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74AG38A CE 4803 1-61 APPLICATION ' FOR BUILDING PERMIT
S COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY TZ-M PL CI"r
JOHN A LAMBIEI COUNTY ENGINEER NEAREST ` r,`,
WILLIAM A JENSEN SUPT OF BUILDING CROSS ST 1.0 14
FOR APPLICANT TO FILL IN DISTRICT O G OUP [TY PR ES BY
O DNST
BU'LD /- STATISTICAL CLASSIFICATION SEWER MAP
ADD EIS317 PF �R F1VI LE L711 ` Ko�
CLASS NO DWELL UNITS
LOT NO BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACT 1113 MAP HIGHWAY
-7 STATE MAJOR SECOND LOCAL
SIZE OF LOT 140' )( I ( I I NOW ON LOTS U(JE USO ZONE SPECIALUS' LE)
EXISTO NG BLDG 51 DENC� CONDITIONS
OWNER 1jPRlAt4LANE— NO ATC7 90 BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS Q EMP�Re �Af�lYW8P.1F�-- FRONT /
ARCHITECT OR TEL P L (r'Q
ENGINEER e:', NO SIDE
ADDRESS G � Z P L }
CONTRACTOR �Ls ,TEL NO INSPECTION RECORD p
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ADDRESS ex
DESCRIPTION OF WORK Lu
NEW ADD �/AALFTER REPAIR DEMOLISH A f
S ZET �X.ZiG NO OF NO O Z
STORIES FAMIIES /¢..�
USE OF
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SIGNATURE OF
APPLICANT
VALUATION$ QQi
APPROVALS DATE INSPECT SISIGNATURE
FOUNDATION LOCATION
PC PMT /
FEE FEE FORMS MATERIALS )
$ $ c7 _
FRAME FIRE STOPS, �j yr v
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS '-/ [O .10
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 HEREBY I WILL NOT EMP OY ANY PERSON IN VIOLA LATH, INT
TION OF THE LABOR CODE OF T S TE OF CALIFORNIA RELAT
ING TO WORKMEN S COM E A I N SURANCE
LATH EXT
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE- /_ RECT AND POSTED
ADDRESS DIy/�' �"�� FINAL
— CLYDE N DIRLAM, PRINCIPAL STRU RAL ENGINEER
PLAN CHECK VALIDATION CK. M o CASH PERMIT VALIDATION cK M o CASH
LN,o.8 7 3 8 MAY 2 5 1 D 6.0 0— Q
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APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN BUILDING
ADDRESS
BUILDINGQ �A p �/ ! C d
ADDRESS q10 O E, cm pr/� oe Y r• LOCALITY
z;;- NEAREST
CITY 15, -n 9R)cL ZIP M CROSS ST
NO OF BLDGS ASSESSOR
SIZE OF LOV 60KI17 NOW ON LOT OlVe MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE PROCES D BY
TRACT n �( BJLOCCKf,S•�- -3� LOLNO � ,,i �� CONSLT � Z�E'
OWNER O2 A L-hA NO %6 O �J �/
ADDRESS dQ L/����� STATISTICAL CLASSIFICATION EWER MAP
a Qn r� CLASS NO DWELL UNITS BK- PG
CITY '544/ V/'�G ZIP 1/77J '
ARCHITECT OR TEL VALUATIONll
ENGINEER NO 6 D u
ADDRESS BLDG SETBACK FROM
TEL FRONT PROP LINE OF (STREET)
CONTRACTOR NO TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH
ADDRESS NO
LIC - +
CITY 'CLASS
BLDG SETBACK FROM
CONSTRUCTION LENDER ,V`0�(.-�
NAME AND BRANCH / SIDE PROP LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS CITY SIDE PROP LINE HIGHWAY WIDTH
SQFT d NO OF NO OF CHECK + _ (�
SIZE j II.9' STORIES FAMILIES ONE
``J O
DESCRIPTION OF WORK NEW ❑ PC Fee$ Permit Fee u
o F ADD 4,
- Issuance Fee d
ALTER
REPAIR ❑ Total Fee
USE OFp� G DEMOL [01EXISTING BLDG/ �1 Z
APPLICANT ' ^ -TEL O
PRINT)�y NOZ������ Q
BY(SIGNATURE) Q
I HEREBY ACKNOWLEDGE THAT AVE READ THIS APPLICATION AND STATE _ Uhe
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE Z
WORK AUTHORIZED HEREBY I WILL NOT NPLOY ANY PERSON IN VIOLATION OF U -
THE LABOR CODE OF THE STATE OF CAL( NIA IN RELATING TO WORKMEN S COM Z
PENSATION INSURANCE 2,']3 2 2 A 3
SIGNATURE OF
PERMITTEE # o o io o;o
ADDRESS to- Fz� 0 2'0)o`'Z''Z 0'0
TELry Q'
CITY f1�/�^' NO !� /D Q o o 0 2 2 0 0 v
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