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CE #8031REV. 6/78) ;yLi
APPLICATION
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRESS
BUILDING
LOCALITY
ADDRESS
1
CITY °
ZIP�A
NEAREST
CROSS ST.
NO. OF BLD S.
ASSESSOR
I
SIZE OF LOT
NOW ON LOT
MAP BOOK PAGE
PARCEL
DISTRICT GROUP TYPE I FIRE
PROCESSED BY
TRACT
LOT NO.
CCO�jNST. ZONE
gBLOCK
y�
"
OWNER J7�" ®
NO.
y` 1
_ _
'-
STATISTICAL CLASS( TION
SEWER MAP
ADDRESS
l&d
CLABEEN=SS NO. r DWELL. UNITS
BK PG
CITYonsoomm
ZIP
ARCHITECT OR
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P
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VALUATION �j�
ENGINEER
SSvLNO. %
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ADDRESS L .. .�j�
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BLDG. SETBACK FROM
TEL.
FRONT PROP. LINE OF
(STREET)
CONTRACTOR Lj)
NO.
HIGHWAY + YARD = TOTAL SETBACK FROM
TYPE OF EXISTING
LIC.
FRONT PROP. LINE HIGHWAY
WIDTH
ADDRESS
NO.
LIC.
+
CITY
CLASS
BLDG. SETBACK FROM
CONSTRUCTION LENDER
AND BRANCH.
SIDE PROP. LINE OF
(STREET)
NAME
TOTAL SETBACK FROM I
TYPE OF FEXISTING
HIGHWAY + YARD = SIDE PROP. LINE IHIGHWAYI
WIDTH
ADDRESS
CITY
SQ.FT. NO.OF
NO. OF
CHECK
+ _
SIZE STORIES
DESCRIPTION OF WORK
FAMILIES
ONE
'NEW L�j
P.C. Fee $ % '' Permit Fee
�p ADD ❑
ALTER ❑
�y REPAIR ❑
USE OFs✓ DEMOL ElEXISTING 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 IN NCE.
SIGNATURE F
PERMITTEE
TEL.
j NO.
NO.
SPECIAL—
C/ONDITIONS
FINAL /'-=: / __ I BY
Issuance Fee
Total Fee 4
Z
O
Q
J
Q
x
v
V
Z
Q
d
PLANS TO APPLICANT
O RETURNED
i APPROVED
F,NO DATE � NO, DATE
E�
I
APPROVALS REQUIRED i O, 9FRECEIVED
YES 1 1,10 OR APPROVED
WATER CERTIFICATE � N4
H DEPARTIAENT
FIRE DEPARTMENT
GRADING
GEOLOGICAL
PEDESTRIAN PROTECTION
(FENCE) (CANOPY)
SPECIAL INSPECTION
(CONC.I 11,AASNRY.) (WELDGT
LOT DRAINAGE
PARKING
r
APPROVALS
)
LOCATIOI`N-
SETBACK & YARDS) t
FOUNDATIONS Lf, !I
FRAME
w Y
LATH/DRYWALL, y 9
INf IOP
H
CORT POSTED_
ENERGY INSULATION
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ENTER ON FRONT
OATS I I I Oi s �ti ,l I U E
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