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76A656A CE#609 1-61 APPLICATION FOR BUILDING P E , I Ll
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DMSION LOCALITY C
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DIST ICT MO. ROUP TYPE P ESSEDBY,
FOR APPLICANT TO FILL IN r CONST.
BUILDING / , STATISTICAL CLASSIFICATION WER MAP
ADDRESS (1 BK
CLASS. NO. • DWELL.UNITS
LOT NO -1 If BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE: Li
TRACT L } Y Gt \ MAPHIGHWAY STATE MAJOR SECON LOCAL
NO.O BLDGS. NO. (CIRCLE)
SIZE OF LOT I NOW N LOT USE ZONE SPECIAL -"
USE OF �,/ / CONDITIONS -
EXISTING BLDG. "-/(/I(C i�-. !`�I A/V U T
TEL.
OWNER r,�f-AI c �� <<'nI T .
BUILDINGEXIST.
SETBACK YARD HWY -,S E NAME WIDTH
ADDRESS ��/��(�
FRONT /
ARCHITECT OR TEL. P.L.
ENGINEER NO. SIDE
P.L. 1.
ADDRESS TEL.IF INSPECTION RECORD O
CONTRACTOR, /UC( �F��� NO. "]Q/aL V
ADDRESS 9 N• �p-i C'nA G i{-+ 0
O
DESCRIPTION OF WORK u
W
O.
NEW ADD ALTER REPAIR DEMOLISH N
Z
SQ.FT. NO. NO.OF
$IZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION$ ,2 a(3.
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMTF E $ I FEE $ � FO FORMS,MATERIIALSON
FRAME: FIRE STOPS,
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI N BRACING,BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
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 CODE OF THE STATE OF CALIFORNIA RELAT.
ING TO WORKMEN'S M PENSATI INSURANCE.
LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERM ITTEERECT AND POSTED
ADDRESS/_f �0 t �-'r — FINAL .
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E NELR
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH
7 :� 5 '\'o 6 - u -11 .5 v
11.55 ADBR•3 'APPLICATION FOR BUILDING PERMIT ],
+I•Ss r s
DIVISION OF BUILDING AND SAFETY ADD EBS 7" /Z 11//��L S
Deportment of County Engineer
County of Los Angeles LOCALITY R O f
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST1 P 4/_-W I qI-
CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS S L• 1� J
FOR APPLICANT TO FILL IN DISTRICT NO. GROU SEWER MAP
,{'T .� TYPE' BK PG
// n�^ /y 3 CONQT C� L
ADDREBUILDSS (� SPL F rT ��1�1'E/7 MBER STATE
YES NO
LOT NO. BLOCK USE ZONE SPECIAL
CONDITIONS
TRACT / 1
NO. OF BLDGS. .
SIZE OF LOT I NOW ON LOT BUILDING EXIST
USE OF YARD HWY STREET NAME
SETBACK WIDTH
EXISTING BLDG. jj (p� [�y� /^ (''�o / FRONT / O
OWNER PHI /! 1, /�)�tL/� fimC��1 l-a A SIDE
ADDRMAI LESS�_S rZI,�1_L eS'T P. L.
/�,9 y� d / O TRACT DWELL. 1 UNIT 5 INDUSTRIAL
EL CITY �0, el / F /✓ NO. �O(��` I DWELL. 1 UNIT 6 PUBLIC BLDG.
ARCHITECT O /� 1 t �TEL.�j-! 2 DUPLEX 2 UNITS
ENGINEER F,y�A L I- A NO.� ��� 3 APT. UNITS 7 ADDN.,ALT.. ETC.
ADDRESS / L _C�� / -� 4 COMMERCIAL 8 MISCEL.
CONTRACTOR yNc
�NCs re/VNO' Kt��, INSPECTION RECORD
ADDRESS
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH
E T. �r NO. OF NO. OF
S Z
4 STORIES / FAMILIES
USE OF STRUCTURE /i) P C 4)p�A/
SIGNATURE OF
APPLICANT p ,yr APPROVALS
ADDRESS 1-��//fes 1\�Sr//G DATE INSPECTOR'S SIGNATURE
$
FOUNDATION: ION
P. C. $ `� FORMS,MATERIALS -
/ FEE FRAME: FIRE STOPS. ,
VALUATION ( �OO $-� BRACING, BOLTS
FEE �'�'" ti FURNACE: LOCATION.
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT.
AND STATE LAWS REG TING BU DING CONSTRUC-
TION.
ONSTRUC-
TION.
