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76A638A CE14803 5 65 APPLICATION FOR BUILDING ERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION L O C A L I T
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST +
FOR APPLICANT TO FILL IN DI l 0 G CONST TYPE PR CEs 6Y
BUILDING STATISTICAL ASSI FIC ATION SEWER MAP
A DD R ESS�p�lO CLASS NO DWELL UNITS BK PG
LOT NO BLOCK USE ZONE MAP
/ NO / C�
TRACT �. Z �j A-(
SPECIAL
NO OF BLDGS 1 CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLQG BLDG SETBACK FROM
d TEL FRONT PROP LINE OF (STREET)
OWNER TYPE OF EXISTING SETBAC HIGHWAY -YARD = TOTAL
ADDRESS,5--21/,o HIGHWAY WIDTH FRO L
CITY
BLDG SETBACK FR
ENGINEER NO
ARCHITECT TEL SIDE PROP LINE F (STREET)
TYPE OF EXI ING SETBACK HIGHWAY + RD = TOTAL
ADDRESS HIGHWAY W TH FROM C L
CONTRACT TEL
ADDRES Lp / ` CORNER CUTOFF YES NO S
CIT CILA �/Z� ISEE REVERSE SIDE FOR SPECIAL APPROVALS O
"DESCRIPTION OF WORK
_ a
NEW ADD ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF / {� _ ?
SIZE STORIES FAMILIFS
USE OF d
STRUCTU
SIG URE OF
APPLICANT
VALUATION$
APPROVALS DATE INSPECTOR SSIGNATURE
P C PMT / 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
9UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CO OF THE SM�;;Z
ING TO WORKMEN S C P N ION INLATH EXT 1
'oe
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED r
ADDRES Fl NAL
JOHN F LEWIS PRINCIPAL STRUC-TRAL ENGINEER
PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION cK M c CASH
5 0 8 V8 OCT 3 1 D 1 150- a
I -