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CE N803(REV.�11%78)• . . . .. . . .
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� �APPLICATIOiV FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUIIDING AND SAFETY
. FOR APPLICANT TO FILL IN . . _ _ . A�pREss �7 -
ADDRE55 C.: p l.,J 114�� \ .. .
IOCALITY
p n NEAREST
CITY�IC.��,�10� {`�� ZIP 'I � S CROSSST.
NO.OF BI�GS. ASSESSOR
SIZE OF LOT I I� NOW ON LOT � MAP BOOK � PAGE - P CEL
J DiSTRICT GROUP TYPE FIRE PROCES D Y
TRACT �S�Q,S BLOCK LOTNO. (C - _ CON ZONE -
- IEL. - .�0 ._ �� � .
OWNER ��� Cc��UC:r. NO. - -
r ST C1A55 NO.LASS�DWELL.UNITS �ER MA G
ADDRESS lG 3g Q 7 a(
CITY�(fyv�W•�� }�}�r ZIP- ` 17 L J .
AaCHI1ECT OR TE�. VALUATION � �
ENGINEER - - NO.--- • /� �(JU
ADDRESS bLIX;.StftiaCKfkc�M �
\ 1 TE� ,l�4 FRONT PROP.LINEOF ISTREETI
CONTRACTOR 1.�jr�—Wt?�I CUnST NO. o�I',o2 .�� TOTALSET A KFROM iYPEOF EXISTING
LiC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
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QTY 1`t�d 1�P:..� C`'� Ct SS
BLDG.SETBACK FROM � ����, �
CONSTRUCTION IENDER • " ' SIDE PROP.IINE OF S »/'-"'V�/;$TREETI
NAME AND BRANCH �-
HIGHWAV �+ �YARD = TOTALSETBACKFRpM TYPEOF EXISTING 0.
ADDRESS CITY � � � •SIDE PROP.LINE HIGHWAY WIDTH Q
SO.FT. �I �, NO.OF NO.OF CHECK "• � "-+ � '--'- _ ' , ,v
SIZE �� STORIES FAMIUES " �'" " ONE - a
+ + USF ZQNE MAP 0
DESCRIPTION OF VYORK � �c��`T�i . NEyy ❑ 1 � NO. � � W
SPKIAL �
ADO CONDITIONS y
ALTER ❑ p�Nq� BY + Z
REPAIR � DATE 3�(„�� ��� � ,
USE OF DEfr,Ol ❑
EXiSTING BLDG. Z
APPUCANT TEL 7 1¢ ' ' � ' � '
iPRINTl�1�,17-++:dl �+r.91 NO. ,� -aja� 4 .
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BY�SIGNATUREI . y- l� ♦ _: _ . . - . �
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I HEREBY ACKNOWIEWE THAT I HAVE RfAD THiS APPLICATION AND STA7E � ' Y - � -
THAT THE ApqVE I$CORRECT AND AGREE TO COMPtV W11H ALL ORD�NANCES W
AND IAWS REGUTATING BU�LD�NG CONS7RUCTION 1 CERTIFY IHAT IN�OING 1HE y � �
WORK AUTHORIZED MERFBY 1 Wlll NOi EMPLO�ANY PERSON IN VIOIATiON OF ' �
THE IABOR CODE OF THE S7AfE OF CALIFQRNIA IN PEIATING TO WORKMEN 5 COM�, _ Z .
PENSATION INSURANCE.' � . � � � , �
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SIGNATURE OF ��,(� ------ ------ '-----rr ti(;.� ,y----. '
PERMITTEE �'"tiU �
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