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7GA63BA CENS035-B5 APPLICATION FOR BUILDING PERMIT //
COUNTY OF LOS ANGELES 5UILDIN
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DEPARTMENT OF COUNTY ENGINEER Ap DREII T -<
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN JENKINSSUITOF BUILDING CROSSST 4::� /
DISTgtCT N O O TYPE PROCESSED BY
FOR APPLICANT TO FILL IN a 0 CONST
B UILDINO ,_ STATISTICALJ��y'A SSIFICATION SEWER MAP
App REBS S'J(J LE C L� CLASS NO `� DWELL UNITS 8K`PG�
LOT NO OjCI BLOCK USE NOP SOD
TRACT SPECIAL
NOW
OF SLOGS CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
rBLDO SETBACK FROM
OWNER 170/-J / NEL FRONT PROP LINE OF - IBTREE
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TYPE O! [%ISTINO SETBACK HIGHWAY YARD - TOTAL
ADDRESS HIGHWAY 'SETBACK
C L
CITY
ARCHITECT OR TEL [LOG SETBACK FROM
ENGINEER NO SIDE PROP LIN[Of (STREET)
TYPE 01 [%ISTIMO SETBACK HIGHWAY } YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
CONTRACTORC/ Q� fJ %/T0L '22 d } /Q - `d 0
ADDRESS Gµ NO / CORNER CUTOFF YES NO V
CITY a LIE -� SEE REVERSE SIDE FOR SPECIAL APPROVALS O
DESCRIPTION OF WORK
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NEW ® ALTER REPAIR DEMOLISH �-
SO FT NO OF NO OF d� Z
SIZE STORIES ,FAMILIFS
USE OF
STRUCTURE Al /
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SIGNATURE OFA //-,j- �r
APPLICANT C�X4(�((
VALUATION$ / v O O
APPR ALS DATE INSPECTOR'S SIGNATURE
PC PMT FOUNDATION LOCATION
FEE$ FEES FORMS, MATERIALS
FRAME FIRE STOPS
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 'RAC", BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
9UILOING CONSTRUCTION I CERTIFY THAT IN DOING THE WORN
AUTHORIZED HERESY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THELABOR CODE OF THE STATE OF CALIFORNIA RELAY
ING TO WORKMEN 3Cn/ry�PENBATION IN ANC LATH ENT
SIGNATURE OF ////. e HOUSE NUMBER COR-
PERMITTEE YTI///fff RF9T AND POSTE
ADDRESS-[A-2. v S.ZFI NAL
JOHN F LEWIS 1.161 P L ST RAL ENGINEER
PLAN CHECK VALIDATION CK M D CASH _ PERMIT VALIDATION CK NO CASH
LHLo 4 9 5 0 SEP 2 6 1 D 1 1-50- Q