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I (V�S 76A838A � �
GE i809lREV.6/78) � � � �
APPLICATION FOR BUILDING PERMtT
COUNTY OF LOS ANGELES � BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRE55
ADDRESS 20925 E. Runnin Branch Rd. �ocaurr D1 m
NEAREST
CITY ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PR ESSED BY
TRACT 29053 BLOCK LOT NO. �� CONST. ZONE
TEL. �O R-3 et.wa 1 I ��-v
OWNER NO.
^' STATISTICAL CLASSIFICATION SEWER MAP
ADDRE55 ZOO IY. TUSt'n Ave. ��AUNO. 21 OWELL.UNITS BK PG
CITY ZIP
ARCHITECT OR TEL. VALUATION $350.��
ENGINEER NO.
ADDRESS BLDG.SETBACK FROM
- iE� FRONT PROP.LINE OF ISTREET�
CONTRACTOR Di amond Ri d e N� 95 � HIGHWAY + YARD TOTAL SETBACK FROM TYPE Of EXISTING
ADDRESS ZOO N• TUSt�I� NO. 3236+40 FRQNTPROP.LINE HIGHWAY WIDTFi
LIC. + _
CIiY S CLASS
CONSTRUCTION IENDER p BIDG.SETBAC
NAME AND BRANCH HO� F d. S at � SIDE GROP.LINE OF ISTREETI
TOTAL SETBACK FROM TYPE O EXISTING �"
p FtIGfiWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH d'
ADORE55 f.�• Box 988 C1TY �a "ta (�a d
SQ.FT. NO.OF NO.OF CHECK + = V
SIZE STORIES FAMILIES ONE Ci
DESCRIPTION OF WORK NEW P.C.fee$ Permit Fee � �"� �
ADD ❑ �
� ❑ Issuance Fee . GU �
�dison transf rmer AISER
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REPAIR ❑ Total Fee / S � ll��
USE OF DEMOL
EXISTING BLDG. Z
APPIICANT TEL Q
IPRINTI NO. Q
C
�
BY 151GNATURE� `
�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPIICATION AND STATE �
THAT TF{E ABOVE IS CORRKT AND AGREE TO COMPIY WITH ALL ORDINANCES yVj
AND LAWS REGULATING BUIIDING CONSTRUCTION.I CERTIFY THAT IN DOING THE S
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF V
THE LABOR CODE O STATE OF CALIF RNIA IN RELATING TO WORKMEN�S COM� Z
PENSATION INSUR CE
�: 1 �G,C; f�
SIGNATURE OF : � � � � �.� .�
PERMITTEE
ADDRESS 20 N. u t n A o I o • 1 5.0 C
TEL.
CtTY Santa Ana NO. - ~
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