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T6ABSSA CE TF BO] 6-82 APPLICATION FOR B G PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY_ENGINEER II ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY .yAl
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST \� I
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST n• 'I—
DISTRICT NO. GROUP TYPE RO E S D BY
FOR APPLICANT TO FILL IN // CONST. A/
BUILDING n
STATISTICAL CLA , SEWER MAP
AODRESS]' L /(DAO '✓ CLASS. NO, DWELL. UNITS
]� BK P
LOT NO.- BLOCK WATER NOT REQUIRED I N RECEIVED ❑
/} CERTIFICATE: 0
TRACT �[[ Q MAP HIGHWAY
p{�' -� NOW ON LOTS PID. O
(CIRCLE) STATE MAJOR SECOND OCAL '
SIZE OF LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.. W/c LL/Alr
TEL.
NO, BUILDING YARD HWY STREET NAME EXIST.
/ SETBACK WIDTH
ADDRESS/ ,,%CLS• Fn�l� /PF/ h'LO FRONT
ARCHITECT OR TEL, P. L J /�
ENGINEER NO. SIDE
P. I
ADDRESS /)
TEL.. % In 1�l
CONT RACTORj)�U 4/I✓,K GYJf/ f NO. �' �' �14 �J, �I /. J- ./t ^j- r
ADDRESS Y V 3.5 �ag'LLk, \/ 13L✓ ��_ �^''7Gf� W IP'VIO /1/`�'',,/.+✓ /'�- /l..
i/✓E �T /� , / °
DESCRIPTION OF WORK
NEW ✓ ;ADD }/ALTER REPAIR DEMOLISH' I' g Kms, Z
Z Z/
SIOZET /�` /�.6V TO/RIES FAMILIES
//� �T –! /
USE
STRUOCTUREC/,/7F/� �O.i 1/ -% �'•
L v �
SIGN ATUR .F r� ^ /V,> .WAXG w.f /
APPLICANT
VALUATION $ �V
PMT. �j APPROVALS PATE INSPECTOR SIGNATURE
PEE
$ / FEE $ lJ FO FORMS, ATERIALSON
FRAME: FIRE STOPS,
1 HEREBY'AC KNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS /S lI // .Y� NI'•�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
.BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF TME LABORJCODE-OF THE STATE OF CALIFORNIA_ RELAT.
IN TO WORKMfi1f vLGo MPENSgTION INSDRANCE. ' LATH, EXT.
S IGN ATr/OFsfr�/� HOUSE NUMBER COR- /1 ,
/PERMITTEE ✓��iaKKy-K RECT AND POSTED /
ADDRESS ,L v'��1 �s� FINAL /
r ' JOHN F. LEWIS. PRINCIPAL STRYICTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.D. CASH _ PERMIT VALIDATION CK. M.O. CASH
L7?l,U eE I J 'I `1 •."?A'i �!(1 1. J Lam'') C
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76A0dA CE 9803 1/71
APPLICATION FOR BUILDINERMIT 7 fl
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS pl)lfl 'M
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL"IN NEAREST
ROSS ST. W 2C�
Print ort a only)"
BUILDING DISTRICT NO R P TYPE // P O B
ADDRESS 0/ V K/ L ,570 CONST. �/J
LOT NO.
STATISTICAL. CLA SIFICATION J� SEWER MA�P,�
,� BLOCK, CLASS NODWELL,UNITS_ BtI!NP PG
TRACT USE ZONEMAP• 9
NO.OF SLOGS. NO. GZ
SIZE OF LOT NOW ON LOT SPECIAL
USE OF CONDITIONS
EXISTING BLDG, - - -
l, TEL.
OWNER /y J_ FfCO t-10 NO. BLDG.SETBACK FROM
ADDRESS (f ��fJ 0 FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY . r HIGHWAY WIDTH FROM C.L. ,
ARCHITECT OR TEL. +- _
ENGINEER NO. BLDG,SETBACK FR
ADDRESS S1DE PROP. LINEOF (STREET)
TEL. . TYPE OF EXISTING SETBACK H Y + YARD = TOTAL 6Y.
CONTRACTOR A ` L NO.•-�. ,`r/ GHWAY WIDTH FROM D.L. C3
ADDRESS ,jam A�/•.[t S N/ LO, i Z S� + - p
LIC. / U
CIT P /T CLASS f0—/ CORNER CUTOFF YES ❑ NoLj-,,� Ly
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS ^
SO. FT. NO. OP NO. OF 11 ••-7C4L'� 'O //A� Int/--
SIZE STORI ES FAMILIES NEW .
U5E,OFADD ❑ O�F_G�/ �.Q(�
STRUCTURE '
ALTER ❑ r � .n�
eB ✓� XeREPAIR
SIGNATOR F r�
APPLICANT OL ❑
VALUAT O Q� O (7
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION
FEE $ FEE $ FORMS, MATERIALS
FRAME: FIRE STOPS.
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS.
ANO STATE THAT THE ABOVE 15 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 PERSONIN VIOLATION OF THE LATH, INT. -
LABOR CODE OF THE STATE OF CALIFOR NIA IN RELATING TO
WORKMEN'S C NSATION INSURANCE. LATH, EXT,
. SIPERMITTEE GNATURE .HOUSE NUMBER COR-
'L+ -
RECT AND POSTED
ADDRESS ° FINAL
9 R8=7C 97,9YI,r?ur,/
• JOHN F. LEWIS PRINCIPAL STRUCTURAL ENGINEER.
PLAN CHECK VALIDATION CK. M.O, CAGH _ PERMIT VALIDATION OK. . M.D. CASH
1.1!{ .0 9 5 7ti •JUN18 1 D 9.00-