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COUNTY OF LOS ANGELES . .BUILDING AND SAFETY
BUILDING
FOR APPLICANT TO FILL IN .ADDREss. ( l
BUILDING ✓ _ •�'
ADDRESS / LOCALITY
rr NEAREST
CITY L� c ZIP CROSSST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT �0 NOW ON LOT MAP BOOK . PAGE PARCEL.
'DISTRICT GROUP TYPE FIRE PROCESSED BY
TRACT LOCK LOT NO. //�) CONrSTT. ZONE
OWNER�j/ j �� �G k 1 NO. sof ✓ LS
i ADDRESS /"/"•ate /V• M#A�� fr'jJ
STATISTICAL CLASSIFICATION SEWER MAP
CLASS NO.rZL_DWELL.UNITS BK�7PG
CITY �i �' ZIP
ARCHITECT OR TEL VALUATION $
ENGINEER NO. 71'0 0 0
ADDRESS BLDG.SETBACK FROM
TEL. w' FRONT PROP.LINE OF (STREET)
CONTRACTOR ' NO. Cf HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING
ADDRESS JNO
LIC. FRONT PROP.LINE, HIGHWAY WIDTH
.
/ LIC. // +_2_o = �. 6
CITY g� (f:4 CLASS
BLDG.SETBACK'FROM
CONSTRUCTION LENDER SIDE PROP.LINE OF (STREET)
NAME AND BRANCH
HIGHWAY + YARD = 'TOTAL SETBACK FROM TYPE OF 1EXISTING �
ADDRESS CITY SIDE PROP.LINE HIGHWAYI WIDTH-
SO.FT^7 NO.OF / NO.OF CHECK + _
SIZE �C�Z STORIES / FAMILIES ONE
USE ZONE MAP
DESCRIPTION OF WORK NEW- / NO.
l rj l� SPECIAL'
/Lo ADD ❑ � /`� CONDITIONS
ALTER ❑ BY
FINAL �� � rQT i
s
REPAIR ❑ DATE (�.�
USE OF DEMOL ❑
EXISTING BLDG. ��L('/_ O
APPLICANT TEL �N' �/
(PRINT) L NO. /�a GZ 71'O a
J
BY(SIGNATURE( ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A (CATION AND STATE U
THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES W
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V # p ? �. C
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- - Z
PENSATION INSURAN gZ .1 C' 412
SIGNATURE OF
PERMITTEE
ADDRESS
Cc i
TEL.
P.C. Fee$ Permit Fee >
Issuance Fee
W
d
Total Fee
76A638A CE#8035-61APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ol
ADDRESS 9'
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE ` SSED BY
FOR APPLICANT TO FILL IN CONT. c
BUILDING — STATISTICAL CLASSIFICATION SEVER MAP
ADDRESS I r K
Q CLASS. NO. DWELL. UNITS
I +
LOT NO. - —�-C.. _ C_� BLOCK "ATER NOT REQUIRED RECEIVED
,/t,�, CERTIFICATE:
TRACT _L G' MAP �y `J'HIGHWAY T3 Li
! NO. OF BLDGS. - IAO. (J l] (CIRCLE) STATE MAJOR SECOND L CAL
SIZE OF LOT ,3 I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG.
TEL. IV
OWNER kl_kf'n•tctAI t tt_ey-j NO. YARD HWY BUILDING EXISTH
.
TREET AME
C ) J SETBACK WIDT
ADDRESS y�{7 }�C� Ili AI{.S FRONT id
ARCHITECT OR -.... TEL. P. L. �) }
ENGINEER NO. SIDE
ADDRESS ` r jn TEL. .7 INSPECTION RECORD
CONTRACTOR S 4ui`C Liti t -d'j(.'( NO. � Q
7 1�
ADDRESS L:,}. NC i1m,'tk' W
DESCRIPTION OF WORK CL
Z_
NEW or ADD( ALTER REPAIR DEMOLISH J
�IQZET `(�� 0 L TORIES FAMIILIES [
USE OF t /
STRUCTURE
II
SIGNATURE OF
APPLICAN -- '
VALUATION S
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. �� FOON
FFEE 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. I CERTIFY 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 CY,P.,N,SATION INSURA E.
LATH,EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE �4— RECT AND POSTED "
ADDRESS S � W{�~u'-L FINAL
CLYDE N. DIRLAM, PRINCIPAL STRRAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CAfH PERMIT VALIDATION (CK. I M.O. CASH
7637 JAI431230 19.5
093 � . .-3 i59.G �