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APPLICATION FOR BUILDING PERMIT LJ
COUNTY OF LOS ANGELES BUILDING �7
DEPARTMENT OF COUNTY ENGINEER ADDRESS / 3� /Y!'rt�it✓
BUILDING AND SAFETY DIVISION LOCA LI TYZnc
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS, SUPT Or BUILDING CROSS ST.
DISTRICT NO. GRO TYPE PROC6� BY
FOR APPLICANT TO FILL IN CONST. o
(Pri of or type an IV)
[ADDRESS
LDING X�j�J Z STATISTICAL CLASSIFICATION SEWER MAP
(/ / / — a. CLASS NOOWELL,UNITS BK PGT NO. BLOCK USE ZONE MAP
NO.ACT (,� Z If / SPECIAL
NO.OF BLDGS. CONDITIONS
E OF LOT NOW LOT
OF �� �'XTING/B�L7DG, V� BLOC.SETBACK FROM
OWNER J.B, er ,� ,NOL. /�O� FRONT PROP.LINE OF _(STREET)
L9 O TYPE OF EXISTING SETBACK HIGHWAY } YARD — TOTAL
I--1�/' _�G,M /C / Y WIDTH FROM C.L.
ADDRESS�7-�-J� !O `I, I
CITY /�/� G / }
ARCHITECTO TEL. BLDG.SETBACK F
SIDE PROP. LINE OF I (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGH Yq RD = TOTAL
ADDRESS HIGHWAY WIDTH FROM C.L.
_
CONTRACTOR NO.TEL. } d
LIC.
ADDRESS NO. L CORNER CUTOFF YES ❑ NO ❑ U
LIC.
LC
clTv CLASS B-I SEE REVERSE SIDE FOR SPECIAL APPROVALS
DESCRIPTION OF WORK i
z
NEW ADD ALTER REPAIRDEMOLISH
SO. FT. NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE t°
-17
SIGNATURE OF
APPLICANT
VALUATIO $
APPROVALS DATE INS PEcroR's smNA ru RE
P.C. PMT. FOUNDATION: LOCATION
FEE S FEE S E FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY /,C KNOWLEDGE THAT 1 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
BUILD AD
CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTMORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA
TION OF THE LABOR CODE OF THE ST ATE P CAL, ORNIA RIt LATH, INT.
ING TO WORKMEN'S COMP ATION INSURA CE.
LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS — �� lt5l FINAL
JOHN F. LEWIS, PRINCIPAL STRU URAL ENGINEER
PLAN CHECK VALIDATION «. M.D. GABN _ PERMIT VALIDATION CK. MD. GASH
LACO 5 3 1 72 JUL 2 1 A 4.00-