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7SA533A CEu303 3.53 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING n
DEPARTMENT OF COUNTY ENGINEER ADDRESS C/ L
BUILDING AND SAFETY DIVISION LOCALITY
VL/ ,C9
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST C
WILLIAM A. JENSEN. SOFT OF BUILDING CROSS ST. ✓cV/_111P r
TYPE
FOR APPLICANT TO FILL INDIRICT Nps GRaaP CONST. PROCE�sJB i
D C cwt
BUILDING '0 � l•� /, v STATISTICAL CLASSIFICATION SEWER MAP �i
r ADDRESS IY [I BKPGX/.
CLASS. NO. DWELL. UNITS vt'>
LOT NO. T��CF, a'�J BLOCK WATER
CERTIFICATE: NOT REQUIRED ❑ RECEIVED ❑
TRACT MAP �. 1-yl HIGHWAY
n 1 NO.OF BLOGS. NO, (CIRCLE) STATE MAJOR SECON LOCAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL
USE OF I CONDITIONS
EXISTING BLDG. /J /
OWNER �{/ C� rG' NOjW J/�T4S j
UU /{ ' BUli ILDING YARD
EXIST.
ADDRESS
Of � .Gs/Pj/j� �.5 SFRONTK HWY STREET NAME WI
�
ARCHITECT OR - TEL. P. L.
ENGINEER NO. SIDE
ADDRESS
P. 'L�t.
,,f TEL. Z-2-6--(,S "moi
' .1 .1
CONTRACTOR - ` NO. U
- ADDRESS
DESCRIPTION OF WORK ho 0--r IZ..) tj ?A 2 A Li r C_ 0
NEW t ADD ALTER REPAIR DEMOLISH p' ♦,n�
1 SO. FT. NO. OF NO. OF / t�1'•Ip � ^� - V
SIZE STORIES I FAMILIES
STR UOCTU RE OT C'//r��� / y� �-. /
SIGNATURE OF
APPLICANT
VALUATION
/ - APP VALS DATE UIISPIECTO.SSIGNLTUR
P.C. PMT. FOUNDATION LOCATION
FEE $� /� FEE $ FORMS. MATERIALS
FRAME: FIE STOPS. i C
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRAQING.RGS
BOLTS TA r•
AND STATE THAT THE AGO
IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINACES AND STATE LAWS REGULATING GAS VENT.-DUCTS '7
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA '•QA
LATH. INT.
TION OF THE LABOR CODE rTHE STATE OF CALIFORNIA RELAT. ti"'
IND TO WORKMEN'S COMP SALION IN KANDE.i LATH. EXT.SIGNATURE
P RM TTEE OF / G �"/Lq HRECT AND POSTEDOUSE NUMBER R
ADDRESS "' FINAL
JOHN F. LEWIS. PRINCIPAL ST ` RAL ENGINEER
PLAN CHECK VALIDATION DK. M.D. CASH PERMIT VALIDATION cK. M.D. CASH
2U JAN26 2 3 D 3 7.254 v
a 3 6 5 u FEB 8 1 D 7 4.5 0^'
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