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76AG38A CE T'I 8036-62APPLICATION FOR BUIL NG PERMIT
COUNTY OF LOS ANGELES BUILDING t
DEPARTMENT OF COUNTY ENGINEER ADDRESS'
BUILDING AND SAFETY DIVISION LOCALITY �\
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST. �
YPE
FOR APPLICANT. TO FILL IN DIsr R1cT N GROUP CONST. SHD BY
BUILDING /'4 �� f\ STA�TI STICAL CLASSIFICATION SEWER MAPy�
ADORESSV77./� �G /! CLASS. NO.�OWELL UNITS K PV
LOT NO. '�Y/3. BLOCK G WATER NOT REQUIRED RECEIVED ❑
CERTIFICATE: .\`\
TRACT / MAP HIGHWAY V`
SIZE OF LOT NOW ON LOTS NO, O (CIRCLE)
STATE MAJOR SECOND;• CAL '
USE OF U O�E SPECCONDITIAL
ONS
ONS
EXISTIN LOG.
OWN TE �� BUILDING YARD HWY STREET NAME EXIST.
AD SS �� '� SETBACK WIDTH (�
FRONT D "\
ARCH E OR TEL. P. L.
ENGINE1
ENGINEER NO. SIDE Y
P. L. C
ADDR S �/ � O
NO V
ADDR
DESCRIPTION OF WORK
NEW k� ADD ALTER REPAIR DEMOLISH
R�E
NO. OF NO. OF / W
STORIES FAMILIES (awn _USE t,:/'�S/I'".4 IQQ v C o
L71 � IS TRK � IiSV. ft' S
/hKV ALL I(IKI4 P14 1 FAULT%iFS ,QFj�/pyO� APPROVALS DA E I NSPECTOR'5$1GN LIRE
> Q FOUNDATION: LOCATION
FEE S v / FORMS. MATERIALS !/ V�
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION BRACING, BOLTS !
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS
BUILDING CONSTRUCTION_ I CERTIFY THAT IN DOING THE WORK
AUTHORIZED V I WIL NOT EMPLOY ANY PERBON IN,RAou. LATH. INT.
TION OF TH LAD R CO, OF THE STATE OF CALIFORN RELR
ING TO WO NMEN O i(P NSATI 5 E.
L
ATH, EXT.
P RMITTE HRECT AND POSTE DOUSE R 7,I/n�/I! /" +"<f �' •.'`,'
ADDR FINAL
JOHN F. LEWIS, PRINCIPALS RAL ENGINEER \
PLAN CHECK VALIDATION cK. M.D. CASH _ PERMIT VALIDATION CK. M.G. CASH SC
LACc) 1 2 7 2'2 FEB 2 5 2 3 0 1 8 .0 ,')8
�lil o A `1 1 7�- PAY 8 1 0 3 9.5 o" Y.:
-`1
A ROAD DEPT. PEcAAIT IS REQUIRED
FOR ANY MATERIAL M--W% 'E WORK
DONE IN THE R'-AD (;rt.,:i C„ VJAY. '
••••••.=E�• APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE• COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN, SUPT oP BOILDING CROSS ST. -
DISTRICT NO. GROUP TYPE PR D
FOR APPLICA�iT TO FILL IN CONST.
BUILDING STATISTICAL CL IFICATION SEWER MAP
ADDRESS BK PGO
CLASS.NO._DWELL UNITS
LOT NO. BLOCK MAP STATE
NUMBER �� � HWY. YES O
TRACT USE ZONE SPECIAL -
NO.OF SLOGS. �j CONDITIONS
SIZE OF LOT ) NOW ON LOT S Ai J -
USE OF I
EXISTING BLDG. - BUILDING EXIST.
y - SETBACK YARD HWY STREET NAME WIDTH
OWNE .% ,,��Jj,,�� A.�
AMAIL If
DDRESS 0 I
TE %✓Z J P.L.
CITY N� INSPECTION RECORD
ARCHITECT OR T
ENGINEER N- .
ADDRESS
TEL.
CONTRACTOR NO.
ADDRESS
D SCRIPTION OF WORK
NEW ALTER REPAIR DEMOLISH I
Sq. FT. NO. OF NO. OF t
SIZE - STORIES FAMILIES -
USE OF
STRUCTURE
t —
SIGNATURE.OF _
APPLICANT -
APPROVALS DATEINSPECTOR'S SIGNATURE
RAME: FIRE
ADDRESS - FOUNDATION: LOCATION
FORMS,MATERIALS
VALUATION $ .`O I FBRACING, BOLTTSS l
FURNACE: LOCATION,
P.C. PMT. GAS VENT,DUCTS
FEE S I FEE S L? -
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH, INT.
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO C "LY WITH ALL COUNTY ORDINANCES AND
STATE LAW EGULAT WG BUILDING ONSTRUCTION. LAI H, EXT.
IGNATURE HOUSE NUMBER COR- -
ERMITTE RL"CT AND POSTED
ADORESS • FIPIALIf 1 -�I' �—L
'CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENR
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
,s3a4 FEB -1 1 n 2.Q0 ®.