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7GA638A CE#8033 88-APPLICATION FOR BU I LDIG PERM
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST
DISTRICT N G P TYPE R D BY
FOR APPLICANT TO FILL IN CONST
I BUILDING C STATISTICAL CL IFICATIONI S ER MAP _
ADDRESS Y9/.3 Na, RENES ✓E CLASS NO DWELL UNITS BK PG
LOT NO / BLOCK � US ONE MAP -
NO
TRACT �� SPECIAL
CONDI ION �-L -
r/ / NO OF BLDOS _
SIZE OF LOT � JVD NOW ON LOT
USE OF
yy�� BLDG SETBACK FROM
/F/ON NO .a 617 FRONT PROP LINE OF (STREET)
OWNER TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL
ADDRESS 1/C 13 D HIGHWAY T F M C L
CITY ' P/lL (,�T� + -
ARCHITECT OR TEL BLDG SETBACK FROM
ENGINEER - NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK NIGNWAY { YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
n TEL +
CONTRACTOR WADI♦ NO
LIC
ADDRESS NO CORNER CUTOFF YES NO
C
CITY L'C SEE REVERSE SIDE FOR SPECIAL APPROVALS c
DESCRIPTION OF WORK c
h u
NEW ADD ALTER REPAIR DEMOLISH i B N� �� C
SQ FT Ri NO OF NO OF
SIZE STORIES FAMILIES
STRUCTUREjj-DRACE r ?
do
SIGNATURE OF
APPLICANT ffe
VALUATION$ d (/ 00 APPROVALS DATE INSPECT 8 IGNATURE
P C PMT FOUNDATION LOCATION //z,7 t/ 060,
FEE$ FEE$ FORMS MATERIALS vv
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING 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
SUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INTAL
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE LATH EXT
SIGNATUREAee. HOUSE NUMBER COR
PERMITTEE �_' RE AND POSTED
ADDRESS FINAL
JOHN F LEWIS PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK M 0 CASH �.o PERM VALIDATION CK MO NAS
kPR 8 1 D 6 00N
I �'