HomeMy Public PortalAbout9019 BROADWAY_Building__ 3
7BA638A CE#803 B-63 APPLICATION FOR BUILDING PERM,
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
.JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SVP'T OF BUILDING CROSS ST.
DISTRICT NO. FOUP TYPE P B.
FOR APPLICANT TO FILL IN CONST,V !Q
BUILD'
NGG STATISTICAL CLASSCATION 5 WER MAP
ADDRESS / Q I BKZ PG
CLASS. NO. WELL. UNITS
LOT NO. BLOCK WATER
CERTIFICATE: NOT REQUIRED ❑ RECEIVED ❑
TRACT,, MAP HIGHWAY
NO.OF SLOGS, NO.L7 IC IRCLEI STATE MAJO SECOND LOCAL
SIZE OF LOT NOW ON LOT USE ZN
USE OF ^
EXISTING BLDG. �
TEL./
OWNER NO. I'q BUILDEXIST.
JJ SETBSTREET NAME, WIDTH
ADDRESS
FRO0
ARCHITECT OR TEL. P.
ENGINEER NO. — SID
P. /ADDRESS � /�
TEL.
CONTRACTOR _ V•
ADDRESS 'r ...
DESCRIPTION OF WORK ` f
A � W
a
NEW ADD ALTER REPAIR DEMOLISH I` VI
T. NO.OF NO. OF Z
SIZE 0 O STORIES FAMILIES
USE OF
�S}TTRR.U�CTU RR
SIGNATURE
-_F'
APPLICANT
VALUATION $
APPROVALS DATE INSPECTOR sIGNAiu RE
P.C. ✓� PMT. 5G FOUNDATION: LOCATION
FEE $ FEE $ 0 FORMS. MATERIALS \
• FRAME: FIRE STOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AOS
AND STATE THAT THE A80VE 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 LA80R COO F THE SLATE OF CALIFORNIA RELAT-
ING TO WORKMEN' if
S C ATIpN ItRAN
LATH. EXT. P-
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED '!
ADDRESS_`7'4/ FINAL
JOHN F. LEWIS. PRINCIPAL STR URAL ENGINEER
IDATION CK.
PLAN CHECK VALIDATION CK M.D. GASH PERMIT VALM.G. CASH
937GDS ma 923 D 5.75
Lhuo9 5 9 3a fnR16 1 0 1 1 .50