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CE#803(REV.I1�78) ..
APPLICATION FOR B U 1LDING PE RM (T
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRESS � � .Q �jJ/ I
BUILDING �- y� �,/� f� ` �
ADDRE55 � rT �L,✓ �(.-' IOCALITY ,� �. i
CITY
i• wi �V �r�✓C-21P CROSSST. "a �
NO.OF BLDGS. ` ASSESSOR
SlZE OF LOT NOW ON lOT 1 MAP BOOK PAGE PARCEL
TRAC? {,/�,� BLOCK LOT NO. "1� � DISTRICT GROUP TYPE FIRE PROCESSED BY
�j CONST. ZONE /�
OWNER � ��W�� C • �{ �� ��
���� G'�T�./�(i(�I� STATISTICALCLASSIFICATION SEWERMAP
ADDRESS CLASSNO.�DWELL.UNlTS BK PG
CI7Y �,4/y . ZVP
ARCHITECT OR TEL, VALUATION � f Q��_
ENGiNEER NO.
ADDRE55 BLDG.SETBACK FR M
��� TEL. FRONT VROP.LINE OF ' ISTREETI
CONTRACTOR �� � �� NIGFiWAY + YARD TOTAlSETBACKFROM TYPEOF EXISTING
ADDRESS � G(/ . 'v�/�'�/ NO Lf:/� fRONTPROP.LINE HIGMWAY WIDTH
LIC. +
cirv IP/.i'j-YI t�� c�nss �
CONSiRUCTION LENDER BLDG.SETBACK FROM
NAME AND BRANCH SIDE PROP.LINE OF iSTREETi
HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING 0.
ADDR:55 ' CITY SIDE PROP.LINE HIGHWAY WIDTH V
5�.FT. �/ NO.OF NO.OF CHECK t = �
SIZE O -/ STORIES FAMILIES ONE USE ZONE MAP 0
DESCRIVTION OF WORK NEW � N�' Q S �/ ��� �j
v'9`��.r ��j/L � ADD ❑ SONDItlO S ��'
N
ALTER ❑ FINAL � B ?
�� REPAIR ❑ DATE �O
USE OF DEMOL
EX!STING BLDG. Z
APPLICANT TEL � � .. .� r
IPRINTI NO. � : �i � G �. 7'
� O
` ;� s � r • e 1
BY iSIGNATUREi � •
�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y �'� ° ° � C•r���
THAT THE ABOVE IS CORRKT AND AGREE TO COMPLY WITM ALL ORDINANCES 1Vy � �
AND LAWS REGULATING BU1lDING CONSTRUCTION.I CERTIFY TMAT IN DOING TME = E, ;_. �, " r' i= ;;L
WORK AUTHORIZED HEREBY I WIIL NOT,EMPLOY ANY PERSON IN VIOLATION Of V ' �
iHE LABOR CODF OF THE STATE OF CALIPORNIA IN RELATING TO WORKMEN�S COM- Z �
PENSATIONINSURANCE.' s t� ��i � ! t+ ('
. � ��� `
SIGNATURE OF
PERMITTEE
ADDRE55 ���� � _
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P.C. Fee$ Permit Fee / . >
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Issuance Fee �
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