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76A638A CE�803 8 64 APPLICATION FeRBUlkG PER_MI
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENG=ER ADDRESS
BUILDING AND SAFETY DIVISION 'LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS5UP T OF BUILDING CROSS ST (,(
DISTRICT NO =GROUP 'TYPPROCE SED BY
FOR APPLICANT TO FILL IN iCONST m r I
BUILDING STATISTICAL C�ASS]FICATION� SEW R MAP
ADDRE CLASS NO DWELL UNITS " BK PG
LOT NO BLOCK USE ZONE MAP
_ _ g NO
TRACT ^� ,�Y SPECIAL
NO OF BLDGS I 1 C DITTO
SIZE OF LOT NOW ON LOT i I.LS
USE OF AA ij �•C.
EX S G /! � BLDG SET CK FROM
TEL 0 ! FRONT PROPJ LINE OF (STREET)
OWNER NO L TYPE OF EXISTING I SETBACK HIGHWAY „+ YARD = TOTAL'
ADDRESS HIGHWAY WIDTH FROM C L
CITY SLOGr _ _
ARCHITECT OR T^L SIDE SETBACK FROM
ENGINEER � O SIDE PROP LINE OF � N - (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL,
ADDRESS -- HIGHWAY WIDTH FROM C L - d
�^}T E L eIW3r ,, + = 0
CONTRACTOR /T NO V
ADDRESS -n NO��� CORNER CUTOFF YES NO O
CITY LIL SEE REVERSE SIDE FOR SPECIAL APPROVALS u
DESCRIPTION OF WORK (-!l r-LreA2. Mu Z
NEW ADD ALTER REPAIR DEMOLISH /
SQ FTNO OF / NO OF
SIZE STORIES {. FAMILIES
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SIGNATURE-OF ALSO -rn»k. -&� /4 1 4'-r
APPLICAN
VALUATION ) sr--
APPROVALS DATE INSPECTOR SSIGNATURE
FOUNDATION LOCATION
FEE$ "'-- FEE$ `7 FORMS MATERIALS _
FRAME FIRE STOPS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION (�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS v
9UILDING 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 WORKMEN 5 C PENSATION INSURANCE LATH EXT
SIGNATURE Oar HOUSE NUMBER COR
PERMITTEE i... / RE AND POSTED
ADDRESS -� FINAL
VV ��/, q JOHN F LEWIS PRINK IPALISTRU TUIRfAL ENGINEER
PLAN CHECK ' A O^'" C CK CASH _ PERMTT VALIDATION CK �M O CASH
J"'o05s2 nr `g 0 1500
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76AG38ACE#8091157 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
571
BUILDING AND SAFETY DMSION LOCALITY
JOHN A LAMBIE COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
DISTRI?:j GRA .TYPE SEWER MAP
FOR APPLICANT TO FILL IN
CONST �f
BUILDING c?l�C� U
ADDRESS STATIST]CAL[LASSIFICATION
CLASS NO DWELL UNITS
LOT NO BLOCK MAPSTATE
r t NUMBER s-D HWY YES O
TRACT 433q USE?ONESPECIAL
/ NO OF BLDGS CONDITIONS
SIZE OF LOT,J /�-'y Z� 1� NOW ON LOT
USE OF
EXISTING BLDG BUILDING EXIST
SETBACK YARD HWY STREET NAME WIDTH
OWNER L n e c- FRONT <y� /l/)I
MAILP L (/ o
ADDRESS ��L//� 3 Q�2 Q r r SIDE
TEL
CITY SQ N a 6 e-I NO P L INSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO
ADDRESS
TEL
CONTRACTOR )- .� � L�� N
2 O OSS
ADDRESS /Z� J cQK ab"
D SCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
SQ FTJ NO OF NO OF
SIZE / STORIES FAMILIES
USE OF STRUCTURE
AM
SIGNATURE OF APPROVALS
APPLICANT
DATE /INSPECTOR S SIGNATURE
ADDRESS -S, .�LJ FOUNDATION LOCATION /P
FORMS MATERIALS g-74 j
P C $ FRAME FIRE STOPS
FEE BRACING BOLTS
VALUATION $ FURNACE
LOCATION
FEE GAS VENTDUCTS
Cr
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORD NANCES AND
STATE LAWS REGULATINg.BUIL I NSTRUCTION LATH EXT J
SIGNATURE OF HOUSE NUMBER COR / 9 "44A04-PERM ITT r RECT AND POSTED f A� iY2 r n d r or)
ADDRESS X72 Z �QH y d FINAL /sp-o&
CLYDE N DIRLAM PRINCIPAL S-T RU URAL ENGINEER
PLAN CHECK VALIDATION M O CASH PERMIT VALIDATIONK M O CASH
L'EO3 9 6"8�;T AUG 182 3 A 8 3 8 1 ' ®.
LAW AW 18 1 A 3350
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