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'APPLICATIONI
.F'
COUNTY OF LOS ANGELES
BUILDING AND SAFETY
'04BUILDING �'
FOR APPLICANT TO FILL IN
o� 1
ADDRESS/ �# t� "
BUILDING / ✓ �'/`
/
��
OCALIT
ADDRESS a
NEAREST ->
CITY�c2� �"Y� �•
CROSS ST.
2 NO. F BLDGS.
SIZE OF LOT NOW ON LOT
ASSESSOR
MAP BOOK
PAGE
PARCEL
� BLOC LOT NO.
DISTRICT GROUP TYPE FIRE PROCESSED BY
CONST. ZONE
TRACTz
TEL.
OWNER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESSWe&
CLASS NO. DWELL. UNITS BK PG
CITY ZI'917M
ARCHITECT OR TEL.
VALUATION $ 1, f
ENGINEER NO.
ADDRESS BLDG. SETBACK FROM
FRONT PROP. LINE OF (STREET)
TEL
CONTRACTOR NO. HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
FRONT PROP. LINE HIGHWAY WIDTH
LIC.
ADDRESS NO.
_
+
LIC.
CITY CLASS
BLDG. SETBACK FROM
CONSTRUCTION LENDER
SIDE PROP. LINE OF- (STREET(
NAME AND BRANCHTOTAL
SETBACK FROM TYPE OF EXISTING
OL
HIGHWAY + YARD = SIDE PROP. LINE HIGHWAY WIDTH
0
ADDRESS CITY
",
SO. FT. NO. OF NO. OF CHECK
SIZE STORIES FAMILIES ONE
+ _
USE ZONE AP
?
C
DESCRIPTION OF WORK NEW ®
NOO.
ADD ❑
SPECIAL
CONDI IONS �
ALTER ❑
r. .° BY
FINALS. t ,�'% > �
®ziREPAIR
DATE'
USE OF DEMOL ❑
Z I
EXISTING BLDG,
APPLICANT TEL
(PRINT) 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
PERMITTEE
ADDRESS
TEL.
CITY NO._
" 0 P.C. Fee $ Ife,
Permit Fee
�a
e�
Issuance Fee
Total Fee 21 9
�--2'1 P,S-
711
Q
Y
Lm
g
V
Q
r
PLANS TO APPLICANT
rRETURNED
APPROVED
DATE NO. DATE
L ,PPROVAI S
VIATEP CERTIFICATE
HEALTH DEEPAPTNENT
FIRE DEPAPTN'iENJT
GRADING
GEOLOGICAL
PEDESTRIAN PROTECTION
IFENCE) fCANOPY)
GPE',4*U INSPECTION
4CONICJ (filiASKIRY.1 WELDG.6
1-01 DPAINAGE
PARKING
APPROVALS
LOCATIONI,
iSETBACK & YARDS)
FRAME
LATH/DRYWALL
LATH 4EXTER
M
HOUSE NUMBER-
CORPECT� POSTED
ENE,GY INSULATION
F IN 11 L
ENI "IEIR 0 N,' F RO N T
R'S NOTES
V,11-42"7 "L