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APPL,ICA . 101 OR..BUIL IN6 PERMIT
.. COUNTY OF.LOS ANGELES - BUILDING AND SAFETY - - -
BUILDING 'A ,
{' FOR APPLICANT TO FILL IN -AADDRESS - T R d A
-
ADDRESS -(, 2aJl0.W",- _._-. LOCALITY
NEAREST
CITY L ZIP CRO55 ST.
NO,OF BUDGE. ASSESSOR ..
SIZE OF LOT NOW ON LOT . MAPBOOKPAGE
DISTRICT I GROUP'I f`YPE E
TRACT BLOCK LOT NO. CONS - '
OWNER OEA - - 2t �Al
STATISTICAL CLASSI FICATION SEWER MAP f
ADDRESS . CLASS NO�_DWELL.UNITS_ � R?{ G .
CITY _ ... ZIP - 1 2
ARCHITECT OR TEL. VALUATION $ — _
ENGINEER - --- NO- -
ADDRESS _ _ BLDG.SETBACK FROM
FRONT PROP.LINE OF / ISTREETI
.r T
CO T R N — _ TOTAL SETBACK FROM PE OF EXISTING
�7 LIC. ^ HIGHWAY + YARD - FRONT PROP.LINE IGHW Y WIDTH
ADDRESS ,] V— NO. �^�ZZ
. _
r . . LIC. - +
CITY CLASS T-.
BLDG.SETBACK FROM
CONSTRUCTION LENDER` s.. -' - SIDE PROP.LINE OF (STREET)
NAME AND BRANCH
_ ,HIGHWAY + YARD - 'TOTAL SETBACK FROM -TYPE OF EXISTING - G.'-
ADDRESS CITY - SIDE PROP.LINE IHIGHWAYI WIDTH C
SO FT. I NO.OF NO.OF CHECK "" ' + _ V
SIZE STORIES'- FAMILIES `ONE 0
❑ 4ITEL
NE AP_ n%Q - Q -
DESCRIPTIONOFWORK L.G NEW O
SPECIAL N
�� ADD �E❑ CONDDIONS - -
ALTER 'tel BY Z
- REPAIR/❑
USE
O . .
. DEMOL oo -
e o a
EXISTING BLDG. G
APPLICANT TEL 2 5 0.
CL.OIPRwn .p ( No2 0 5 0,40
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BY SIGNATu r AZRqaY
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE M 1 5—80
THAT
THE ABOVE IS CORRKT AND AGREE TO COMPLY WITH ALL,ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE a V «
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF '
THE LABOR CODE OF THE 5TATE OF CALIFORNIA IN RELATING TO WORKMEN S COM- Z _
PENSATION INSURANCE.'
3 �au :29902A ."
SIGNATURE
PERMITTEE 3L, e o 0 0 0 1
ADDRESS - - - - - - - ----_ _ ,
2 2 . 124.00
CITY * o _ NO C- T.Q . .. o a 1 24 0
�7/� J
P.C. Fee$ _ O Permit Fee 117 / "' - > 0 4 1 S—P 0
Issuance Fee t m
6
J /
Tocol Fee `�-'(
P i . i
]6A83eA e94.9 a.55
PPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY BUILDING G tL
ADDRESS 7
tDep"Gnt of County Engineer
County of Los Angeles LOCALITY
WM.J. FOX. COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN. SUPT OF BUILDING CROSS BL
DISTRICT NO GROUP EWER MAP
FOR APPLICANT TO FELL IN i I TYPE
CONST. �
BUILDINGff MAP STATE NG9
ADDRESS Ln I NUMBER �D HWY
USOt1E SPECIAL
LOT NO. Z' / LOCK" /// CONDITIONS
TRACT
NO. OF BLOGS. BUIL NG EXIST.
SIZE OF LOT L NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH
USE OF
EXISTING SLOG. - FRROLTP.
OWNER J SIDE
P. E
MAIL
O
ADDRESS � � RACT DWELL. f UNIT
T
5 INDUSTRIAL
TEL. L DWELL. f UNIT
CI N .r/ NO. �+ - 61 PUBLIC BLDG.
ARCHITEC R TEL. 2 DUPLEX I UNIT 7 ADDN., ALT.. ETC.
ENGINEER - NO. 3 APT. -UNITS
6 MISCEL. .
ADDRESS 4 COMMERCIAL _
L
CONTRACTOR C� P(
TEL-INSPECTION RECORD
ADDRESS
DESCRIPTION OF WORK
NEW ADD ' ALTER REPAIR DEMOLISH
SO. FT. }� NO. OF NO. OF .'
SIZE �,/ 9� STORIES / FAMILIES
USE 0 TRRUUC:T,U/RE
SIGNATURE OF/
APPLICANlF [. / AppROVALS
T
ADDRESS DATE INSPQCTOR'S SIGNATURE
S P. C. $ FOUNDATION.FORMS,
MAT RIIALSION RA
/n..0-J
^•QQ � B 04) FEE FRAME:
/`' 00 BRACING, BOLTS / SRT
VALUATION
- FEE -� FURNACE: LOCATION.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT, DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. /"��
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION. LATH. EXT. I /IIL77
SIGNATURE OF �'!'/�A /I/+ an.rv-✓Iw^" HOUSE NUMBER COR-
PERMITTEE- RECT AND POSTED
ADDRESS FINAL
WM.J. FOX, COUNTY ENGINEER VALIDATION C. N. DIRLAM.CHIEF BiDG-1_N csP�ion_
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