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APPLICATION FOR BUILDI G PER IT
COUNTY OF LOS ANGELES BUILDING �}
e DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY ,
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUP T OF BUILDING CROSS ST
FOR APPLICANT TO FILL IN DISTR CT NO G P TYPE P o s Y
CONST
(Print or type only) Q
BUILDING ry�_ / A'D�� p STATISTICAL C IFICATION SE ER MAP
ADORES �( L �7 l.� CLASS NO DWELL UNITS BK PG
LOT NO BLOCK USE ZONE MAP C2 (90 y
^ No
TRACT SPECIAL
NO OF BLDGS CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG BLDG SETBACK FROM
OWNERTj Q /e .j.TEL �/ FRONT PROP LINE OF -(STREET)
nC w/ NO (Oe_ TYPE OF EXISTING SETBACK HIGHWAY } YARD - TOTAL
ADDRES ,2- )_c&s 'v fQ HIGHWAY WIDTH FROM C L
CITY BLDG SET OM
ARCHITECT R TEL SIDEPROP LINED (STREET)
ENGINEER NO TYPE OF EXISTING SETBACK Y } YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C L
TEL t = o
CONTRACTOR NO C
C
ADDRESS Np CORNER CUTOFF _ YES ❑ NO C
C
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS c_
CONSTRUCTION LENDER n
NAME AND BRANCH
N
ADDRESS
SQ FT NO OF NO OF NEW ❑
SIZE STORIES FAMILIES ❑
USE OF1 ADD
STRUCTUR Y %& ALTER ❑
SIGNATURE OF REPAIR❑
APPLICANT 14 MOL ❑
VALUATION $ &_0 APPROVALS DATE INSPECTOR S SIGNATURE
P C PMT FOUNDATION LOCATION
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 ORDINANCES AND LAWS REGULATING BUILDING CON GAS VENT DUCTS
STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH INT
LABOR CODE OF THE STATE OF CALIF RNIA IN RELATING TO
WORKMEN S COMPE ATIONINSURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR
PERMITTEE RECT AND POSTED qq y
ADDRESS FINAL 7 C U
PLAN CHECK VALIDATION CK Mo CASH JOHN F LEWIS PRINCIPAL STRUCTURAL EN
PERMIT VALIDATION CK M o CASH
DEC 8 1 a 600