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76A638A CE 48031-62 APPLICATION FOR BUILDING PERMIT u
COUNTY OF LOS ANGELES ADDRESS ¢ 6 G L 1 G K►u
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY 1-N1 P L-19— 6 1TY-
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. �-��� L(�— A-2V S k
DISTRICT NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN S_ CONST. C Lp VKZ)
BUILDING YA"�36 L- /1 1.0 K+� STATISTICAL CLASSIFICATION i SEWER MAP
ADDRESS C� }
CLASS. NO. DWELL. UNITS BK
LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑
CERTIFICATE:
TRACTr T
NO. OF BLDGS. NOP y d (�` HIGHWAY
STATE MAJOR SECOND C
SIZE OF
USE OF LOT NOW ON LOT USE ZONE COND TSPECI ONS 4— `
EXISTING BLDG. ,Q A
OWNER TEL. _ f' J
'� NO. ,: BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS FRONT1
ARCHITECT OR TEL. P. L. O (� �. 6O
ENGINEER NO. SIDE
P. L. }
ADDRESS IL
TEL. 0
CONTRACTOR NO. _ - �..
ADDRESS -i Im
J O
J
DESCRIPTION OF WORK °'' PW �` g�, W
C-
EW ADD ALTER REPAIR DEMOLISH _ Z
SQ. FT. NO. OF NO. OF
SIZE STORIES FAMILIES _
USE OF '—
._�=.---1:
STRUCTURE
SIGNATURE OF
APPLICANT
f O
VALUATION $ �r D bQ
APPROVALS ,'DATE INSPECTOR'S SIGNATURE
P.C. ''77 �t? PMT. FOUNDATION: LOCATION
FEE $,,.L1 FEE $ FORMS, MATERIALS
FRAME: FIRE STOPS, _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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. 1 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 COP
EN SATI INSURANCE.
/1(x/!7// LATH, EXT.
SIGNATURE O .1:1/ / HOUSE NUMBER COR-
PERMITTEE o RECT AND POSTED
ADDRESS FINAL - r
JOHN F. LEWIS, PRINCIPALS URAL ENGINEER
PLAN CHECK VALIDATION -K,) M.D. CASH _ PERMIT VALIDATION CK. M.O. CASH