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76A638A CE#803864 APPLICATION FOR BUILDING PERMIT _
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRES
BUILDING AND SAFETY DIVISION L OIC A L I T Y
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN •j„ o6 1 -Z CONSTT
BUILDING STATISTICAL CLASSIFICATION t SEWER MAP _
ADDRESS CLASS NO DWELL UNITS K �`
LOT N05e Qr 8 BLOCK USE ZONE MAP
NO LSA
TRACT It4-e5 I SPECIAL
V
r NO OF SLOGS O I
T IONS
SIZE OF LOT �UY I V NOW ON LOT '
USE OF Y
BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
OWNER NO TYPE OF EXISTING SETBACK -HIGHWAY YARD = TOTAL
ADDRAqVjr;:�LHIGHWAY WIDTH FROM C L
O +
CIT BLDG SETBACK FROM
ARC E T OR TEL SIDE PROP LINE OF (STREET)
ENGINEER NO
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL }
ADDRESS HIGHWAY WIDTH FROM C L I d
T L + _
CONTRACTOR - - U
ADDRES Np G' h CORNER CUTOFF YES NO O
c Y G CL ;SEE REVERSE SIDE FOR SPECIAL APPROVALS w
U
DESCRIPTION OF WORK )
z
NEW ADD ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIES I
USE OF
STRUCTUR
SIGNATURE 6F
APPLICANT
VALUATION$ APPROVALS DATE I NSPECTOR,991G NATURE
FEE$ FEE$ FOUNDATION LOCATION , f
FORMS MATERIALS
FRAME FIRE STOPS f 1 A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTJ 1
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION } i
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS 1 1
9UILDI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK o
AUTHORIZED HEREBY I NOT EMPLOY ANY RSON IN VIOLA LATH INT
TION OF THE LABOR C C OF THE STATE OF A IFORNIA RELAT
ING TO WORKMEN 6 P SATIO NSURANC LATH EXT
SIGNATURE OF HOUSE NUMBER COR W `
PE42MITTEE RE AND POSTE 1
ADDRESS Fl NAL W'2;5Aj
PLAN CHECK VALIDATION CK MO CASH JOHN F LEWIS PRINCIPAL STuucc��TURAL ENGINEER
PERMIT VALIDATION U mo CASH
nU30 4 0'12
PGP15 1 D BOON
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