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CE #803 (REV. 11 / 78)
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APPLICATION FOR
BUILDING
COUNTY OF LOS ANGELS
BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
BUILDING
ADDRESS
BUILDING
ADDRESS
LOCALITY yx r
DI 10— �91755
NEAREST
CITY `�- ZIP
CROSS ST.
NO. OF BLDGS. M- 01 —
ASSESSOR
SIZE OF LOT NOW ON LOT
MAP BOOK
PAGE
PARCEL
DISTRICT GROUP TYPE FIRE
PROCESSED BY
TRACT ? °7 I BLOCK LOT NO. r,
CONST. ZONE_
2P 1 'tea r ,,.DEL `a
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r,„! ; ; g
3220 BR.ra�A { t; ;L D U i
STATISTICAL CLASSIFICATION
SEWER MAP
ADDRESS t ,,
CLASS NO. a' DWELL. UNITS _f
BK PG
CITYT-q r I T ¢ ZIP s) 7 ✓ c-
ARC9I T`O`k fEC F
VALUATION �j �,y T
ENGINEER E E'.aa�3_. NO , » C ..
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,1 !' C
ADDRESS
BLDG. SETBACK FROM
TEL.
FRONT PROP. LINE OF
(STREET)
CONTRACTOR -yT ; ,- NO. - -,, r
TOTAL SETBACK FROM
HIGHWAY + YARD =
TYPE OF EXISTING
LIC
FRONT PROP. LINE HIGHWAY
WIDTH
ADDRESS O T O E ., I' NO.
n
-� r r5 � LIC
CITY IZA10 M) A )-d CLASS
+ _
BLDG. SETBACK FROM
CONSTRUCTION LENDER
SIDE PROP. LINE OF
(STREET)
NAME AND BRANCH
HIGHWAY + YARD = TOTAL SETBACK FROM I
TYPE OF 1EXISTING
ADDRESS - CITY
SIDE PROP. LINE IHIGHWAYI WIDTH
SO FT ' , NO. OF _ NO. OE CHECK
SIZE STORIES FAMILIES ONE
+ _
USE ZONE MAPNO
ESCRIPTION OF WORK NEW
j F
®
SPECIAL
ADD
CONDITIONS
�s,-a 3rdU'b vet ALTER
BY
FINAL
-�
REPAIR ®
DATE
USE OF 1 pp----��
_ DEMOL
EXISTING BLDG.
Z
APPLICANT TEL
PRINT) fr?' I a T vT NO-
-,
BY (SIGNATURE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
Y
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
Uj
AND LAWS REGULATING BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE
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WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
'i
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
'� r" Z
PENSATION INSURANCE.'
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SIGNATURE OF
PERMITTEE
ADDRESS `; 2 fZ R F € v;
DL�a-T.1100,.�ND B.r:_R� TEL. 594 26
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,
CITY NO.-
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P.C. Fee $ ee,_ z Permit Fee
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Issuance Fee
LU '
Total Fee