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...•••.' Ea•o.,�l APPLICATION FOR .BUILDING PERMIT
COUNTY OF LOS ANGELES noop'ss /Q
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY l
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSSST.
FOR APPLICANT TO FILL IN DIST;T O. GROUP TYPE P E SED BY
` CONST.
BUILDING '/ J L STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS �fI CLASS. NO. DWELL.UNITS 1 s 5--
LOT NO. 6il!$LLABLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE:
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TRACT
MAP { IGHwAY STATE MAJOR SECOND OCAL
SIZE OF LOT NO.OF BlDGS. NO. Q ICIgc LEI
6a- /OIO I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
USEDEXIST,
NG BLDG. O
` TEL.
OWNE d.// �Q SAL'C 7N -DING- 7E3 SETBACK YARD HWY STREET NAME WIDTH
ADDRESSJ0t37 FRONT
ARCHITECT OR TE - P. L f�fi
ENGINEER I SIDE
P. L.
ADDRESS TEL. INSPECTION RECORD a
CONTRACTOR NO.
ADDRESS �" ��'/ /—"t���`"•'o'� rC1 R9"%1nn/{z 1J f-c9K3
DR§CREPTION OF WORK 0
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2O s . F /'J ` •�t d
NEW ADD ALTER REPAIR DEMOLISH - y
SO.FT. NO.OF NO.OF Q Q. /�� Z
IZE STORIES FAMILIES
USEOF URE j7 > Av
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STRUCT
,cAAd1fIk-
SIGNAT
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VALUATION$
G/ APPROVALS DATE INSPECTOR'S SIGNATURE
...e FO FORMS.MATERIALS
FEE $��� FEE $ 69
FRAME' ESTOPS. '� 1lI L.• //{'/�
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING,
NG, BOLTS
AND STATE THAT THE ABOVE I6 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, I IL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS I
BUILDING CONSTRUCTION. ICERTIFY 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 CALIFOq IIA RELAT-
ING TO WORKMEN'S COMP NSATION INSURANCE. LATH.EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE '4 RECTANDPOSTED I/ I / I /q/D✓//,/////
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL'STRUCTURAL EN
PLAN CHECK VALIDATION DR. M.o, c sm PERMIT VALIDATION OK. M.o. CASH
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADDRESNS fsl
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION LOCALITY c
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. I
DIST CT NS GR UP TYPE PRq S
FOR APPLICANT TO FILL IN CONST'.'
BUILDING ✓✓ STATISTICAL SIFICATION. SEWER MAP
ADDRESS E / Pf CLASS. NO. DWELL. UNITS J �G/
LOT NO. GYM BLOCK WATER NOT REQUIRED RECEIVED
Li
CERTIFICATE:
TRACTMAP NI GNwnY STATE MAJOR SECOND. LOCAL
/ I� NO.OF BLOGS. NO. �.O-O IURctE)
S IZE OF LOTG. 0 T /ZO NOW ON LOT USc ZONE SPECIAL
USEOF ''11 /n7 CONDITIONS
EXISTING BLDG. S — // A
TEL
PA
OWNE A � �� �C NO.—.147973 'BUILDING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
ADORESS5032 FRONT I
ARCHITECT OR TEL. P. L. ! I
ENGINEER NO. SIDE
P.L.
ADDRESS TEL. INSPECTION RE¢ORD a
CONTRACTOR NO. / // // E Q
ADDRESS CO'"S'tF"� "v'r;o°7 a //Ll AFl
DESCRIPTION OF WORE �III�>i lA..-mob lev J l O
NEW ADD ALTER REPAIR DEMOLISH
N
SO.FT. N OF
FA
IZE STORIES FAMILIES
USE OF
STRUCTUREA 12
SIGNATURE OF -y
APPLICANT +o -
VALUATION S
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
P.C. PMT.
FEE �� FORMS,MATERIALS
F S
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT THE DIVA IS CORRECT TE AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING WORGAS VENT DUCTS /.
ABUILDINGTRICONSTRUCTION. CERTIFY THAT IN DOING THE WORK
AUTHORIZED THE
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. �7 1/.G�/�/ �)A.1l P/J
TION OF THE LABOR CODE OF THE STATE A CA LI.ORNIA RELAY-
INC TO WORK EN'S COMPENSATION INSIIR/NCE.
LATH, EXT.
SIGNATUREO HOUSE, COR--,.,\1PERMI RECT AND POSTED
// ,^24
ADDRESS FINAL I �� ITT-/ XV 111
CLYDE N. DIRLA M , PRI{JCIPALISTC RAL ENGINEER
PLAN CHECK VALIDATION cK. N.D. GBH PERMIT VALIDATION(':K/ m.o. DASH
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