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76A638A CE*803 8 64 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS y
BUILDING AND SAFETY DIVISION 'LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINSAUP T OF BUILDING CROSS ST
DISTRICT O y G OUP TYPE P C SSED BY
FOR APPLICANT TO FILL IN CONST vt
BUILDING �n/) a STATISTICAL C A IFICATION SEWER MAP
ADDRESS ` , 1 1� CLASS NO DWELL UNITS- BK PG `{
c J
LO OV r BLOCK FUSE ZONE MAP
NO
TRACT SPECIAL I
NO OF BLDGS CONDITIONS '
SIZE OF LOT NOW ON LOT
USE OF _
IS BLDG SETBACK FROM
NOL A'�' ` FRONT PROP LINE OF (STREET)
OWNER (� TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL
ADDRESS nw� I �� �a L,. � Dizo HI HWAY FROM C L
C 52
ITY-TIC-,K �k-e `J�� + `
ARCHITECT OR TEL BLDG 9E BACK FROM
ENGINEER NO SIDE PROP LINE OF - (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS I HIGHWAY WIDTH FROM C L d
' L-7 v -
9 TEL
CONTRACTOR QQ 7i,.1 NO `�
ADDRESS109Z C- ND NO Le i) CORNER CUTOFF YES NO O
clrY �EMPC « cls STR7 SEE REVERSE SIDE FOR SPECIAL APPROVALS bd
DESCRIPTION OF WORK N
Z_
EW ADD ALTER REPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE /► STORIES FAMILIFS
USE OF ���-T1' Cr) �O 0,00
STRUCTURE
SIGNATURE OF
APPLICANT ��•/���
3U
VALUATION$ Z �
APPROVALS DATE INSPECTOR SSIONATURE
P C PMT uC7 FOUNDATION LOCATION
FEE$ '^-- FEE$ FORMS MATERIALS_
FRAME FIRE STOPS / ) /'J
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT I I _ 1 /
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS O' e7
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 CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S CO PEPT
ION SU RANCE LATH EXT ^
t
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F LEWIS PRINCIPAL ST URAL ENGINEERt
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M D CASH
Ly;�B 61� CEC20 1 D, 6.00' a
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