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75AGSAA CE tl0019 60 APPLICATION FOR BUILDINGPERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER °DDRESS v v
BUILDINGAND SAFETY DIVISION LOCALITY
JOHN A._LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST
DISTRICTG TYP S BY
FOR APPLICANT TO FILL IN 0 I CONST
STATISTICALCLAS
ABU'LDDRD NG
ESS LFICATION S ER MAP
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CLASS NO /�JDWEL UNITS
LOT NO BLOCK MAPNTE
UMBER (/O S.WY YES NO
TRACT Qt,� USE ZONE SPECIAL
NO O LDGS - / CONDITIONS
SIZE OF LOT T.� I NOW O LOT
USE OF
EXISTING BLDG BUILDING EXj'HI
_ L - YARD HWY STREET NAME
SETBACK WI
OWNEF� O FRONT _'� � ^ -
ADDRESS . d Qk.vu-^ SIDE
ARCHITECTOR TEL _ P L
ENGINEER NO INSPECTION RECORD
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/ ADDRESS �-
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CONTRACTOR ``\_j; �Q ��t _NO V
ADDRESS �f DD q./v��� Q
DESCRIPTION OF WORKCL
C
W
N
NEW ADD ALTER - REPAIR DEMOLISH Z
SQ FT c NO OF NO OF '
SIZE 16 x�.7. STORIES FAMILIES
USE OF
STRUCTURE GL'
SIGNATURE OF
APPLICANT
VALUATION$ / /�� U� I • , : ,
v v APPROVALS DATE .INSPECTOR S SIGNATURE
P C , PMTiy�) FOUNDATION LOCATION
FEE $ FEE $ , (/(/ FORMS MATERIALS _
FRAME FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE-THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION, - 1
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS N
BUILDING CONSTRUCTION I CERTIFY THAT IN THE PERFORMANCE A
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED SHALL NOT LATHINT Y
EMPLOY ANY PERSON IN ANY MANNER SO AS TO ,BECOME SUBUECT
TO THE WORKMEN S COMPENSATION LAWS OF CALIFORNIA LATH,EXT Fj i` G L I► ! VV
SIGNATUREO HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRESS f v ll; FINAL
M, PRINCIPAL
PLAN CHECK VALIDATION CK. M 0. CASH CLYDE P PERMIT VALIDATION CK.
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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER BUILDING
I
NO OF BLDG ORD NO DISTR
ICT
NO FLAN CK NO. P RMIT NO I
PLANS SETBACK LINE
FIRE APPROVED
ZONE�_{USEq-� BY ATC [ R/E CC�EEIIIVED BY I DATE OF APPL _ DATE ISSUED
ZONE'J _/ BY ATE
DATE I C" /4 " _
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
BUILDING �J
O m NAME ADDRESS
F W %
W Z ADDRESS LOCALITY
F
NEAREST
W CITY r /J� CROSS ST /
Q STATE /1/ TEL
L'CENSE O A l NO K NAME—/('
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z MAIL
O NAME _ 3 ADDRESS
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U TEL
Q ADDRES CITY NO
F L 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
z CITY
O APPLICATION AND STATE THAT THE ABOVE IS CORRECT
U STATE TEL S AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
LICENSE Nr` NO /U`3 �` ZAND STATE LAWS REGULATI G BUILDING CONSTRUCTION
/ r-'p, _ < ✓ SIGNATURE OF e
z LOT NO SIZE OF LOT
p OWNER
NO OF BLDGS
/
/ HORIZED AGT
Q4 BLOCK UT
^r NOW ON LOT �'
wit
-'rb TRACT /�% �� ^(o G lj� �L „ CORRECTIONS
W
D USE OF BLDGS
NOW ON LOT ""•'[ (. !1 A''i/li5l
DESCRIPTION OF WORKV1
USE OF I I
BUILDING
71—
lee-
0 GO
- Gt
z
i� D
r
NEW TYPE GROUP
NOOma- NO OF t
ALTERATION - ROOM
FAMILIES
f
ADDITION SIZE
p;
REPAIR STORIES
t1OVING WALL COVERING
DEMOLISH ROOF COVERING
P C SFINAL APPROVAL
s
! "`� /
_! INSPECTOR'S
VALUATION FEEDjkTE NAME
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DEPARTMENT OF BUILDING AND SAFETY ; APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES ® ' ®��®
WM. J. FOX, CHIEF ENGINEER
FOR AAPPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDINGrte , I DISTRICT NO. PLAN CK NO. PERMIT N^O*
AD REBBv p S
LOCALITY j y f ,,,�-y i}.j ECEIVED BY DATE OF APPL. DATE ISSUED
NEAREST - �j'7 / � 1-7
CROSS ST. /•A-��/,/� ""_{r:f
OWNER c ar.J '/1 r 1 del i`°zz ADD E19S lO 19- rM&S 'olf/
DDMAILEBB ' ��� A1� ;r _ � LOCALITY Y r' / C,
ADDRESS 1/ �„�/
NEAREST
TEL.,y� �9 Iq CR0998T. [�V
CITY :�'�' ?.- ♦ {�J, i' NO. PS�i�l.�G/�L�F FIRENO.OF TYPE GROUP
ARCHITECT OR , `•�� TEL ZONE `_ PLANS ��"�
ENGINEER ���,i''A� NO.
BLDG. / 1 ORD.NO.
ADDRESS SETBACK LINE t "�
APPROVED - - -- -
/y v,TEL.�
CONTRACTOR NO. BY DATE
USE APPROVED
ADDRESS ��p,,�`` ZONE-J BY DATELEGAL
"-
DESCRIPTION LOTNO�,-'JK/
tr I BLOCV' "� J ZU` CORRECTIONS
TRACTL f�i.r�n�Y�si f _.,.�ag7�1��+r$�y i .•YAf.'n1,r``1) /7 A
SIZE OF LOT,25 A I NOW ON LOTS
USE OF I � NO.OF ` NO.OF d�
EXISTING BLDG. •�'T' '���-� FAMILIES / ROOMS 9X
DESCRIPTION OF WORK
NEW a'a ALTERATION ADDITION _
O
- A
REPAIR ��`�'/� tr7, MOVING DEMOLISHSO q
NO OF z
SIZE T e.�4;.% 4+' ROOMS STORIES D
WALL s� ROOF r
—COVERING COVERING -
USE OF NEW
1 BUILDING �" . .�,J�'.=fid/✓ i(�
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS ��Sc4�
AND STATE LAWS REGULATING BUILDING CONSTRUCTION
FRAME: FIRE STOPS,
SIGNATURE OF °,°. /�/ BRACING.BOLTS
PERMITTEE
LATH,INT.:
AUTHORIZED AGT LATH,EXT.:
�1
DBS-3 SDM SETS 7-47 $ CY P.C.0 PLASTER, INT. J
FEE c� PLASTER,EXT. ,
VALUATION
FEE FINAL ��! m