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BUILDING ADDREIBB d
APPLICATION LOCALITY e (,
NEAREST
DIVISION OF BUILDING AND SAFETY CRC BT
Departmentof DISTRICT NO V EIPTpNO PERMIT No.
county of Los Angeles 'Sr `J
WM. J. FOX, COUNTY ENGINEERBR P DATE RECEIVED DATE 188UZD
CA88ATT D GRIFFIN, BLLP'T or BYILOINO
FOR APPLICANT TO FILL IN TYPE CONST. a e1VE BY Qia'ue
OWNER 11, w. 4 MAP
. , NUMBER DD STATE
(19
AMAIL DDRESS YES
`T� USE ZONE SPECIAL
CI c.t'/ NO 7612
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ARCHITECT OR &&&®WVR NO @A
ENGINEER BUILDING YARD HWY STREET NAME EXIBT
a SETBACK WIDTH
ADDRESS �s p �(� FRONT
CONTRACTOR E /v A. �/EAN. ' BIDE (J V
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I QOSCA Y @ O 1Msl P L.
_ / DATE CORRECTIONS INSPECTOR
BUILDING ADDRESS ..�1 O (�
LOT NO OL BLOCK n �
TRACT •vim ,
.( No OF BLOOS. 20 �`"c C QO �.rte' L7• - q!G
SIZE OP LOT NOW ON LOT O
USE OF �"� "'n �� 'e+s lS u/� ivr i✓ QA✓
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DESCRIPTION OF WORE
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NEADD ALTER REPAIR DEMOLISH Z
Bq FT NO OF NO OF r
SIZE STORIES FAMILIES
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ TH18 AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN In APPROVALS �,NspEcTqfilsIGNATURE ATB
CORRECT
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION LOCATION,
AND STATE LAWS REGULATING BUILDING CONSTRUCTION FORMB,MATERIALST moi' S7�
FRAMs FIRE STOPS,
SIGNATURE OF BRACING.8OLTS OAA /m S
PERMITTZ FURNACE' LOCATION, K
GAB VENT.DUCTS �
ADDREBA �+
LATH INT LION_
AUTHORIZED AST
LATH, ®(T µ %A N
6C
CIO P o ; D—U HOUSE NUMBER COR-
S FEE r- RECT AND POBTED
VALUATION FEE ®(3 a, FINAL
7&A4a8^ D883 4-84
(Y 8/78)
ti �
1 + �
• APPLICATION FO BUILDI PERMIT
COUNTY OF LOS ANGELES BUILDING
- AND SAFETY r
FOR APPLICANT TO FILL IN ADDRIESS (C/�/ fQ
ADIDRESS L &
11V,
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LOCALITY C
ZIP NEAREST
CITYy`t;MAlE CLT CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK : PAGE PARCEL
DISTRICT GROUP TYPE FIRE SSED BY
TRACT BLOCK LOT NO CONST ZONE
JZ TE�L��j �,Q
OWNER lT)V STATISTIC CLASSIFI TION (I SEWER
ADDRESS �,)) /. L CIV, CLASSIC DWELL UNITS BK PG
CITY;',--/V Ab `� ZIP 9/
ARCHITECT OR TEL VALUATION $ U v V
ENGINEER NO "'
ADDRESS BLDG SETBACK FROM
TEL < , FRONT PROP LINEOF (STREET)
CONTRACTOR NO HIGHWAY + YARD __ TOTAL SETBACK FROM TYPE OF EXISTING
LIC' FRONT PROP LINE IMIGHWAY WIDTH
ADDRESS r NO -r
LIC +
CIT CLASS
ONSTRUCTION LENDER BLDG SETBACK FROM
NAME AND BRANCH � SIDE PROP LINE OF (STREET(
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING '
ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH w
SO FT B NO OF NO OF CHECK , + _
SIZE � 8
� STORIES FAMILIES ONE O
DESCRIPTION OF WORK NEW ❑ PC Fee.$ Permit Fee 0
' ADD O Issuance Fee y!1
ALTER
REPAIR ❑ Total Fee
USE OF DEMOL
1-3EXISTING BLDG Z
APPLICANT TEL O
(PRINT) NO
D
BY ISIGNATUREI
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE {{Y�
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCESAND LAWS 1L
NG
WORK AUTHORIZED T EING REBYI IDING WILLL NOTEMPLOYANY PERSON IN V OLLTRUCTION I CERTIFY THAT IN A II ONTHE OF @W61 8 A
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM Z
PENSATION INSURANCE # • 8 8 8 8 1
SIGNATURE OF L.41 2 • 97900
PERMITTEE
ADDRESS 5 6060 A a LZ • • • 7 9 0 0TEL v
O
CITY , NO < 07- 21-79
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US ZONE NOoG AP .e�o O b
SPECIAL
CONDITIONS
FINAL,,/ O BY
DATE n v -+�•
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