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APPLICATION FOR BUILDING P RMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUP T OF BUILDING NEAREST
CROSS ST f/;z
DISTRICT NO GROUP TYPE PROCESSED BY
rEXISTING
OR APPLICANT TO FILL IN s CONST
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ING „ �� I STATISTICAL CLASSIFICATION SEWER MAP
Y" r �
SS CLASS NOF-DWELL UNITS BKC PIS 7(p
O Po� lB BLOCK USE
ZONE NO
O/
/ �/ CONDITIONS
SPECTAL
NO OF SLOG S
F LOT , a NOW ON LOT
NG BLDG � BLDG SETBACK FROM /�TEL r/f FRONT PROP LINEOF �U���-(STREET)
NO !(7VTYPE OF EXISTING SETBACK HIGHWAY } YARD - TOTAL
HIGHWAY WIDTH FROM C L
SS U J (J tBLDG SETBACK FROM
TECT R TEL SIDEPROP LINEOF (STREET)
EER NO
TYPE OF EXISTING1 SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
TEL } = y
CONTRACTOR NO d
461 4 LIC C:)
ADDRESS NO CORNER CUTOFF YES ❑ NO U
LIC
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS o
U
DESCRIPTION OF WORK
z
NEW ADD ALTER REPAIR EMOLIS
SQ FT NO OF N
SIZE STORIES FAMILIES
USE /
STRUCTURE�
E r C= G
SIGNATURE OD
APPLICANT
VALUATION $
APPROVALS DATE INSPECTOR S SIGNATURE
P C PMT 1 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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION 1 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 5 COMPENSATION. INSURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
A
ADDRESS FINAL f'O (p
JOHN F LEWIS PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION CK M o CASH
PERMIT VALIDATIONCK M o CASH
8 ' 9 5- FES 6 1 D