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78A838A CE#803 3_83 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING J
DEPARTMENT OF COUNTY ENGINEER ADDRESS D
r
BUILDING AND SAFETY DIVISION LOCALIT
JOHN A LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A JENSEN, SUP T OF BUILDING CROSS ST
DISTRICT N G�FQJJP TYPE P O D BY
FOR APPLICANT TO FILL IN a�J( CO
BUILDING �L/Cj Gf�NC►1N!]� STATISTICAL CL SI FICATION SEWER R MAP —
ADDRESS / / ,
^^77 �7 CLASS NO DWELL UNITS
LOT NO L G� BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑
�''} CERTIFICATE
TRACT / MAP HIGHWAY
y NO OF BLDGS v� NO O� (CIRCLE) STATE MAJOR SECOND LOCAL
SIZE OF LOT ,�L�^ NOW ON LOT �'"� USE ZONE SPECIAL
USE OF �y /�uCF 7 CONDITIONS
EXISTING BLDGY //ES/ TEL
p / +
OW N E R7?1r-f'TU W E Lf/Q �1_ NO A �C BUILDING EXIST
SETBACK
YARD HWY STREET NAME
�/ I WIDTH
ADDRESS J �rA��/�' / FRONT D�
ARCHITECT OR TEL P L '
ENGINEER NO I SIDE /@
P
ADDRESS
CONTRACTOR ;F4($sE/,/11YIIA n�� Toy �43�7 rr - / v
ADDRESS G /�� D ��^� ` OC
DESCRIPTION OF WORK Ou
U
' W
NEW ADD ALTER REPAIR DEMOLISH tn
z
SQ FT NO OF f NO OF
SIZE 0� STORIES / FAMILIES _
USE OFf �¢
STRUCTURE ,t/ff�A(f, Ai
SIGNATURE O
APPLICANT
VALUATION $ / w
APPROVALS ,DATE INSPECTOR SSIGNATURE
PC PMT- �'^D= FOUNDATION LOCATION
FEi FEE $ / FORMS MATERIALS l C!
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 •4
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 CODC OF THE STATE OF CALIFORNIA RELAT
ING TO WORKMEXSC PENSATION INSURANCE
JLATH EXT
SIGNATURE HOUSE NUMBER COR
PERMITTEE RECT AND POSTED ... .�:.0
ADDRESS FINAL
PLAN CHECK VALIDATION CK Mo CASH JOHN F LEWIS PRINCIPAL ST AL ENGINEER
PERMIT VALIDATION CK M o CASH
• 7
Lhbo 5 5 0 9,. NOV 2 1 D 1 1.50-
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DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX. CHIEF ENGINEER I D
i
FOR APP ICANT TO FILL IN FOR OFFICE USE ONLY-
BUILDING
• DISTRICJT O PLAN CK NOT_ PERMIT NO.
L�9
ADDRESS �r� ,( �'- ' �I [,f� 7
(fj /
LOCALITY RECEIVE0"8Y DATE OFAPPL DATE ISSUED
NEARESTAl 'r 2
CROSS ST
rJ ( BUILDING
OWNER I ADDRESS 1� L
s
ADDRESS MAIL
LOCALITY
NEAREST
CITY � TEL NO CROSS ST
FIRE I OF TYPE GROUP /
ARCHITECT OR _ TEL. ZONE PLANS r
ENGINEER NO
BLDG ORD NO
1 ADDRESS SETBACK LINE 1 ±
_ APPROVED
CONTRACTOR L BY t DATE ,
1 n USE APPROVED
ADDRESS �{!ql = ZONE BY } DATE
LEGAL CORRECTIONS '
DESCRIPTION LOT NO BLOCK 1
TRACT
NO OFBLDGS
SIZE OF LOT NOW ON LOT
USE OF NO OFNO OF
EXISTING BLDG FAMILIES ROOMS
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
O
A
REPAIR MOVING DEMOLISH �
Sq FT. NO OF , Z
SIZE ROOMS STORIES y
WALL ROOF ,. I _ 1� r
COVERING COVERING
1
USE OF NEW
BUILDING
40
I HEREBY ACKNOWLEDGE THAT I 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
AND STATE LAWS REGULATING BUILDING CONSTRUCTION
FRAME FIRE STOPS,
SIGNATURE OF {{// BRACING,BOLTS
PERMITTEE,
LATH, INT
I�
AUTHORIZED AGT-
LATH, EXT.
76A638A 9-413
DBS-3 50M SETS s )/900 FFEE
PLASTER,INT.
�J
PLASTER,EXT.
ALUATION FINAL