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Os 76A638A
CE/803(REV.6/78) 1
• rte ___4'APPLICATION FOR BUILDI G PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETYBUILDING
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FOR APPLICANT TO FILL IN ADDRESS AM-3 04(v'a V T-
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BY(SIGNATURE) Q
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 7 2 3,7 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES w
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _
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@IS 776A638A
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Y�APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADIDRESS
BUILDING '7 L
ADDRESS j ' / /G.. -O�L��i /y/ LOCALITY
NEAREST
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SIZE OF LOT N�.dX/G�.r NOW ON LOT OASSESSOR
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ARCHITECT OR . TEL. VALUATION
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CONTRACTOR NO._ HIGHWAY +• YARD __ TOTAL SETBACK FROM TYPE OF EXISTING
LIC. FRONT PROP.LINE HIGHWAY1 WIDTH
ADDRESS NO:
CITY CLASS BLDG.SETBACK FROM
CONSTRUCTION LENDER - SIDE PROP.LINE OF (STREET)
NAME AND BRANCH
_ TOTAL SETBACK FROM TYPE OF EXISTING :912-
` HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY 'WIDTH
ADDRESS CITY
SO.FT/9 NO.OF NO.OF CHECK + _
SIZE STORIES FAMILIES ONE.
DESCRIPTION OF WORK klWa NEW ❑ P.C.Fee$ Permit Fee
L•f�y v ADD Issuance Fee us
ALTER
REPAIR ❑ Total Fee 79
USE DEMOL ❑
EXISTING BLDG. Z
APPLICANT TEL r C
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BY(SIGNATURE)
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE. V ,
THAT THE ABOVE-Is CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES 4u
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Z
PENSATION INSURANCE.
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SIGNATURE OF \ o c r
PERMITTEE
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