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DEPARTMENT OF BUILDING AND SAFETY } APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
WM J FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING (� / / DISTRICT NO PLAN CK NO PERMIT NO
ADDRESS
LOCALITY I 1!4 Ip c 4* st= RECEIVED BY DATE OF A'P/PL DATEISSUED
NEAREST C -f' ►• �.J /
I
CROSS-ST 1 (�(
BUILDING
..OWNER ► !� ► I vt C COO ADD ES9 F; +'
MAIL
ADDRESS /C/ ��"..S ��(��.s ��� LOCALITY ;� fE..�p (,�y
1NEARE9T
CROSST
CITY "P Ea C NOTEL
FIRE I NO OF I TYPE �I GROUP
ARCHITECT OR TEL ZONE �- PLANS�^
ENGINEER NO
BLDG y ORD NO
ADDRESS SETBACK LINE
APPROVED
TEL
CONTRACTOR � NO BY DATE
USE APPROVED
ADDRESS ZONE BY DATE
LEGAL
—DESCRIPTION LOT NO /v� q.Jr I BLOCK CORRECTIONS
TRACT 4 d% f �
i
// NO OF BLDGS a.
SIZE OF LOT(O X �d NOW ON LOT
USE OF U�crC 1. (J +�` I NO OF ... I NO OF Y
EXISTING BLDG /u� FAMILIES ROOMS
DESCRIPTION OF WORK
1�
NEW ALTERATION ADDITION O
A_
REPAIR MOVING DEMOLISH O
8q FT /� NO OF 1 Z
SIZE c+�A X Yc7 ROOMS STORIES / D
/J r
WALL4 f_ .j I ROOF
COVERING l��V� COVERING 4.�i1eC.►w./� 1�7�
USE NEW
BUILDING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION LOCATION, INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS, MATERIALS i1 dt \(I�►W�I'1`�
AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME FIRE STOPS, �•t-� y q 41
SIGNATURE OF BRACING BOLTS I lJ iVW
OWNER LATH INT T4�q�/�
AUTHORIZED ADT V(' leiLATH, EXT
I
$ P C PLASTER, INT
d FEE PLASTER EXT
VALUATION FEE d FINAL 9