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TEMPLE CIT'
76A638A CE x:803 2-63 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING ,
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST /
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST.
DIST CT OUP TYPE ESSED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING /7 /',`�� �• STATISTICAL CLASSI FICATION S WER MAP
ADDRESS '+�' I NJ + /1 BK PG
CLASS. NO. DWELL. UNITS
LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑
7 CERTIFICATE:
TRACT MNO�"AP HIGHWAY STATE MAJOR SECOND, OCAL
NO.OF BLOGS. D (CIRCLE)
SIZE OF LOT I� NOW ON LOT Q U ONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
TEL. '
OWNER NO �6Z8 B IL ING EXIST.
SETBACK YARD HWY STREY NAM WIDTH
ADDRESS (>a"� GAJ f+/{Q7i FRONT /
ARCHITECT EL. P. L.
ENGINEER NO. SIDE
ADDRESS
CONTRACTOR O �Y T� --®
1 r
ADDRESS-5 az�Eelmw'
DESCRIPTION OF WOR } '` uu
a.
NEW k ADD ALTER REPAIR DEMOLISH a""
SQ. FT. NO. OF NO. OF ,i / / `l • '
SIZE STORIES FAMILIES / c,.,,-.
USE OF `'
STRUCTURE R *-
SIGNATURE OF
APPLICANT
VALUATION ��-�
APPROVALS DATE INSPECTOR'S SIGNA u
FOUNDATION: LOCATION
P.C. PMT. FORMS, MATERIALS
FEE FEE $
FRAME: FIRE STOPS, '
1 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, DUCTSffl
- '
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK s, _
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE STAT OF IFORNIA RELAT-
ING TO WORKMEN'S COMP S N INSU NC
LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR- rte•-, �.�.-,-,•�""
PERMITTEE — RECT AND POSTED 1 -•";4"
ADDRESS '� FINAL 5—
JOHN F. LEWIS. P INC AL STIR URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
,� s s >J�t� 26 2 3 D 4 C.75 '
�. 8307 FEB 5 1 D 81.50
7&AS 3"CR�1E032-63 APPLICATION FOR BUILDING P1=RMI
COUNTY OF LOS. ANGELES BUILDING
DEPARTMENT OF COUNTY ENGWEER ADDRESS.
BUILDING AND SAFETY DIVISION LOCALITY
�IOHN A. LAMBIE.. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUF'T OF.BUILDING GROSS ST.
DISTRICT O P TYPE P B
FOR APPLICANT TO FILL IN CONST.
-BUILDING STATISTICAL CLASSIFI TION SLSHEIR MAP
i
ADDRESS � � CL-6,S. NO. D6
WELL UNITS EK P
LOT N-O. BLOCK WATER
CERTIFICATES. NOT REQUIRED r RECEIVED
YRAC,T- ' 9A0 HIGHWAY
NO.OF BLDNO. (clRcLi) STATE MAJOR SECON
TS. D LOCAL '
SIZE OF LO - NOW ON LOT OM6 USE ZOE PECIAL
hI
USE OF '� CONDITIONS
EXISTING BLDG.
Owluyr RL
OWNERNG
SETBAICK YARD HWY STREET NAM 1DTH
ADDRESS •'C FRONT ,r)
ARCHITE OR TEL P. L V12)
-ENGINEER NO. - SIDE
P. L 7-
ADDRESS a n'
tEL �•
CONTRACTOR N
ADDRF86 - O
DESCRIPTION OF WO)Rg e
ALTER REPAIR DEMOLISH - Z
9 FT. NO. OF NO. OF -
SIZE STORI S FAMILIES -
USE OF
STRUCTURE 'K- S{�
SIGNATUREb '
APPLICANT' - - - -
VALUAT16N s a
APPROVALS DATE I CTOR'S SIGMA
'FOUNDATION: JJ....00ATION
FEE S FEE'$
/ cv ''FORMS MATERIALS
_ .FRAME: FIR STOPS, (yam
.I HQtS.IY AGKNOWLmGI T11AT I HAVI'RIAD tHIS /RTLICATIO}I BRACING, BOLTS O ,
ANRR STATS. THAT THE ABOVE IR CORRICT ANb AGRII TO COMPLY FURNACE: LOC,��11?ION. -
WrTHW AL1, COUNTY 6RDINANCkS AND STATS. LAW& RKQULATING GAS VE PLT.
4U ILDING CONSTRUCTION. 1CTAT"Y THAT IN•DOING THE WORK r
AUTHORIZm'F{ERISY.] WILLI NOT EMPLOY ANY PKRZON,IN VIOLA- L_44 H. INT.
TIOK.OF THS. LADOR COD[ OF,THE ETA TL F CR
ALIFONIA'RILAT. -
ING TO WORKMEN'S.COMM N6AT7ON INS U LATH,'EXT.
SIGNATURE HOU8t NUMBER COR-.'
