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APPLICATION FOR BUILDING PERMIT U
�.- COUNTY OF LOS ANGELES ASSESSOR
y DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING ADDRESS /�j�[j, / I S�
JOHN A LAMBIE, COUNTY ENGINEER (JF / L
COLEMAN W JENKINS SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST /CROSS ST �ZOSO
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DISTRICT NO GROUP TYPE ES SED BY
BUILDING "05) D S 0 CONST
ADDRESS
STATISTICAL CLASSIFICATION SEWER MAP
LOT NO BLOCK A CLASS NO--Z-/ DWELL UNITS BK PG
TRACT k� / 7� NO OF BLDGS USE ZONE No I�
SIZE OF LOTd - Ile NOW ON LOT I SPECIAL ! C�
USE OF 1\ CONDITIONS
EXISTING BLDG
TEL
OWNER/" v C NO ,2" BLDG SETBACK FROM
ADDRESS f FRONT PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY / r HIGHWAY WIDTH FROM C L j
1
ARCHITECT OR, TEL + =
ENGINEER G NO 5v- I--
BLDG SETBACK FROM
ADDRESS �0 SIDE PROP LINE OF (STREET)
TEL // TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CONTRACTOR p NO /7 HIGHWAY WIDTH FROM C L
LIC a _ o
ADDRESS + ti - C.7
1
CITY C J�/(CL SS CORNER CUTIOFF� YES ❑ �S NO =
CONSTRUCTION LENDER � >> t
NAME AND BRANCH /Vb SEE REVERSE SIDE,FOR SPECIAL APPROVALS a
ADDRESS - N
SQ FT i i NO OF NO OF NEW L Z
SIZE STORIES FAMILIES CJ p
USE OF ADD ❑ G (\
STRUCTURE
ALTER ❑
REPAIR❑ C! '�/ ,7 7
SIGNATURE OF A /�t/!.� ko
APPLICANT DEMOL ❑
VALUATION $ APPROVAL,, DATE INSP OR S ATU RE
FOUNDATION LOCATION
FEE $ FEE$ FORMS MATERIALS
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS ;6Z 4X7
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL ORDINANCES AND LAWS-REGULATING BUILDING CON GAS VENT DUCTS
STRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION 0 LATH INT
LABOR CODE OF THE STATE OF CALIFORNIA IN REL NG T
WORKMEN S COMPENS N INS E LATH EXT ,
SIGNATURE O HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS FINAL
PLAN CHECK VALIDATION CK M o cnsH _ JOHN F LEWIS PRINCIPAL STRUCTURAL E
PERMIT VALIDATION CK mo CASH
j Apr 7 5 l 3ct-- ROY 6 10 1200-