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CE #803 (REV. 11 / 78)
0—
APPLICATION FOR
BUILDING
COUNTY OF L S ANGELS
BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
v�I�RESS
BUILDING
ADDRESS
LOCALITY.
u�'a Ca r
9 7
NEAREST
CITY ZIP 5
CROSS ST.
NO. OF BLDGS. - ?
ASSESSOR
I
SIZE OF LOT NOW ON LOT
MAP BOOK
PAGE
PARCEL
'
DISTRICT GROUP TYPE
FIRE PROCESSED BY
TRACT s 5 '- BLOCK LOT NO. _)
CONST.
ZON t„
p `O.
OWNER.'z'�w3`.t'i`T..a'a/1'i.f�'s..+��.s
� T
47°,i�/:
_
F T? C 1 tl
2 2 0 3 P C+�'��NI
STATISTICAL CLASSIFICATION
SEWER MAP
,
ADDRESS
CLASS NO. L DWELL.
UNITS BK
PG
CITY � -j T V ° ,'FAT: ; T ZIP t r- -
ARCHITECT OR M. TES
n '�`"
VALUATION ' fy'
�
C9,
q
ENGINEER t� OEIRS .a EL��, NO. 42 ,� - � K
gb.
�
ADDRESS w
BLDG. SETBACK FROM
TEL.
FRONT PROP. LINE OF
(STREET)
CONTRACTOR y I :,� NO.
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF
EXISTING
LIC. - r
FRONT PROP. LINE HIGHWAY
WIDTH
ADDRESS '1`1 ,
7j, 7,T r°° NO.')
,,1
DI-4 0-19 Ste°-R, E"" 1
+ _
CITY - CLASS
BLDG. SETBACK FROM
CONSTRUCTION LENDER
SIDE PROP. LINE OF
(STREET)
NAME AND BRANCH
TOTAL SETBACK FROM TYPE OF
EXISTING
HIGHWAY + YARD =
SIDE PROP. LINE HIGHWAY
WIDTH 0
ADDRESS„_' CITY
9-�
SQ FT. NO. OF NO. OF CHECK
{"
IF _
tIZE STORIES FAMILIES E ONE
DESCRIPTIONN OFN 0RK v ° `T '
USE ZONE MAP
NO.
7
SPECIAL
'1
ADD ®
CONDITIONS
ALTER ❑ FINAL
BY
REPAIR ®
DATE
USE OF DEMOL ®
EXISTING BLDG
C)
APPLICANT' _ TEL
O
�
(PRINT) a 6 n d _ NO. 4-2 6
<
p
BY (SIGNATURE) _
I HEREBY. ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
`
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE
v
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM
Z
PENSATION INSURANCE."
J
SIGNATURE OF
PERMITTEE
ADDRESS 32 ` iMEA C"1 11 p6T by ,2I
Z
p
» BEAR TEL -42 6 1 �"
�
_J .:f
CITY NO._
P.C. Fee $� Permit Fee
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Issuance Fee
cc
L
Total Fee