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38ACEi1#033-66 APIRE ICATION FOR BUILDING ERMIT
• COUNTY OF LOS ANGELES BUILDINGL
DEPARTMENT OF COUNTY ENGINEER ADDRESS9pe 71F g2-
BUILDING AND SAFETY DIVISION LOCAL[ Y
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING. CROSS ST
FOR APPLICANT TO FILL IN DISNO GR CONST , R c s
TRI
BUILDING STATISTICAL ASSIFICATION SEWE MAP/
ADDRESSC/G• �° CLASS NO —2MELL UNITS ^BK- PG6
L I16y' 3} 2 LOCK iUSE ZONE NOP ��((JJ
TRACT — �Z SPECIAL /
' NO OF SLOGS CONDITION
SIZE OF LOT NOW ON LOT Z t
USE OF
OLDS SETBACK FROM
TEL FRONT PROP LINE OR '� (ATREET)
OWNER _j-, ! IE N �•"�"C3'"'T' TYPE OF EXISTING SETBACK HIGHWAY -+ YARD = ' TOTAL
ADDRESS �� i — G' -• H HWAY W DT F OM C L
CITY 7 [" '� , 4. bLDO 9E BACK.FROM
ARCHITECT OR 'TEL /oA SIDE PROP LINE OF (STREET)
ENGINEER NO �p iRR
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS
HIGHWAY WIDTH FROM C L t
TEL +
CONTRACTOR ® NO
LIC CORNER CUTOFF YES ❑ NO V
ADDRESS NO
CITY cic SEE REVERSE,SIDE%FOfhPECI9L•,APPROVALS o
` DESCRIPTION OF WORK
16 ' , f, yfV
- r t y
NEW ADD ALTER REPAIR DEMOLISH ' - Z
SO FT NO OF NO OF ! Ayr t ' '♦� • ��
SIZE a STORIES FAMILIES
'USE OF
i
STRUCTURE S-w: � � cf +�, .�J , y "�-•-ti- °' " I
SIGNATURE OF
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APPLICANT IYs(d//9'f.RA1 /) ld�gl}7N�ei .�� v , A/1•ieJd
VALUATION.' I IS , I� I .00 a, �:t
APPROVALS DATE +IN8PEC R' SIGNATURE
P C• PMT FOUNDATION_LOCATION �i.��/ - a� f
FEE FEE$ FORMS, MATERIALS !/'- b
FRAME, FIRE STOPS, zv `
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT •'�:� A Y
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION ♦ -'+ "1
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS' a 7•. W ♦ • , �• 4 +�, I
RUILDI NG CONSTRUCTION •1 CERTIFY THAT IN DOING THE WORK _
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT ��`
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT s I•'L�• ^1 w a t
ING TO WORKMEN SCOMPENSATION INSURANCE LATH EXT 1 �ZY�v�- • ` `,
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SIGNATURE OFHOUSE NUMBER COR- I}
PERMITTEE 1LdA— jL .RE VAND POSTED -t }
ADDRESS b FI NAL •````' ' �' r - 'fl ,1j, •
JOHN F LEWIS PR IN I AL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK M o CASH _ PERMIT VALIDATION Mo CASH
6 0 9 tPE Nov 30 1 D' 11.5 0'!t'
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