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APPLICATION FOR BUILDING PERMIT 1
DIVISION OF BUILDING AND SAFETY 2ooRelse :l //� /4/ 4 c6.✓
DepaIrtment of County Engineer
County of Los Angeles LOCALITY
WM.J. FOX. COUNTY ENGINEER NEAREST 17
CASSATT D. GRIFFIN. SUPT OF BUILDING CROSS ST.
FOR APPLICANT TO FILL IN DlsrRlc{r�fJO. GROUP ,PE SEWER MAP
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BUILDINGADDRESS '.i �J MAP �b �. BHWY �
NUMBER
USE%ONE SPECIAL
CONDITIONS_
TRACT O'- Y- QO
NO. OF BLDGS, BUILDING EXIST.
SIZE OF LOT WON T SETBACK . YARD HWY STREET'NAME WIDTH
USEFRONT
EXISTING BLDG. Y P L
OWNERJE'S SIDE -
MAILf /� A �(� A P. L.
ADDRESS Sri/� J/ / (/ t/� � -At O TRACT DWELL. 1 UNIT
�v. 5 INDUSTRIAL
CITY T M _I/ Y NO. F&
OG�UJ I DWELL. 1 UNIT 6 PUBLIC BLDG.
ARCHITECT OR u f TEL. 2 DUPLEX UNIT
ENGINEER NO. ADDN., ALT.. ETC.
(J /[ 3 APT. _UNITS
B MISCEL.
ADDRESS 4 COMMERCIAL
CONTRACTOR O w vi e P' TTTL. INSPECTION RECORD
ADDRESS '
DESCRIPTION OF WORE
NEW ADD �/ ALTER REPAIR DEMOLISH
SO. FT. NO. OF NO. OF _
SIZE I ��„ .�-/g STORIES FAMILIES
STRUCTURE
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SIGNATURE OFM
APPLICANT APPROVALS /
.ADDRESS I, OAT INSPE OR'S SIGNATURE
S P. C. S F FORMS. MATERIIALSION R ly
BQ FEE FRAME: FIRE STOPS.
VALUATION
S
BRACING.BOLTS
FEE FURNACE: LOCATION,
I HEREBY ACKNOWLEDGE THAT 1 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.
91 GNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS r
=& I FINAL
WM.J.FOX,COUNTY ENGINEER VALIDATION C. N. DIRLAM. CHIEF BLDG. INSPECTOR
AD 3 8 9 1 MAR, 8 1 8.0 0 .In
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C. 53 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES' BUILDING . J~
' DEPARTMENT OF COUNTY ENGINEER .•• noDRESS
BUILDING 'AND SAFETY'DIVISION " LocALITY•
JOHN.A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN. SUPT of BUILDING CROSS ST.
DISpCT 1{O. GROUP ' T. PE PROCESSED BY
FOR APPLICANT TO FILL'IN , p. OV .1 �_T I CONST. a4
BUILDING STATISTICAL CLASSIFICATION S WER MAP
ADDRESS /%,` .(i>„� '.' - BKL�PG
I CLASS, NO.- DWELL'. UNITS
LOT NO. If BLOCK " ` WATER
q CERTIFICATE: NOT REQUIRED RECEIVED ❑
TRACT !� L O., _. Pr .
MAP' '/
IND.IOF SLOGS. NO. C Rc EI STATE MAJOR SECOND,
SIZE OF LOT O+. NOW'ON LOT
�.
`USE ZONE SPECIAL U
'USE-OF CONDITIONS
_ EXISTING BLDG.
OWNER •.NEOGtT b_6yOB ,G,. y EXIST.
YARD' HWY .STREET NAME
SETBACK,' WIDTH.
ADDRESS S;� -�• FRONT.
ARCHITECT OR -- TEL P. L.
ENGINEER NO: SIDE,
P.
L. }
ADDP
ADDRESS 1 O
CONTRALTO _h'" tryE T J V O
AD6 w
ORE551•' ,�AA.+,I�t: ': ' - � O
DESCRIPTION OF WORK G
BE
a
NEW ADD ALTER REPAIR' DEMOLISH 4. • _ N
SO. FT. 'NO. OF NO. OF ?
SIZE STORIES FAM ILI ES I); 1 USE OF
STRUCTURE
SIGNAT,URE'O
APPLICANT_ i '^
VALUPTION S - -E lcp ytL -
- APPROVALS DATINSPEcroR's snrcE
—, FOUNDATION: LOCATION
.FEES : �- FEES _ FORMS . MATERIALS"
•, FRAME: FIRE STOPS.
G /
I HEREBY ACKNOWLEDE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS,CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, % I
WITH ALL COUNTY ORDINANCES AND STATE LAWS -REGULATING :. GAS-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 CALIFOfl IA RELAT- - '
INGI TO WORKMEN�' ITF'OMP EN-BA''T�I/tO�IN INSURANCE. .:LATH. EXT.- t, `
.SIGNATURE-O 1 HOUSE NUMBER COR - \_
PERMITTEE w�"'v__// NNNW///'1111 NNN`77C///YYY��^������"' RECT AND POSTED '� t
ADDRESS- t ' FINAL
JOHN F. LEWIS.4PRINCIPAL7ST NAl ENGINEER
PLAN CHECK VALIDATION R. ..0. CASH _ PERMIT'VALIDATION cK. M.D. GAB.•
y LALI6..9'.9. 5 :8 G..SEP 1 Q 1 'D 6.00-
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