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APPLICATION FOF BULL:
PERMIT
COUNT; OF LOS ANGELES
B:i11LD(NG AND
5 M Y
FOR APPLICANTTOFILL IN
aooREss
`
BUILDING
)
ADDRESSQ Lc e L
OCALITY
a. _
CITY ZIP
•NEAREST
CROSS ST.
R �NO. OF BLDGS.
Q1�Dt1iV�liJi `
SIZE OF LOT. NOW ON LOT �
ASSESSOR
MAP BOOK
PAGE
PARCEL;
���, (^,,
`C
DISTRICT GROUP TYPE
CONSTJ't!
FIRE
ZONE
PROCESSED BY
TRACT 7: BLOCK LOT NO..
'
g
OWNER 1... 1 Tl4�ICiRf NO.
C'
`.
iAl .�
STATISTICAL CLASSIFICATION
SEWER:E AP
ADDRESS �j DL ii
CLASS NO. A DWELL.
UNITS
BK PG
CITY
ARCHITECT OR ��// TEL. 5^ i
�� `/®��
VALUATION
}
ENGINEER %��j�la+NO.
ADDRESS 'jt® �� Zj
BLDG. SETBACK FROM
, TEJ
FRONT PROP. LINE OF
—ISTREET)
CONTRACTOR all NO. —G
_ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD -
,
7 2 )
ADDRESS 7 LN ' NO.
FRONT PROP. LINE HIGHWAY
WIDTH
`
t =
�p
CITY M S� CLASS
BLDG. SETBACK FROM
CONSTRUCTION LENDER
NAME AND BRANCH !`�-
SIDE PROP. LINE OF
(STREET)
a
TOTAL SETBACK FROM
HIGHWAY + YARD = SIDE PROP. LINE HIGHWAY
TYPEOF EXISTING
WIDTH
0
ADDRESS CITY
.
U
SQ. FT. NO. OF NO. OF CHECK
+ _
r
SIZE STORIES FAMILIES ONE
r
N
USE ,�r}}
r
DESCRIPTION OF WORK 1 NEW ❑
i.UV NOP
ADD ❑
SPECIAL
u CONDITIONS
ALTER ❑ FINAL
BY
?
REPAIR ❑
DATE
USE OF
EXISTING BLDG. DEMOL ❑
APPLICANT 0cq Lr4S spy D� �2_ TEL
C
(PRINT) N .
BY (SIGNATURE)
HEREBY ACKN EDGE THAT I AVE READ THIS APPLICAT NAND STATE
UY
THAT THE ABOVE S CORRECT AND GREE TO COMPLY WITH LL ORDINANCES
..I
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
V
::WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
TITHE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING O WORKMEN'S COM.
Z
-
PENSATION I
J
f
SIGNATURE OF I
m
PERMITTEE
Y
14
ADDRESS WT�a__Z
TEL
NO._
CITY -
G
P.C. Fee $ Permit Fee
'€'
>
~
! Issuance Fee r.
w
Total F
Fee
INSPECTOR'S NOTES
REQUIRED DATE RECEIVED
APPROVALS
YES
NO
OR APPROVED
_--------__� _
WATER CERTIFICATE
HEALTH DEPARTMENT
FIRE DEPARTMENT
GRADING
—
GEOLOGICAL
PEDESTRIAN PROTECTION
(FENCEI !CANOPY)
a
SPECIAL INSPECTION
ICONC.I iMASNRY.) IWELDG.1
— — —`
LOT DRAINAGE
PARKING
APPROVALS I
DATE INSPECTOR'S SIGNATURE
LOCATION-
a
,(SETBACK & YARDS6
LATH/DRY ALL �J %
INTERIOR , }
LATtI `"% A�v
HOUSENUMBER•
CORRECT & POSTED`:. / j. C cam« 0 „ - o 7
ENERGY IN5ULATION? ?/0
FINAL-
ENTEROTJFRONf #:T f 1 fat
;l a x - w
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