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76A638A CE#803 8 §4 APPLICATION FOR BUILDIN PERMIT
COUNTY OF LOS ANGELES BUILDING
22,
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T of BUILDING CROSS ST
DISTRUSZO GRR S O B
P TYPE P
FOR APPLICANT TO FILL IN �� _�� CONST
BUILDING STATISTICAL �ASSIFICATION SEWER MAP
ADDRESS V� CLASS NO DWELL UNITS BK&—P G/
LOT NO 3rr7� BLOCK USE ZONE MAP
NO
/�
IAC, D
TRACT
L..Q —I SPECIAL
NO OF BLDGS CONDI 10 S
SIZE OF LOT NOW ON LOT
USE OF Q �5 IS
EXItTjNG BLDG, � �T BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
OWNERr 041RA NO I TYPE OF EXISTING SETBACK HIOHWA + YARD = TOTAL
ADDRESS ", I QS J HIGHWAY WIDTH FROM C L
CITY Q V
ARCHITECT OR TEL BLDG SETBACK FROM
ENGINEER NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING ISFTBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L d
TEL I + = 0
CONTRACTOR NO
ADDRESS NO LIC CORNER CUTOFF YES NO 0
F-
Y LICss SEE REVERSE SIDE FOR SPECIAL APPROVALS w
DESCRIPTION OF WORK )
z
NEW ADD CAI TE REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION$ OD
APPROVALS DATE INSPECTOR SSIGNATURE
P C PMT FOUNDATION LOCATION --
F E F E E$ FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT 7*/
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION Y 1
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 /,I }�Q
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT p
ING TO WORKM S COMPENSATION j SURA CE ^ LATH EXT
SIGNATURE IPF ..:w\e. 1 HOUSE NUMBER COR , „
PERMITTEE ���++111777'���++� i RECT AND POSTED A
ADDRESS FINAL
JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CASH
L&O 1 5 8 5"f--,) &Y 13 1 D 600- u