HomeMy Public PortalAbout4821 CLOVERLY AVE_Building__ 76A638A CE #803 3-69 APPLICATION F R BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING ^
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER
COLEMAN W JENKINS, SUP'T OF BUILDING NEAREST -
CROSS ST
FOR APPLICANT TO FILL IN DISTRICTT�90 GROUP TYPE NS 0 "SS
ED Y
(PRINT OR TYPE ONLY) V
BUILDING STATISTICAL A SIFICATION MAP
ADDRESS ,yZ �„ lG 'VC/� �� CLASS NO DWELL UNITS BK P
LOT NO BLOCK USE ONE MAP
NO
TRACT ..- ISPECAL
GX/79j+l/ NO OF BLDGS ^ CONDITIONS
SIZE OF LOT o NOW ON LOT oL
USE OF
EXISTING BLDG BLDG SETBACK FROM
7` NO LZ�1�d` 2 FRONT PROP LINE OF (STREET)
OWNER r7N
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
HIGHWAY WIDTH FROM C L
ADDRESS n ,
CITY e Imo, 6 __
ARCHITECT OR TEL BLDG SETBACK FROM (STREET)
ENGINEER NO SIDE PROP LINE OF
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL '
ADDRESS HIGHWAY WDTH FROM C L _
TEL + _
CONTRACTOR NO - -^
LIC CORNER CUTOFF YES ❑ NO ❑_ c
ADDRESS NO Q
LIC U
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS le
CONSTRUCTION LENDER / c
NAME AND BRANCH �� ��V .S/'� ,//Vf/-O -1-P oPw,,,1gk
W
ADDRESS
SQ F NO OF NO OF / ay Z
SIZE _XT STORIES FAMILIES NEW ❑ 7�G�7o
USE 0 /'1 ADD ❑
STRUCTURE ❑
,ALTER
�. EPAIR ❑
SIGNATURE/OF DE MOL ❑
APPLICANT
VALUATION $ Q 00 ` APPROVALS DATE INSPECTOR'S SIGNATURE
P C PMTFOUNDATION LOCATION
FEE $ FEE $ �'� FORMS MATERIALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME FIRE STOPS,
BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GA VENT DUCTS
TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I
WILL NOT EMPLOY ANY PERSON IN VIRLATION OF THE LABOR CODE LATH, INT
OF THE STATE OF CAL IN VLATING To KMEN'S COM-
PENSATION INSURANCE'_' LATH, EXT
SIGNATURE OF HOUSE NUMBER CORRECT
PERMITTEE AND POSTED
ADDRES FINAL n
JOHN F LEWIS, PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION CK m o CASH - PERMIT VALIDATION CK m 0 CASH
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