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76A638A CE#803S-67.�PY LSR.`Qf!-Y ll Y.®l �IFO O BU�L�9e/II! a
COUNTi OF LOS ANGELES BUILDING _
ADORES
DEPARTMENT'S OF COUNTY ENGINEER
.BUILDING AND SAFETY DIVISION . LOCALITY.
JOHN A:-LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.. _ �b
FOR APPLICANT TO FILL IN Dlsr CT NO. GROUP PE y P ESSED BY _
BUILDING _ _ :STATISTICAL CLASSIFICATION WER.MAP
'ADDRESS _ BK"Q _
r: - CLASS NO�DWELL:. UNITS,'' - '9>f
LOT NO. ✓L BLOCK WATERi•" - '
- CERTIFICATE: ,N OT REQUIRED RECEIVED
TRACT _ . . MAP, - HIGHWA S - -
fs - NO.OF BLDGS. NO. (uRcLEI TATE,MAJOR SECOND, OCAL-
SIZE OF LOT�.0 -`o Y I NOW ON.LOT .. v' USE ZONE SPECIAL'
USE OF, CONDITIONS..
.'
'EXISTING BLDG. i
F
7 - .TNEL.
OWNER' [. O "BUILDING' -'EXIST:
D H _
•YARWY T E NAME
/� SETBACK',. WIDTH
_ ADDRESS y�� �•"Y-'Pj�Cc= �I��Q FRONT
ARCHiTECT;OR -. TEL. _ ?' •- .P. L. - �
ENGINEER NO. _ SIDE - a -,
ADDRESS
• -TEL. !6L is ,INSPECTION RECORD.
CONTRACTOR __ • NO. - - 09
ADDRESS . :�0 re mC- Iva r .i1w.,cV Fe.0�. „U.
DESCRIPTION•OF VVORg ' �1 z, i: Yo fe�,r,—�,,, /fix,d iE a.
Z
NEk _ ADD.. ALTER REPAIR 'DEMOLISH yy.
SQ. FT. %- � NO. OF `/.,
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IES L�✓ B�w _ .' a: n•s �I- •' r - /�>a
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:. STRUCTURES ' • _ ,
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SIGNATURE OF r dn•-s� I�•.0 C •tta i-x.f, tt• . �+- /s:A
APPLICANT
S
VALUATION$
APPROVALS. DATE' `INSPECTOR'S SIGNATURE
' • : LOCATIONP CPMT.
'FORMS,MATERIALSFEE 's.17 _FEE FOUNDATION: �^�.`. •�y iC�
'
_
FRAME:FIRE STOPS,'
I HEREBY ACKNOWLEDGE THAT) HAVE READ THIS APPLICATION " 'BRACING, BOLTS * '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE•TO COMPLYFURNACE: LOCATION,
WITH ALL COUNTY-ORDINANCES AND STATE LAWS REGULATING - FU S 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 THE LABOR CODE•OF,THE STATE OF CALIFORNIA RELAT-,
ING TO WORKMEN'S COMPENSATION INSURANCE. - -
LATH• EXT.
SIGNATURE OF.," - .HOUSE NUMBER COR-
_PERMITTEE ' ��-� - RECT AND POSTED
ADDRESS- FINAL -
. CLYDE N. DIRLAM, PRINCIPAL STR T RAL ENGINEER
PLAN CHECK' VALIDATION cK. M.O. cAsrt PERMIT VALIDATION. cK WO. cASH,.'
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TEMPLE CIT'
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76A638A CE 4 803 1-62APPLICATION FOR BUILDING P
COUNTY OF LOS ANGELESBUILDING i
DEPARTMENT OF COUNTY ENGINEER AODREss
A
BUILDING AND SAFETY DIVISION LOCALITY c
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTR CT NO. GROUP TYPE - O ESSED BY
FOR APPLICANT TO FILL IN ( oNsr.
BUILDING STATISTICAL CLASSIFICATION EWER MAP
ADDRE��:__ ._ _ - .� BK C G
-- CLASS. NO. DWELL. UNITS
LOT NO. j'7Z (-.. BLOCK WATER �y
CERTIFICATE: NOT REQUIRED I VI RECEIVED ❑
TRACT MAPHIGHWAY L111
NO.OF BLOGS. NO, ' - fcIRCLE) STATE MAJOR SECOND,
SIZE OF LOT �CJ X /,1J NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. > /
OWN �GI+a IJ Y e_NEOL.
;L BUILDING YARD HWY E NAME EXIST.
SETBACK WIDTH
ADDRESS �p �.Q�'' FPOLNT /
ARCHITECT OR TEL.
ENGINEER Z" NO. SIDE
P. L. ' O.
ADDRESS 3 A/) rp /1 �. V
/ tTEL C ��, - C !� T�
CONTRACTOR Z� n/ NO.
r ae
ADDRESS 7 V" '' + - - O
u
DESCRIPTION OF WORK u,
N
NEW ADD ALTER REPAIR DEMOLISH Z
SQ. FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE Z2Q..
I
SIGNATURE OF
APPLICANT
II
VALUATIONS (i
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FEE $ FEE $ ` FORMS, MATERIALS
FRAME: FIRE STOPS,
] HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY 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 CALIFORNIA RELAT.
ING TO WORKMEN'S COMPENSATION INS AANCE. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR- Vie•
PERMITTEE RECT AND POSTED
ADDRESS FINAL
JOHN F. LEWIS, RINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT V LIDATION M.O. CASH