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7UGSBACc#8011-1-151 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADD ESS (P
BUILDING AND SAFETY DMSION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A JENSEN SUPT OF BUILDING CROSS ST
FOR APPLICANT TO FILL IN DISTRICT NO G O P
j � TYPE P ESSED
CONST
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDRESSK PG
CLASS NO DWELL UNITS
LOT NO BLOCK WATER NOT REQUIRED RECEIVED
CERTIFICATE
TRACTMAP HIGHWAY STATE MAJOR SECOND, LOCAL
NO OF BLDGS NO / (CIRCLE)
SIZE OF LOT I NOW ON LOT USE ZONE SPECIAL
' J
USE OF f CONDITIONS
EXISTING BLDG
TEL
OWNER // N - -PI BUILDING YARD HWY - STREET NAME EXIST
ADDRESS �[O SETBACK WIDTH
FRONT QI_
ARCHITECT OP4 TEL P L �L/b7=
ENGINEER NO SIDE
P L
ADDRESS / TES INSPECTION RECORD D_
CONTRACTOR i. NO!A/- 7
ADDRES a.
DESCRIP ON OF WORIC 0
U
W
NEW ADD ALTER REPAIR DEMOLISH a
V)
SQ FT NO OF NO OF Z
IZE S RIES FAMILIES
USE OF
STRUCTURE
SIGNATURE
APPLICANT J
VALUATION
GGG666 APPROVALS DATE INSPECTOR
S SIGNATURE
ATUND
FEE $ _-` FEE $PMTFOFORMSI MATERIALS LOCATION
FRAME FIRESTOPS,-
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 IWILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT
TION OF THE LABOR CODE OF THE STATE OF CAL I FOR A RELAT
ING TO WORKMEN S COMPENSATION INSUR NCE
LATH,EXT
SIGNATURE F HOUSE NUMBER COR-
PERMITTE ,q•U RECT AND POSTED
ADDRESS _ ` e` FINAL
CLYDE N DIRLAM, PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION aIc r M.O. CASH PERNIIT VALIDATION m o CASH
fi �2524SEP1 C1 ' Jc.GU �;'
DIVISION OF BURRING AND SAFETY
Department of County Engineer
County of Los Angeles
WM. J. FOX, COUNTY ENGINEER APPLICATION
FOR APPLICANT TO FILL IN ADD EISS
BUILDING LOCALITY C
ADDRESS A
- NEAREST
LOCAL ITY —\ • CRO88 VI
\ ,l NEARESTDISTRICT NO. PLAN CK.-OR REc. No. PERMIT No
CROSS ST. �/
c
�, 'P, I 'lq C c)S-Q- 4
OWNER RECEIVED BY
BY DATE OF APPL. DATE 18SUED /
MAIL gCLa-CJ 1./� -S �1�, I
y
ADDRESS • USE ZONES NO OF17:.Zr—
ARCHITECTOR
TYPE GROUP l FIRE ZONE
TEL.�i/ I
`�PLANB CITY c���7 NO. Jr /� \TEL ZONING- ... DA7tD q
ENGINEER- NO. APPROVED BY- CA 4�'i R^ ✓ '��11-5�-
BUILDINGORD.NO,
1
ADDRESS SETBACK LINE. , •\74 ei
TEL. APPROVED DATE,
CONTRACTOR NO BY cw
r HOUSE NUMBERING
ADDRESS
LEGAL MAP NUMBE -2 'NO ASSIGNED BY
DESCRIPTION I LOT NO BLOCK 1 V
DATE I CORRECTIONS I INSPECTOR
TRACTNO OF
SIZE OF LOT s� 2.K 1/7 I NOW ON LOT BLDG8USE NO.
EXISTOING BLDG F MIOLI,ES ;.`/ /�ST,aC-L J�7e6.iB/? �A•�/
O
DESCRIPTION OF WORE -+ ,aT .� •_ — �'/ems �G �C y o
NEW ALTERATION ADDITION '1 /�,Q Co d�,Ie/Q A 0P (o
REPAIR DEMOLITIONr*Q
NO OF
Sar '{' ROOMS STORIES .
