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COUNTY OF LOS ANGELES BUILDING �-
DEPARTMENT OF COUNTY ENGU41MR ADDRESS r
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING. CROSS ST.
DISTRICT NQ- G P RE P E B
FOR APPLICANT TO FILL IN p /�I CONST. Y2:!�
BUILDING <y ry J / f� STATISTICAL CLAS IFICATION SEWER MAP
ADDRESS �O�t7 //GAG1A)oaJ a.+r. K CLASS.NO.- DWELL.UNITS I PG
LOT NO. BLOCK WATER NOT REQUIRE D� I RECEIVED
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CERTIFICATE: /
TRACT MAPHIGHWAY STATE MAJOR SECON LOCAL
NO.OF BLDGS. - NO. (�/ ICIRCLE>
SIZE OF LOT, NOW ON LOT USF ZONE SPECIAL
USE OF / CONDITIONS
EXISTING BLDG. 9,06///pf 4 'C%Q%t11.4'� '
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OWNER NO. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH'
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ARCHITECT OR TEL. P. L. �
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DESCRIPTION OF WORK
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USE OF
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SIGNATURE OF
APPLICANT
VALUATION$
_ APPROVALS DATE INSPECTOR'S SIGNATURE
FEE $ I FEE $ FOUNDATION:
ON
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 �f-
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE: - a
LATH,EXT. \•
SIGNATURE OF //�/) HOUSE NUMBER COR-
PERMITTEE 'w 'RECTAND.POSTED
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION. CF_ M.O. CASH PERMIT VALIDATION M.O. CASH
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7BA638A CE-V 8031-62 AP LICA Y io FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ADBUILDING
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DEPARTMENT OF COUNTY'ENGINEER
BUILDING- .ND SAFETY DIVISION: LOCALITY" `
JOHN A. L4MBIE, COUNTY ENGINEER NEAREST
WILLIAM.A_.=JENSEN, SUPT OF BUILDING CROSS ST.
DISTRICT NOOU� TYPE ` OC > D B._,
FOR APPLICANT TO FILL IN �J � l coNsr. /I ✓�
BUILDING _ S.TATISTICALCLASSIFICATION S WER-MAP
ADDRESS- K
CLASS. N0. 1 DWELL. UNITS
-LOT NO.NO. BLOCK WATER NOT REQUIRED RECEIVED ❑
CERTIFICATE:
TRACT MAPNO. OF LOGS. NO. L� HIGHWAY
STATE MAJOR SECOND LOCA
SIZE OF LOT—,.-,Z,) P(u' NOW ON LOT � USE ZONE - SPECIAL 1
USE OF CONDITIONS
EXISTING BLDG. U _T
TEL. K j.
OWNER NO. BUILDING EXIST.
SETBACK YARD IiWY STREET NAME WIDTH
ADDRESS {�,(y� -FRONT
ARCHITECT 51 TEL.(' P. L
ENG B^",�,. NO. ) P3cy`� SIDE
C ADDRESS _(��, P. L. �✓f ,� a
TEL. L .!1 G' >�c f as+' a✓�'.y O
CONTRACT -p - C_,Q4O.Lb7 S FZ
ADDRESS S�C� �_ ., O
DESCRIPTION OF WORK ' ,g�
NEW- ADD ALTER REPAIR DEMOLISH I c
SQ. i NO. OF NO. OF 1 d"'
SIZE - 50 STORIES '�" FAMILIES I -
USE C
STRUCTURE I
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.SIGNATURE OF ! V
APPLICANT
VALUATION $ �� - -
• APPROVALS DATE INSPECTOR'S SIGNATURE,
P.C. el �\ FOUNDATION: LOCATION J•7 / / ' "_..,r�'-
FEE $ Sol FEE $ 1'�� -U FORMS, MATERIALS
FRAME: FIRE STOPS, - N°''
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE " AN-
AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY,OR INANCES AND S ATE LAWS UL GAS VENT, DUCTS
BUILDING CONSTRUCT . I CERTIFY TH T'IN OI T E O
AUTHORIZED HEREBY ILL NO E LOQ AN PER ON IOL - LATH.,INT. -
TION OF THE LABOR,C DEOF E-ST TE OF CAL OR A ELA - i
ING TO WORKMEN'S O PENS I N RA
m LATH, EXT. _
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE ' RECT AND POSTED
ADDRESS �'IT�� ', ��9-- FINAL /-9-6 _3
JOHN F. LEWIS, PRINCIPAL STRUCT RAL E GINEER
PLAN CHECK VALIDATION Q M.O. CASH _ PERMIT VALIDATION -M.D. CASH
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