HomeMy Public PortalAbout6403 GOLDEN WEST AVE_Building__ 76A 638A CE9803 9-67
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APPLICATION FOR BUILDING PERM
COUNTY OF LOS ANGELES BUILDING �
DEPARTMENT OF COUNTY ENGINEER ADDRESS GIwx le,
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST
CROSS ST.
FEXISTING
OR APPLICANT TO FILL IN DISTRICT N GROUP T PE Oc BY
(Print or 1 -.� NST.
type only)
STATISTICA�SIFICATION SEWER-MAP
y� C/ 2 " L" CLASS NO. DWELL,UNITS BK PG
O , BLOCK USE ZONE MAP
D n NO. (/
` `� CONDSPECIT ONS
AL
_ NO.OF BLDGS.
LOT / NOW ON LOT
/
BLDG, S` ed ," S'Uwm-e Y 01SC BLDG"SETBACK FROM
TEL. FRONT PROP,LINE OF (STREET)
NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
/ HIGHWAY WIDTH FROM C.L.
CITY
BLDG,SETBACK FROM
ARCHITECT OR TEL. SIDE PROP.LINEOF (STREET)
ENGINEER y NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
TEL. + _
CONTRACTOR NO. O
ADDRESS NO CORNER CUTOFF YES ❑ NO ❑ �
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS o
DESCRIPTION OF WORK N
z_
NEW ADD ALTER REPAIR DEMOLISH
SQ. FT. NO OF F
SIZE STORIES FAMILIES
USE OF
STRUCTURE 1 ^r
SIGNATURE OF �1
APPLICANT
VALUATION $ �
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT, FOUNDATION: LOCATION
FEE $ FEE $ t 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"
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT.
ING TO WORKMEN'S COMPENSATION INSURANCE.
/J� L.// LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE - RECT AND POSTED
ADDRESS —2// e2 . ': 'Q ' FINAL
JOHN F. LEWIS, PRINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH
Lko 2 5 91-;- ,JM 12 6.00—