HomeMy WebLinkAbout0800A 0801A ��s 76A638A �
CE k803(REV.11/78) ,, _ � � g
�� APPLICATION F�R BUlLDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN aU�tDING .� �
ADDRE55 , 3� �
BUILDING ��j,� y � � �
ADDRE55 � i LOCALITY � ` �'J
� � EAREST '�'
CITY v { ZIP .� CRO55 ST. !�( �^
NO.OF BLDGS. ASSESSOR
SIZE OF LOT .`�Gr.r• , NOW ON LOT /�/�i'y Q MAP BOOK � PAGE PARCEL
,L D157RICT GROUP TYPE FIRE PR ESSED BY
TRACT �f� BLOCK LOT NO. T L CONST. ZONE
� -�{ , TEL. �O
OWNER L '� NO. � G�
ADDRESS yV T� J i STATISTICAL C1A551FICATION SEWER MAP
CLAS$NO. C�j�_DWELL.UNITS BK PG
CITY�� �' ZIP �
ARCHITECT OR TEL. VALUATION $ O
ENGINEER SIJ � NC� l j'� I��
ADDRE55 '�k � BLDG.SETBACK FROM
TEL. FRONT PROP.LINE Of �STREET�
CONTRACTOR Q(N' i(! � NO. TOTAL SETBACK FROM TYPE Of EXISTING
LIC. H�GHW RD = FRONT PROP.LINE HIGNWAY WIDiH
ADDRESS NO.
LIC. t =
CRY CLASS
CONSTRUCTIOtJ LENDER � BLDG.SETBACK FROM
NAME AND BRANCH �� _ , SIDE PROP.IIfVE OF TREETI �
HIGHWAY + YARD TOTAL SEIBACK FROM TYPE OF EXIST �
ADDRESS ►� i CITY � SIDE PROP.LINE HIGHWAY WIDTFI �
SQ.FT NO.OF NO.O CHECK + _ �
SIZE STORIES Y FAMILIES ONE ' �/ 0
DESCRIPTION Of WORK �d�(J NEW ❑ US�� NOP �� � „�?"I �j �
SPECIAL �
� � ADD ❑ O`'L�� CONDITIONS y�
ALTER ❑ FINAL, BY � Z
-- - REPAIR � DATE - p2� �`�-- -- ���----
USE OF DEMOL ❑ : l �: f l. ��
EXISTING BLDG. � 2
APPLICANT � TEL 0 a' r _ ` � -
�PRINTI /� � �1 NO �SSG � fr G.:
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BY iSiGNATUREI�j � �
I HEREBY OWLEDGE THAT 1 HAVE READ TH A LICATION AND STATE V � =' •� I 4 �� i_t i��
THAi THE A OVE IS CORRECi AND AGREE TO CO l ITH ALL ORDINANCES w
ANp LqWS EG{,MTING BUIIDING CONSTRUCTION I TIFY THAT IN DOING THE S
WORK AUT OR�ZED HEREBY 1 WIIL NOT EMPIOY A PERSON IN VIOLATION OF V Ci �',�,�, `�C%G
iHE IABOR COUE OF THE STATE Of CALIFORNIA IN REl TING 10 WORKMEN S COM� Z
PENSA i IOr?fNSURANCE.' �
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SIGNATURE OF � ` ��`' `- � ''
PERMITTEE ' ^
ADDRE55 �( , �' � t� y 4 � ''
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