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76A638A CE#8035.6, APPLICATION FOR BUILDING PE T
COUNTY OF LOS ANGELES BUILDING /
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN $UP'T OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE O ESSED BY
FOR APPLIC TO FI IN 9 CONST. .0
BUILDING
STATISTICAL CLASSIFICATION EWER MAP
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ADDRESS < P
CLASS. NO.---/—DWELL. UNITS
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED
TRACT /��(� ✓ Q CERTIFICATE:/
SIZE OF LOT��i��v /j I NOW ON LOTS �} NOP / 'CGRCWAYLEl STATE MAJOR SECOND, CAL
US-- ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. �'` /" n
OWNER -P/L L(Z/I,�I C.
ej N1e� OL&,NJ/��� BUILDING EXIST.
( Q � / SETBACK YARD HWY ST T NAME WIDTH
ADDRESS��,!/ d -f,.4,6 6'_/z-r FRONT
ARCHITECT OR �� TEL. / - P. L. 1� 9'
ENGINEER NO. L SIDE O.
/ P. L. O
ADDRESS f TEL. INSPECTION RECORD w
CONTRACTOR !f NO. l� O
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ADDRESS // U
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DESCRIPTION OF WORK 4A
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NEVI l HADD ALTER REPAIR DEMOLISH .e.
'�TFT. NO.OF NO.OF
IZE STORIO FAMILIES
USE OF
STRUCTURE
SIGNATURE OF I
APPLICANT �y -rffff✓✓/
VALUATION$ 3
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/ APPROVALS DATE INSPECTOR'S SIGNATURE
P C -5;pU PMT L' FOUNDATION: LOCATION
FEE $ ` FEE $ 79 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. ICERTIFY 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 NSATION IN RANG
LATH, EXT.
SIGNATURE OF - HOUSE NUMBER COR-
PERMITTEE ( i / RECT AND POSTED
ADDRESS •`�/ ��`"� L� f +'�tI FINAL
CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION cK M.O. CASH PERMIT VALIDATION CK. M.O. CASH
i P P L'tiCi4Td 0 N F R COUNTY OF LOS-ANGAES v
- -�� ` '•'DEPARTMENT,OF'COUNT-Y ENGINEER- -
., I3 U tLD-1' 'NG PERMIT . BUILDING-AND•SAFETYbIVISION
FOR APPLICANT TO FILL`IN BUILDING '
ADDRESS
•BUILDING•' `:(• ;,_� �..•`. e .r ,
ADDRESS'; ' LOCA
LG�-r!6 -LOCALITY,NEAREST C�.l.� ��✓' _ ".i�,
CITY, M �Ir'• 'G.l' y. ZIP (! ,CROSS ST -
NO'OF,BLDGS' ASSESSOR
SIZE'OF LOT`. " '',NOW ON LOT. MAP BOOK, PAGE PARCEL',. w
�[ 'DISTRICT GROUP TYPE• FIRE' RO SED BY
TRACT r '•D''�Ss BLOCK - - LOT NO "T' "✓" CONSTE '
EL
OWNER._ ,1 .: - NO
1� V��
STATISTICAL CLASSIFICATION' SEWER MAP
ADDRESS /. L• L O.Ki f� C Cr :2V
_••.'-:., �^ Q
CLASS NO .�.' DWELL UNITS G^BK / •`J '-
CIT.Y, '.' ,ZIP U EE ' MAP a.
'ARCHITECT'OR', TEL NO (' v.
ENGINEER �_ R i`, NO. 7'a NDITIONS•' w
ADDRESS' y 'ROADDEPARTMENT•APPROVAL•REQUIRED-• -YES ❑ ,NO'O-
.- r •. - �.TEL.-' ,/ ..
CONTRACTOR G� �O,G SI?/L CG m NO �^i 0 BLDG-,SETBACK FROM• -5, @.. `
A FRON.IRO_P�LINEOF' ''' (STREET)
ADDRESS C7 f +. %'1!7G NdL NO l T� 1 6• "`{ TOTAL SETBACK FROM TYPE OF. 'EXISTING
' t ,LIC j 'HIGHWAY •+ YARD =
pp ;• FRONT PROP. LINE HIGHWAY WIDTH
CITY,' 'a C-OJ-1 l h A - CLASS A'•.
CONSTRUCTION LENDER':-" + }
NAME AND'BRANCH.. _ ?- p,
BLDG'SETBACK FROM V
ACITY "_ SIDE PROP LINE OF STREETI-•. -
DDRESS p
•r�-' - - TOTAL ETBACK-FROM,-- TYPE OF'" EXISTING
SO FT _ ^ NO OF ,NO OF: CHECK HIGHWAY• '+ YARD = U
SIZE' 'STORIES"�, FAMILIES I ONE '. ,SID ROP LINE\ ,. HIGHWAY .WIDTH
- Z
DESCRIPTION OF WORKNEW
El +. •: •
ADD CORNER CUTOFF, '. YES '❑ NO ❑ '
ALTER: El 'IN'OPEN SPACE Y•ES• ❑ .- 1 NO ❑
`:.
REPAIR :❑
_USE OF: . � _ _ :IN'COASTAL.PERMIT ZONE YES ,Q,'. ;NO ElEXISTING BLDG A o�r^.L(: DEMOL ¢
APPLICANT. 4. :e TEL, �/
IPRINTI` �L ' daSF'11. ,NO;'. 3.K'oc,41 ti
BY(SIGNATURE) ?
-'•'I HEREBYACKNOWL EDGE THAT'I'HAVE,READ THI57APPLICATION,AND'STATE' �'� ' t' • 1 _,
THATtJHE ABOVEISCORRECT AND AGRECTO COMPLY WITH•ALL'ORDINANCES ,
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY-THAT IN DOING-THE- • - - •
'.WORK AUTHORIZED'HEREBY'I'WILL NOT EMPLOY ANY PERSON'IN'VIOLATION,OF
'THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO-WORKMEN S COM-
PENSATIONINSURANCE•_f"' ,r_ - •- e '� _ �-�' ,} .�, _ t :;+ .
SIGNATURE OF- FINALE/ BY
PERMITTEE'"-''' `
ADDRESS:
TEL. —�O -,P C Fee$. :Perfmit Fee
CITY,: C.It U_�-<��' 'N0- �q
Issuance Fee
VALUATION
.a.
Total Fe
,,.PLAN'CHECK VALIDATION ',", - "cK-.'.`,:M o' cn.SH:, PERMIT VALIDATI• cK.' M.o' ' CASH: '•'
D'
6 'AUG: 15. . 6- :6 0' b
•®5-'76A638A CE N8o3A 6/76 '- - -'{"�.i' •. - ' -