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CE #803 (REV. 11 78)
APPLICATION FOR B;,aILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN
ADDRESS
BUILDING _
ADDRESS —1 V � � �
LOCALITY
?`s
NEA EST
CITY ZIP
CROSS ST_ (A,e
NO, OF BLDGS.
ASSESSOR
SIZE OF LOT NOW ON LOT
MAR BOOK
PAGE
PARCEL
_
TRACT !_ C9 . BLOCK LOT NO.1,��_77ESSEDBY
DI1 TRICT GROUP_ TYPE
FIRE
vF7
TEL..
OWNER 14 _j_ 8120 CA� NO.
S7A11STICAL CLASSIFICATION
SEWER MAP
'1 ADDRESS _ .S
CLASS NO. DWELL. UNITS
BK PG
I ]
'i CITY _ q.' ZIP 49 % /
ARCHITECT OR TEL.
ENGINEER NO.
VALUATION $
(g
ADDRESS F=
BLD, . SETBACK FROM
TEL.
FRO T PROP. LINE OF
ISTREETI
CONTRACTOR Ll�'L9 NO. .a � Z d"
+ YARD - TOTAL SETBACK FROM TYPE OF EXISTING
4a LIC.HIGHWAY
FRONT
PROP. LINE HIGHWAY WIDTH
_
s ADDRESS S � Na , 4j'3 Y-
`:;a LIC.
%CITY CLASS -
+ _
BLDG. SETBACK FROM
CONSTRUCTION LENDER
SIDE PROP. LINE OF
(STREET)
-' NAME AND BRANCH
TOTAL SETBACK FROM TYPE OF EXISTING
HIGHWAY + YARD =
ADDRESS CITY
SIDE
PROP, LINE HIGHWAY WIDTH.
I SQ. FT. NO, OF NO.OF CHECK
+
L SIZE STORIES FAMMES ONE
USE ZONE MAP
DESCRIPTION OF WORK �, 4'; {� NEW
NO. '
CJ.a
_�«� ADD ❑
SPEC AL
CON-ITIONS
I.
y / �❑ , BY ALTER FINAL
i:- pzhrvY� REPAIR ❑
( l
DATEUSE
DEMOL El
�s
y G�
I"),EXISTTIING BLDG.
9
' APPLICANT TEL
IPRINTI r NO _, 1126`ii�7NC��(/G
f
t I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
X
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALt 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 CODEOFTHE-STATE OFCALIFORNIA INRELATING TOWORKMEN'SCOM-
PENSAHON INSURANCE,' .�
SIGNATUREOF -
PERMITTEE��L"�
ADDRESS 1 -0
Z
TEL. L 1
CITY Ait NO. G
r
/
P.C. Fee $ Permit Fee cnG l
r
I-Ja Issuance Fee
w
Total Fee
k
0
U
09
0
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