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CE #803 (REV. 11 / 78)
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS '
BUILD'NG
ADDRESS LOCALITY
NEAREST
CITY ZIP CROSS ST. V^
NO. OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT BLOCK LOT NO. CONST. ZONE
EL.
OWNERag N
STATISTICAL CLASSIFICATION SEWER MAPrr
ADDRES 9 CLASS NO. DWELL. UNITS BK PG
CITY LOS Aj%"169 ZIP
VALUATIONNO
ENGINEEITECTOR
S#4rW" sM!
ADDRESS211fiS HUntingtft bri stiIBLDG. SETBACK FROM
T L FRONT PROP, LINE OF STREET)
TOTAL SETBACK FROM TYPE OF EXISTINGCONTRACTORNO,
LIC.
HIGHWAY + YARD - FRONT PROP. LINE HIGHWAY WIDTH
ADDRESS NO.
U C.
CITY CLASS "w
kBLDG. SETBACK FROM
SIDE PROP. LINE OF STREET( NDECONSTRUCTIONLER
NAME AND BRANCH O
HIGHWAY + YARD - TOTAL SETBACK FROM TYPEOF EXISTING I.)
ADDRESS TY SIDE PROP. LINE HIGHWAY WIDTH,
44
SQ. FT. NO. OF NO OF CHECK
SIZE S1 I FAMILIES ONE
USE ZONE MAP
OF WORK NEW NO. 09DESCRIPTION
SPECIAL 9
45 ft,* of rataining wall- ADD CONDITIONS O
FINAL
BY
4' hia
ALTER
DATE 886
USE OF
REPAIR
EXISTING BLDG. DEMOL
ZCAPPLICANTTEL
yPRINT) ."C1 .'NO.. 9 -
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BY (SIGNATURE)
Y1HEREBYACKNOWLEDGETHATIHAVEREADTHISAPPLICATIONANDSTATE
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCESUA
r
V
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY WILL NOVEMPLOY ANY PERSON IN VIOLATION OF V
THE LABOR CODE OF THE STATEOF CALIFORNIA IN RELATING TO WORKMEN COM-
PENSATION NSURANCE.'
Z i1'S '0 +C7 I 'a frq
SIGNATURE QF
PERMITTEE - y qqyy M ggto`-" q y, 6Ww5#+k d.`i
1
ADDRESS Z 1.'
TEL.
CITY
O
P.C. Fee $ Permit Fee
Wd
Issuance Feeliz
Total Fee
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