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APPLICATION FOR BUILDI G PERM
COUNTY OF LOS ANGELES BUILDI s /
DEPARTMENT OF COUNTY HNGINHER IDDIE
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN DIST NO. GR TYPE CONS PR B
(PRINT OR T P< ONLY)
BUILDING �/ S ATISTI L C SIFICATION SE MAP
ADDRESS ti` CLASS N0. DWELL.UNITS BK PG
LOT NO. BLOCK USE ZONE FMAPD (2,0,92 TRACT _ �_ 6 IAL
ITIONS
SIZE OF LOT NOW ON LONO OF TS I
USE OF
EXISTING BLDG. ZJ f A. 0 BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OW N E R NO. TYPE OF EXISTING SETBACK HIGHWAY + -YARD = TOTAL
ADDRESS
HIGHWAY IDTH FROM C.L.
Ti, �
+
CITY
ARCHITECT OR TEL. BLDG.SETBACK FROM (STREET)
ENGINEER N0. SIDE PROP. LINE OF
TYPE OF EXL7TlG SETBACK HIGHWAY + D = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
TEL
CONTRACTOR NOLIC.. .� + _
ADDRESS NO CORNER CUTOFF YES ❑ NO ❑- u
ex
CITY cLASS �Z SHE REVERSE SIDE FOR SPECIAL APPROVALS 0
CONSTRUCTION LENDER
NAME AND BRANCH
ADDRESS Z
3a FT. NO. OF NO. OF
SIDE STORIES FAMILIES NEW ❑
USE OF ' ADD ❑
STRU URE `- ALTER ❑
REPAIR ❑
g DEMOL
APPLICANT
VALUATION / APPROVALS DATE INSP[CTORV 816HATUIRK
P.C. PMT. FOUNDATION: LOCATION
FEES FEE S r R
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS,
RRt�CINQ, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCGAS VENT, DWTS
-
TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT.
OF THE STATE OF CALIF RNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANC . LATH, EXT.
SIGNATURE OF HOUSE NUMBER CORRECT
PERMITTEE AND POSTED
ADDRESS- FINAL D
JOHN F. LEWIS, PRINCIPAL STRU TUBAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CMH - PERMIT VALIDATION CK• W•O. CA15H
C�,,4 9 9 4R 1AY1I� 1 D 6.0&^
--------------
7eAeaeA cEreDa fl-eeAPPLICATION FOR BUILDING PE
PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
B=ING AND SAFETY DIVISION LOCALI
JOHN A. LAMBIE, COUNTY ENGINEER NEAR
ESfC
COLEMAN W. JENKINS, EUF'T OF BUILDING CROSS ST S
R APPLICANT T FILL IN DISTRIC GRO P TYPE P"07MED BY
Print or • only) G� CONST.
BUILDING STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO- ,�DWELL.UNITS BK PG
LOT NO. Q BLOCK USE ;ONEJ MAP �7
N O. 2
TRACT ] SPECIAL
NO.OF BLDGS. / CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLa2. BLDG.SETBACK FROM
OWNER t FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGIHWAY + RD = TOTAL
ADDRESS
HIGHWAY WIDTH FROM C.L.
CITY
BLDG.SETBACK FROM
ARCHITECT OTEL. SIDE PROP.LINE OF (STREET)
ENGINEER NO TYPE OF EXISTI ETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WID FROM C.L_
TEL. -_
CONTRACTOR NO. +
ADDRESS LIC.NO. CORNER CUTOFF YES ❑ NO ❑
CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS
CONSTRUCTION LENDER v
NAME AND BRANCH ! t
ADDRESS
Sq. FT. NO. OF NO. OF NEW ElSIZE STORIES FAMILIES
USE OF ADD ❑
STRUCTURE ALTER ❑
SIGNATURE OF REPAIR❑
APPLICANT MOL
VALUATION S
APPROVALS DATE I49PCCTOR'E SIGNATURE
P.C. PMT. /' c7'Ob FOUNDATION: LOCATION
FEE S FEES `p"� FORMS MATERIALS
FRAME: FISTOPS,
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACIRE NG BOLTS
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT DUCTS
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WI NOT EMPLOY AMY PERSON IN VIOLATION OF THE LATH, INT.
LABOR CODE F THE STATE OF •CA IFO IN RHL�TING TO
WORKMEN'S CO I.
NC * LATH, EXT,
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE 10, RECT AND POSTED
ADDRESS
FINAL T
JOHN F. LEWIS. PRINCIPAL STRUCTURALR�
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.�
�A('a_ 9 1 8 6G A,Dft 7 1 D 6.00— 4