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76A638A CE 11803 2-63 APPLICATION FOR BUILDING PERIffT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY \ r
JOHN A. LAMBIE, COUNTY ENG I NEER NEAREST
WILLIAM A. JENSEN. SUPT OF BUILDING CROSS ST.
DISTRI TGROUP TYPE 0?).,ESSED BY
FOR'AUT-ITFANT TO FILL IN coNss`r
BUIILDINGp STATISTICAL CLASSIFICATION WER MAP
ADDRESS +40 Glickman, T .C. BK PG�
CLASS. NO. DWELL. UNITS
LOT NO. 8 BLOCK "A" WATER
CERTIFICATE: NOT REQUIRED ❑ ' RECEIVED ❑
TRACT 10992
MAPS / HIGHWAY STATE MAJOR SECOND, L CA
NO. OF BLDGS. NO,. ! (CIRCLE)
SIZE OF LOT 73 X 9 NOW ON LOT USE ZONE SPECIAL
USE OF res i ence CONDITIo ��-
EXISTING BLDG. 7 y
OWNER Loui se Bracken No'448-226i 7
BUILDING EXIST.
ADDRESS4857 GI ickman T .C. SETBACK YARD HWY PpE AME WIDTH
FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE �.
P. L. Q
ADDRESS O
\,
CONTRACTOR Va I I e Cra t No 443-174
ADDRESS 10523 Lower Azusa Rd. , T . /, .. o
DESCRIPTION OF WORK �' `�aa�0 a
---------------
,o a H
(NEW / ADD ALTER NO.REPAIR DOF NO DEMOLISH
� Iana ueDa .`n 01
OS>r� G._Z
SIZE 1218 STORIES 1 FAMILIES 1 QP, .la P• `ax a� tdp
USE OF �� , O S• �.• 0a 0 e
STRUCTURE res i dence & 20X20 gara - a°�`�{at} ��e` +ca�•�S,�a`I{�
-1 {o< ae� kot Q
SIGNATURE OFKv ? �n SQA
APPLICANT 1, Go. ci ti aa. PQ.
VALUATION $ O O-U _}�O
ty P'PRQVA•Off• e¢n DATE INSPE�O�R.'S SIfGNATURE
FEE $ •f FEE $� 0 FO F A 1 AL
S ION N
FRAMB> $FOPS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRAC
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACOCATION. }
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 COMPENSATION INSURANCE. LATH, EXT.
SIGNATURE OF I" � HOUSE NUMBER COR-
PERMITTEE 4 � RECT AND POSTED
i /
ADDRESS 6L. � FINAL A /e > ��'Cm s'•.�
JOHN F. LEWIS, PRINCIPAL ST URALENGIN ER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
_, fl 3 3 9 211-D' jUL 72 3 D 2 6.7 5
' � 4 �'� i , D 53 `