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76A638A CE#803 3 68Ile APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING �]
DEPARTMENT OF COUNTY ENGINEER ADDRESS / IVP lq,6
BUILDING AND SAFETY DIVISION LOCALITY _ - r C `�
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUP T OF BUILDING NEAREST
CROSS ST v/0R l
DISTRIC�NO GROUP TYPE -P CESSED BY,
FOR APPLICANT TO FILL IN ` CONST
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BUILDING STATISTICAL CLASSIFICATION , , 1 SEWER MAP R
ADDRESS�� II t�iv !C� CLASS NO DWELL UNITS )—BK PG/?
LOT NO BLOCK USE ZONE MAP ���
1-1 NO _ ° r
TRACT SPECIAL
NO OF BLDGS �
CONDITIONS
SIZE OF,LOT NOW ON LOT , s
USE OF } '
EXISTING !BLDG �S - GF_ BLDG SETBACK FROM
OWNER D`Al j�l VA,ly � 'eE4' A, NO FRONT PROP LINE OF -(STREET)
TYPE OF EXISTING SETBACK HIGHWAY +1 YARD - TOTAL
HIGHWAY WIDTH FROM C L
ADDRESS �j [T IJP /r7y O r s
CITY
TP-Pm— F_ �,7
+
ABLDG SETBACK FROM
ARCHITECT OR TEL 1 (STREET)
SIDE PROP LINE OF
ENGINEER NO TYPE OF EXISTING SETBACK HIGHWAY-- -+ YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L - Y
a� LTEL 6 G + = y
CONTRACTOR eRSPdv 7a-k"1A;0 p0�/�3 r 9�� a-
LICADDRESS (75'Gaz /7-AI1F- NO z�d 3yJ CORNER CUTOFF YES ❑ NO ❑ V
CITY�n .2 A JV CL SS — SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESC IPTION OF WORK G v z
NEW ADD ALTER EPAIR DEMOLISH
SQ FT NO OF NO OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
a
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SIGNATURE OF
APPLICANT
VALUATION $
APPROVALS DATE INSPECTOR 5 SIGNATURE
P C PM T /0 LOCATION r
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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA LATH INT j
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEN S COMPENSATION INSURANCE
LATH EXT
SIGNATURE F dw/ HOUSE NUMBER COR
PERMITT p RECT AND POSTED
ADDRESS ` t FINAL �/
JOHN F LEWIS
PLAN CHECK VALIDATION ,, CK M o cases _ PRINCIPA SD'CK
ENGINEER
UBALPERMIT VALIDATION M O CASH
7 2 4 ,5w NOv12, 1 06 00~ v
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