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APPLICATIO FOR BUILDING PERMIT 9
COUNTY OF LOS ANGELES ASSESSOR
MAP BOOK PAGE PARCEL
DEPARTMENT OF COUNTY ENGINEER BUILDING r �J
BUILDING AND SAFETY DIVISION ADDRESS J
,NA hE CNECAN PAI ABLL IO
HARVEY T BRANDT COUNTY ENGINEER LOCALITY
FOR APPLICANT LL IN NEAREST
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BUILDING ,/r t /J� J DISTRICT NO GROUP TYPE PR ESSE BY
ADDRESS �21 O c �� U'1`L7 (� a CONST
TION SEW
LOT NO UZ BLOCK IS ATISTIGAL��C77LA/SSIFICA SEWER IN
I CLASS NO. DWELL UNITS BKG PdI,6
TRACT
ONEMAP
NO OFNo
SIZE OF LOT 7s7� I`-i NOW ON LOTS — SPECIAL
USE OF CONDITIONS
EXISTING BLDG I
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OWNER NO BLDG ETBACK FROM _
ADDRESS IFRONTIVROP LINEOF (STREET)
TYPE OF ISTING SETBACK HIGHWAY } YARD = TOTAL
CITY !HIGHWAY DTH FROM C L
ARCHITECT OR TA� I
I } _
ENGINEER NBLDG SETBACK
ADDRESS ���� SIDE PROP LINEO (STREETI'STp
CONTRACTOR Ratlf1 1'0Nsfffuc
(HIGHWAY WIDTYPP OF H FROM C L AY 4 YARD = TOTAL �O
ADDRESS ��/�O G �• L'C
CITY ?� CILA55 G=39 CORNER CUTOFF VES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SO FT NO OF NO OF NEW ❑
S1ZE STORIES FAMILIES
USE OF ADD —
STRUCTURE _
ALTER ❑
SIGNATURE OF REPAIR❑
APPLICANT DEMOL ❑
VALUATIONS SoA
APPROVALS DATE IHa o[c row•a SIGNATURE
P C PMT /• �� FOUNDATION LOCATION
�
FEE 5 FEES FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ TM13 APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL OR DINANC[S AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS -
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HERESY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT
"SON CODE OF TH[ f OF CALIFORNIA IN RELATING TO
WORKMEN 9 COMPEN IMSUR MC[ LATH EXT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS e [ FINAL l �3
PLAN ClIECB VALIDATION CK M D CASH _ PERMIT VALIDATION CK .0 ueH
s(` 0 9 8 573 fAy 7 1 D 21 .75-