HomeMy WebLinkAbout1262A � C►�s 76A638A « �j
CE#B03(REV.11/78) �• � . 11
APPLICATI�N FOR BUILDING PERMtT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPIICANT TO FILL IN ADIDRESS ���j �� � �ES�a.
ADDRESS 23 23�3 �1Z ��m�t �• IOCAIITY ,Q�
NEAREST
CITY ZIP � �] CROSS ST. -r.C�
SIZE OF LOT� G O,-��� � NOW ON LOT � MAP BOOK AGE PARCEI
TRACT � I Qb O BLOCK l0T NO. E)Q� DISTRICT GROUP CONST r/�.�� ZON P�ESSED BY
TEL rQ �� J`� L�-L/
OWNE � N .
ADDRESS 232JS QUa.Zl SL7I�1IIllf. �'� STATISTICALCLASSfFICATION SEWERMAP
CLASSNO.�_DWELL.UNITS BK PG
CITY ,y,.�1QjZd .1'j�' ZIP g�7 V� /�'
ARCHITEC7 OR TE�, YALUATION $�!l(�' v
ENGINEER NO.
ADDRESS BIDG. EiBACK FROM
TEL. FRONT PROP.LINE OF �STREETI
CONTRACTOR ��� H{GF}WAY + YARD T�TAL SETBACK FROM TYPE OF EXISTING
��C. fRONT PROP.IINE HIGHWAY WIDTH
ADDRE55 NO.
LIC. +
CI T Y ClA55
CONSTRU�TION LENDER BLDG.SETBACK FROM
NAME AND BRANCH ' SIDE PROP.LINE OF 15TREETI �
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING d
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH Q
SQ FT. /�� NO.OF NO.OF CHECK t = V
51ZE br/V STORIES FAMILIES ONE �
USE Z�NE MAP 0
DESCRIPTiON OF WORK NEW �E/ No. //�-3�/ �
� ' ADD SPECIAL a
❑ �� CONDITIONS �
yattice Patia � ALTER ❑ FINAL BY �
REPAIR ❑ DATE � G �,
USE OF pEMQI ^
EXISTING BLDG. - Z �
APPUCANT xaia�rt Palazu.�e1�� 598593`L O
IPRINTI d
C
�
8Y ISIGNATUREI �
�
1 HEREBY ACKNOWLE E THAT I MAVE E D THIS APVLICAiION AND STATE Y
THAT THE ABOVE IS CORRECi AND AGREE COMPLY WIiH ALL ORDINANCES W
AND LAWS REGUTATING BU�LDING CONSTRUC N I CERTIFY THAT IN DOING THE _
WORK AUTNORIZED HEREBY 1 WILL NOT EMPLOV ANY PERSON IN VIOLATION OF V
THE LA80R CODE OF THE STATE Of CALIFORNIA IN RELATING TO WORKMEN 5 COM� Z
VENSATION INSURANCE.' � � 1 2�2 P�
�
SIGNATURE OF � #;.• • • • • �
VERMITTEE �
ADDRE55 Z I:• • .� �.O O
O
CITY NO. Q ,� • • � ��O G�_'-
O
� G6,26�80
P.C.Fee$ Permit Fee � - � >
s� r
Issuance Fee /- � �
W
Totol Fee
�/ � d
� I ► I I� T.--T��r-r-n--��--�--1--r--�---r�
; , , ; � � � .
� ; � ; � i � i ; i ; ; j ;
, �
I � ; -- i
; 'i�
�.
�� .
w
�
z� " .
� -
� ' ; ,
U `
�
W .
a .
N ,
�
& W> �
� a
Q V& ' 2
�a �
a . N
W Q N
N�
0 O 0�-
w
W ~ �
Q Z
Z ? � � Z -
Q � OC
U �
6 �
Q Z � � � F
O � Q
� o
¢ � ,
� O 3 - '
F- J ~7 _ •
Q Q � �Ti �Y O N m Q -O
� O W
o & s a � �Z �� W � a N J � WN g Z '
� g �� a Z a S � &
a o < c� � a- ?- Z > Z� 0 3p � �aa z �
� a z � �- - a � � o� a °'�W X z
F � o o p Q� �z o Y a �m j ,,, o Z ,,, j G r
a � � � o � � �� � �- � ao � �W
� �
O O � = LL C� U' a`� v�i V O. a �'� � � 5 3 x L! W Il W
Z