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76A638ArCE #803:2/6APPLICATION FOR'BUILDI G PERMIT•p
COUNTY `OF-LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS, SUP T OF BUILDING LOCALITY t
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
Pnnt.or tvDe only) a
DISTRICT NC,I„i GROU TY lrlsP D BY
BUILDING l �3 , r f� (JJ� C ST
ADDRESS
STATISTICAL CLASSIFICATION SEWER MAP
LOT T BLOCK CLASS NO DWELL UNITS BK 9PG
TRACT USE ZONE MAP
q NO.OF BLDGS J NO
SIZE OF LOT �Q �is NOW ON LOT 2 / SPECIAL
USE OF CONDITIONS
EXISTING BLDG
TEL
OWNER �� S(,f� NO Z 6517 BLDG SETBACK FROM '-
ADDRESS FRONTPROP LINEOF (STREET)
TYPE OF EXISTING SETBACK _ HIGHWAY + YARD = TOTAL
CITY HIGHWAY WIDTH FROM C L
ARCHITECT OR TEL + = L� (�
ENGINEER NO
BLDG ETBAtKFROM
ADDRESS SIDE PROP LINEOF (STREET)
TEL TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CONTRACTOR vW C NO HIGHWAY WIDTH FROM C L
ADDRESS NO + O
LIC f U
CITY CLASS CORNER CUTOFF YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS w
ADDRESS
SQ FT NO OF NO OF NEW ❑
SIZE STORIES FAMILIES
USE OFADD
STRUCTURE _ QQ
ALTER ❑
REPAIR❑ '
SIGNATURE OF
APPLICANT DEMOL ❑ `
VALUATION $ `/� J
� APPROVALS JDATE NS ECTOR•SSIGNATURE
P C PMTFOUNDATION LOCATION �y
FEE $ FEE $ ♦ 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 ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS
S,TRUC TI ON I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT �j�.��� O 9111 {
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPENSATION INS URANCE
LATH, EXT ►) 7-7�
SIGNATURE OF �� HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED -' -
ADDRESS FINAL -
ell
PLAN CHECK VALIDATION CK ra o CASH JOHN F LEWIS PRINCIPAL STRUCT AL ENGINEER
PERMIT VALIDATION CK o CASH
r� -
!Y 5 31.9 3� X15 2 D.. 2 7.7 5N