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76AA:ACE'f"803369 APPLICATIONFOR OR BUILDING PERMIT �I
•� •COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST /D
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST l
DISTRICT NO GROUP TYPE CONST PROCESSED BY
FOR APPLICANT TO FILL IN 9— r
(PRINT OR TYPE ONLY) 'r y
BUILDING /� �� STATISTICAL CL S IFIc'4 N SEWER MAP `
ADDRESS
CLASS NO DWELL UNITS BK PG
LOT NO BLOCK US ZONE MAP
NO
TRACT SPECIAL
NO OF BLCONDITIONS
SIZE OF LOT NOW ON LOTT
USE OF
EXISTING BLDG �.11 BLDG SETBACK FROM
OWNER cZw e- NO FRONT PROP LINE OF, S /'tL� (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
CITY
ARCHITECTOR TEL BLDG SETBACK FROM
ENGINEER CCJ��� NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
[APPLICANT
SS HIGHWAY WIDTH FROM C L
TEL + -
ACTOR NOLIC
`
SS NO CORNER CUTOFF \1 YES ❑ NO c
IC L
CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS n
RUCTION LENDER
ND BRANCH /} A ✓ //�)
SS / C/rCJI'?G 63 I� ��ONJ�'^ v
S SQ
jE STOOR ES FAMOF NO �LIES / NEW ❑ 97,
.�_
r'`i••c�rTi✓
d ADD
TURE lfc(iCJ Of'G
ALTER
REPAIR ❑
URE OF .rt DEMOL ❑
ANT ^^��
VALUATION $ C.il.l APPROVALS /DATF INSoR S12! TURF
P C PMT dA FOUNDATFORMSO MATERAIALSN d
FEE $ FEE $ ��
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION I FRAME FIRE STOPS
BRACING,
RACING BOLTS 42
AND STATE THAT THE A80VE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC GAS VENT DUCTS
TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE ) LATH INT
OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM 22 yy
PENSATION INSURANCE LATH EXT
SIGNATURE OFHOUSE NUMBER CORRECT
PERMITTEE SOV�o AND POSTED
ADDRES z2zkFINAL !m ��70
JOHN F LEWIS PRINCIPAL STRUCTURAL ENG ER
PLAN CHECK VALIDATION CK M 0 CASH - PERMIT VALIDATION CK m 0 CASH
( '„4 5 6 3C AFR20 1 B 900-