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CE #803 (REV. 11 / 78) a
APPLICATIONI I
COUNTY OF,LOS ANGELS BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDDDR
AREESSSS
BUILDING
ADDRESS LOCALITY 44, Vsv ,'
CITY 9:�9 ! '= aE 'x! R, ZIP ;
NO. OFBLDGS
SIZE OF LOT NOW ON LOT
TRAC 3537 BLOCK LOT NO.
III OWNERS „.- Rr1 T—r,'.a�NO 0onnoGcc�`i 'a t• a c(.,,,4 .. " Y' R9an u`
a0'I�4t
91765
CITY4�
ZIP
ARCHITECT OR
TEL
ENGINEER r 1
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ADDRESS ' t T T.
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CONTRACTOR ,P d
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LIC ,� t.: .a r
ADDRE
NO
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LIC.
CITY
CLASS
CONSTRUCTION LENDER
NAME AND BRANCH
ADDRESS< CITY
SO. FT. "' eY`
NO. OF
NO. OF
CHECK
SIZE` ..
STORIES
FAMILIES
a
ONE
3
CRIPTION OF WORK
NEW
ADD ❑
N,IEW E'^ STL CT10' 1T
ALTER ❑
❑
REPAIR
USE OF — n —
DEMOL ❑
EXISTING BLDG.
APPLICANT
TEL
(PRINT) DT ";EAT3T1,:
NO.
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
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-
PENSATION INSURANCE.'
SIGNATURE OF
PERMITTEE
ADDRESS
11,"110 �: Lu1 B ' TEL. _ci `Or A 2 6 1 -a
CITY NO.
P.C. Fee $I
�-�-J � Permit Fee
Issuance Fee
Total Fee
NEAREST
CROSS ST
ASSESSOR
MAP BOOK
PAGE -
PARCEL
DISTRICT
GROUP TYPE
FIRE
PROCESSED BY
CONST.
ZONE
STATISTICAL CLASSIFICATION SEWER MAP
CLASS NO. '' DWELL. UNITS SK PG
VALUATION
BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
TOTAL SETBACK FROM
TYPEOF
EXISTING
HIGHWAY + YARD =
FRONT PROP. LINE
HIGHWAY
WIDTH
+ _
BLDG. SETBACK FROM
SIDE PROP. LINE OF (STREET)
TOTAL SETBACK FROM I TYPE OF EXISTING
HIGHWAY + YARD =
SIDE PROP. LINE
HIGHWAY
WIDTH
+ _
9
USE ZONE
MAP
"T ml
NO.
SPECIALS
CONDITIONS
BY
_
z1.11
=INAL