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76A638A CE#803162 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES - BuILoING s ?
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY ,
JOHN A LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A JENSEN, SUP T OF BUILDING CROSS,ST
DIST�I JLT NO RO TYPE PR E BY
FOR APPLICANT TO FILL IN -.5 dl CONST
BUILDINGSTATISTICAL CLASSIFICATION SEWER MAP
ADDRESS BK
CLASS NO DWELL UNITS
LOT NO —
/p2 ( BLOCK. WATER
CERTIFICATE NOT REQUIRED RECEIVED
TRACT MAP HIGHWAY STATE MAJOR SECOND LOCAL
A NO OF BLDGS NO (CIRCLE)
SIZE OF LOT `` G NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS i
EXISTING BLDG
OWNER (.�1Vg/• �,y�9,�,,, � NO�� �.J BUILDING YARD HWY STREET NAME EXIST
ADDRESS /aC.�
-7 C7 �•/ls (��{✓'Ly't� LC�++' J FRONT
SETBACK ' WIDTH
ARCHITECT OR TEL P L
ENGINEER NO SIDE 1
ADDRESS _Al A �q a
TEL A f it /Y , � _ f"(ll..i ? � '�4'7C.{� �I'u,"01 0
CONTRACTOR �- NO
ADDRESS -�I'/:�• ✓2.taf✓/,.�( �'' .,d / ClsSG4/`/{u`� ad
� 0
DESCRIPTION OF WORK uu
NEWADD ALTER REPAIR DEMOLISH t`" ,F epi •n Z
SQ FT NO OF NO OF
SIZE STORIES FAMILIESUSE
STRUCTURE / • N'Lt. Z,`/fl{..L�,i[ 1��� IL� �k -L •B
SIGNATURE OF //�� -- p,�. 1 �)'� pl.Ji/I`Yv,.,l.?e�'�Y�l/� yNt�+t :y;�✓r�.}/v�/��`�9 ,,(,'/
APPLICANT ,,J.t�O!
VALUATION $ !APPROVALS t� )WfOJ DAT INSPECTOR S SIGN6tgRE
PCT S C FOUNDATION LOCATION /A �� �1
FEE $ FEE $� p,•�� FORMS, MATERIALS 4 /�� G[,
FRAME FIRE STOPS J
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ',BRACING BOLTS h m O
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENTDUCTS
BUILDING CONSTRUCTION I CERTIFY THAT-'IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- 6,VT:H INT
TION OF THE LABOR COD )l
OF THE STATE OF CALIFORNIA RELAT , —
ING TO WORKMEN S CPP 'NSU ANCE - �/)/ ,/
i 14
LATH EXT -
SIGNATURE OF U / J
l-/L/� �/,j,..E►+r�� HOUSE NUMBER COR- /I i
PERMITTEE
RECT AND POSTED
ADDRESS a FINAL
JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK M'o CASH _ PERMIT VALIDATION CK M O CASH
Li�l,o5 0 6 1 QC( 2, 2 �3 D 2 6.75A
Ir_.. Lt6287 ,D31 53.50, t