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76A638A CE*803 8-64 APPLICATION OR BU ILDI G PER T
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP'T OF BUILDING CROSS ST.
DIST T NO. G TYf�jr P SED BY
FOR APPLICANT TO FILL IN c ST. IY/�' lazzl
BUILDING CA' CLMAP
ASSI FI ATION SE R 41
ADDRESS4,11s � ,,( CLASS NO.QDWELL UNITS B PG j X
L01140' 7 7 OCK USE ZONE MAP O VVV
NO.
TRACT / /Y , SPECIAL
NO. OF BLDGS. V 1 CONDITIONS
SIZE OF LOT NOW ON LOT
USE OFp
EXISTIN - T -d BLDG. SETBACK FROM
EL. FRONT PROP. LINE OF (STREET)
OWNER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH F OM C. .
CITY Z'"L- BLDG. SETBACK FROM +
ARCHITECT O TEL.
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
CL
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CONTRA CTORi�f yy j� O � V
AD DR ESAVIS . /' NO ;2aD /q tI CORNER CUTOFF YES E] NO E] O
CITY '-'tk� CL SEE REVERSE SIDE FOR SPECIAL APPROVALS U
W
DE,SSCRIPTION OF WORK H
NEW ADD" ALTER REPAIR DEMOLISH
SQ.FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
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VALUATION$ .C,�V ' APPROVALS DATE ��INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION, LOCATION
FEE$ !�� FEE$ 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
9U ILDING 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 CO PENSATION INSURANCE. LATH. EXT.
SIGNATURE OF HOUSE NUMBER CR-
PERMITTEE RECT AND POSTED
ADDRESS
Fl NAL
JOHN F. LEWIS, PRINCIPAL STRUCTURAL EN=E
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
4 til iL AY'
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76A638A CE#803 5.61APPLICATION FOR BUIL//DING PERMIT
COUNTY OF LOS ANGELES ADDREISS 6 e L D —
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT O. GROUP TYPE P CE D BY
FOR APPLICANT TO FILL IN S-"o CONS
BUILDINGSTATISTICAL CLASMFICATION - I S ER MAP
ADDRESS C,62 DE61 BK PG
} v CLASS.NO. DWELL.UNITS
LOT NO. .�/ t 6lV C7 t"r-* BLOCK WATER
NOT REQUIREDEsRECEIVED
CERTIFICATE:
TRACT l 14 HIGIIAY
yy P NO.OF BLDGS. NO (� (CIRCLE) STATE MAJOR SECON LOC L
SIZE OF LOT /i.IaL-I NOW ON LOT L USE ZON SPECIAL .�—
USE OF /� CONDITIONS
EXISTING BLDG. ES!DC/VGF Ic V/ I
TEL.
OWNER�,/�A �� /R£SE-r7i�R NO,RT.'6-ftfZ BUIL ING YARD HWY STREET NAME EXIST.
c SETBACK WIDTH
ADDRESS6,3/_-Q,,D_c-W&E Zi;Trna1E o/ry FRONT ^
ARCHITECT OR TEL. P. L. " ��
ENGINEER C-�9 NO. c�ri SIDE
P.L. vlz� O
ADDRESS X14 V
� c TEL.
INSPECTION RECORD
CONTRACTOR Ft7-/a[ I.ICT/mil/(l9NQS�U,r .2.V O
F�
ADDRESS U
DESCRIPTION OF WORE CL
V1
NEW ADD_ ALTER REPAIR DEMOLISH
SQ. FT. NO.OF NO.OF
IZE ��3a STORIES FAMILIES
USE OF c
STRUCTURE PR'7'/0 ICOO F
SIGNATURE O .�� ����
APPLICANT ��
VALUATION$ '34'rOO
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. //i/ FOUNDATION: LOCATION
FEE $ FEE $ (JV 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. 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 WORKM OMPENSATION INSURANCE.
LATH,EXT.
SIGNATU O HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS. -7 - 0
FINAL +"
CLYDE N. DIRLAM, PRINCIPAL ST CT RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION C M.O. CASH
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