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APPLICATION FOR BUILDING PERMIT
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COUNTY OF LOS ANGELES BUILDING AND SAFETY (2,"-
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ADDRESS BLDG SETBACK FROM
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LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
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CITY _ CLASS BLDG SETBACK FROM
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ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH 0
SIZEFT C. NO OF NO OF ! CHECK + = V
STORIES FAMILIES ONE O
DESCRIPTION OF WORK 4 JQj0 0 iv% NEW ❑ PC Fee$ Permit Fee
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BY(SIGNATURE) s � ��7 Ja c
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE '�� 7 / /CS 'Y uY }O ° oi5 7 60 V 1
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE
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WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF C��
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM /� Z 2534,6A
PENSATION INSURANCE r Sv Z iii / _
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SIGNATURE OF
PERMITTEE Z ° 1 2 4 Q O
ADDRESS 2 to 0 1 2 rr1,C
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NO 07 09- 1 `MAP NO` DQSPE IALDITIONS
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