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'CE 8bo3.-. APPLICATION FOR BUIL9194PERMIT LLLIII
COUNTY OF LOS ANGELES BUILDIN
DEPARTMENT OF COUNTY ENGINEER ADDRES — —
BUILDING AND SAFETY DIVISION LOCALIT ,
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST-
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. _
DIS�,CT NO. GROUP TYPE PR CE BY
FOR APPLICANT TO FILL IN coNsr.
BUILDING STATISTICALC IFICATION SEWE MAP
ADDRESS
f / ' r8Yod fl/A CLASS. NO. DWELL.UNITS 'OK
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑
CERTIFICATE:
TRACT �^ MAP D HIGHwgY
N� OF BLDGS. C NO. _ (CIRCLE) STATE-MAJOR SECON , LOCAL '
SIZE O LO �X.�S';0- - NOW ON LOT 3 USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. . AVAGCS- a V01,'(24—
c ��
ER 1 rr TEL
OWN . / /
V 1' V'.7 %�5 C. �• NO.1-2rtl"G3•S/q BUIL INC EXIST.
SET CK YARD HWY _ STgEET NAME WIDTH
ADDRESS �I ,(�YU 3ctW �' � FRONT
ARCHITECT OR - O.
ENGINEER NO. SIDE 1
ADDRESS' U
w.
TEL v J G !Y i.
CONTRACTOR Vr� NO. K
rr 2 O
ADDRESS � F-
DESCRIPTION OF WORK v W
NE ADD ALTER REPAIR DEMOLISH
SQ. FT. G NO. OF NO. OF .S ��iV ✓1+.
SIZE �� `ry'�T STORIES FAMILIES ! J�t� `moi _ 14
STRUCTURE USE ONS idQ/✓C'� /"'v i A K�I�
SIGNATUREOF ,•iB. �_ - u4�
APPLICANT
VALUATION S —APPROVALS DATEI INSPECTORS SIGNATPOE
FEE PMT. FOUNDATION: LOCATION37j*
FEE S FORMS. MATERIALS T
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE NEA. THIS APPLICATION BRACING. BOLTS IA-
AND _
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATOI�ryjyI/f
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING •6As-�sd>:nU.crJ➢tM•f
BUILDING 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 OF CALIFORNIA RELAT-
ING TO WORHM'cN'S NSATION INSURANCE.
LATH. EXT.
SIGNATURE OF _ HOUSE NUMBER COR- ! '
PERMITTEE" " RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUtTURAL ENGINEER
PLAN CHECK-VALIDATION cK: M.O. DASH _ PERMIT VALIDATION cK.
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