HomeMy Public PortalAbout5619 HALLOWELL AVE_Relocation__ 76A639 - CE 879 - 8-62
APPLICATION FOR RELOCATION RUILDING ZERMIT
COUNTY OF LOS ANGELES BUILDING j
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY J
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST s
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DIST.NO GROUP TYPE SEWER MAP PROCESS BY
FOR APPLICANT TO FILL IN
'�Q dI I CONST. BK PG
PROPOSED /. G�(� 0 13 ..Y� C
BUILDING / WATER
ADDRESS CERTIFICATE: NOT REQUIREDzr RECEIVED
LOCALITY MAP NO 00 G
HI
HWA STATE MAJOR SECOND: LOCAL
PRESENT
BUILDING - �, USE SPECIAL
ADDRESS ►,gyp CONDITIONS
LOCALITY +� �'t o
n
OWNER Q BUILDING YARD HWY STREET NAME EXIST,
MAILSETBACK WIDTH
ADDRESS J 1 FRONT
TEL. P. L.
CITY ` NO. SIDE
MOVING TEL. P. L.
CONTRACTOR NO.
SURETY DATE RECD
ADDRESS BOND $ FILED BY
}
BUILDING TEL. CASH DATE RECD �
CONTRACTOR NO. DEPOSIT $ FILED BY O
APPROVALS DATE INSPECTOR'S SIGNATURE
ADDRESS FOUNDATION: LOCATION Of
PRESENT FORMS, MATERIALS 0
USE OF
BUILDINGFRAME: FIRE STOPS, W
PROPOSED BRACING, BOLTS p.
USOF
BUILD NG FURNACE: LOCATION Z
GAS VENTS, DUCTS
SQ. FT. NO. OF LATH, INT.
SIZE ROOMS STORIES 1 G.-4 7
WALL ROOF LATH, EXT. A
COVERING COVERING -
LEGAL HOUSE NUMBER COR- I
DESC IPTION I LOT NO.P. A BLOCK p� RECT AND POSITED
TRACT V FINAL��i 1/a. eh / zV
NO. OF BLDGS. DISTRICT ENGINEER
SIZE OF LOT NOW ON LOT SURETY BOND
RELEASED
USE OF I No. OF
EXISTING BLDG. ,�/,�/��/J FAMILIES I HEREBY;.ACKNOVJLEDGE THAT I HAVE READ THIS APPLICATION
I HEREBY STAT HAT THE INF MAT' 7 GIVEN IS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
CORRECT. L j WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
SIGNATURE OF BUILDING CONSTRUCTION. I 'CERTIFY THAT IN DOING THE WORK
APPLICANT �� AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-
TION OF THE LABOR CODL OF THE STATE OF CALIFORNIA RELAT-
ADDRESS ING TO WORKMEN'S COMPENSATION INSURANCE.
VALUATION $ r SIGNATURE OF
EE �� I PERMITTEE
E $ ADDRESS
VALIDATION CK. M.O. CASH JOHN F. LEWIS, PRINCIPAL STRUCTURAL.ENGINEER
PERMIT VALIDATION CK. M.O. CASH
- 2 5.0Oe
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