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1�A638A C�803B- APPLICATION FOR UILDING ERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER A D D R E SS hl i l V "7��
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST.
DISTRI T N GROUP TYPE P E ED BY
FOR APPLICANT TO FILL IN e coNsr.
BUILDING / sL STATISTICAL
�CLASSIFICATION SEW R MAP
ADDRESS Q` G .� '..!! i� ( - CLASS NO. DWELL UNITS BK PG
LOT NO. BLOCK USE ZONE MAP
NO.
l5re9_—
TRACT PECIAL
NO. OF BLDGS. CONDITIONS
SIZE OF LOT ;[ �> NOW ON LOT
USE OF
E I 4 -o r_.�-z "G%�-�-�+ - BLDG. SETBACK FROM P_711r
T L. _ FRONT PROP. LINE OF l (STREET)
OWNE L NO. S!-� �4 TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS -C`�. �. :�l t- �„ �� it HI WAY W I TH F.OM C.
Im +
CITY _t,.- .
BLDG. SETErAeR FROM
ARC HITECY OR TEL. SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL �
ADDRESS HIGHWAY WIDTH FROM C.L. Ca.
,`�//,, o, TEL.r/ + = 0
CONTRACTOR G!-� l.�u NO
ADDRESS/ '�3 k. (.D ��� NO LIC CORNER CUTOFF YES NO 0
LIC SEE REVERSE SIDE FOR SPECIAL APPROVALS ~
CITY V
W
DESCRIPTION OF WORK Z
NEW ADD ALTER REPAIR DEMOLISH
SQ.FT. "NO/OF NO. OF
i
SIZE STORIES FAMILIES
USE OF
STRUCTURE
i GNATURE OF
APPLICANT -
VALUATION$ APPROVALS DATE INSPECTOR'S SION{,7URE
P.C. PMT. %� FOUNDATION,
ION J . ..
FEE$' FEE$ FORMS !
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
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9UILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT.
TION OF THE LABOR CODE OF THE TE OF CALIFORNIA RELAT-
ING TO WORKMEN'S OMPENSATI I UR LATH. EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTEE RECT AND POSTE
ADDRESS F I N A L - +
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONS CK. ) M.O CASH
-07 5 3 5- NOV 2 3 1 D �-�4.0 0cm
,76A"8A CE[e03B-0S APPLICATION FOR B ILDING�IT
COUNTY OF LOS ANGELES BUILDING_ {j
DEPARTYMNT OF COUNTY ENGINEER ADDRESS (�
BUILDING AND SAFETY DIVISION LOCALITY l
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST _
COLEMAN W. JENKINS,SUP'T.OF BUILDING CROSS ST.
DIbTR T IJ,p. GROUP TYPE. C "Ea-BYFOR APPLICANT TO FILL IN Uv CONS
BI,IILDINO / i STATISTICAL A881FICATION. SE ER'-MAP
A DRESS CLASS NO. ,
bWELL I,INITS PK-
LOTNO. BLOCK UDE ZONE MAP -
NO.
TRACT $PECIAL
CO
X0. OF BLD■l.
SIZE OF LOT NOW ON LOT
USE OF
E STING �-�`n�� '■LID 1KTEAC[ FROM - -
TEL. / FAOXT PROP. LINE OF (l�1TR[[T)
OWNER TYPE OF ' [XI[TIN■ B[T■ACR HI■HWAY' + YARD — NOTAL
ADDR ESS C.L.
CITY LD■. ■ K FROM
ARCHIT15CT OR TEL.
ENGINEER NO. 81D[ PROP. LIXI OF 1TR[[T
YP[ OF [XIBTIN■ SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM.C.L. '
TEL. ,7 ` -}- 7 _
CONTRACTOR NO ✓ O
ADDRESS
LIOC CORN9R.CUTOFF YES NO V
LIG " SEE REVERSE SIDE FOR SPECIAL APPROVALS O
DE CRIPT ON OF WORK
a
NEW ADD ALTERREPAIR DEMOLISH h
Z
SQ FT. NO. O NO. OR
SIZE STORIES FAMILIES
USE OF
STRUCTURE ..
SIONATUIRE OF
APPLICANT
VALUATION$ APPROVALS DATE INSP[CTOR'B EI■NATUR[
P.C. PMT. FOUNDA TI-O N, LOCATION
FEE$ -FEE-$ 9 FORMS, MATERIALS -
FRAME, FIRE STOPS,
'I HEREBY AC KNOWLILDG[_THAT I HAV[ ROAD TI-II■ APPLICATION BRACING BOLT
AND STAT[ THAT TH[ ABOV[ 19 CORRECT AND AORL[ TO Co FURNACE: LOCATION
WITH ALL T
COUNY ORD1NAnc FA AN W R[Ou LA OAS VENT. DUCTS
7UILDINO CONETRUCTIO FTI TH IN INO TH[ K
R
AUTHORIZm H[RIBY.1 NOT O AN N IN LA`i H. INT.
TION OF TH[ LASOR CO OF IFORNIA T.
ING TO WORKM[N'B COM NV.TI u 1 LATH. EXT.
SIGNATURE OF ol HOUSE NUMBER COR-
PERMITTEE RE AND POITEIDf
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL RAL ENGIN R
PLAN CHECK VALIDATION cK M.O. CASH _ PERMIT VALIDAIION CK. MA U1H
I.Go`7 9 8 4t2 .DEC 13 1 D 6.Q 0�'