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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
BU LUIN(J FOR APPLICANT TO FILL IN ADDRESS 1 `
BUILDING
ADDRESS LOCALITY _\ Lam^
CITY L,� LI NEAREST
ZIP
CROSS
Si
__NO OF BLDGS _ ASSESSOR_ —
SIZEOFtOT .SSX/�'-� NOW ON LOT, MAPBOOK PAGE PARCEL
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T BLOCK LOT ,0� k1� CONS], �E �+
OWNER , LLA IW N � \J J;�1—
STATISTICAL CLASSIFICATION SEWER MAP
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CLASS N0 DWELL UNITS r B PG
CITYER iij�,, ZIP
ARCENGH
OC. <„ ATO �� , VALUATION S OO
ADDRESS \ _ LUG SETBACK FROM
TEL FRONT PROP LINE OF (STREET(
CONTRACTOR NO TOTAL SETBACK FROM TYPE OF EXISTING
+� HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
ADDRESS J C�. C � WO�LIC -
CITY /l CIA L'.� .�
C
ONS
TRLKTION(ENDER BLDG SETBACK FROM
BRANCH SIDE PROP LINE OF (STREET)
NAME AN71ONLE
HIGHWAY + YARD TOTAL SETBACK FROM TYPEOF E%ISTING
ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH O
SO
FT NO OF NO OF CHECK + V
SIZE STORIES FAMILIES ONE z / O
DESCRIPTION OF WORK NEW PC Fee E Permit Fee 3 Y
ADD Issuance Fee 7 -1
V�
ALTER ❑ Z_
REPAIR Total Fee
USE OF EXISTING BLDG DEMOL /)
EXISTI �'uWR(/ // /f
APPLICANT TEL `il+�/'�� Z G
3417. 1A
(PRINT)
BY ISIGNATUREI j
HERETY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE OO p
THAI THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCE 2 • 2 p 8 0
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF O Q 0
THELABORCMDFTHESTATECIFCALIFORNIAINRE TINGTONVWK S O • • 21R805
PENSATION INSURANCE '
SIGNATURE OF 1 0 6 0
PERMITTEE �` —44 17 2A '
ADDRESS � _
# • •'� • • �
TEL F
CITY NO < 2'- R, 4300
TAE ZONE [SWEI.AL
a
L'1$ �• • • 400 _ONDITIONS r y
FINAL / Q BY
DATE 7+/2'7 /