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APPLICATION F BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS cl^3 ?- Ad b
BUILDING AND SAFETY DIVISION LOCALITY Elt7
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS, SUP T OF BUILDING NEAREST
CROSS ST •C�/
FOR APPLICANT TO FILL IN DIST CT yq CSR P TYPE P E ev
(Print or type only) P C NST
F
ING _ f1 STATISTICAL
�CLASSIFICATION SEWER MAP
ESS / �`E�/�/ DRa CLASS NO,�.DWELL UNITS BK ZP 6
O BLOCK USE ZONF MAP
NO
T SPECIA
NO OF BLDGS CONDITIONS
F LOT NOW ON LOT
F
NG BLDG l_[� i . BLDG SETBACK FROM
TEL FRONT PROP LINE OFREET)
OWNER U D f'J/V cS�b NO TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
ADDRESS Z [i LSA/fU R'Q HIGHWAY WIDTH FROM C L
CITY 7-r--/-'m7-r--/-'m "L(- G! /7- -7l/ }
ARCHITECT OR TEL
A�ETBACK FROM (STREET)
ENGINEER NO SIDE PROP LINE OF
TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL
ADDRESS �,/ / HIGHWAY WIDTH FROM C L
CONTRACTOR/"//SJj6� /���`Ot No
y �3 + O
LIC
ADDRESS�YrY UQ G NO �} y CORNER CUTOFF YES ❑ NO ❑ V
CITYS/q{^� /t,C LIC ss SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK a
z_
W ADD ALTER REPAIR DEMOLISH
FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE 6 G) �..4-
SIGNATURE OF
APPLICANT
i
VALUATION $
APPROVALS DATE// ¢INSPECTOR 5SIGN�A/T�URE
P C PMT FOUNDATION
MATERIALS
FEE $ - FEE $
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
BUILDING CONSTRUCTION ERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WI L NOT EMP Y ANY PERSON IN VIOLA LATH INT
TION OF THE LABOR CO F TH T E OF CALIFORNIA RELAT
ING TO WORKMEN S CO P AT IN RANCE
LATH EXT
SIGNATURE HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F LEWIS PRINCIPAL
PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION STRUCTURAL ENGINEER
C SH
LACO 3 2 6 3G FEB26 1 D 9.00N