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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND4!
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APPLICATION FOR BUILDING PERMIT
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FOR APPLICANT TO F LL IN BUILDING
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ADDRESS LOCALITY
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APPLICATION FO BUILDING PERMIT
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FOR APPLICANT TO FILL IN ADDRESS,5-6/-3
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ADDRESS y y ♦ LOCALITY
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ARCHITECT OR TEL VALUATION $ /
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CONTRACTOR NO 77 HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING -
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ADDRESS NO 36
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CONSTRUCTION LENDER BLDG SETBACK FROM -
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DESCRIPT OF WORK NEW PC Fee$ Permit Fee
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REPAIR Total Fee
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APPLICANT TEL F _
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BY(SIGNATURE)
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HEREBY A WLEDGE THAT I HA READ THIS APPLICATION AND STATE �{
THAT THE ABOV CORRECT ANDA E TO COMPLY WITH ALL ORDINANCES yY
AND LAWS RECO TING BUILq NGC TRJCTION CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF lJ 1 9 9 6 A
THE LABOR CODE OF THE STATE CIF CALIFORNIA IN RELATING TO WORKMEN 5 COM
PENSATION INSURANCE q
SIGN
PERMATTEEE OF - - 2 • • 31.00
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