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76A638ACE#8031-62 APPLICATION FOR BUILDING Pl:IRMIT , .
CbuNT'Y OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS -
BUILDING AND SAFETY DIVISION LOCALITY `� r
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN;SUPT OF BUILDING CROSS ST.
-` J DISTRICT Ng. GROUP TYPE P ESSED BY
FOR.APPLICANT. O•FILL IN corisr: ff
— �
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS CLASS..NO. DWELL. UNITS
LOT NO. a BLOCKWATER - _ K �jra
1 � �'� - C'j� / r �. '
El NOT REQUIRE RECEIVED
TRACTyj�J�' 6 MAP - HIGHWAY •'
O.OF SLOGS. NO. e9 I 'ROLE) STATE MAJOR SECOND, O-_•AL
SIZE'OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF - CONDITIONS
EXISTING BLDG. -
. T.EL. - '" �
OWNER ' NO.. BUIL ING - EXIST.
SETBACK YARD HWY STREET AME WIDTH
ADDRESS FRONT y +jam
ARCH ITEOR TE P I- r'1 ✓/
ENGINEER NO. "SIDE
ADDRES
TEL U
CO •r NO. .
u
ADDRES vo toQ
DESCRIPTI NOF WORK u
W
0.
Uf
NEW ADD ALTER REPAIR DEMOLISH - z
SQ. FT. NO. OF NO. OF
SIZE STORIES FAMILIES .
USE OF h
STRUCTURE ` c-
SIGNATURE OF
APPLICANT
w � e
' VALUATION $ ^�
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. Q p, FOUNDATION: LOCATION
FEE $ �"�? FEE.$ ..FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE,READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. J
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT., DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF.THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN'S&CPNSATION INSURANCE.
LATH, EXT. -
SIGNATUREfU t HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL
• l�h JOHN F. LEWIS, PRINCIPAL ST `RAL ENGINEER
PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION CK M.O. CASH
G,�i 9 5 4 NOV 14 1 Q 6.G 0