PERMITTEE RE CT AND POSTED - ,
.�ADDRESs FINAL
JOHN'F..LEWIS: PRINCIPAL St _ RAL ENGINEER
-PLAN CHEcK VALIDATION cK- M.O. CASH _ PE&MIT VALIDATION CK MA. CASH
' s:� 4 . .� 1 200
} - _ �
WORKERS' COMPE14SAT10N DEd.ARATION
^ � rark ' hst �self
or6&dtficateofwoenC alo�rmura APPLI.C.ATI.ON FOR BUILDING PERMIT
or a.certffled copy thereof (Sec 3800; Lab.,�) I. a
COUKIrY-OF LOf ANGELES WIRING AND SAFM-
Policy No, Company
U)q NG
❑ Certified copy Is-hereby furnished. FQR APPLICANT TO FILL IN AD` .' B 'DRESS -
❑ Certtfied copy Is filed with the oourrty- ullding Inspec- BUILDING
tion department.. '3e[)
Date Applicant ZIP LOGY
NEAREST CERTIFICATE OF DMMPTICNJ FROM Sig OF LOT NOW ON IAT uboss ST. „ ..
COMPENSATION'INSU RANCE '
ASSESSOR
(This section need not be``com leteid if the permit Is for one TRACT BLCX3C LOT NO. BOOK PAGE PARCEL
hundred dollars{;100) or lase - Tg
OWNEIRZONE
I certify,that In the performance of the work for which this
It Is Issued, , all not ernploy arty n.In any manner ADDRESS S h
as to' su le41 to;the W Compensation laws. O
ClTY. LP I. ✓ .. . U
DateM-N AR(}1 OR TELGROUP TYPE PROCESS®BY Q
NOTIq kin this.Cgrtlficate of E31Glt NO. - - ZONE
Exemption,- you should me the Workers ^( 0 yCX)t6T. 3
Compensatloh prgvisfons.of.the Labor you must forth- ADDRESS J N
with comply,with zLKt provisions. or this-permit shall be iii STATISTIG4 CtASS1PrATKW. APT. CONDO. Z
deemed revoked..., CONTRACTOR NC - _
UCENS>*D.CrONTRAC70R$DECLARATION CLASS NO. LYNITS��
I herby affirm that I am Ilcefued undeF provtalons of Chapfer9 ADDRESS
jcommerxing with Section 7000)of Dlylslon 3 of the Buslrless LLC mmand PrpfeasIons Code,and my Ilterreas In full force-and effect. _ a 4 .13kA PG. VALIDATION
SQ:FT.- NO. OF NO. OF CHECK
Llcenie.Number^ Llc CIan,T_ STORIES FAMILIES C)
- = VALUATION
" DESCRIPTION OF WORK. NEW El
CgntractOr
ADD...•.❑
❑I am exempt under Sec ' ►
B.BP.C:-for:thit reason
USE OF. DEAAOL ❑
EXISTING BLDG.
Signature APPLICANT _ TEL ' . ...RNA1L
OWNER-BUILDER DECLARATION NO. pA
I hereby affirm that I orb exempt.from the Contracrtor's License ADDRESS
Law for the followingreaton.(Ssctlon 7031.5, Business'and
I, as owner of fhe arm em I with BUILDING.
ProP�sati Y t oY ADD ACCT.
wog es as the1Fsole compensation,will do the work and
the structure.ls not Intended'or offw, d for sale(Section LOCALITY , �7 ._..__ 59,'x.
7044, Bwingss and Professions Code.) CONTRACTOR t o 1 I I C1
^` ❑ I, a.'owner.gf the property, am exduslvely contracting _ 1 t G 1� a
ADDRESS .. — -MAL 11 L 5 7 m 25
.wlth.11censed conirodota to construct)hre,proGect-(Sec- � - - �. ,
lion,7044, Bwlnea and Profewons Code.) . �.y
CONSTRUCTION LENDING AG;ff Y. kkWiRtu YARD HWY. -CWCK 59■25
I hereby affirm that thereis q corutrudion iending o�ehcy for
the perf�rinance of the-work fp{.whith this permit is issued P.L. .
00
(� 3097, Clv,..C.). SIDE ---
Lender, Nart,e L> .R.f. �01p0-p0�0-0001 --6/1�3y/78�9
' P G Ise Permit Fee 3T36 1 'A I10:36
Lenders Address t _. - _ -• -
I certify,that I have.read.this appllcotlon and state that,the lw+HInce F« LDMA PLC
o above Informatlon is correct. I agree to comply with all County InvKtigdtlon No
ordinances and State'laws relating to building construction, I Total Fee � LDMA Peart-
and hereby aufbOlze representatives of*is County to enter _
upon thea entionedr'yfor ir.P ,Ion u
rf�!Nlfi!'6[DOIJ1liAT0[Y LA!!O{1A04 `
SlGjk&Ve&f n Date � -