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76A638A CE#803 8-64 APPLICATION FOR BU I DIN IT
COUNTY OF LOS ANGELES BUILDING .J
2
DEPARTMENT OF COUNTY ENGINEER ADDRESS ' a •7. _ rtC� ..
r
BUILDING AND SAFETY DIVISION LOCALi TY /-
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST C
COLEMAN W. JENKINS,SUP'T,OF BUILDING CROSS ST.' ti,
DISTR T .NO. G • u TYPE.- - PROC SEE). B
FOR APPLICANT TO FILL IN coNST. i. �r
BUILDING STATISTICAL CLASSI ICA TION. SEWERMAP
ADDRESS �. 7 - CLASS NO.----:--OWELL UNITS. BK !'^ P -
LOT NO.. BLOCK US ZONE MAP
-- 1 NO. Y
TRACT ` - �,�/ SPECIAL ..NO. OF SLOGS. CONDITIONS
SIZE OF LOT NOW ON LOT -
USEOF -
E IST NG BLDG. ' 4e-- BLDG. SETBACK FROM'
TEL. - FRONT PROP. LINE OF - (STREET)
OWNER iokg tj 3
PNO. TYPE'OF - .EXISTING ,SETBACK. HIGNWA + YARD = TOTAL
ADDRESS (! HIG AY -WIDTH :'F FROM C.L. -
CITY _c + 4),.
BACK FROM.-
. CT OR TEL. - BLD ET
FROM-
ARCHITECT -- - -
RCHIER O NO. SIDE PROP. LINE OF (STREET)
ENGINETYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESSHIGHWAY WIDTH FROM C.L. CL
TEL. O�. + - 0
CONTRACTOR, i NO p
ADDRESS 3-S' s NO.'_ - CORNER CUTOFF YES NO O
0
CITY LIC [SEE REVERSE SIDE FOR SPECIAL APPROVALS w
DESCRIPTION OF WORK a
-- z
NEW REPAIR DEMOLISH
SQ.FT. NO. OF NO. OF
SIZE STORIES FAMILIES '
USE OF -
STRUCTURE -
L"va.. r irs
SIGNATURE OF -
APPLICANT /•` �'
VALUATION ' APPROVALS DATE INSP C OR'SSIGNATURE
�•s!� FOUNDATION, LOCATION �/
•FEE$ - FEE$ � FORMS,_MAT_ER.IALS_;. t.. / _
'FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9U ILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. '
TION OF THE LABOR CODE OF THE STATE OFA F RNIA RELAT.
ING TO WORKMEN'S COM ATION INSU RANCE
LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR- _
PERMITTEEL✓`' RECT AND POSTED
ADDRESS
Fl NAL
JOHN F. LEWIS. PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
LAio 0 8 1 7 MAR 2 8 1 0 5.0 0-