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76A636A�E#6D3 B-64 APPLICATION FOR BUILD NG PERMI�
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
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BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST n
COLEMAN W. JENKINSS2
UP'T OF BUILDING CROSS ST. / -r;Z�
DISTRIC ryO. G. TYPE BY
FOR APPLICANT TO FILL IN �l/ CONST.
BUILDING ��// / STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS `"y" BKPG
CLASS NO. DWELL UNITS
LOT NO. .BLOCK USE ZO MAO.P
TRACT `�=/'Lti VZ� CONQITLONS ��
SIZE OF LOT JJ TT NO. OF BLOBS.
T 0 V NOW ON LOT
USE OF
EXI BLDG. SETBACK FROM
J TEL. FRONT PROP. LINE OF (STREET)
OWNER ��' NO. TYPE OF 1 EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
�^A +
I CITY /i -K BLDG. SETBACK FROM
ARCHITECT OR TEL. SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS �7�,, 7 HIGHWAY WIDTH FROM C.L. CL
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CONTRA CTO/'R 7/LE- / NOL 77!�V- / + = OV
ADDRES 6off-
2 — LO 8rc/en I CORNER CUTOFF YES � NO � O
CITY '�— LLA SEE REVERSE SIDE FOR SPECIAL APPROVALS u
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DESCRIPTION OF WORK CL
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NEW ADD ALTER REPAIR DEMOLISHAr',
SQ.FT. NO. OF N r`�-.
SIZE STORIES FAMILIES '
USE OF
STRUCTURE
^ -A ce.., 51' a
SIGNATURE! OF
APPLICANT �.
VALUATIONj. G�> APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. ` PMT. FOUNDATION, LOCATION
FEE$ FEE$ I/+ 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
13UILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT.
TION OF THE LABOR CODE OF THE ST/ATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSAA/T+ON IFJS RANGE. " LATH. EXT.
SIGNATURE OF//i.r�GQ-// (/ HOUSE NUMBER COR- ---
PE,RMITTEE �/ LLL /J RECT AND POSTED
ADDRESSi �Ldt (p FI NAL S'� .►.�
JOHN F. LEWIS, PRINCIPAL STRUCTURAL ENrCA..
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PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O