HomeMy WebLinkAbout1458A I �s 76A638A �
CE#903(REV.i l/78) �
APPLICATION FOR BUILD[NG PERMI`f
COUNTY OF LOS ANGELE5 BUILDING AND SAFETY
FOR APPLICANT TO FILL IN Ao�oREss � �� ,F f�.�I ' � !
ADC�RESS �-�� � '�� � �,� + �_GCALIT" � r
NEARESi � .^ � �j3
CIiY P , � ' ZIP CROSSST. :�! I Y,��
NO.OF BLDGS. ASSESSOR
SIZE OF LOi -(" NOW ON LOT MAP BOOK PAGE PARCEL
DISiRICT GROUP TYPE FIRE PR CESSED BY
TRAC 1G� BLOCK LOT NO.. � CONST.� ZO�E
OWNER NO"�C� l�� �� � "�`}_'at''
..„�. SiATISTICAL CLASSIFICATICN �EWER MAP
ADDRESS �- (_� . C� . � � ! '' �p�
, CLASSNO. -,�,_D'N/=LL.UNITS HK PG
CITY . �„ ZIP �1��
ARCHITEQOR y+ / , TEL" / - r VALUATION ,�j
ENGINEER �(" ��.('.,Ji�.�l,. NO. C"�
ADDRESS BLDG.SEiBACK FROM
TEL =RONi PROP.LINE OF ISTREETI
CONTRACTOR � IT '�(� NO. HfGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING
LIC. FRONT P�ROP.LINE HIGHWAY WIDTH
ADDRESS NO.
LIC + –
CITY �;LASS
CONS'RUCTION LENDER BLDG.SETBACK fROM
NAA4E AND BRANCH SIDE PROP.LINE OF (STREETi
TOTALSETBACKFROM TYPEOP EXISTING �
HIGHWAY + YARD – SIDE PROP LINE HIGH1n�'AY WIDTH
ADDRFSS CITY V
SQ FT NO.OF �., NO.OF f "HECK + _ �
SIZE (7�' "� STORIES FAMILIES � yoNe �
USEZONE MAP �
DESCRIPTION OF WpRK '�" . .s;) �C%/L7� �. NEW N��
SPECIAL
ADD ❑ CONDITIONS N
ALTER ❑ FINAL BY Z
REPAIR ❑ DATE
USE OF � � � � ;�h
EXISTING BLDG. DEMOL ///''''''))'J � s , Z
APPLICANT TEL �t�� �ry/r�„� -w^...�-''��-�'� o �, �`.
IPRINTI �: � VO. _ ���� a � ��� �
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BY;SIGNATUREI ; �
I HEREBY ACKNOWLED E�THAT I HAb'E READ THIS APPLICATION AND STATE UY ` � � �'���C'��L
THA'THE ABOVE S C CT AND AGREE TO COMPLY �A'ITH ALL ORDINANCES � W p C
AND LAJVS REGULATING BUILDING CONSTRUCi'�ON I CERTIFY THAT IN OOING THE V [� I,�j[1""(�1 C7 �
WOP.K AUTHORIZED HEREBY I WIIL NOT EMPLOY ANY PERSON IN VIOLATION OF � �
TNE LABOR COCE OF THE STATE OF CALIFORNIA IN RELATING TO'JJORKMEN'S COM� Z
PENSATION INSJRANCE.' �
SIGNATURE OF �'�,��,�„�
?ER�1ITTEE
ADDRESS � � �
Z
(� 7EL. �
CITY `�— NO. Q
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P.C. Fee$ � '7–�i. �'d Permi^Fee >
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Issuance Fee �
W
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Total Fee
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����--`� PLANSTOAPPLICANT � y� INSPECTOR�SNOTES _���Y��p�—� E
7� O RETURNEO �
� AP9ROV EO �
�yNO DATE Np. DATE
b,____... -
REQUiRED DATE RECEIVED
APPROVALS � ORAPPRQVED
YES NO
WAT�R C[RTIFiCATE �
HEALTH L'EPART:NciJT , . �
FI RE DEPP,RTM�NT
�
GRADING • �
GE'JLO.r,iCA�
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l _.� .. ,
PEDESTRIAN PROT�CTIt7N '
IFENCE; ICAN�PYI
SPECfALiNSPEC?ION i
�CONC.) IMASNRYI IWEtDGJ
LOT DRAINAGE
3'ARKIN6
APPROVALS DATE INSPECTOR'SSIGNATURE
LOCATION-
ISETBACK&YARDS) � � �
FOUNDATiOC�iS
FRAME
IATN/DRYWALL
INTERfOR
LATH-cXTERIOF
� HOUSENUMB£R- .
CO2RECT&POSTED
ENERGY iIVSULA?!ON
' FINAL• �
EN'ER ON fROPf7
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