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APPLICATION FOR BUILDING PERMIT
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COUNTY OF LOS ANGELES ,. -BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADIDRESS �19Z-4
BUILDING FJ`�2 r� r`
ADDRESS _ LOCALITY
/� ` NEAREST
CITY .i G� ZIP CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOT 9116 NOW ON LOT 40 MAP BOOK ' �� PAGE PARCEL
/or DISTRICT GROUP TYPE FIRE PR CESSED BY
TRAC � BLOCK V LOT N'Clp Q �� CON ZONE
OWNE ,0V,0W Nur'O 7J�cd 3 �}
_ STATISTICAL CLASSIFICATION : / SEWER MAP
ADDRE59*1f 11r .w CLASS NO OfJ DWELL UNITS BK/(/PG e
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CITY �ra�1` //y'JL `. ZIP ' +
ARCHITECT OR TEL VALUATION $ '�!�'�d 'y 1
ENGINEER •NO
ADDRESS_ BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
CONTR4& N ySz O HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC FRONT PROP LINE HIGHWAYl WIDTH
ADDRESS NO
LIC + _
1 A
CITY CONSTRUCTION LE CLASS r BLDG SETBACK FROMIII r
NAME AND BRAN ✓ � SIDE PROP LINE Of (STREET( I"
SETBACK FROM TYPE OF EXISTING 16- 1
HIGHWAY + Y�= TO'ADDRYZWV //o Y �/ SIDE PROP LINE HIGHWAY WIDTH V
SQ F NO OF NO OF CHECK + 0
'� =
SI � STORIES FAMILIES / ONE � U5�ZONA MAP
DESCRIPTION OF WORK Z Orli/ C NEW O
(D` I
SPECIAL
ES ADD ❑ � CONDITIONS 1 N
/' �p ALTER ❑ FINAL jBQe 1 � a
S' e, dJ AIR-❑ DATE
USE OF DEMOL REPr t
EXISTING BLDG r _ 1.9 ,1� z�r T
APPLIC T TEL a / /U
NO
BY(SIGN
I HEREBY ACKNON( GE THAT I E READ IS CATION AND T E Q uY
THAT THE ABOVE IS RRECT AND REE TO MPL ITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE i�I/� �v R=
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF (J V
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
PENSATION INSURANCE ,-
;199a3A
SIGNATUREOF
PERMITTEE # 0 0 0 0 a f, r r
ADDRESS 000-
O 2 0 5 5 IL 5 0
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TEL '' F c
CITY NO 0 0 554 5Qv
PC Fee$T Permit Fee S-0 > 0 4' 16;-80
Issuance Fee ? It
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Total Fee If 0 +
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