HomeMy WebLinkAbout1045A (5) Iry;s 76A638A
CE#803(REV.i l/78) `t �
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN AppRE55v���,� ,c.�Q,,�
BU�LDING
ADDRESS �Q, LOCALITY
NEAREST
CITY � _ ZIP CROSSST. �.s(�e.�•�w�—�-G /��
NO.OF BLDGS ASSESSUR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEI
DISTRICT GROUP TYPE FIRE PROC SED BY
TRACT BLOCK LOT NO. CON$ �ZON;EJ
OWNER � � NO. `O �� � ' " "���
STATISTICAL CLASSIFICATION SEWER MAV
ADDRESS � CLASSNO.��DWELL.UNITS BK PG
GTY� ZIP �' � �
ARCHITECT OR TE� VALUATION $ `f,�/
ENGINEER NO. / �v
ADDRESS BIPG SETBA K FROM
TEL. FRONT PROP.LINE OF ISTREETI
CONTRACTOIi � � � ` � • ` HIGH AY + YARD TOTAlSETBACK FROM TYPE OF EXISTING
`'�� j LIC. fRONT PROP.LINE HIGHWAY WIDTH
ADDRE55 {'�O �`}�i,+ 'j NO.
LIC. +
CITY - CLASS
CONSTRUC��ON LENDER BIDG.SETBACK FROM ' •
NAME AND BRANCH SIDE PROP.LtNE OF ISTREETi
TOTAL SETBACK FROM TYPE OF EXISTING �
HIGHWAY + YARD SIDE PROP.LINE HIGHWAY WIDTH
ACDRESS CITY �
SQ FT NO.OF NO.OF CHECK + = a
SIZE STORIES FAMILIES ONE
USEZONE MAP � 0
DESCRIPTIONOFWpRK NEW ❑ ,� i NO. I�..< ��` J �
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ADD I�I `7'�Ol9C� CONDITIONS N
AITER ❑ FINAL iI gY - Z
REPAIR � DAiE T �a 8�
USE OF DEMOL
EXISTING BIDG. �.� 2
APPL!CANT �� `�.�TE J � .� � O
(PRINTI (O ff Q
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BY�SIGNATURE� -, .� �
1 HEREBY ACKNOWLE E T AT I HAVE READ�}II$APPIICAT�ON AN�STATE Y �
THAT THE ABOVE 15 CORRECT A AGREE TO COMPLY WITH ALL ORDINANCES W
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIfY THAT IN DOING THE S
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSpN IN VIOLATION OF V
THE IABOR CODE OF THE STAiE OF CALIFORNIA IN RELATING TO WORKMEN 5 COM� Z'
PENSATION INSURANCE.'
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SIGNATURE O � � � � o �,1
PERMITTEE
ADDRE55 • Z � • ° � (� G G'
TEL. �
CITY NO. � •;• • � �`: Ci Q U
P.C.Fee$ Permit Fee
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