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76A638A CE#803 5-65 APPLICATION FOR BUILDINPERMIT
COUNTY OF LOS ANGELES BUILDING F �'
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION L O CALITY p
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST,.
DISTRICT NO,_ GROUP TYPE PR E D,B
FOR APPLICANT TO FILL IN ' ` � CONST. -/
STATISTICAL ASSIFICATION SEWER MAP
ADDRESS �� �j �= 'SyN / CLASS NO. DWELL UNITS El FC -PG
LOT NO. ..3, BLOCK USE 101E MAP /)
r
'NO. f
TRACT �� �.S` � SPECIAL
CONDITIONS
y r N0. OF BLDGS.
SIZE OF LOT ,J�� '•l SIO NOW ON LOT /
USE OF
EXISTING BLDG. BLDG. SETBACK FROM r T -
E.iT /� TEL FRONT PROP. LINE OF
OWNER TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
AD �•DRESS 7 7 //. HIGHWAY WIDTH FROM C.L.
CITY
•BLDG. SETBACK FROM
ARCHITECT R TEL.
NGINEER NO. SIDE PROP. LINE OF (STREET)
E
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
CONTRACTOR* S�fIRN.S611V NO .y�j.J`,� �C�� 0
ADDRESS tfO3L s✓ NOaL '7-3CORNER CUTOFF YES NO �., U
CITY o� CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS 0
DESCRIPTION OF WORK LV,AY APPROACH, W
SAND PARKWAY TI-r,-, CL
v>
NEW ADD ALTER REPAIR DEMOLISH ` Z
SQ,FT. NO. OF NO. OF
slzE or cur gu .cr, Way approach i
STORIES FAMILIFS
USE OF sfallations should be ta.l.cn
STRUCTURE S Office, or T. C. Co. Er.;neclj'S`C: c'.' : in`order Maqe/ 11 e/it 7°L — ra..c:s ar, Is no
SIGNA; URE OF v unfil Permit has boon issued. App!y App! for padkway free
APPLICANT ^l(/ I y Nall.
VALUATION$ /3 90, v
APPROVALS DATE INSPECR'S SIGNATURE
P.C. PMT. I FOUNDATION, LOCA-TION i
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
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. _
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN 5 C ENSATION IN,SU/R/ C�EJ. q LATH. EXT.
SIGNATURE OF �A `/ f(/ HOUSE NUMBER COR-
PERMITTEE ///CCC/// V./"C. �! RECT AND POSTED
ADDRESS �Q e Z �'�/ F I N A L
JOHN F. LEWIS. PRINCIPAL T RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION cK. M.O CASH
LJ�i G 1 6 8 7 w I-AY 2 1 D 1 1.5 0