WAL
CO ERINGL I COOVVERING 000
C/B GLP LioO� I�OQ-S
USE F ST U UR
SS�ROVALS e
1NSPECT0R-S)SIGNATURE ! DATE
FOUNDATION- LOCATION
FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME FIRE STOPS, /
PLICATION AND STATE THAT THE INFORMATION GIVEN 18
CORRECT BRACING, BOLTS
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION,
AND STATE LAWS REGULATING BUILDINq CO TRUCTION. GAS VENT, DUCTS
SIGNATURE OF LATH, INT
P.ERMITTE
� LATH. EXT.
pDDRE85
PLASTER, INT. /J, ,�+•
AUTHORIZED AGT
- PLASTER, EXT
FEE �O HOUSE NUMBER COR- e -
Q) 8 O O RECT AND POSTED
VALUATION FEE 2 C�, FINAL
76A698A D88 3 E-88 - d
APPLICAT 1 O"N FOR COUNTY OF LOS ANGELES
"iB U I LD I N G PERMIT DEPARTMENT BUILD NG AND SAFETY DIV SIONBU
ENGINEER
FOR APPLICANT TO FILL IN ADIDRESS
BUILDING; -- — �+� `
ADDRESS' LOCALITY ] C/l^I�{
NEAREST_
CI `y
TY T E ZIP CROSS ST ~
NO OF BLDGS ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT GROUP TYPE FIRE OCESSED BY
TRACT jq,, 3 :' BLOCK + LTE NO 7 �V �' CONST ZO OWNER,, `�.'. 1 1 NO ' / I �.
STATISTICAL CLASSIFICATION SEWER MAP '
ADDRESS- a e CLASS NO DWELL UNITS BK PG,,-
CITY ZIP USE ZONE MAP ``--
ARCHITECT OR TEL �L— NO ��cP
ENGINEER NO ) SPECIAL d ,
_ }}-- 1 �� CONDITIONS
ADDRESS G c 1 G P 1 ROAD DEPARTMENT APPROVAL REQUIRED - - YES ❑ NO ❑
TL
CONTRACTOR NO ] oq BLDG SETBACK FROM '
LIC FRONT PROP LINE OF (STREET)
ADDRESS ,y HIGHWAY' + YARD = TOTAL
OFRONT PROP KL NEEM HIGHWAY TYPE OF 'EWID HXIS G
LIC
CITY L CLASS `
CONSTRUCTION LIEN DER
+ }
NAME AND BRANCH a
L BLDG SETBACK FROM - - . OU
ADDRESS `� � _tfWIfnA1" SIDE PROP LINE OF (STREET(
SQ FT ANO OF NO OF Q CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING U
SIZE STORIES' FAMILIES ONE SIDEPROP LINE HIGHWAY WIDTH N
a + - r Z
DESCRIPTION OF WORK NEW
ADD CORNER CUTOFF YES ❑ NO ❑
ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
REPAIR ❑ 1
EUSEUSE XISTING
BLDG `~f y DEMOL ❑ 'IN COASTAL PERMIT ZONE r YES ❑ NO ❑
APPLICANT TEL %t9�
(PRINT)
NO 4 7
LSI
NATURE)
EREBY ACKNOWLEDGE THAT I HAVE D THIS'APPLICATION AND STATE A!/;1(y
HE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL,ORDINANCES
WS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE �
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF ? G
BOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM
ION INSURANCE
TURE OF FINAL_ BY
TTEE ' DATE // >
ESS �� Z
&
_ TEL P Ce,Fee$ Permrt Fee Issuance Fee
ATION��
Total Fee
PLAN CHECK VALIDATION cK` _M o , CASH _ PERMIT VALIDATION <cK M o CASH
' 8. 6.8 tihR Z p
4 8.7 5 Alt,,
®S 76A63E1A CE¢'603A 6/76 ,� •- � �, --y V