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76A638A CE7803 5-65 APPLICATION FOR 13UILDING PERMIT
'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.
DISTRICT NO. GROUP TYPE .,�a_. P SSED B
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CLASSIFICATION SEIT
ER MAP
ADDRESS CLASS NO.._t�DWELL UNITS . UK G
LOT NO. BLOCK USE ZONE MAP
NO.
TRACT SPECIAL
NO. OF SLOGS. CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG. BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
t HIG AY IDTH FROM C.L.
ADD ESS �7
CITY
ARCHITECT TEL. BLDG. SETBACK FROM
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
TO (C f'�J + d
CON TRAC O
{ / ,LIC CORNER CUTOFF YES NO V
ADDRESS (0
LIC
CITY CLASS �`"'Y!a SEE REVERSE SIDE FOR SPECIAL APPROVALS O
DESCRIPTION OF WORK ` U
NEW ADD TER REPAIR DEMOLISH N
SQ.FT. -----NO. OF NO. OF
SIZE ST RIES FA ILIFS
7
U S E F
ST CTUR
SIG TURE OFV,
A ICANT ¢Z o
VALUATION l)
G�> 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 BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS "•-�},.
9UILDI NG CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK -
AUTHORIZED HEREBY I L NOT EMPLOY ANY PE ON IN VIOLA. LATH. INT.
TION OF THE LABOR OF THE STATE OF C FORNIA RELAT_
ING TO WORKMEN'S ENSATION INS E LATH. EXT.
SIGNATURE " - HOUSE NUMBER COR-
PE,RMITTEE i'Y RECT AND POSTED
ADDRESS FI NAL _ _� l>•"{„�,,;..
JOHN F. LEWIS. PRINCIPAL ST RAL ENGIN R
PLAN CHECK VALIDATION CK. M.G. CASH _ PERMIT VALIDATION CK. M.O CASH
47778 DEC 3 1D B00
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79A330A CE#0032/60 APPLICATION FOR BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT N 4GROU - TypE S BY
FOR APPLICANT TO FILL IN oj�, jl' CONST. >
BUILDING/^�/3 ��^ STATISTICALCSIFICATION XlFWPrR MAP
ADDRESS V BK P�
CLASS.NO. DWELL.UNITS T
LOT NO. BLOCK MAP STATE
NUMBER ;� / HWY. YES NO
TRACT e7 Fpl, r7 USE ZONE SPECIAL
�+ O.OF BLDGS. / / CONDITIONS
SIZE OF LOT y X / 0 S NOW ON LOT /
USE OF
EXISTING DG., OCL•+-•' BUILDING YARD HWY STREET NAME EXIST.
TEL. SETBACK WIDTH
OWNER - < NO. FRONT
ADDRESS S P. E/QL.
ARCHITECT OR TEL. P.L.
ENGINEER NO. INSPECTION RECORD
ADDRESS J
TEL.�Q d '/ a
CONTRACTOAR N0. � O
ADDRESS�f/�
DESCRIPTION OF WORK a
O
/ H
NEW ADD tl- ALTER REPAIR DEMOLISH w
SQ.FT. NO.OF NO.OF
/ a
SIZE �V'-3 STORIES / FAMILIES
USE OF y�
STRUCTURE _x ev
e
SIGNATURE OF
APPLICANT
VALUATION$ 0. I
APPROVALS DATE INSPECT'OR'S SIGNATURE
P.C. PMT. .+.�/'9 FOUNDATION: LOCATION
FEE FEE $ (.� L� FORMS.MATERIALS
FRAME: FIRE STOPS, /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- BRACING, BOLTS �-/
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION,
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT,DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION.
I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT. >
WILL NOT EMPLOY NY PERSON IN VIOLATION OF THE
i WORKMEN'S CO SATION LA OF C/+LIF RNIA. LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTE RECT AND POSTED
ADDRESS FINAL ~ l
CLYDE N. DIRLAM, PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH
I
I
DEPARTMENT COUNTY ENGINEER � ' D'
.DIVISION OF BUILDING AND SAFETY -
% COUNTY OF LOS ANGELES i
NG
WILLIAM d" FOX, COUNTY ENGINEER APPLICATION
CASSATT D. GRIFFIN, SUP'T OF BUILDING
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING DISTRICT NO. PLAN CK,oR REc.No. PERMIT NO.
ADDRESS D •/
I F•
LOCALITY Q)t R �EIYED BY A EqF DATE ISSUED
NEAREST
CROSS ST, Ave- BUILDING 1
OWNER
ADDRESS �it
"�' J , /
MAIL LOCALITY �..A./�A„n
ADDRESS F �� .y� �f�n /�. NEAREST ..
CITY SG/7 GAbr� / NO.TEL. '/r�1 9to CROSS ST.
ARCHITECT OR TEL. FIRE NO. OF TYPE__g_'� GROUP
ENGINEER NO. ZONE PLANS
BLDG. /� 1 Y^ 17fD�Nq•
ADDRESS ..} �,/ 2/ SETBACK LINE
CONTRALTO NO. /"�TrJ�"'>�4� USE 'r 3 APPROVED � 7:.
ZONE BY AT �-
HOUSE NUMBERING
ADDRESS
LEGAL MAP NUMBER �' ,�I NO. ASSIGNED BY
DESCRIPTION �I LOT NO. I BLOCK CORRECTIONS
T CT
�y J.
NO. OF BLDGS. �� 1 ,I .•
SITE OF LOT -/ � �ia3� NO ON LOT .C.-'fit%4
USE OF I NO. OF
EXISTING BLDG. FAMILIES
DESCRIPTION OF WORK o
ALTERATION
RE AIR I DEMOLITION I-I ADDITION t7
r
SO. FT. S� /sNO.I OF
SIZE R
ST(�.Ow.yR. IIESO
EXT. WALL
ROOF
COVERING
STRUCTURE
r
APPROVALS
INSPECTO 'S SIGNATURE DATE
FOUNDATION: LOCATION
FORMS, MATERIALS .aJ
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT. FURNACE: LOCATION, ~Y
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS ` y/
AND STATE LAWS REGULATING B/UIILDING CONSTRUCTION.
SIGNATURE OF �4� /ifrr
LATH, INT. T r r
PERMITTEE- LATH. EXT. y
ADDRESS ^ `
�,• PLASTER, INT.
AUTHORIZED AGT.
f'► ay PLASTER, EXT. '
$ 1/ 1,./1 1/�• FEE $ f HOUSE NUMBER COR-
/ / RECT AND POSTED y
VALUATION FEE $ p (� FINAL
76A888A 0883 9-82 1