LATH. EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE ERECT AND POSTED
ADDRESS FINAL
JOHN A.LAMBIE. COUNTY ENGINEER VALIDATION CLYDE N. DIRLAM, CHIEF BLDG. INSPECTOR
CK / MSO CASH
V
r 4723- FFR 4 1- 6 14.001in
t1L
4 4—_ FEB 7 1 2 8.0 0 in
r
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO Fol.IN BU DING AmRs
I herby affirm ttrt I hese■certMloalo of oonewd to serf ksure,
or a owdrpoate of vlbr"C,omponsetlon Irsurano%or■certiled
copy th reof(sea 3M Lab.a) CITY zu,
Y
L=
Poioy fdo CorrFparry SIZE OF LOT NO.OF BE DCIB NOW ON LOT
❑ CwW d copy I•hereby fum WFed NEAREST CF409B ST
❑ copy Y Mod wtth the omwity txjklrQ k opedion TRACT LOT NO WE ZDNE +o,
Dari Appioant MAP FJOOi( PAGE PARCB � `/ _;Z
6
CERTIFICATE Of:D�i�TION FROM WORIE' TEL Jf�
COMPENSATION INSURANCE. WITH PI Togo r=r.of sct• 00 r� rlo
A
(n*section need not be oompioted If the permit Is for one hundred - DOMUCT C*IOUP TYPE RRE ZOW FROG ray
I ow 0hsd or to p Crry . er
� I certify that In to perforTrrarrce of the work for whbh ttFY permit
Is issued, I .Ball not employ any person bF any marww so se to OR ENO?dEM TEL NO.
become subject to the Work"conFpersaaon Laws. SMUISTx/U ION APT CONDO
We App&oant ADMV M a--mm mE-L mrr8
NOPCE TO APPUQANT: If, a for ffm*ft this Carttftoste of REQURED TOTALFROM EXIST
Exemption, you should beoome. subject to the Workers' CONTRACTOR TEL NO. SETBACK )%M Fwf P� EXISTvnDTH
Compensation provblons of the Labor Code, you must kx#nvf h FRONT
oornply with such provisions or this pwnk stroll be deemed revoked ADoftE98 Lr-NO. PL ACCT.Jr'
ME
LICE MED CONTRACTORS DECLARATION My LEC.CLA88 PL
I hereby affirm that I am Ilc meed under provleion s of Chapbr 8 SEVAER MAP A
(cwnnw1cinp with Secticn 7000)of DtvWon 3 of the l3uotness srFd Sa Fr.SIZE Na OF STORM Na OF M&GUES NEW El BK PO
r Proleank"code,and my Ik»nse is In fF� Torn and Torand etreot , TOT& 67 _ u 9�.
Lkwre Nun ber Lia Own DEBMPTFON OF WORK ADD ❑ vAiw►rM w.� ci 67.89 n� �
ConFtractw Date ALTER # �a HAKE .OIDz
❑ I am am. under Seo. REPAIR ❑ #
l3.aPa for thea reason DBAGIL ❑ LDMA PIC a C►OL �1 11/ 9/90
Dole: usE of EXISTING IN DG U RM ❑
376 1 AM9:11
S vture APMJC"fr(PRFr'fF) TEL / LDMA Perm r
L se owner of the propWty or my eRrpk yeee with vmQn is ,/ ACCT..T
thea sob componse on,wM do the work and the structure r .78
AaDf�B
not kFcr 44
offered for sale (Sectio, 7D , &dress and (� 7 9
terlded
Professions Code.) wLL THE APP JO WT OR rLmnFE B■�OOarwrT HIArDLaA HAZAFKXXA w MPLQ. �l f l `q 1 I TEMS
DR A�CONUMq A FiAZARDOUB MAr"AL EDUAL TO OR�4f1 THAN TM rI.►r _
❑ I, Y owner of the f X am L++ Y con TG with TM Ab"ArM Sreos•m ON THE FFAZAMX S MArEWLe M-ORMIa•FON eUDer t�ML fn 782'
lioerreed contraotom to construct the pr*d.(SeodDn 7044, yes❑ No❑
f3uskFeee end Proleesiorr Code) BY TFC APPLK MiT OR RIrtAiE i 9
1VLL THE liTeDt9 Ue8 Or T}� • n e rrn
OCCUPANT rBOLWAA PaFMT POR OOfaTTFUMON OR LOOC64WM rROM THE SOUTH
CONSTRUCTION LJ!NDM AGENCY LUAU AGF oLWJW MAMA Q""DWTFSOT paaxo am Pm rrm asaaa_rT .W
rm G IDIRO
I hereby affirm bud there Is a oorstnrction iendbv agency for Yes❑ No❑
the pwimranoe of the work for whk�h thY penia Is issued(Sec. r HAM READ TFTs FM7.ARDOUs WaWdALS WOMMATM OLME AFD TFT.90AOW Lq.Jip�--4J!JLl1 1
Qo 3097,Ctv.a). � PERWrrn Q OCOIa..ISi FI U/DW � UEWDVD RIOICRI EM THE LOS AN�m
d. CCLWTY COM Trn-Z R C~TM Ls]MOTIONS NCCa
a IMM TI-00"LM1COMM3
�0 LWKWs NaRM HAZAFCOLX WI ALL FEPONTM AND POR CSIASM!0 A PQMT TROY TFC 415 1 A 11 1:52
tenders Add roes
a�a Arrr
I certify that I hoe read tide appttcatlon and state that the above Ra FEE Parr FEE
mon
hforeriIs correct I agree to comply with all oDunty /} Ar
ordinoonoss and State kane relating to bdklft construction,and (fes Z,v' —
hereby audx rme repreeentativas of this County to enter upon Ie6<FANCE FEE
the � IrF.pection purposes.
� wvEBTFOATFON FEE TOTAL FEE
OW FWV9W FOR 09-LAMTORY