i ;7 ./'..:^ LOCALITY i1
NEAREST
CITY ?�•. n,.,: '!^:_ 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,, - NO.IT
1
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS I.3 l +I'. i`,� 7_I CLASS NO.` DWELL.UNITS -°8KPG
CITY I ,�+T,.� ZIP USEZONE MAP V _
ARCHITECTOR 4 - TEL. NO.
ENGINEER NO. SPECIAL '
CONDITIONS _
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
TEL.
CONTRACTOR. NO: 4; FR
BLDG.SET BACK FROM
(( 1 LIC` FRONT PROP.LINE OF ISTREET)
ADDRESS) l( ' NO. 1`II?- I
TOTAL SETBACK FROM TYPE OF EXISTING
LhlLIC HIGHWAY + YARD FRONT PROP.LINE HIGHWAY WIDTH
CITY ` .?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 CHECK HIGHWAY + YARD TOTALSETBACK FROM TYPEOf EXISTING
SIZE STOR/IE-S FAWL,5 ONE
P SID
E PROP,LINE HIGHWAY WIDTH
DESCRIPTION OF WORK\, I�. NEW ❑ +
ADD ❑ CORNERCUTOFF YES ❑ NO ',❑
ALTER IN OPEN SPACE YES ❑ NO.Q
REPAIR El
USE OF - IN COASTAL PERMIT ZONE YES ❑ NO Q
EXISTING BLDG. - DEMOL
APPLICANT TEL Y
LPRINTI NO. p
V
BY ISIGNATUREI I f ),` �•, —
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI'v N AND STATE
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH AlL AND <
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THATTTTT IN DOING THE p
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'$COM
PENSATION INSURANCE.
SIGNATURE OF +-wT FINAL BY
PERMITTEE I',SL,.' `�'�` -Y0 DATE
ADDRESS
TEL. P.C.Fee S ✓%r' Permit Fee
CITY NO.
Is—rice Fee
VALUATION
1. Total Fee
PLAN CHECK VALIDATION C. M.O. CASH PERMIT VALIDATION CK. M.O.' CASH
r 7x)0
t3 76AD38A GE ABa3A B/]7 L-• r{L� �'- Y�` ^`• k`
a
MIT POITA&WRITA
1-I't C!J;,1-1
�il jj!ii clTli"'%' i.;q,-A 5 J�
7 3
1-1;J-
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